A CASK OF PARASITIC GRANULOMA 



209 



forms of the Leishman parasite obtained from cases of kala-azar in India. Similar bodies 

 have been obtained by me in cultures of the Leishman parasite obtained from cases of 

 kala-azar in the Sudan ; they represent, therefore, a cultural stage of the parasite in a 

 local sore. Many of the parasites exhibited marked vacuolation. The kiuetonucleus 

 appeared either in the form of a dot or well-defined rod, which, in some of the largest 

 parasites had segmented into two, or even three, parts ; a further evidence of a develop- 

 mental stage. Mitotic changes vpere present in some of the trophonuclei. All the films 

 taken from the contents of the papules and from this sore showed the presence of a 

 well-marked eosinophilia. The character of the sore which contained the Leishman Character 

 bodies merits some descrijotion. of the sore 



In appearance it resembled a syphilide (Fig. 51), and was rather of the nature 

 of a granuloma. It measured 3-| by 3 inches and was limited by a sinuous margin, 

 composed of confluent masses of papules similar to the discrete papules described on the 

 other parts of the body. 



The surface of this lesion was irregular and consisted of projecting masses of 

 granulation tissue ; some of these were covered by scaly scabs, underneath which a 

 sero-purulent fluid was present. In smears taken from the centre of this ulcer a large 

 number of diplococci were present, as well as a few degenerated Leishman bodies. Even 

 in the margins of the ulcer but few parasites were present and these totally disappeared 

 in two or three days. 



Cultivation experiments on blood agar were failures. This was possibly due to the 

 paucity of parasites present in the local lesion. 



A differential blood count of blood taken from the peripheral zone of the granuloma 

 was as follows : — 



PolymorphoQuclear leucocytes 



Large mononuclears 



Large lymphocytes 



Small lymphocytes 



Eosiuophiles 



Transitionals 



•11% 

 19-3% 



4% 



7-4% 



27-7% 



•6% 



There was evidently a well-marked eosinophilia, and an increase of the mononuclear Local 

 leucocytes at the expense of the polymorphs and lymphocytes. On the same day a ei^sinophiiia 

 blood count, of blood taken from the tip of the finger, showed 5,436,000 red blood cells 

 and 5,260 white blood cells. A differential blood count showed : — 



Polyuiorphs 



Mouonuclear leucocytes 

 Large lymphocyte!? 

 Small lymphocytes 

 Eosinophiles 

 Transitionals 



63-3% 



14% 



6% 

 13% 



3-2% 

 ■5% 



