Early delayed hypersensitivity responses in tuberculin skin tests after heavy occupational exposure to tuberculosis

Article Abstract:

If the skin test for tuberculosis (TB) is positive, the reaction is usually first seen 18 to 24 hours after testing, with maximum positivity at 48 to 72 hours. However, within six hours, reddening of the area of the skin test and itchiness, occurs in some individuals, particularly those who are exposed to patients with TB. This early reaction to the tuberculin test was analyzed at the tissue level in 33 hospital workers in Indonesia, who are frequently exposed to TB. The reaction was compared with that of the normal 48-hour response of factory workers in the same geographic location, who are only occasionally exposed to TB. The response seen in the skin of the early and normal reaction was similar. Infiltration of cells involved in the immune response, macrophages and T lymphocytes, were seen in both types of responses. However, the number of cells that infiltrated into the area was lower in the six-hour response compared with the 48-hour response. Proportionally, there were slightly more macrophages in the earlier response. The type of reaction in the six-hour response was classified as an accelerated delayed hypersensitivity reaction. No secretion of the immunoglobulin IgE, which is normally seen in delayed hypersensitivity, was seen. Complexes of immunoglobulin or the serum protein complement were not seen in the six-hour response. It was thought that those who are frequently exposed to TB have immune T lymphocytes that are reactive to TB so that the response can occur immediately and does not depend on the large infiltration of immune cells to the area. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Delayed hypersensitivity, Tuberculin test

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Pancreatitis associated with a wandering spleen

Article Abstract:

A three-and-a-half year-old boy was diagnosed with acute pancreatitis and a wandering spleen. He was admitted with abdominal pain, loss of appetite, and vomiting. The patient also had an earlier diagnosis of fragile X syndrome. CT imaging revealed an abnormally mobile spleen wandering from the left to the right/middle. After 3 months, the spleen had enlarged slightly and moved considerably. A mobile spleen may twist and cause other complications if not properly secured. The patient had splenopexy whereby the spleen is connected to its regular location by surgical stitches or synthetic mesh. The surgical removal of the spleen may be necessary when the spleen cannot function. Cases of wandering spleens are rare and mostly seen in women. There are very few cases in children under 10 years old and none in children with fragile X syndrome.

Case studies, Abnormalities, Pancreatitis, Spleen

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