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Goto Y, Ito T, Ghosh S, Mukherjee B. Access and utilization of host-derived iron by Leishmania parasites. J Biochem 2023; 175:17-24. [PMID: 37830941 PMCID: PMC10771036 DOI: 10.1093/jb/mvad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
Iron is involved in many biochemical processes including oxygen transport, ATP production, DNA synthesis and antioxidant defense. The importance of iron also applies to Leishmania parasites, an intracellular protozoan pathogen causing leishmaniasis. Leishmania are heme-auxotrophs, devoid of iron storage proteins and the heme synthesis pathway. Acquisition of iron and heme from the surrounding niche is thus critical for the intracellular survival of Leishmania inside the host macrophages. Moreover, Leishmania parasites are also exposed to oxidative stress within phagolysosomes of macrophages in mammalian hosts, and they need iron superoxide dismutase for overcoming this stress. Therefore, untangling the strategy adopted by these parasites for iron acquisition and utilization can be good targets for the development of antileishmanial drugs. Here, in this review, we will address how Leishmania parasites acquire and utilize iron and heme during infection to macrophages.
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Affiliation(s)
- Yasuyuki Goto
- Laboratory of Molecular Immunology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tatsumi Ito
- Laboratory of Molecular Immunology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Souradeepa Ghosh
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
| | - Budhaditya Mukherjee
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
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2
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Goto Y, Mizobuchi H. Pathological roles of macrophages in Leishmania infections. Parasitol Int 2023; 94:102738. [PMID: 36738983 DOI: 10.1016/j.parint.2023.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Macrophages are the major host cells for Leishmania parasites, and determine the fate of infection by either limiting or allowing growth of the parasites, resulting in development or control of leishmaniasis, respectively. They also play important roles in causing pathological outcomes during Leishmania infection. The pathophysiology is complex and include a wide variety of molecular and cellular responses including enhancement of inflammatory responses by releasing cytokines, causing damages to surrounding cells by reactive oxygen species, or disordered phagocytosis of other cells. It is of note that disease severity in leishmaniasis sometimes does not correlate with parasite burdens, indicating that pathological roles of macrophages are not necessarily linked to their parasite-killing activities that are often defined by M1/M2 status. Here, we review the roles of macrophages in leishmaniasis with a focus on their pathological mechanisms in disease development.
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Affiliation(s)
- Yasuyuki Goto
- Laboratory of Molecular Immunology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.
| | - Haruka Mizobuchi
- Laboratory of Molecular Immunology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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Abstract
Leishmaniasis is a zoonotic and vector-borne infectious disease that is caused by the genus Leishmania belonging to the trypanosomatid family. The protozoan parasite has a digenetic life cycle involving a mammalian host and an insect vector. Leishmaniasisis is a worldwide public health problem falling under the neglected tropical disease category, with over 90 endemic countries, and approximately 1 million new cases and 20,000 deaths annually. Leishmania infection can progress toward the development of species–specific pathologic disorders, ranging in severity from self-healing cutaneous lesions to disseminating muco-cutaneous and fatal visceral manifestations. The severity and the outcome of leishmaniasis is determined by the parasite’s antigenic epitope characteristics, the vector physiology, and most importantly, the immune response and immune status of the host. This review examines the nature of host–pathogen interaction in leishmaniasis, innate and adaptive immune responses, and various strategies that have been employed for vaccine development.
