Experimental Malaria in Man. Ii. Liver Function 1

Abstract

It is generally known that malaria may produce signs of impaired liver function. In studies on experimentally induced malaria in this laboratory (1, 2), special efforts were made in an attempt to obtain information on four aspects of the question as to the effects on the liver: (1) The magnitude and character of the impairment as indicated by the several methods customarily used in the study of liver disease; (2) the time course of change during continuance of the infection; (3) the relationship of the liver function to the body temperature; (4) the recovery course following termination of the malaria with quinine. The present paper summarizes the findings on these points. SUBJECTS AND PROGRAMThe general characteristics of the subjects and the experimental program were described in a preceding paper (2). The 12 volunteer subjects were Conscientious Objectors who were considered to represent well-nourished normal young men in a fair state of physical fitness. Prior to the experiment, emphasis was placed on discovering any indications of previous episodes or history of liver disease. One subject (No. 9) gave a history of illness at the age of 12 which was characterized by an insidious onset with fever, malaise and jaundice of two months' duration, with subsequent full recovery without evidence of residues. Two other subjects had occasionally noted mild indigestion after eating fatty foods. There were no other suggestive points in the histories and no physical abnormalities were found on physical examination. In five subjects the liver could not be palpated. In seven subjects the liver was palpated at the right costal margin on deep inspiration and was apparently of normal texture; the liver was not tender in any of the men.For three weeks before inoculation the subjects were housed and fed in the laboratory on a standard regimen of moderate activity and a standard "good" diet of 3,600 Cal. with (5, 6); previous experiences with this procedure in inoculation malaria have been described (7,8). Urine was analysed for bilirubin with the Harrison strip test (9) and the methylene blue test (10). In a series of control studies it was found that heparinized plasma gave results identical with those obtained on serum for both prompt and total bilirubin and was more satisfactory than either oxalated or citrated plasma. A few trials with freezing plasma and urine samples indicated that subsequent analyses for bilirubin did not agree closely with the results of analyses on the fresh materials so attempts at storage were abandoned. Accordingly, all bilirubin analyses were made on the fresh materials.For the bromsulfalein excretion test a dosage of 5 mg. per kg. of body weight (11) and a 45-minute time interval (12) were employed.Cephalin-cholesterol flocculation was estimated according to Hanger (13), readings being made at 24 and at 48 hours. The thymol turbidity reaction was estimated with Maclagan's method (14).Urobilinogen was estimated with the method of Watson et al. (15,16) in urine samples collected over twohour peri...

Parasitaemia estimation and prediction of hepatocellular dysfunction among Ghanaian children with acute malaria using haemoglobin levels

“…Although malaria hepatopathy has been considered a rare occurrence, the malady has seen an increase, particularly in endemic areas [ 6 ]. Liver compromise in people with malaria and correlates with a greater likelihood of complications and death [ 7 , 8 , 9 ]. P. falciparum malarial infection has been shown to significantly increase the serum activities of aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) in a manner that positively correlates with the parasites’ density [ 10 ].…”