The American Journal of Tropical Medicine and Hygiene - Volume s1-30, Issue 5, 1950

Labeled diodoquin, vioform, and chiniofon were prepared using I131 and the distribution, absorption, and excretion of iodine determined after oral and intravenous administration to rabbits. Similar determinations were made with labeled potassium iodide for comparison. The route and rate of excretion of iodine was different for each of the 3 drugs as was the blood-iodine pictures and tissue distributions. The results also indicated that chiniofon was not present in the blood as such after oral administration, but as a metabolite, and that all of the compounds are degraded to some extent by the time they appear in the urine.

• 1.  Ninety-four cases of chronic intestinal amebiasis were treated with Milibis® (bismuthoxy p-N-glycolylarsanilate (Wia, Win 1011)) and/or chiniofon, alone or in combination with bismuth subgallate. Sixteen of the patients who relapsed after the first courses of treatment were given a second course of treatment with Milibis®, bringing the total number of treatments to 106.
• 2.  The patients who were freed of Endamoeba histolytica were followed up for an average period of 287 days (range 35 to 543 days, median 344 days). During this period of observation, an average of 10 post-treatment stool specimens per patient were examined.
• 3.  In thirty-two cases chiniofon was used as the principal amebacide. It was used either alone, or with, or alternately with bismuth subgallate. Of the thirty-two cases thus treated fifteen (47 per cent) were cleared of their amebas, and seventeen (53 per cent) relapsed.
• 4.  Milibis® alone, or in combination with chiniofon and/or bismuth subgallate was given to seventy-two persons; sixty-four (89 per cent) of these were immediately cleared of Endamoeba histolytica. Sixty-two (93 per cent) of sixty-seven cases in which chiniofon was not a complicating factor were cleared of E. histolytica for an average observation period of 320 days (median, 433 days).
• 5.  Milibis® also affected other intestinal protozoa. Sixteen of eighteen cases (90 per cent) of Iodamoeba williamsi infections; twenty-three of forty-nine (47 per cent) cases of Endamoeba coli infections and twelve of twenty-nine (41 per cent) cases of Endolimax nana infections were cleared. Milibis® had very little effect on the flagellate Giardia lamblia, but it eliminated Chilomastix mesnili from the three cases observed.
• 6.  The clinical efficacy of Milibis® in the treatment of chronic intestinal amebiasis was confirmed; all of six severe cases which had been resistant to other therapy were cleared with a single course of Milibis®.
• 7.  Milibis® is easy to administer. Treatment does not require hospitalization or confinement to bed. None of the patients treated showed any toxic symptoms or manifestations of intolerance.

Enteric-coated Camoquin proved ineffectual in the treatment of intestinal amebiasis in 15 individuals; only 4 or 27 per cent were apparently cured even with total dosages as high as 11.4 Gm. The drug was equally ineffectual in treatment of the Trichomonas hominis that 8 of these patients harbored. Two-thirds of the patients had definite symptoms of toxicity with dizziness being the most pronounced and frequent complaint. As a result of these observations, enteric-coated Camoquin is not recommended for the treatment of intestinal amebiasis.

• 1.  The effects of various amounts of rice powder were studied on the growth of 3 strains of E. histolytica cultured with a mixed bacterial flora.
• 2.  The addition of rice flour increased the amount and duration of amebic growth.
• 3.  The length of survival of the ameba cultures was directly related to the rice flour content of the medium.
• 4.  There was an optimal amount of rice powder for the most abundant growth of amebae.
• 5.  In cultures containing the largest amounts of rice powder, the lag phase of amebic growth was prolonged and there was a relative depression of the fold increase of the populations and in the rates of multiplication.
• 6.  The addition of rice powder produced no gross changes in the bacterial flora growing with each strain.
• 7.  Within 48 hours after inoculation, there was a fall in the pH of the cultures containing the largest amounts of rice.
• 8.  Amebic growth accelerated the disintegration of rice particles into granules and the disappearance of the latter from the culture medium.

A brief study of the effect of X-ray treatment in vitro upon the culturability, reproduction and infectivity of Endamoeba histolytica was carried out. It was observed that single irradiations up to 120,000 roentgen units failed to kill or inactivate the organisms in Shaffer-Frye and Balamuth media. Exposure of the “streptobacillus” up to 120,000 r failed to produce any change in its ability to permit growth of amebae in S-F medium. Exposure of amebae in Balamuth culture up to 30,000 r did not seem to affect visibly the normal cycle of population growth. On the other hand, exposures to 60,000 and 120,000 r seemed to inhibit somewhat amebic population growth. Whether this was due to the fact that these doses were lethal for most of the amebae or whether they just prevented or slowed down reproduction is impossible to state on the basis of the evidence presented here. It is unlikely, however, that inhibition of growth was due to the action of X-ray on the accompanying bacterial flora, in view of the fact that amebic growth in the tubes that had been preconditioned with unexposed bacteria was also inhibited. No difference in population growth was observed in the groups that had been treated with neutral red and their controls. Viable amebae were observed for 16 transfers after irradiation with 120,000 roentgens. Injection of the progeny of the X-rayed amebae (120,000 r) into normal guinea pigs produced severe intestinal lesions like their unexposed controls.

