The excretion of urobilinogen in the stools and urine during malarial infection.

With the technical assistance of F. Schiffer, Dipl. Ing. A VARIABLE degree of blood destruction over and above that occurring physiologically is a constant phenomenon in attacks of malaria. Although blood destruction is always increased in a malarial attack, clinical signs of hemolysis ( jaundice, anemia, etc.) are not always present. The clinical syndrome of hemolytic anemia in malaria is known in its severest form as blackwater fever, which is characterized by the acute development of a marked anemia, hemoglobinuria, intense jaundice, and marked reticulocytosis. In less severe hemolysis, there is only slight jaundice and moderate anemia, accompanied by a slight rise in the number of reticulocytes and by an increased excretion of urobilinogen in the urine. However, in these cases the hemolytic nature of the jaundice is not generally accepted. Stitt” remarks: “It is not improbable, although this point is often disputed, that the yellow tinge of the skin and the sclerae often observed in malaria is due to the tinting of the tissues by the liberated hemoglobin and not as popularly believed to biliousness or cholaemia from bile absorption.” Hemolysis in its slightest form may at times be manifested, according to Stitt and Manson Bahr, by a positive indirect van den Bergh reaction in the blood, even without clinical jaundice. In addition, there are cases of malaria in which neither clinical signs nor laboratory findings pointing to hemolysis are observed. In this mild form, if treated early, no appreciable anemia develops, no jaundice is observed, no increase of bile pigments in the blood is found, even urobilinogenuria may be absent and reticulocytosis may not be encountered. The purpose of this paper is to show that increased blood destruction in malaria is manifested by an increased excretion of urobilinogen in the stools, even when all the above recorded signs of hemolysis are lacking. These studies give further indication of the importance of the fecal urobilinogen output as a criterion of the degree of blood destruction.