Jamaican cardiomyopathy

Eight cases of cardiomyopathy found in Jamaica are described. The ages ranged from 19 to 60 years. There were six men and two women. All the hearts were enlarged, the weights ranging from 480-370 g, except for one patient in whom the heart weighed 275 g. The principal pathological finding was fibrous thickning of the endocardium confined to the left side in seven patients and most evident in the ventricles. Four hearts showed mural thrombi which in two instances had given rise to systemic emboli. Valvular involvement -slight-was seen in only three patients. The endocardial thickenings contained deposits of fibrin and originated from them. This cardiomyopathy resembles most closely "heart muscle" disease found in Nigeria (Summary)

A study of the blood in leprosy: cytology and clotting

Ninety cases of leprosy were examined. All cases except two were under treatment with the sulphones. A hypochromic, normocytic anaemia was present in 80 percent of males and 60 percent of females. This had been reported previously in leprosy and also in patients under treatment with the sulphones. Nine per cent of cases showed a marked basophilia and basophils were present in 26 percent of cases. The relationship is not understood. Twenty-five per cent of cases showed the presence of atypical monocytes, a finding which has previously been observed in leprosy. A contradictory tendency to thrombocytopenia with a shortened bleeding time was found, with normal clotting and prothrombin times. The significance of these findings is not understood. (AU)

Veno-occlusive disease of the liver: essential pathology

The lesions of veno-occlusive disease of the liver appear to surround blockage of the hepatic veins. For this reason it is suggested that other names - serous hepatosis, collagenosis - used earlier to describe this condition be abandoned and that only the veno-occlusive disease be used. In progressive cases the end-result is non-portal cirrhosis (often with fatal haemorrhage from the oesophageal varices). The pancreas shows lesions which are commonly accepted as associated with protein undernutrition (Summary)

Experimental yaws - abstract

This paper outlines some experimental studies on the pathogenesis of the granulomatous inflammation produced by the treponoma. Lesions clinically and histologically similar to human yaws have been induced in the Golden Hamster (Cricetus auratus) by inoculation with Treponema pertenue from human cases. The disease is localised affecting the skin tissues only; there appears to be no serological response and no systemic dissemination to viscera or bones. One interesting features has been the exacerbation and remission of the lesions at the site of inoculation; evidence is produced which suggests that during a remission there is a residual, latent, infection at the roots of the hair follicles. This may explain the exacerbation of the disease at the site of an old scar in human cases (AU)

Yaws: clinical aspects - abstract

Detail and long term observations in the field of a small, closed community suggest that: 1. Serological reactions are of little assistance in the control of framboesia in the community; 2. Approved medical methods of control are often both impractical and unsuccessful; 3. A large proportion of framboesial lesions are not recognised as such (AU)

Some immunological aspects of leprosy - abstract

Most cases of leprosy belong to two very contrasting types of the disease - the lepromatous and the tuberculoid. The lepromatous type is usually lepromin test negative, whereas the tuberculoid type is generally lepromin test positive. It is generally accepted that lepromin test positive individuals rarely develop leprosy and if they do, the disease is mild and the prognosis relatively good. There is some evidence that tuberculosis or B.C.G. vaccination produces conversion from lepromin negativity to lepromin positivity. This has been explained on the basis of a cross-immunity between leprosy and tuberculosis and has led French and South American workers to advocate B.C.G. vaccination as a means of leprosy control. In view of the above statements the specific problem at present under review is the answer to the following question:- Does the allergic response of the host's tissues determine the type of leprosy or does the type of leprosy determine the allergic response? RESULTS (Preliminary investigations): 1. Tuberculin Test: 53 percent(57/108) were tuberculin positive. In Jamaica generally, tuberculin positivity (all ages) is about 50 percent. 2. Histology of positive tuberculin reactions: Twelve patients were studied (7 lepromatous, 3 tuberculous and 2 indeterminate). (a) All showed acute reaction consisting of oedema, focal haemorrhage and tissue necrosis and also a granulomatous infiltration of mononuclear cells. Five showed marked vesication. (b) Four of the lepromatous type showed a lepromatous reaction (isopathic phenomenon) in that the macrophage cells contained acid-fast bacilli and fat. CONCLUSIONS (Provisional): Clinically (and histologically about 50 percent of the patients were found to be sensitive to tuberculo-protein. If this sensitivity is due to tuberculosis (and the incidence is the same as in the general populace), the result suggests that there is little evidence of cross-immunity between tuberculosis and leprosy. Histologically, 4/7 lepromatous cases biopsied showed an isopathic phenomenon which may indicate that the type of leprosy influences the allergic response (AU)