A casein hydrolysate-serum medium is described for the cultivation of Trichomonas vaginalis. This simplified medium is more easily manufactured, contains fewer constituents than a previously described formula and adequately supports the growth of trichomonads as shown in over 160 subcultures.

• 1.  A case of accidental infection caused by Leishmania donovani is presented. It is believed to be the only reported case of leishmaniasis due to Leishmania donovani originating in the United States and the only reported case of an accidental infection in a laboratory worker due to this parasite.
• 2.  The disease was manifest by swelling of a finger and regional epitrochlear and axillary adenopathy. There was no evidence of systemic infection.
• 3.  The diagnosis was made by detection of the parasite in fluid secured by aspiration biopsy; in impression smears of the excised lymph node and fixed tissue sections of the lymph node, and growth in culture of the tissue on NNN medium.
• 4.  The patient responded satisfactorily to treatment with Stibanose, a pentavalent antimony preparation. He has been followed for one year and shows no evidence of relapse.

Observations were made to detect malaria occurrence from April 1939 through 1948, in an area where the disease occurred formerly at a high rate. Transmission of vivax was negligible during the period of the study. A single epidemic of falciparum was apparently responsible for a majority of infections encountered. Treatment of positive cases with quinacrine hydrochloride may have been responsible for the rapid termination and limited extent of the epidemic.

Factors which prevent the recurrence of malaria in the study area are obscure. It is believed that improvement of economic conditions has enabled the population to apply, intentionally and indirectly, individual control, prophylactic, and curative measures.

It appears that a new human agglutinable blood factor has been demonstrated by the use of chimpanzee-immune serum developed in rabbits.

The presence in 97 per cent of all healthy white group O individuals and 97.4 per cent of all healthy group O negroes studied strongly suggested that it is not associated with the AB, MN, Rh-Hr, or P systems.

While we are not certain as to the usefulness of this factor it appears from previous work that its absence is intimately associated with the etiology of blackwater fever.

It is possible that this factor may explain the unaccounted for reactions following the transfusion of compatible bloods of both AB group and Rh type.

• 1.  A case of naturally occurring toxoplasmosis in the dog is reported. It is the first instance of canine toxoplasmosis reported from the Canal Zone.
• 2.  Similarity of pathologic changes in human and animal toxoplasmosis is stressed. Calcific change due to parasitization of heart muscle is described.
• 3.  The possibility of various methods of transmission of the disease from the dog to man is discussed.

The introduction of sulfonamides in the treatment of trachoma (granular conjunctivitis) has resulted in bringing about an amelioration of the disease (1, 2, 3). In general, the treatment consists of the systemic use of the drug rather than local application to the eyes, the course of therapy lasting from ten days to two weeks, allowing a rest period, and then repeating the process once again. Improvement may be dramatic or gradual or, in some cases, requiring several months before the effects are noticeable. These studies have been confirmed experimentally in baboons infected with trachoma (4). Under carefully controlled conditions the sulfonamides have been generally successful for the treatment of this disease. The precise mechanism of how these agents act, whether as a structural analog of para-amino benzoic acid, and substituting for this necessary bacterial vitamin, is unknown with respect to trachoma. It must also be further noted that trachoma is a protean disease varying in its manifestation and degree of infectiousness.

This is a brief report on the types of Shigellae encountered in patients with dysentery in two United Fruit Company hospitals in Central America during 1949–1950. No attempt has been made to determine the incidence of the disease or the percentages of the types present in these localities.

The isolation and identification of the Shigellae was accomplished by commonly used methods. Preferably, mucopurulent portions of the fecal specimens were streaked on plates of S S Agar and McConkey's Agar. The characteristic colonies were then further differentiated by inoculation into slants of Triple Sugar Iron Agar. The Proteus group was excluded by the use of Urea Broth. Organisms giving typical reactions on Triple Sugar Iron Agar were then identified by cultural and serologic methods. Commercial Shigella Anti Serum (Lederle) was used for serologic identification.

The following table shows the types of Shigellae that were isolated from cases of dysentery in Tela, Honduras, and in Quepos, Costa Rica.

