68 DISEASES DUE TO PROTOZOA 



O. S. At 28° C, in infecled, unhealed, undiluled serum w illi no 

 citrate, flagella forms appear in live days. 

 At 28° C\ flagella forms liave been obtained. 



Contamination with micrococci and certain bacteria 

 highly favourable, as the parasite develops sym- 

 bioticall}- with masses of these organisms. 



Staphylococci the most favourable contamination. 

 Further, the most perfect monadina forms are seen 

 attached to large masses of staphylococci. 



Xaso-oral and Oro-phalangeal Leishmaniasis. 



There is no real difference between this and the ordinary Dermal 

 Leishmaniasis, except that the mucous membranes of the nose, mouth 

 and pharynx are primarily attacked by L. tropica. Xaso-oral 

 Leishmaniasis is also known as Espundia. The condition is often 

 more chronic than the dermal condition, but it is seldom produced as 

 a result of direct extension from the skin. 



It seems to be common in I^eru, Brazil and Colombia. 



The larvnx, trachea and ivsophagus may be aft'ected by the exten- 

 sion of the granulomatous ulcerations. 



In such cases death may be due to exhaustion and am^'loid disease. 



There may be destruction of the nasal cartilage inducing a marked 

 deformity of the nose; the skin may be trdematotis, with patches of 

 hard oedema below the eyes. 



The breath may be offensive. 



Deglutition may be difficult. 



The disease may last from twenty to thirty years, the final appear- 

 ance not being unlike that of a cachectic carcinomatous patient. 



The condition is much more chronic than the dermal type, and 

 usuallv commences in the mucous membranes primarily, the skin 

 perhaps remaining free throughout. 



The microscope onlv will differentiate it from Tuberculosis and 

 Blastomycosis. 



An attempt must be made to destroy the initial lesion, otherwise the 

 treatment is purely symptomatic. 



Canine Leishmaniasis. 



This is mentioned only because it is affirmed by some that Leish- 

 maniasis in dogs forms the reservoir of infective parasites in humans, 

 especially for Infantile Kala-azar. 



Pulex serraticeps, which occasionally feeds on man, can serve as 

 a carrier of the disease because parasites develop in the fleas. 



Dogs have not been infected by Indian Kala-azar. 