A case of glycogen storage disease in a West Indian infant

A case of glycogen storage disease is described. The patient was a 21 month old female of negroid extraction, who has been ill for over a year. About one week previous to death she developed a pyrexia and tonsilitis, generalised lymphoadenopathy and splenomegaly. At postmortem she was found to have a generalised glycogen storage disease involving heart, liver, muscle, kidneys and macrophagic cells. In addition, she was found to have histological changes in the reticulo-endothelial system consistent with a virus infection, and this was probably the precipating factor in the cause of death. (AU)

Microfilariasis in the Turks Islands

The incidental finding of microfilariasis, possibly by Mansonella ozzardi, in two patients receiving treatment for leprosy is described. Both patients live in the same island in the Turks Islands Dependency and this is the first reported incidence of filariasis in this region. In neither patient was there any symptomatology referable to the infestation and the microfilariae were demonstrated during a routine blood examination prior to the institution of sulphone therapy for leprosy. Apart from the demonstration of the organisms and the presence of an eosinophilia, laboratory findings were not remarkable. Both patients responded well to the sulphone therapy and were discharged home to continued ambulatory treatment. No specific treatment for M. ozzardi filariasis has yet been described and, in the absence of untoward symptoms, none was attempted. The field treatment of complete populations by Hetrazan is briefly referred to. (AU)

Rhesus factor distribution in the Caribbean: preliminary communication

A preliminary survey of the distribution of Rhesus factors in Jamaica is recorded and comparisons are made with data from some of the other Caribbean territories. The Rhesus negative chromosome (cde) is not found in the Amerindian; it is rare among Asiatics; it is present in Africans at about half the European frequency. In the Caribbean region, these preliminary enquiries have shown that the scatter of the Rhesus negative chromosome is about that to be expected from the known trends of population miscegenation. It is hoped that the publication of these figures will stimulate a more detailed investigation in the various territories of the West Indies

Acute toxic hypoglycaemia occurring in the vomiting sickness of Jamaica: morbid anatomical aspects

Seven autopsies and one clinical case of a syndrome known as the Vomiting Sickness of Jamaica are described. In these cases hypoglycaemia was associated with fatty metamorphosis of the liver and other organs, tissue oedema, and ailmentary lymphoid hyperplasia. During the acute phase biopsies and post mortem material show a depletion of liver glycogen. Evidence is presented that restoration can take place by intravenous glucose therapy. The mechanism of the change is discussed and it is suggested that the defect may be one of deficient gluconeogenesis. (AU)

Recurrence of experimental yaws (framboessial) infection in the hamster

Relapsing framboesial infection in the infra-nasal region of the hamster has been observed clinically, by dark field examination, and histo-logically. From histological observations it is suggested that the relapsing infection is caused by the organism lying dormant at the roots of the hair follicles during remissions (AU)

A case of acute, metastatic, myositis caused by a new organism of the family pseudomonadaceae: a preliminary report

An acute fulminating septicemic illness has been described. The lesions consist of a metastatic necrosis of muscle tissue. The causative organism is believed to be a member of the pseudomonadaceae family. Details of a further study of the disease from the human, bacteriological and experimental aspects will be published later (AU)

Non-specific factors in the epidemiology of yaws

Yaws is found in hot countries where the mean isotherm is in the region of 80§. It is found in humid areas which implies a heavy rainfall, a non-previous soil and luxurious vegetation. It is found in rural districts where the economic circumstances are poor, where socially the order is low and the standards of hygiene and sanitation are not high. The highest incidence of yaws infection and of active lesions, and of non-immunity, appears to be in the first two decades, after which there is a decrease within the community of the above three factors. It is probable that the main mode of infection is by contact, but flies may also have a considerable part to play in the transmission of the disease. There is a low incidence of infection in adult life, the cause of which appears to be quite distinct from a low incidence due to an acquired immunity from a previous child infection. The reason for this is not understood. However, if this assumption is correct, it would be logical to introduce some method of immunization into the mass treatment programmes. After many mass treatment the attack rates within the community are considerably reduced but there remains a small residue of relapsed, reinfected, and new cases. It has been suggested that the type of case which is responsible for the continued propagation of the disease is the latent case with relapsing ulcerative plantar framboesides. In view of the fact that yaws is infrequent or even abscent in those areas of the tropics where the economic and social status of the populace is relatively high, it is possible, that with further socio-economic progress in the so-called under developed areas, that yaws may eventually be eliminated. So may it be with many other disease (AU)