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Chloroquine in hepatic amoebiasis
351 TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYClENE. Vol. 44. No. 3. D e c e m b e r , 1950.
CORRESPONDENCE. To the Editor.
CHLOROQUINE IN HEPATIC AMOEBIASIS. SIR,--The following case illustrating the action of chloroquine in amoebic hepatitis is worth publishing. A male patient 30 years of age was admitted to the Royal Hospital on 9th May, 1949, complaining of a hectic and persistent fever with chills, cough and pain in the right side of the chest. Clinical and radiological examination revealed the presence of an abscess at the base of the right lung with a moderately enlarged liver. He had been previously admitted to hospital on 15th March, 1949, with fever and pain on the right side of the chest diagnosed as a simple pleurisy with effusion confirmed by paracenthesis. The patient had discharged himself on the 16th April, 1949, and was advised to rest with the usual conservative treatment. In view of the poor general state of health of the patient on this admission, surgery was out of the question and aspiration was decided upon. A total amount of 3,500 c.c. of anchovy sauce purulent material was withdrawn. Bacteriological examination of this fluid proved sterile. With view of the enlargement of the liver and the colour of the fluid an amoebic origin was suspected and treatment by penicillin, streptomycin and emetine was instituted and he was given two courses of emetine (grain 12) during his first stay in the hospital. A course of atebrin was also given in view of an enlarged spleen although no malarial parasites were detected on repeated examination. The patient discharged himself on the 24th July, 1949, in fairly good health, and afebrile. The liver remaining palpable but not tender. He was readmitted on 24th April, 1950, again with a continuous fever, upper abdominal pain and mild symptoms of colitis. Follow-up radiography of the chest revealed no new development except an old healed fibrotic lesion
352
CORRESPONDENCE
at the site of the old abscess. The liver was enlarged about four fingers and was tender. The spleen was just palpable, but again no malarial parasites could be detected. Another course of emetine (grain 12) was given, and the patient was discharged on the 8th May, 1950, with marked improvement in the condition of the liver and the clearing up of the symptoms of colitis. He was readmitted for the third time on 18th May, 1950, with fever, chills and sweats and upper abdominal pain with a toxic and very ill appearance. The liver was enlarged to about five fingers below the right costal margin with general tenderness all over the area of the liver. The spleen was just palpable. The condition of the right chest remained clinically and radiologieally the same. Fluoroscopy of the chest confirmed the enlargement of the liver with distortion of the cardiophrenic angle and fixation of the right dome of the diaphragm. There was no doubt in our mind of the diagnosis of an amoebic hepatitis and a trial of chloroquine diphosphate was thought worth while in view of the article by CONmq (Amer. reed. J., 1949, 6, 309) abstracted in Trop. Dis. Bull, 1950, 47, 40. It was given in tablet form each containing the equivalent of gramme 0.15 base, issued by Messrs. May and Baker. An intensive dose was given for the first 2 days (two tabs. t.d.s, for the first 48 hours followed by one tab. t.d.s, for 2 weeks). The patient tolerated the dose very well and the temperature began to drop from the third day of the treatment by lysis, the general condition improved and the liver became less tender and came within normal limits by the time of his discharge on the 30th May, 1950. Before completing the course of treatment and against medical advice, he discharged himself and was advised to continue the treatment at home ; he has remained in good health since. The treatment of this single case should not be taken as strong evidence in favour of the remedy but should encourage others to further trial. I am, etc., M. FAWZI. Royal College of Medicine, Baghdad. 31st July, 1950.
CYANHAEMATIN METHOD OF ESTIMATING HAEMOGLOBIN. SIR,--LEHMANN and BAIRD, Transactions, 43, 67, report difficulties with turbidity in haemoglobin estimations by the cyanhaemafin nlethod used in warm climates. In 1948 we were investigating the possibilities of a large-scale haemoglobin survey of the population of Malaya, and the cym]haematin method was obviously the method of choice, as stated by KING et al. (1948), Lancet ii, 563. A
CORRESPONDENCE. To the Editor.
