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A Study of Pigmentation and Other Changes in the Liver in Malaria

The results of our studies of the liver in 25 cases of malaria were as follows:

1. The thymol flocculation test and the iodine test showed positive reactions in 92 per cent and 46 per cent of the series, respectively. The iodine test was more sensitive in cases of malaria with clinical hepatitis while the thymol flocculation test showed a positive reaction in almost every case of malaria (with or without clinically evident hepatitis). Correlation between the positive reactions of these two tests was not evident in our series.

2. In this series 28 per cent of cases showed clinical symptoms of hepatitis. The species of parasite and degree of parasitemia seem to be the important factors in causing the symptom. But hepatic dysfunction, which commonly occurred, did not depend upon either species of parasite or degree of parasitemia.

3. Of the series of cases 83 per cent showed malarial pigment in Kupffer cells. Of these infections, 63.2 per cent were caused by Plasmodium falciparum and 36.8 per cent by Plasmodium vivax.

4. We found that pigment could be demonstrated in the liver as early as 6 days after commencement of the clinical attack and as long as 6 months after beginning treatment. The time of disappearance of the pigment depended upon the amount of pigment deposited at the beginning of infection. The amount of pigment in the liver depended on the duration or chronicity of the disease as well as the time when biopsy was performed after the beginning of treatment.

5. A constant relation between hepatic dysfunction, amount of pigment, degree of parasitemia and pathological changes in the liver could not be demonstrated in our series of observations.