TOXIC MANIFESTATIONS OF MALARIA By G. S. MOHAPATRA,
m.b., b-s.
Civil Assistant Surgeon, Khurda Subdivisional District Puri
Hospital
of benign tertian malaria recently under the treatment of the writer, which manifested unusual features. The case notes of the subject are as follows :? B. J., a boy, aged eleven, came on 10th March, 1949, with the following complaints '? (1) Fever with rigor of a quotidian type, duration one week. (2) Urticarial eruptions spreading over the whole body along with the onset of fever, of the same duration. (3) Defective speech (with nasal tone in the voice) and inability to perform acts of deglutition completely, duration three days. As observed during a bout of febrile attack, the patient was seen tossing about with violent itching over the urticarial eruptions which had spread over the whole body. The itching was more troublesome to the patient than the fever itself. Temperature used to come down daily at about 9 p.m. with profuse sweating and along with remission of the fever the urticarial eruptions used to vanish leaving only a faint stainingThe troublesome itching also subsided with the remission. After about four bouts of rigoff fever and urticaria, on the fifth day of the attack the patient was detected to have a nasal voice and on administration of some milk quite a lot of it came out through the nasal passages. A
case
came
Physical examination revealed definite ansemia and the. spleen was enlarged two fingers beloW the costal margin. The soft palate was definitely partially paralysed producing defect in the speech and deglutition. It was found to be sluggish in movement during an act of deglutition. # definitely lagged behind the actions of other muscles of deglutition with the result that the nasal passages were not properly and timely closed during the act. Blood: total rbc
Sept., 1949]
TOXIC EFFECT OF SULPHATHIAZOLE c.mm.,
Hh ber c U u
^er c-mm-> total W.B.C. 7,812 per ir?**^8r cen^* Differential count : poly
52 7.5 mono per L. 25 per cent, ,cenVlymPh? ' eosino 15 per cent, baso 0.5 per cent, aria Parasites B.T. forms found in fair nums, no M.T. forms detected in spite of repeated
rninati?ns.
tt
ne : no
: no ova or
Stool
abnormality. was put
Pa^ent
tw
on
cysts detected.
paludrine by mouth
day. On the third day no fever complete and there was of or ,rjl?P0n.se eruption. The partial paralysis the recovery a gradual had very P&late week whi K Was n?t completed until the second nf t\/t 01 s
the
,
three times
a
was
May 1949
Comments
,
of the organs of the body malaria has revealed changes that U?11^ manifestaexplain the varied clinical tion The ^le disease. polygonal hepatic celltf +?tlie convoluted uic kidney and oi the was, tubules of thp ^ cells ? e aitrkvoTAnal elands have cortical the of suprarenal glands [he ^een observed to manifest degenerative changes
inXf ^'oscopic Cases
study
Malarial nephritis, reported for the first time 11 India by Heilig (1941) and Heilig and Visweswar 11942) has been proved to be a manifestation o benign tertian infection. The change m the Kl(Jney that would subsequently give rise to nephritis cannot be taken as a mere physical ??e due to blockage by parasites or to an allergic due to }
Phenomenon; toxins
some
reactions
presumably
malaria must be playing a part, similarly urticaria in malaria reported by various Workers though taken as an allergic reaction aPPears to have definitely toxic basis behind it of
consequent
on the infection. In the present case repeated examination of olood during the height of temperature only B.T. forms of malarial parasite. Hence ^vealed ^e manifestations were obviously due to benign in lertian infection. Allergic phenomenon fhalarial infection though rare with B.T. forms *as been solt reported but paralysis of the Palate is almost unheard of. This phenomenon
,
ot
isolated paralysis of the soft palate cannot be explained without recognition of a nialarial toxin ', more so when the condition is combined with urticaria. Thus though a denni e malarial toxin has not been isolated, the mani-
Possibly
'
festations
of such a go to prove the existence
REFERENCES
*
w
g^io,
R.
R., JUG, War
(1Q41)
..
and Viswes-
(1942).