CHLOROQUINE IN HEPATIC AMOEBIASIS. SIR,--The following case illustrating the action of chloroquine in amoebic hepatitis is worth publishing. A male patient 30 years of age was admitted to the Royal Hospital on 9th May, 1949, complaining of a hectic and persistent fever with chills, cough and pain in the right side of the chest. Clinical and radiological examination revealed the presence of an abscess at the base of the right lung with a moderately enlarged liver. He had been previously admitted to hospital on 15th March, 1949, with fever and pain on the right side of the chest diagnosed as a simple pleurisy with effusion confirmed by paracenthesis. The patient had discharged himself on the 16th April, 1949, and was advised to rest with the usual conservative treatment. In view of the poor general state of health of the patient on this admission, surgery was out of the question and aspiration was decided upon. A total amount of 3,500 c.c. of anchovy sauce purulent material was withdrawn. Bacteriological examination of this fluid proved sterile. With view of the enlargement of the liver and the colour of the fluid an amoebic origin was suspected and treatment by penicillin, streptomycin and emetine was instituted and he was given two courses of emetine (grain 12) during his first stay in the hospital. A course of atebrin was also given in view of an enlarged spleen although no malarial parasites were detected on repeated examination. The patient discharged himself on the 24th July, 1949, in fairly good health, and afebrile. The liver remaining palpable but not tender. He was readmitted on 24th April, 1950, again with a continuous fever, upper abdominal pain and mild symptoms of colitis. Follow-up radiography of the chest revealed no new development except an old healed fibrotic lesion
352
CORRESPONDENCE
at the site of the old abscess. The liver was enlarged about four fingers and was tender. The spleen was just palpable, but again no malarial parasites could be detected. Another course of emetine (grain 12) was given, and the patient was discharged on the 8th May, 1950, with marked improvement in the condition of the liver and the clearing up of the symptoms of colitis. He was readmitted for the third time on 18th May, 1950, with fever, chills and sweats and upper abdominal pain with a toxic and very ill appearance. The liver was enlarged to about five fingers below the right costal margin with general tenderness all over the area of the liver. The spleen was just palpable. The condition of the right chest remained clinically and radiologieally the same. Fluoroscopy of the chest confirmed the enlargement of the liver with distortion of the cardiophrenic angle and fixation of the right dome of the diaphragm. There was no doubt in our mind of the diagnosis of an amoebic hepatitis and a trial of chloroquine diphosphate was thought worth while in view of the article by CONmq (Amer. reed. J., 1949, 6, 309) abstracted in Trop. Dis. Bull, 1950, 47, 40. It was given in tablet form each containing the equivalent of gramme 0.15 base, issued by Messrs. May and Baker. An intensive dose was given for the first 2 days (two tabs. t.d.s, for the first 48 hours followed by one tab. t.d.s, for 2 weeks). The patient tolerated the dose very well and the temperature began to drop from the third day of the treatment by lysis, the general condition improved and the liver became less tender and came within normal limits by the time of his discharge on the 30th May, 1950. Before completing the course of treatment and against medical advice, he discharged himself and was advised to continue the treatment at home ; he has remained in good health since. The treatment of this single case should not be taken as strong evidence in favour of the remedy but should encourage others to further trial. I am, etc., M. FAWZI. Royal College of Medicine, Baghdad. 31st July, 1950.
CYANHAEMATIN METHOD OF ESTIMATING HAEMOGLOBIN. SIR,--LEHMANN and BAIRD, Transactions, 43, 67, report difficulties with turbidity in haemoglobin estimations by the cyanhaemafin nlethod used in warm climates. In 1948 we were investigating the possibilities of a large-scale haemoglobin survey of the population of Malaya, and the cym]haematin method was obviously the method of choice, as stated by KING et al. (1948), Lancet ii, 563. A