A Mirror of
Hospital
FJractice.
A FATAL CASE OF MALAGA IN A DIABETIC SUBJECT. By Assistant Surgeon B. M. DAS GUPTA,
Assistant Professor of Protozoology, Calcutta School of Tropical Medicine and Hygiene.
It has been shown by several workers that the blood-inhabiting protozoa are largelydependent upon blood sugar for their nutrition. Thus Schern (1925), working with T. brucei, T. equiperdum, and T. rhodesiense, has shown that death in acute trypanosomiasis in experimental animals occurs in a condition of acute Knowles and Das hypoglycemia. Gupta (1928) have shown that the same phenomenon holds for rats infected with T. evansi. Bass and Johns (1912) found that the presence of dextrose was necessary for the cultivation of the malaria parasites of man in vitro; whereas the same workers?(Bass and Johns, 1913) succeeded in cultivating the parasites from a case of diabetes without the addition of sugar. Rudolf and Marsh (1927) found glycosuria in a higher percentage of cases of general paralysis treated with malaria than in control un?
treated cases. They also found that the titre of the blood sugar during the course of experimentally induced malaria varied inversely with the temperature chart. Hegner and MacDougal (1926), working upon infections in birds with Plasmodium cathemerium (prcecox), came to the following conclusions:? " There seems to be no doubt from the data obtained that an increase in the sugar content of the blood modifies the course of the infection, bringing about conditions favourable for the parasite and hence prolonging the infection until death results. According to our hypothesis, decreasing the sugar content of the blood should bring about unfavourable conditions for the parasite. We have attempted to do this with insulin, with suggestive?but not conclusive?results." In a later paper, MacDougal (1927) studied the same problem in bird malaria on an extensive scale. She came to the following conclusions:? " The conclusions reached in the preliminary work seem to be justified by more extensive experiments, i.e., that the increase of the sugar content of the blood brings about a condition favourable for the parasite in bird malaria, and a decrease in the blood sugar by the use of insulin creates a condition unfavourable for the parasite. The quantitative work, now under way, bears out the above findings so far as it has gone." In view of these findings, it is interesting to enquire whether malaria is or is not a more severe disease in diabetic than in non-diabetic subjects. The following record of a fatal case of malaria in a diabetic subject may perhaps have some bearing on this matter. The patient was under the care of Dr. J. P. Bose and Dr. J. C. Gupta of the Calcutta School of Tropical Medicine, to whom I am indebted for details of the history. The patient was a Hindu male aged 58 years. He was a mild case of diabetes. The blood sugar was never above 0.150 per cent. Slight dietetic modifications brought it down to a normal level. At this point he contracted a infection with P. falciparum. severe very Cerebral symptoms and coma supervened and despite the administration of quinine intramuscularly and as far as possible orally the case ended fatally from heart failure. Twelve hours before death the blood sugar titre was only 0.0714 per cent. Blood films were taken early in the case, and also a series twelve hours before death. Plate 1, fig. 5 shows the state of affairs in the latter films. There was present an exceedingly intense infection of the blood stream with P. falciparum, innumerable growing trophozoites and schizonts being present in the peripheral blood. In connection with our studies on untreated of malaria by cultural and enumerative
cases
Plate I.
4
'V
?
?}.
?
A-%,
?
um*
??-
4ji
Jr
'
Jan., 1931.] methods, reported have recently had
EOSINOPHILIC IN DRACONTIASIS: CHUKERBUTI. page 1 of this issue, we most interesting case. The
on a
a Hindu male, aged 14 years, who kept in hospital for one month, untreated, suffering from a chronic residual infection with P. falciparum of an afebrile character, with low parasite counts. In this patient oral administration of large doses of glucose in solution promptly brought about a febrile relapse, the number of parasites increasing at a very rapid rate and passing well above the febrile threshold for the infection. We hope to give details of this case, and of further cases studied,
patient is was
in
future communication. thanks are due to Mr. H. M. Roy, artist at the Calcutta School of Tropical Medicine, for the execution of the colour plate. a
My
References.
Bass, C. C., and Johns, F. M. (1912). The cultivation of malarial plasmodia (Plasmodium vivax and Plasmodium falciparum) in vitro. Journ. Exp. Med., XVI, 567. Bass, C. C., and Johns, F. M. (1913). Cultivation of malaria plasmodia (Plasmodium falciparum) in vitro
in the blood of a diabetic without the addition of dextrose. Amer. Journ. Trop. Dis., I, 240. Hegner, R. W., and MacDougal, M. S. (1926). Modifying the course of infections in bird malaria by changing the sugar content of the blood. Amer. Journ. Hyg., VI, 602. ^Knowles,-R., and Das Gupta, B. M. (1928). On the role of the thyroid gland in susceptibility and resistance to a protozoal infection. Indian Journ. Med. Res., XV, 997. MacDougal, M. S. (1927). The effects of changes in the sugar content of the blood on bird malaria. Amer. Journ. Hyg., VII, 635. Rudolf, G. de M., and Marsh, R. G. B. (1927). Some observations upon carbohydrate metabolism in malaria, with special reference to the effect of insulin and glucose upon benign tertian malaria. Journ. Trop. Med. and Hyg., XXX, 57. Schcrn, Iv. (1925). Ueber Trypanosomen. I?VI. Centralbl. f. Bakt. Orig., XCVI, pp. 356, 360, 362, 440, 444, 451.
