62 DISEASES DUE TO PROTOZOA 



^ETIOLOGY. 



The causative organism is Leishmania infantum. 



The carriers blamed are Pulex irritans and P. serraticeps. 



The parasite is indistinguishable from L. donovani morphologically, 

 but the latter is not inoculable with success into dogs. 



The parasite can be found in the peripheral circulation, bone 

 marrow, spleen and liver in both children and dogs. 



The organism can be cultured and subcultured indefinitely. 



The disease can be reproduced in monkeys and dogs, but the latter 

 are spontaneously infected and may form the reservoir of the virus and 

 its ectoparasites, e.g., fleas (Basile). Wenyon doubts this. 



The disease manifests itself in children usually between the ages of 

 two and three in the springtime and early summer. 



Several members of the family may be attacked. 



The pathological findings are as in Kala-azar. 



SYMPTOMATOLOGY. 



There is an insidious onset which may coincide with an attack of 

 diarrhoea and vomiting. 



These are : irregular fever, pallor, epistaxis, apathy, with some 

 enlargement of the spleen. 



Hcemorrhages from the nose, gums and under the skin. 



A diarrhoeic or dysenteric attack may be marked, alternating with 

 constipation. The appetite is usually preserved. 



Wasting, auccmia progressive, 1,500,000 — 3,000,000 reds. 



Hb. is below 50 per cent. Leucocytes from 1,500 — 3,000. Mono- 

 nuclears form 70 per cent, to 80 per cent. 



Ulcerative stomatitis is not uncommon. Noma on the face or 

 genitalia. 



The spleen now enlarges enormously, bulging out the abdomen. 



The pulse-rate is rapid, 120 — 160. Ha&mic murmurs are rare. 



The opsonic index is low, especially for B. coli communis. 



Transient a^demas of any part may occur. 



The liver is generally enlarged. 



Death is from exhaustion, rarely under six months. 



Second attacks are rare, hence the Jews of Baghdad at one time 

 inoculated their children. 



COMPLICATIONS. 



Bronchitis, broncho-pneumonia, pleurisy, fatal dyspnoea from 

 oedema of the glottis. 



Noma is common in Italy and Greece. 

 Otitis media is rare. 



