MEDITERRANEAN KALA-AZAR 



1299 



MEDITERRANEAN KALA-AZAR. 



Synonyms. — Infantile kala-azar, Infantile leishmaniasis, Mediterranean 

 leishmaniasis, Febrile splenic anaemia (Fede), Ancsmia infantum a Leish- 

 mania (Pianese), Leishmania ancemia (Jemma and di Cristina), Mar da tal biccia 

 (Malta), Ponos (Greece), Malattia da mensa (Sicily). 



Definition. — ^Mediterranean kala-azar is a subacute or chronic 

 specific disease due to Leishmania infantum NicoUe, and clinically 

 closely resembling tropical kala-azar, but occurring in temperate or 

 subtropical climates. 



Historical. — ^Fede several years ago described in Italy a form of 

 splenic anaemia among young children characterized by irregular 

 fever, progressive anaemia, and a fatal ending. He considered it a 

 disease by itself, separating it from the non-febrile type of splenic 

 anaemia. In 1904 Laveran and Cathoire found a Leishmania in 

 films from the spleen of a child who had died of an ill-defined disease 

 in Tunisia. Pianese in 1905 called attention to the similarity of the 

 symptoms of Fede's splenic anaemia with kala-azar, and described 

 parasitic bodies in the spleen of the affected children morphologi- 

 cally identical with Leishmania donovani. Later NicoUe suggested 

 for the disease the name of ' infantile kala-azar,' and completed 

 the study of the parasite, which he called Leishmania infantum. 

 Gabbi considers the disease to be identical with tropical kala-azar, 

 having found it also among adults. A fuller account of the history 

 will be found on p. 373. 



Cristina and Caronia in 1915 applied to this complaint Vianna's 

 tartar emetic treatment for American muco-cutaneous leishmaniasis. 



Climatology. — ^The malady is met with in Southern Europe, in 

 the northern regions of Africa, and perhaps Egypt. Future in- 

 vestigations will probably show that it is endemic in many countries. 



>ffitiology. — ^The malady is due to Leishmania infantum NicoUe- 

 The description of this parasite will be found on p. 373. Nicolle 

 has succeeded in reproducing the disease in monkeys, and less 

 typically in dogs. He has also found that dogs may be spon- 

 taneously affected with a leishmania; in fact, in his opinion, the 

 dog acts as a reservoir of L. infantum, and its ectoparasites, such as 

 fleas, may possibly serve as the transmitting agents to human beings. 

 These views have been tested experimentally by Basile, but to-day 

 doubt is cast upon canine leishmaniasis being the same disease as 

 that in man, and the flea infection of man is also considered to be 

 doubtful. 



The majority of the cases occur in young children of two to three 

 years of age, among whom there is a slight preponderance of males. 

 The disease sometimes occurs in more than one member of a family, 

 and more often begins in the spring or early summer. 



Pathology. — ^The pathology has been carefully studied by Pianese, 

 who finds that the post-mortem lesions are similar to those observed 

 in Indian kala-azar, the spleen and liver being greatly enlarged. 

 Microscopically, there is great increase of the lymphoid tissue in 