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Carvalho FHGD, Lula JF, Teles LDF, Caldeira AP, Carvalho SFGD. Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis in an endemic area in the north of Minas Gerais, Brazil. Rev Soc Bras Med Trop 2020; 53:e20190491. [PMID: 32578702 PMCID: PMC7310370 DOI: 10.1590/0037-8682-0491-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/29/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Visceral leishmaniasis (VL) is an ill-studied disease that is endemic to several regions of Brazil. It is often complicated by hemophagocytic lymphohistiocytosis (HLH), a potentially fatal disorder resulting from excessive non-malignant activation/proliferation of T lymphocytes and macrophages. Considering the overlapping clinical and laboratory characteristics of these diseases, diagnosing HLH is a challenge. Therefore, tracking the association between VL and HLH is necessary in endemic areas. Although HLH can be inapparent and resolve with antileishmanicides, this may not always occur. HLH causes high lethality; therefore, immunosuppressive therapy should be instituted immediately in order to avoid a fatal outcome. METHODS: We described the epidemiological, clinical, laboratory, and therapeutic profile of this association in a region of Brazil endemic for VL. RESULTS We presented 39 patients with this association in a retrospective cohort of 258 children who were admitted from January 2012 to June 2017. Of the 39 patients, 31 were from urban areas (79.5%), and 21 (53%) were males. The mean age and weight were 2.86 (2.08) years and 14.03 (5.96) kg, respectively. The main symptoms were fever (100%), hepatosplenomegaly (100%), pallor of the skin and mucosa (82.5%), edema (38.5%), bleeding (25%), and jaundice (7.5%). Hemophagocytosis was identified in 16/37 (43.24%) patients, and direct examination revealed that 26/37 (70.27%) patients were positive for VL. The patients were treated as recommended by the Ministry of Health. CONCLUSIONS It was observed that HLH is a common complication in endemic areas, and its diagnosis must consider the overlapping of clinical characteristics and pancytopenia.
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Affiliation(s)
| | | | - Leandro de Freitas Teles
- Unimontes, Hospital Universitário Clemente de Faria, Montes Claros, MG, Brasil.,Fundação Hemominas, Montes Claros, MG, Brasil
| | | | - Sílvio Fernando Guimarães de Carvalho
- Unimontes, Hospital Universitário Clemente de Faria, Montes Claros, MG, Brasil.,Unimontes, Departamento de Saúde da Mulher e da Criança, Montes Claros, MG, Brasil
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5
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Morimoto A, Uchida K, Chambers JK, Sato K, Hong J, Sanjoba C, Matsumoto Y, Yamagishi J, Goto Y. Hemophagocytosis induced by Leishmania donovani infection is beneficial to parasite survival within macrophages. PLoS Negl Trop Dis 2019; 13:e0007816. [PMID: 31738750 PMCID: PMC6886864 DOI: 10.1371/journal.pntd.0007816] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/02/2019] [Accepted: 09/29/2019] [Indexed: 02/07/2023] Open
Abstract
Visceral leishmaniasis (VL) is caused by parasitic protozoa of the genus Leishmania and is characterized by clinical manifestations such as fever, hepatosplenomegaly and anemia. Hemophagocytosis, the phenomenon of phagocytosis of blood cells by macrophages, is found in VL patients. In a previous study we established an experimental model of VL, reproducing anemia in mice for the first time, and identified hemophagocytosis by heavily infected macrophages in the spleen as a possible cause of anemia. However, the mechanism for parasite-induced hemophagocytosis or its role in parasite survival remained unclear. Here, we established an in vitro model of Leishmania-induced hemophagocytosis to explore the molecules involved in this process. In contrast to naïve RAW264.7 cells (mouse macrophage cell line) which did not uptake freshly isolated erythrocytes, RAW264.7 cells infected with L. donovani showed enhanced phagocytosis of erythrocytes. Additionally, for hemophagocytes found both in vitro and in vivo, the expression of signal regulatory protein α (SIRPα), one of the receptors responsible for the ‘don’t-eat-me’ signal was suppressed by post-transcriptional control. Furthermore, the overlapped phagocytosis of erythrocytes and Leishmania parasites within a given macrophage appeared to be beneficial to the parasites; the in vitro experiments showed a higher number of parasites within macrophages that had been induced to engulf erythrocytes. Together, these results suggest that Leishmania parasites may actively induce hemophagocytosis by manipulating the expression of SIRPα in macrophages/hemophagocytes, in order to secure their parasitism. Parasites can manipulate host immune responses to build favorable environment to them. Because this parasite-driven immune modulation is often linked to symptoms in infected individuals, not only parasiticidal compounds but also immunological interventions limiting such the parasites’ abilities will serve as treatment options. In this study, we studied the mechanism and its role of hemophagocytosis (the phenomenon whereby macrophages engulf erythrocytes) caused by Leishmania donovani, a causative agent of VL. In vitro experiments revealed parasites have ability to directly disrupt macrophage’s recognition of self-cells, and that the induced engulfment of erythrocytes by L. donovani infection is beneficial to the parasites for their intracellular survival. These results suggest that Leishmania parasites actively induce hemophagocytosis by manipulating the ‘don’t-eat-me’ signal in macrophages for their survival. Although it is still to be determined how Leishmania parasites change the ‘don’t-eat-me’ signal in macrophages, our study may facilitate development of an immunotherapy which limits the change and lead to improvement of anemia due to hemophagocytosis as well as control of parasite survival.
