The diagnostics and treatment of tropical diseases

by E. R. Stitt

Rarely one may observe a critical flow of urine in dengue at the time of the fall of the primary febrile accession.

Albuminuria

The disease in which this is of peculiar diagnostic and prognostic value is yellow fever. We expect albumin about the second day with a steady increase in amount during succeeding days of the fever. The degree of oliguria or rather anuria is of greater prognostic value than the degree of albuminuria. The albuminuria is of great diagnostic value in differentiating yellow fever from dengue.

Blackwater fever shows a great abundance of albumin with the appearance of the haemoglobinuria and diminishes as the color of the urine clears up.

In malaria albumin was present in 38% of benign tertian infections and 58% of malignant ones at Johns Hopkins Hospital.

The absence of albumin in beriberic urine is important in differential diagnosis from acute nephritis.

Haemoglobinuria

Paroxysmal haemoglobinuria or haemoglobinuria resulting from potassium chlorate poisoning, severe burns, intravenous injections of foreign sera, or—most commonly—syphilis, may be noted in the tropics.

The vast majority of cases of true tropical haemoglobinuria, however, are due either to blackwater fever or to the administration of the acid salts of quinine to one predisposed to quinine haemoglobinuria. While it must be admitted that haemoglobinuria may result from quinine it is certainly so rare in subtropical countries, where great amounts of quinine are administered in treatment of malaria, as to be unimportant. It is only where the malignant tertian parasite flourishes that we have the question of the importance of quinine in producing haemoglobinuria brought up.