A Test for Diagnosis of Thrombo-Angiitis Obliterans. ∗

Abstract

In a previous report, one of us (Goodman) had outlined the evidence for the belief based upon epidemiological studies of others that thrombo-angiitis obliterans was a late manifestation of typhus fever. Since that time, Zinsser has pointed out in studies of Brill's disease that typhus infection may remain latent in the body for an indefinite length of time.

In a previous communication we have pointed out that a formalized Rickettsia suspension seemed to give a positive skin reaction in individuals with a previous typhus infection. Therefore we attempted this skin test in a number of cases of thrombo-angiitis obliterans in order to determine whether or not they had had a previous infection of typhus fever.

Accordingly, 14 males clinically diagnosed as thrombo-angiitis obliterans, some with and some without gangrene, were given intracutaneously 0.1 to 0.2 cc. of formalized Rickettsia suspension as used previously. At the same time for control, an injection of a similar amount of Proteus X19 filtrate was also likewise injected at a different site. A group of 12 controls included 2 with arteriosclerosis. The site of the injections was examined as in the previous study after 24 to 48 hours following the injection. The results are enumerated in Table I, where a negative reaction indicates no erythema or induration, and a + reaction a wheal or raised, reddened, indurated area 1/2 cm. to 1 cm. in diameter, and a ++ reaction from 1 cm. to 3 cm.

The cases diagnosed clinically as thrombo-angiitis obliterans show a positive skin test with Rickettsia organisms which suggests the possibility of previous typhus fever infection. Moreover, a number of the cases diagnosed as thrombo-angiitis obliterans came from typhus infected areas.

Of course the series is small and likewise further controls are required by skin-testing other vascular conditions as well as skin tests with further control suspension, such as tunica vaginalis and guinea pig testicle.