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Affiliation(s)
- Ayako Morimoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Department of Veterinary Medical Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - James K. Chambers
- Laboratory of Veterinary Pathology, Department of Veterinary Medical Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kai Sato
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jing Hong
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Chizu Sanjoba
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yoshitsugu Matsumoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Junya Yamagishi
- Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
- Global Station for Zoonosis Control, GI-CoRE, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
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6
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Goto Y, Cheng J, Omachi S, Morimoto A. Prevalence, severity, and pathogeneses of anemia in visceral leishmaniasis. Parasitol Res 2016; 116:457-464. [PMID: 27822583 DOI: 10.1007/s00436-016-5313-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/26/2016] [Indexed: 01/22/2023]
Abstract
Anemia is a typical symptom during visceral leishmaniasis (VL). We performed a systematic analysis of the literature on anemia in VL to understand the prevalence, severity, and possible mechanisms. Anemia is very common in VL patients with an overall prevalence higher than 90 %. The degree of anemia in VL is moderate to severe (hemoglobin level ∼7.5 g/dl), and the status can be recovered by treatment with antileishmanial drugs within a certain period of time. Possible pathogeneses of anemia in VL based on clinical observations included anti-RBC antibodies, dysfunction in erythropoiesis, and hemophagocytosis in the bone marrow or spleen, while hemolysis is a more likely cause than dyserythropoiesis. In hamsters with experimental VL, hemophagocytosis induced by immune complex and changes on erythrocyte membrane is speculated as the pathogenesis for anemia. In contrast, our recent study on murine VL indicated that hemophagocytosis contributes to anemia in contrast to lower contribution of anti-RBC antibodies or dysfunction in erythropoiesis. Together, hemophagocytosis is most likely associated with anemia in VL, and elucidation of the immunological mechanisms may lead to development of novel interventions to manage the symptom.
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Affiliation(s)
- Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.
| | - Jingjie Cheng
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.,Faculty of Medicine, Imperial College London, London, England
| | - Satoko Omachi
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Ayako Morimoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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7
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Morimoto A, Omachi S, Osada Y, Chambers JK, Uchida K, Sanjoba C, Matsumoto Y, Goto Y. Hemophagocytosis in Experimental Visceral Leishmaniasis by Leishmania donovani. PLoS Negl Trop Dis 2016; 10:e0004505. [PMID: 26942577 PMCID: PMC4778860 DOI: 10.1371/journal.pntd.0004505] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/10/2016] [Indexed: 11/17/2022] Open
Abstract
Hemophagocytosis is a phenomenon in which macrophages phagocytose blood cells. There are reports on up-regulated hemophagocytosis in patients with infectious diseases including typhoid fever, tuberculosis, influenza and visceral leishmaniasis (VL). However, mechanisms of infection-associated hemophagocytosis remained elusive due to a lack of appropriate animal models. Here, we have established a mouse model of VL with hemophagocytosis. At 24 weeks after infection with 1 x 107Leishmania donovani promastigotes, BALB/cA mice exhibited splenomegaly with an average tissue weight per body weight of 2.96%. In the tissues, 28.6% of macrophages contained phagocytosed erythrocytes. All of the hemophagocytosing macrophages were parasitized by L. donovani, and higher levels of hemophagocytosis was observed in heavily infected cells. Furthermore, more than half of these hemophagocytes had two or more macrophage-derived nuclei, whereas only 15.0% of splenic macrophages were bi- or multi-nuclear. These results suggest that direct infection by L. donovani causes hyper-activation of host macrophages to engulf blood cells. To our knowledge, this is the first report on hemophagocytosis in experimental Leishmania infections and may be useful for further understanding of the pathogenesis. Anemia is one of the major clinical manifestations during visceral leishmaniasis (VL), whereas mechanisms behind this symptom remain elusive. To get a better understanding of the responsible mechanism(s), we have developed for the first time a mouse model of VL exhibiting anemia. Mice chronically infected with L. donovani had low hematocrit, hemoglobin and erythrocyte counts while having up-regulated erythropoiesis, suggesting hemolytic events due to infection. We propose here that hemophagocytosis is one of the hemolytic events associated with anemia in the infected mice. The spleen is the major place for hemophagocytosis; there, multinucleated giant cells heavily infected with amastigotes are markedly observed and are the major cell type phagocytosing erythrocytes. These results suggest that heavy infection of macrophages with Leishmania parasites triggers phagocytosis of erythrocytes resulting in anemia during murine VL. Because hemophagocytosis has been reported in human VL cases, reproduction of the pathology in mice may facilitate an understanding of the mechanisms leading to anemia during VL.