• 1.  The results demonstrate that mice infected by the bite of Culex quinquefasciatus develop a sufficient concentration of virus in the blood to produce a transmissible infection in mosquitoes which feed upon them.
• 2.  Mice 3–5 days old when infected developed blood titers which ranged from 3.6 to 5.2 while those 7–12 days old had titers of 2.8–3.8. The mosquitoes transmitted the virus when infected by blood having titers of 2.8, 3.2, 4.5, and 5.2, respectively. The titer is expressed as the exponent of the reciprocal of the LD50 dilution.

• 1.  Complete data pertaining to studies on Japanese B encephalitis on Okinawa during the years 1945 through 1949 is presented.
• 2.  The occurrence of the disease in natives is examined in the light of population trends and accuracy of diagnosis. A total of 401 cases, with a case fatality of 35 per cent, have been observed during these five years. During the same period twenty-one cases have occurred in Americans, with a case fatality of 28 per cent.
• 3.  Laboratory aspects of the disease are presented with particular emphasis on time of development and persistence of antibodies. The role of “inapparent” infections is reviewed. Definite evidence is presented to validate the occurrence of such infections.
• 4.  The serologic response to vaccination is demonstrated. The number of cases in vaccinated Americans is not sufficient to permit deductions as to the protective value. The response to recall vaccination is greater than the initial response. The use of vaccine with the subsequent recall serological response as a survey tool is outlined.
• 5.  The serological pattern in various animals suggests that practically all mammals are or have been infected. Potential arthropod vectors are reviewed, and the thus-far futile efforts to prove vector are summated.
• 6.  Areas for future study are delineated.

• 1.  Two species of Brazilian howler monkeys were found to be highly susceptible to the Olímpio Cristo strain of yellow fever virus when transmitted by mosquito bite.
• 2.  Four cyclic transmissions were obtained with A. scapularis and three with A. leucocelaenus.
• 3.  The facility with which laboratory transmissions were obtained with A. scapularis suggests a possible explanation for the survival of virus in the winter months in south Brazil.

• 1.  A survey of natural immunity to yellow fever among the primates of Brazil has been going on for the past 15 years, more than 5,800 sera have been examined in all.
• 2.  Sixty-five per cent were obtained from monkeys and 35 per cent from marmosets.
• 3.  Immune primates have been found almost everywhere except in the seven states of the northeast, no extensive surveys having yet been carried out in that region.
• 4.  The wide extent of specific immunity among primates captured in nature confirms the fact that jungle yellow fever has prevailed throughout most of Brazil during the past decade and a half.

• 1.  A study was made of the concentration of virus which was necessary to infect certain species of Aedes mosquitoes with yellow fever.
• 2.  The lowest titer at which transmission by bite occurred was 10-3.0.
• 3.  Half or more than half of the mosquitoes, which fed on primates circulating yellow fever virus at titers of 10-5.0 or above, became infected after extrinsic incubation periods of at least 28 days at 28°C.

Results have been presented of a survey of single stool examinations of 5,000 persons in northwestern Honduras, and a comparison made with previous studies in Honduras. Three-fourths of all persons examied were revealed to have one or more species of intestinal parasites on such single examinations. The incidence of round-worm infection and of amebiasis is high.

• (1).  The second case of actual infection with Capillaria hepatica (producing death) is presented with a review of the literature.
• (2).  A spurious infestation is also reported, the first for the continental United States and northern hemisphere.
• (3).  Criteria for diagnosis are given.

A case of Schistosoma mansoni infestation is reported which had two unusual complications, diabetes mellitus and acute pylephlebitic abscess of the liver. The findings in this case and a review of the literature suggest that glucose tolerance curves may discover the first complication to be more frequent than is believed, since usually only fasting blood sugar levels have been studied and involvement of the pancreas is frequently found in autopsy material. The complication of acute abscess of the liver apparently is unique.

For many ages insects have drastically affected the life of mankind. In bygone centuries these tiny creatures spread frightful epidemics of plague, of typhus and of malaria among the peoples of Europe. They have sometimes determined the course of history and decided the destiny of nations.

During this time humanity has scarcely been aware of the deadly influence that insects have exerted upon their health and well-being. The parasitic insects of man were considered as an unavoidable nuisance and did not arouse much disgust. Lice, for instance, were found on individuals of all social classes and many anecdotes tell of their presence even in royal palaces. By and large, men were passively resigned to suffering from the effects of obnoxious insects.

It was only when scientific investigations revealed that some parasitic insects transmit disease-spreading germs, and when the means of insect-control were also discovered, that the presence of parasitic insects began to be seen as an alarming menace requiring positive counter-measures.