21
Hospital
FJractice.
A FATAL CASE OF MALAGA IN A DIABETIC SUBJECT. By Assistant Surgeon B. M. DAS GUPTA,
Assistant Professor of Protozoology, Calcutta School of Tropical Medicine and Hygiene.
It has been shown by several workers that the blood-inhabiting protozoa are largelydependent upon blood sugar for their nutrition. Thus Schern (1925), working with T. brucei, T. equiperdum, and T. rhodesiense, has shown that death in acute trypanosomiasis in experimental animals occurs in a condition of acute Knowles and Das hypoglycemia. Gupta (1928) have shown that the same phenomenon holds for rats infected with T. evansi. Bass and Johns (1912) found that the presence of dextrose was necessary for the cultivation of the malaria parasites of man in vitro; whereas the same workers?(Bass and Johns, 1913) succeeded in cultivating the parasites from a case of diabetes without the addition of sugar. Rudolf and Marsh (1927) found glycosuria in a higher percentage of cases of general paralysis treated with malaria than in control un?
treated cases. They also found that the titre of the blood sugar during the course of experimentally induced malaria varied inversely with the temperature chart. Hegner and MacDougal (1926), working upon infections in birds with Plasmodium cathemerium (prcecox), came to the following conclusions:? " There seems to be no doubt from the data obtained that an increase in the sugar content of the blood modifies the course of the infection, bringing about conditions favourable for the parasite and hence prolonging the infection until death results. According to our hypothesis, decreasing the sugar content of the blood should bring about unfavourable conditions for the parasite. We have attempted to do this with insulin, with suggestive?but not conclusive?results." In a later paper, MacDougal (1927) studied the same problem in bird malaria on an extensive scale. She came to the following conclusions:? " The conclusions reached in the preliminary work seem to be justified by more extensive experiments, i.e., that the increase of the sugar content of the blood brings about a condition favourable for the parasite in bird malaria, and a decrease in the blood sugar by the use of insulin creates a condition unfavourable for the parasite. The quantitative work, now under way, bears out the above findings so far as it has gone." In view of these findings, it is interesting to enquire whether malaria is or is not a more severe disease in diabetic than in non-diabetic subjects. The following record of a fatal case of malaria in a diabetic subject may perhaps have some bearing on this matter. The patient was under the care of Dr. J. P. Bose and Dr. J. C. Gupta of the Calcutta School of Tropical Medicine, to whom I am indebted for details of the history. The patient was a Hindu male aged 58 years. He was a mild case of diabetes. The blood sugar was never above 0.150 per cent. Slight dietetic modifications brought it down to a normal level. At this point he contracted a infection with P. falciparum. severe very Cerebral symptoms and coma supervened and despite the administration of quinine intramuscularly and as far as possible orally the case ended fatally from heart failure. Twelve hours before death the blood sugar titre was only 0.0714 per cent. Blood films were taken early in the case, and also a series twelve hours before death. Plate 1, fig. 5 shows the state of affairs in the latter films. There was present an exceedingly intense infection of the blood stream with P. falciparum, innumerable growing trophozoites and schizonts being present in the peripheral blood. In connection with our studies on untreated of malaria by cultural and enumerative
cases
Plate I.
4
'V
?
?}.
?
A-%,
?
um*
??-
4ji
Jr
'
Jan., 1931.] methods, reported have recently had
EOSINOPHILIC IN DRACONTIASIS: CHUKERBUTI. page 1 of this issue, we most interesting case. The
on a
a Hindu male, aged 14 years, who kept in hospital for one month, untreated, suffering from a chronic residual infection with P. falciparum of an afebrile character, with low parasite counts. In this patient oral administration of large doses of glucose in solution promptly brought about a febrile relapse, the number of parasites increasing at a very rapid rate and passing well above the febrile threshold for the infection. We hope to give details of this case, and of further cases studied,
patient is was
in
future communication. thanks are due to Mr. H. M. Roy, artist at the Calcutta School of Tropical Medicine, for the execution of the colour plate. a
My
References.
Bass, C. C., and Johns, F. M. (1912). The cultivation of malarial plasmodia (Plasmodium vivax and Plasmodium falciparum) in vitro. Journ. Exp. Med., XVI, 567. Bass, C. C., and Johns, F. M. (1913). Cultivation of malaria plasmodia (Plasmodium falciparum) in vitro
in the blood of a diabetic without the addition of dextrose. Amer. Journ. Trop. Dis., I, 240. Hegner, R. W., and MacDougal, M. S. (1926). Modifying the course of infections in bird malaria by changing the sugar content of the blood. Amer. Journ. Hyg., VI, 602. ^Knowles,-R., and Das Gupta, B. M. (1928). On the role of the thyroid gland in susceptibility and resistance to a protozoal infection. Indian Journ. Med. Res., XV, 997. MacDougal, M. S. (1927). The effects of changes in the sugar content of the blood on bird malaria. Amer. Journ. Hyg., VII, 635. Rudolf, G. de M., and Marsh, R. G. B. (1927). Some observations upon carbohydrate metabolism in malaria, with special reference to the effect of insulin and glucose upon benign tertian malaria. Journ. Trop. Med. and Hyg., XXX, 57. Schcrn, Iv. (1925). Ueber Trypanosomen. I?VI. Centralbl. f. Bakt. Orig., XCVI, pp. 356, 360, 362, 440, 444, 451.
21