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Affiliation(s)
- Ayako Morimoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Satoko Omachi
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasutaka Osada
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - James K Chambers
- Laboratory of Veterinary Pathology, Department of Veterinary Medical Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Department of Veterinary Medical Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Chizu Sanjoba
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yoshitsugu Matsumoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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8
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FATAL HAEMOPHAGOCYTIC SYNDROME AND HEPATITIS ASSOCIATED WITH VISCERAL LEISHMANIASIS. Indian J Med Microbiol 2007. [DOI: 10.1016/s0255-0857(21)02066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Agarwal S, Narayan S, Sharma S, Kahkashan E, Patwari AK. Hemophagocytic syndrome associated with visceral leishmaniasis. Indian J Pediatr 2006; 73:445-6. [PMID: 16741336 DOI: 10.1007/bf02758574] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present paper reports a case of 6-year-old male child, suffering from pallor, fever and hepatosplenomegaly. A clinical diagnosis of enteric fever with a second possibility of malaria was considered. Laboratory findings included bicytopenia, hyperbilirubinemia and raised liver enzymes. Bone marrow examination revealed active hemophagocytosis. On extensive search few amastigote forms of Leishmania donovani were seen. Patient was negative for other viral, bacterial and malaria infections. The final diagnosis of hemophagocytic syndrome associated with visceral leishmaniasis was made. There was response of anti-Leishmanial treatment with improvement in clinical condition.
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Affiliation(s)
- Shilpi Agarwal
- Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Connought Place, New Delhi, India
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10
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Green MRJ, Kennell ASM, Larche MJ, Seifert MH, Isenberg DA, Salaman MR. Natural killer cell activity in families of patients with systemic lupus erythematosus: demonstration of a killing defect in patients. Clin Exp Immunol 2005; 56:381-8. [PMID: 15958083 DOI: 10.1016/j.jinf.2008.02.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Revised: 12/07/2007] [Accepted: 02/26/2008] [Indexed: 12/27/2022] Open
Abstract
Natural killer (NK) cell cytotoxic activity and cell frequency, expressed as a percentage of total lymphocytes, have been determined in peripheral blood mononuclear cells from first-degree relatives of patients with systemic lupus erythematosus (SLE), the patients themselves, a group of rheumatoid arthritis (RA) patients and controls. Low levels of killing activity relative to controls were found in some members of all groups with the extent of depression falling into two ranges. Moderate reductions were seen in female (3/31, 10%) and male (4/14, 29%) relatives of SLE patients, female (12/60, 20%) and male (3/4, 75%) SLE patients and female RA patients (6/17, 35%). A more profound depression of killing activity was confined to other female SLE patients (15/60, 25%). There were strong correlations in all groups between killing activity and percentage of NK cells, but analysis of the ratio of these parameters and studies with purified preparations of NK cells suggest that the reduced activity in SLE frequently involves a defect in the killing capacity of the individual cells in addition to the reduced levels of NK cells. Azathioprine (AZA), which was used in treatment of 12 SLE patients, was invariably associated with low values of killing activity. It appears to substantially reduce the percentage of NK and B cells in an action unconnected with the NK cell abnormalities associated with SLE. The finding of low killing activity in relatives and a correlation between their activity and that of their patients support the view that NK cell deficiency is a genetic determinant of SLE. NK cells in SLE may produce insufficient levels of cytokines required for the regulation of IgG production.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antirheumatic Agents/therapeutic use
- Arthritis, Rheumatoid/immunology
- Azathioprine/therapeutic use
- Cells, Cultured
