The diagnostics and treatment of tropical diseases

by E. R. Stitt

In infantile beriberi the child often becomes rigid. There is not a true convulsion but such cases are at times thought to have meningitis.

In schistosomiasis and paragonomiasis as well as in infections with the larval stage of Taenia solium we may have brain involvement and manifestations of Jacksonian epilepsy.

Altered Reflexes Including Sensory and Motor Disturbances

Beriberi.—It is usually stated that the tendon reflexes of the lower extremity, especially the patellar reflex, are absent. While this is generally true they may at first show an exaggeration and some cases do not seem to show any decided change. There may be striking variation from day to day in the reflexes. The superficial reflexes, especially the cremasteric, are as a rule more active than normally.

The sensory changes in beriberi are less marked than those of the motor side. There is rarely complete anaesthesia but rather a blunting of sensation. Hyperaesthesia, particularly of the muscles of the calf of the leg, is well marked when the muscles are grasped with the hand.

The anaesthesia is earliest noted over the shin bone and dorsum of the foot. A loss of tactile sense is often noted about finger tips making it difficult for the patient to button his coat.

The most striking motor phenomena are the foot and wrist-drop, especially the former. The extensor muscles are more markedly involved than the flexors. There is marked muscular weakness of foot as well as hands. The weakness of the muscles of the leg is often the first symptom to be complained of. The type of palsy in beriberi is mainly paraplegic although hemiplegic and monoplegic types have been reported. The paralysis of the diaphragm is the most serious of the muscle palsies.

Contractures of the muscles of the foot or calf of the leg may occur. Contractures of the muscles of the upper extremity are more rare. Muscular atrophy of the leg muscles is often marked. In the upper extremity the muscles of the hand are most frequently atrophied.

Pellagra.—There is considerable variation from time to time in the reflexes. Some authorities attach diagnostic value to the appearance of an exaggerated reflex on one side and a diminution or absence of the corresponding reflex on the other side. Ankle clonus may be present.