Indian Med. Gaz., 76. 519. > Ibid.,
:
GUPTA
-
395
m.b., b-s.
Civil Assistant Surgeon, Khurda Subdivisional District Puri
Hospital
of benign tertian malaria recently under the treatment of the writer, which manifested unusual features. The case notes of the subject are as follows :? B. J., a boy, aged eleven, came on 10th March, 1949, with the following complaints '? (1) Fever with rigor of a quotidian type, duration one week. (2) Urticarial eruptions spreading over the whole body along with the onset of fever, of the same duration. (3) Defective speech (with nasal tone in the voice) and inability to perform acts of deglutition completely, duration three days. As observed during a bout of febrile attack, the patient was seen tossing about with violent itching over the urticarial eruptions which had spread over the whole body. The itching was more troublesome to the patient than the fever itself. Temperature used to come down daily at about 9 p.m. with profuse sweating and along with remission of the fever the urticarial eruptions used to vanish leaving only a faint stainingThe troublesome itching also subsided with the remission. After about four bouts of rigoff fever and urticaria, on the fifth day of the attack the patient was detected to have a nasal voice and on administration of some milk quite a lot of it came out through the nasal passages. A
case
came
Physical examination revealed definite ansemia and the. spleen was enlarged two fingers beloW the costal margin. The soft palate was definitely partially paralysed producing defect in the speech and deglutition. It was found to be sluggish in movement during an act of deglutition. # definitely lagged behind the actions of other muscles of deglutition with the result that the nasal passages were not properly and timely closed during the act. Blood: total rbc
Sept., 1949]
TOXIC EFFECT OF SULPHATHIAZOLE c.mm.,
Hh ber c U u
^er c-mm-> total W.B.C. 7,812 per ir?**^8r cen^* Differential count : poly
52 7.5 mono per L. 25 per cent, ,cenVlymPh? ' eosino 15 per cent, baso 0.5 per cent, aria Parasites B.T. forms found in fair nums, no M.T. forms detected in spite of repeated
rninati?ns.
tt
ne : no
: no ova or
Stool
abnormality. was put
Pa^ent
tw
on
cysts detected.
paludrine by mouth
day. On the third day no fever complete and there was of or ,rjl?P0n.se eruption. The partial paralysis the recovery a gradual had very P&late week whi K Was n?t completed until the second nf t\/t 01 s
the
,
three times
a
was
May 1949
Comments
,
of the organs of the body malaria has revealed changes that U?11^ manifestaexplain the varied clinical tion The ^le disease. polygonal hepatic celltf +?tlie convoluted uic kidney and oi the was, tubules of thp ^ cells ? e aitrkvoTAnal elands have cortical the of suprarenal glands [he ^een observed to manifest degenerative changes
inXf ^'oscopic Cases
study
Malarial nephritis, reported for the first time 11 India by Heilig (1941) and Heilig and Visweswar 11942) has been proved to be a manifestation o benign tertian infection. The change m the Kl(Jney that would subsequently give rise to nephritis cannot be taken as a mere physical ??e due to blockage by parasites or to an allergic due to }
Phenomenon; toxins
some
reactions
presumably
malaria must be playing a part, similarly urticaria in malaria reported by various Workers though taken as an allergic reaction aPPears to have definitely toxic basis behind it of
consequent
on the infection. In the present case repeated examination of olood during the height of temperature only B.T. forms of malarial parasite. Hence ^vealed ^e manifestations were obviously due to benign in lertian infection. Allergic phenomenon fhalarial infection though rare with B.T. forms *as been solt reported but paralysis of the Palate is almost unheard of. This phenomenon
,
ot
isolated paralysis of the soft palate cannot be explained without recognition of a nialarial toxin ', more so when the condition is combined with urticaria. Thus though a denni e malarial toxin has not been isolated, the mani-
Possibly
'
festations
of such a go to prove the existence
REFERENCES
*
w
g^io,
R.
R., JUG, War
(1Q41)
..
and Viswes-
(1942).
Indian Med. Gaz., 76. 519. > Ibid.,
:
GUPTA
-
395