- Cytotoxicity, Immunologic/drug effects
- Cytotoxicity, Immunologic/immunology
- Female
- Humans
- Immune Tolerance
- Immunity, Cellular
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/genetics
- Lupus Erythematosus, Systemic/immunology
- Male
- Middle Aged
- Severity of Illness Index
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Affiliation(s)
- M R J Green
- Department of Immunology, Imperial College School of Medicine, London, UK
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11
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Reus M, García B, Vázquez V, Morales D, Fuster M, Sola J. Visceral leishmaniasis: diagnosis by ultrasound-guided fine needle aspiration of an axillary node. Br J Radiol 2005; 78:158-60. [PMID: 15681330 DOI: 10.1259/bjr/33263789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 77-year-old woman presented with fever up to 39 degrees C and acute pain in the left upper quadrant and renal fossa. Full blood count and biochemical screen revealed a haemoglobin (Hb) of 9.8 g dl(-1), an increased erythrocyte sedimentation rate and an elevated lactate dehydrogenase, all other parameters were normal. Thoracic and abdominal CT demonstrated two enlarged lymph nodes in the left axilla, and splenic infarcts. Ultrasound-guided fine needle aspiration of one of the axillary lymph nodes revealed macrophages filled with leishmanias.
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Affiliation(s)
- M Reus
- Department of Radiology, Hospital Universitario "Virgen de la Arrixaca", 30120 El Palmar (Murcia), Spain
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12
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Fiteni I, Perez-Lungmus G, Grasa J, Motis C. The hemophagocytic syndrome in an immunocompromised patient: A diagnostic challenge. Can J Infect Dis 2004; 15:101-3. [PMID: 18159484 PMCID: PMC2094959 DOI: 10.1155/2004/325836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- I Fiteni
- Department of Internal Medicine, Clínica Montpellier
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13
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Abstract
Pancytopenia in an acutely ill child is commonly a result of bone marrow suppression. Rarely pancytopenia is a manifestation of inappropriate macrophage activation associated with hemophagocytosis. Viral infections account for most cases of secondary hemophagocytosis. We report a case of malaria-associated hemophagocytosis in a child from an endemic area. Systemic parasitic infections should be included in the differential diagnosis of pancytopenia and infection-associated hemophagocytosis. In this rare subgroup of hemophagocytosis, malaria caused by Plasmodium falciparum is the most common parasitic infection
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Affiliation(s)
- Alex Zvulunov
- Department of Pediatrics, Joseftal Hospital, Eilat, Israel
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14
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Abstract
OBJECTIVE Visceral leishmaniasis (VL) in children is endemic in southern Europe but has not been previously reported from Albania. This prospective study reports the clinical and laboratory findings in 50 children with visceral leishmaniasis, the value of a direct agglutination test (DAT), and the result of treatment with meglumine antimonate. MATERIALS AND METHODS Sera obtained from 50 children with VL confirmed by bone marrow examination, 40 household contacts, and 30 hospitalized children with other infections were examined using DAT. RESULTS Clinical features included fever (100%), hepatosplenomegaly (100%), pallor (100%), weight loss (98%), vomiting (68%), diarrhea (32%), and bleeding disorders (8%). Laboratory findings were anemia (94%), neutropenia (85%), hypergammaglobulinemia (70%), and thrombocytopenia (22%). Thirty children who developed secondary bacterial infections had significantly lower hemoglobin and neutrophil counts (P<0.0001). Direct agglutination test had a sensitivity of 98%, a specificity of 100%, and a positive predictive value of 100%. One child with severe generalized bleeding died within 48 hours of admission before receiving treatment. CONCLUSION The direct agglutination test was highly valuable in diagnosis of VL in this series. Meglumine antimonate was an effective therapeutic agent. Post-treatment bone marrow examination confirmed recovery in all patients. There were no relapses of VL during one-year follow up.
