Hepatic dysfunction in human trypanosomiasis: I. Abnormalities of excretory function, seroflocculation phenomena and other tests of hepatic function with observations on the alterations of these tests during treatment and convalescence

Abstract

1. 1) Though clinical jaundice is uncommon in T. rhodesiense infections in man, an increase in the total serum bilirubin is common in early cases in the acute febrile stage. A raised serum bilirubin level was common even in very early cases with a trypanosome chancre. The serum bilirubin was not raised in six consecutive chronic late cases. 2. 2) Excess urobilinogen in the urine was found in 83 per cent. of early cases, 67 per cent. of the intermediate and only 40 per cent. of the late cases. Bilirubinuria occurred in 80 per cent. of the early cases but was less common and less severe in the late. 3. 3) The bromsulphthalein tolerance test was always abnormal in the acute febrile early case, but was normal in clinically mild apyrexial cases. The test became normal rapidly after treatment. Those late cases of T. rhodesiense and T. gambiense infections which were examined, showed abnormalities of BSP tolerance, which also became normal rapidly after treatment. 4. 4) The BSP tolerance test became normal before the serum bilirubin had returned to normal. 5. 5) The seroflocculation abnormalities in 46 early cases and in 10 late cases of T. rhodesiense infections are described. Similar abnormalities were noted in two late cases due to T. gambiense. The improvements of these tests during recovery are described. 6. 6) Abnormal hippuric acid synthesis was noted in one late case due to T. gambiense, and in another due to T. rhodesiense. This test became normal soon after treatment was begun. 7. 7) The clinical and biochemical investigations indicated that, in T. rhodesiense infections in man, there is a parenchymatous disorder of the liver of greatly varying severity which is reversible by specific treatment with suramin or mel B. Hepatic dysfunction may be responsible for the intolerance of severely ill cases to mel B. Because of this, Apted's (1953, 1957) cautious approach to treatment is to be commended.