• 1.  A total of fifty-seven people became poisoned after eating a poisonous cooked eel of whom seventeen were hospitalized.
• 2.  Of the seventeen patients, eleven were admitted in coma, and of the remaining six, three became comatose after a few hours of hospitalization.
• 3.  Treatment was symptomatic, and their symptoms provided a major nursing problem.
• 4.  Of the seventeen, two died and one required a tracheotomy as a result of vocal cord steonosis following intubation.

The Leonard Wood Memorial (American Leprosy Foundation) is sponsoring a new Registry of Leprosy at The American Registry of Pathology, a department of the Armed Forces Institute of Pathology, Washington 25, D. C., under the auspices of the National Research Council. The purpose of this Registry is to promote the study of the pathology of leprosy based on material contributed by leprologists and pathologists throughout the world. Since there is a considerable degree of variation in the behavior of the disease in different parts of the world, the concentration of material in a single center should permit more adequate evaluation of the scope and significance of such variation.

The Leonard Wood Memorial (American Leprosy Foundation) and the Armed Forces Institute of Pathology will shortly appoint a Committee of Consultants to the new Registry. They will assist in the study of the material as a whole and will be available for consultation on individual cases which will be initially reviewed in the Armed Forces Institute of Pathology.

June 13, 1950

Editor

American Journal of Tropical Medicine

Dear Sir:

In the March, 1950 issue of the American Journal of Tropical Medicine, in an article entitled “The Evaluation of the Influence of World War II on the Incidence of Amebiasis”, the authors quote me as reporting the incidence of amebiasis among veterans of World War II as 5.5% (Table 1).

It is regrettable that my report was misinterpreted. The figure of 5.5% is not quoted from the article but is derived from the fact that 74 cases of amebiasis were found among 1324 veterans. Your authors did not realize that some of the 1324 were not examined for intestinal parasites. They were seen for conditions such as malaria and skin affections. The incidence of amebiasis is therefore higher than they calculated.

In the course of our experience with more than 2,000 veterans, we have encountered 260 in whom we were able to perform stool examinations on a routine basis.

Note: Books received for editorial consideration will be intermittently listed. This acknowledgment must be regarded as an adequate expression of appreciation for the courtesy of the author or publisher. Selections will be made for review in the interest of our readers.

Jonathan Campbell Meakins. Practice of Medicine. 5th edition. Pp. 1500, Figs. 500 (50 in color). St. Louis, Mo., C. V. Mosby Co., 1950. $13.50.

Friedrich Karl Kliene. Ein Deutscher Tropenarzt. Einführung von Herbert Kunert. Pp. 182, Figs. 19. Boards. Hannover. Schmorl & von Seefeld Nachf. 1949.

John G. Kidd, Editor. The Pathogenesis and Pathology of Viral Diseases (By fifteen contributors). Symposium held at the New York Academy of Medicine, December 14 and 15, 1948. Pp. x + 235. Figs. Cloth. New York, Columbia University Press. 1950. $5.00.

Anon. The Merck Manual of Diagnosis and Therapy, A Source of Ready Reference for the Physician. 8th edition. Pp. viii + 1592. 12mo:, fabricoid.

This is a comprehensive presentation of schistosomiasis in a cross section of the indigenous population of South Central Africa, primarily the area around Salisbury, Southern Rhodesia, but also including native laborers of Northern Rhodesia, Portuguese Africa and Nyasaland, who come to Southern Rhodesia every year in search of work. The study provides minimum necessary information on the biology and epidemiology of the two etiologic agents, Schistosoma haematobium and S. mansoni, and is concerned for the most part with the pathology of these diseases and their symptomatology. It is based on several hundred cases studied by the author over a ten-year period on the medical wards, in the mortuary and in the public health laboratory at Salisbury. These infections are highly prevalent in the area, much more common as revealed by autopsy section than examination of feces and urine would indicate.

Contrary to current views, Doctor Gelfand has found that S. mansoni is easier to detect than is S. haematobium unless careful post-mortem study is conducted.

This is a diagrammatic, clear presentation by a distinguished clinician of the fundamental distinction between water depletion and salt depletion. To quote the author in his introduction: “Pure water depletion occurs when water intake stops or is inadequate, and when there is no significant loss in secretions. The common causes are great weakness from any serious medical or surgical condition, coma of any causation, and dysphagia due to local conditions … Pure salt depletion arises when water and salt are lost in secretions—for example in vomiting or diarrhea—and water only is replaced.” The author takes up in sequence basic phyolsiogical considerations, osmotic phenomena, body water balance, causation and effect of pure water depletion, body salt balance, physiological functions of NaCl, renal regulation of extracellular Na and Cl, causation and effects of pure salt depletion, including those due to loss of osmotic pressure and disturbance due to acid-base balance, quantitative correlations, differential clinical diagnosis, prevention and treatment.