Brief history of the clinical diagnosis of malaria: from Hippocrates to Osler.

Since antiquity, malaria had a major impact on world history but this brief historical overview focuses on clinical features of malaria from Hippocrates to Osler. In antiquity, physicians tried to differentiate malaria from other acute fevers. The classic descriptions of malaria by Hippocrates in ancient Greece and Celsus in ancient Rome are excerpted here from the original Greek and Latin. Their clear clinical descriptions prove malaria was recognized in antiquity. In the modern era, it remains difficult to clinically differentiate malaria from typhoid fever. Since physicians used the term 'typhomalaria' to describe acute undifferentiated fevers a testimony to their lack of clinical acumen. Osler, the great clinician, by careful observation in clinical features and fever patterns was able to clearly differentiate malaria from typhoid fever as did the ancients.

Compromiso hepatico en infecciones sistemicas / Hepatic involvement in systemic infections

El paciente que tiene ictericia clinica, resultados anormales en las pruebas de funcion heptatica, o ambos, representa un dificil reto diagnostico. Muchas enfermedades infecciosas comprometen el higado y la gravedad del compromiso determnina el grado de ictericia clinicamente evidente. Algunas enfermedades que comprometen levemente el higado no producen ictericia. Una clave importante para establecer la causa del transtorno es el patron de resultados anormales en las pruebas de funcion hepatica. Una mayor concentracion de fosfatasa alcalina predomina en la fiebre Q, la sifilis secundaria o terciaria, la clonorquiasis y la candidiasis hepatica; mientras que un mayor nivel de transaminasas sericas caracteriza a la hepatitis viral, la leptospirosis, los sindromes de mononucleosis, la enfermedad de los legionarios, la fiebre tifoidea, el sindrome de choque toxico y la fiebre amarilla. Los incrementos en los niveles de bilirrubina serica son tipicos en la ictericia causada por gangrena gaseosa, sepsis bacteriana grave y fiebre recurrente. Estos hallazgos, conjuntamente con la historia del paciente, los resultados fisicos y las pruebas basicas de laboratorio, permiten un diagnostico presuntivo en la mayoria de los casos