ATYPICAL SUBTERTIAN FEVERS 



1181 



VII. With 'Cutaneous' Localization. 



Pseudo -Smallpox Type. — This is characterized by high fever, 

 severe pains in the back, associated with the papular eruption which 

 appears on the second or third day, and consists of small shotty 

 papules which never become vesicles or pustules, which are especially 

 abundant on the face. It may require repeated blood examinations 

 to find the parasites, and the spleen may not be enlarged, but 

 quinine quickly cures the condition. 



Herpes. — Herpes is not rare in attacks of malarial fever. It 

 recurs with each attack, and usually at exactly the same spot on 

 which it was situate during a previous attack — e.g., on the lips, the 

 tongue, the face, and the genital organs, etc. 



It may occur without febrile symptoms, at a time when an attack 

 of fever is due. Herpes zoster is very rarely seen. 



Rarer Eruptions. — Malarial erythemata, malarial urticaria, 

 malarial purpura, and malarial patchy oedema, resembling Malabar 

 swellings or Quincke's oedema, may be mentioned. Ulcerative and 

 gangrenous conditions have been recorded. 



Pigmentation. — The black hyperpigmentation of malaria is quite 

 common, and may be present in patches, chloasma malaricum, or it 

 may be diffused, and in the latter case may be associated with the 

 syndrome of Addison's disease (see p. 1180). In chronic cases the 

 skin takes on a peculiar pale yellow or ashy grey tinge. 



VIII. With ' vSpecial Sense ' Localization. 



Subtertian malaria may concentrate its attacks upon the eye or 

 the ear (see also p. 2004). 



Amaurotic Type. — During an attack of pernicious fever a patient 

 may complain that he is unable to see. When treated with quinine, 

 as a rule sight soon returns, but more rarely blindness may result, 

 due to thrombosis of the retinal vessels, and consequently retinal 

 haemorrhages and optic neuritis. One eye only may be attacked. 

 This condition must be differentiated from quinine amaurosis. 

 In malarial amaurosis the pupils react to light, and vision is, as a 

 rule, not completely lost . In quinine amaurosis the pupils are widely 

 dilated, do not react to light and other symptoms of cinchonism, 

 such as deafness, severe tinnitus aurium, etc., will be present. 



Aural Type. — In this there is a deafness which is not due to 

 quinine, but to the lack thereof permitting the subtertian parasites 

 to damage the organ of hearing. It is rare and chronic. Richardson 

 records cases simulating mastoid disease. 



Meniere's Type. — Buzzing of the ears with giddiness, and at times 

 the patient falls down. These attacks, which are very severe, are 

 of malarial origin, but rare. The practitioner must differentiate 

 this disease from aural symptoms due to quinine, which may 

 induce buzzing, but seldom severe giddiness. Moreover, symptoms 

 due to quinine improve or disappear on the drug being discontinued. 



Loss of taste and anosmia may be noted. Symptoms simulating a frontal 

 sinus affection may occur. 



