Tumor necrosis factor (cachectin) in human visceral leishmaniasis

Article Abstract:

Visceral leishmaniasis (VL) or kala-azar, is a disease caused by the parasite Leishmania donovani, which is transmitted by the bite of sandflies. The clinical disease is characterized by fever, anemia, leukopenia (reduced white cell count), and hepatosplenomegaly (enlargement of the liver and spleen), and in full blown cases, by marked immunologic dysfunction. Cachectin, or tumor necrosis factor-alpha (TNF-alpha), is a cytokine, a nonantibody protein produced in response to specific antigenic stimuli. It acts as an intercellular mediator, and is believed to play a role in the mediation of normal cellular function, inflammation, and in the body's response to bacterial or parasitic infection. The levels of TNF-alpha in patients with VL were measured to assess the possibility of using these levels as indicators of the progress of the disease. The study group consisted of 58 patients with VL; 28 patients with acute disease, and 30 with cryptic disease. Cryptic disease patients had no symptoms of VL, but had a positive skin test, indicating an immune response to the infection. Fifteen healthy volunteers comprised the control group. Blood levels of TNF-alpha were elevated in the patients with acute VL prior to treatment and fell afterward. In cases refractory (resistant) to treatment, TNF-alpha levels remained high. Normal levels were observed in the asymptomatic and control groups. Levels of TNF-alpha appear to be a suitable marker for measuring the progress of VL and patient response to therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, Tumor necrosis factor, Leishmaniasis

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Cat-scratch disease presenting as abdominal visceral granulomas

Article Abstract:

Cat scratch disease (CSD) is commonly found in children and adolescents, and usually resolves with minimal residual effects. Single case reports have appeared in the literature describing atypical incidents with involvement of the eyes, skin or internal organs. Therapeutic intervention is usually not required, although some clinicians recommend antituberculous medication or antibiotics in cases involving AIDS or AIDS-related complex (ARC). The organism in cat scratch disease is best visualized by staining the specimens with the Warthin-Starry silver impregnation technique. Diagnoses are usually made by: (1) association with a cat and a cutaneous or conjunctival inoculation site, (2) a positive CSD skin test (Foshay test), (3) other negative findings for lymphadenopathy (usually swelling of lymph nodes), and ( 4) the presence of characteristic features of CSD. Three case reports are presented describing abnormal, atypical, disseminated, visceral infection; two cases with spleen involvement (one in a patient with ARC), and one case of liver involvement. Microscopic examination of tissue biopsies revealed granulomatous, inflammatory processes, already described as characteristic in CSD lymphadenitis (inflammation of lymph nodes). The patients recovered without complications. Clinical awareness of the wide spectrum of tissues that can potentially be involved in CSD should be developed in order to minimize unnecessary invasive intervention and hospitalization and to promote effective treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects

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Cat scratch disease

Article Abstract:

Cat scratch disease (CSD) is caused by the scratch or bite of a cat. It is more common in children, but can occur in adults as well. Bacteria called cat scratch bacilli (CSB) are present in the mouth and on the claws of healthy cats, and are transmitted to humans who are exposed to the scratch or bite of a cat. The disease affects the lymph tissue, causing inflammation (lymphadenitis) and usually disappears by itself within two-to-four months. In a few cases, pus may form and persist in the wound site, and may have to be removed. In about 5 percent of CSD cases, the disease may last a long time or may recur. In these rare cases, it is not uncommon to have pneumonia, and inflammation of the skin, joint membranes, brain, and spinal cord. If the disease spreads, it will affect the liver and spleen, causing them to be come enlarged, and will result in abdominal pain. A skin sensitivity test is used to determine if a person has been exposed to or has CSD. It is estimated that 36 percent of all of cat lovers in the US would have a positive skin test indicating exposure, and that less than 1 percent of those who dislike cats would test positive. Infection with CSB is probably more common than previously thought, and may be responsible for some cases of hepatitis of unknown origin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lymphatic diseases, editorial

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