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Affiliation(s)
- Gjeorgjina Lita
- Department of Pediatrics, University Hospital Center of Tirana, Tirana, Albania
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15
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Mégarbane B, Bruneel F, Cazals-Hatem D, Adle-Biassette H, Houze S, Wolff M, Régnier B. [A strange disease of the plateaux. Visceral leishmaniasis]. Rev Med Interne 2001; 22 Suppl 2:219s-222s. [PMID: 11433575 DOI: 10.1016/s0248-8663(01)83653-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- B Mégarbane
- Clinique de réanimation des maladies infectieuses, hôpital Bichat Claude-Bernard, 75018 Paris, France
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16
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Gagnaire MH, Galambrun C, Stéphan JL. Hemophagocytic syndrome: A misleading complication of visceral leishmaniasis in children--a series of 12 cases. Pediatrics 2000; 106:E58. [PMID: 11015553 DOI: 10.1542/peds.106.4.e58] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the difficulties in diagnosing visceral leishmaniasis (VL) when revealed by hemophagocytic syndrome (HS) in young children. DESIGN Retrospective study of patients identified over a 17-year period in French pediatric units. RESULTS This series comprises 12 cases of VL that were either revealed (n = 11) or complicated (on starting treatment with antimony salts [n = 1]) by HS. Clinical manifestations were those of severe VL with sustained high fever and hepatosplenomegaly in children in very poor condition. Biological manifestations always included pancytopenia, marked hypofibrinogenemia and hypertriglyceridemia, hepatic cytolysis, and prominent hemophagocytosis on the bone marrow smear. These features led to transfer to a hematology unit. Ten children were very young (<38 months) at onset (and consequently at infection). Signs of autoimmunity (Coombs' test-positive erythrocytes, antinuclear factors, and various autoantibodies) were found in 4 cases and were probably secondary to polyclonal B cell activation. Serologic tests for Leishmania were negative at onset in 6 children, and no amastigotes were found on the first marrow smear in 8 of 12 cases despite extensive search. Seven patients had not visited foreign countries. All these factors explain the initial diagnostic confusion. Three cases were initially misdiagnosed as familial erythrophagocytic lymphohistiocytosis or infection-associated HS, and these patients were treated with etoposide (once for 5 months) to control the HS after failure of steroids. The diagnostic delay in these cases was 50, 74, and 134 days. When VL was finally diagnosed, amphotericin B monotherapy was effective in 4 cases. Eight patients were treated with antimony salts; 4 were cured, 3 required adjunctive treatment, and 1 worsened (HS) and was cured with steroids and liposomal amphotericin. Regardless of the type of therapy, all 12 children are presumed cured with a mean follow-up of 7 years (range: 6 months-16 years). CONCLUSIONS A diagnosis of VL should, therefore, be seriously considered in all young patients with HS exposed to visceralizing Leishmania sp in Southern Europe. Clinicians and cytopathologists must be aware of the association. Early diagnosis of VL will minimize unnecessary hospitalization and potentially harmful investigations and treatments.
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Affiliation(s)
- M H Gagnaire
- Unité d'Hématologie Pédiatrique, Hôpital Nord, Saint-Etienne, France
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17
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Kraus MD, Bartlett NL, Fleming MD, Dorfman DM. Splenic pathology in myelodysplasia: a report of 13 cases with clinical correlation. Am J Surg Pathol 1998; 22:1255-66. [PMID: 9777988 DOI: 10.1097/00000478-199810000-00011] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Splenomegaly is uncommon in myelodysplasia (MDS) and, although cytopenias may be severe, therapeutic splenectomy is rarely performed. We report the histologic, histochemical, and immunophenotypic findings of nine cases of surgical splenectomy and four postmortem spleens from MDS patients. Four histologic patterns were identified: one dominated by erythrophagocytosis, one characterized by red pulp plasmacytosis, one with extramedullary hematopoiesis as the only salient finding, and one with marked red pulp expansion caused by a monocytic proliferation. Wright-Giemsa and histochemical stains were performed on touch preparations in three cases and played a critical role in the precise subclassification of one MDS patient's hematologic disorder, which ultimately proved to be chronic myelomonocytic leukemia. Splenectomy led to sustained improvement of cytopenias in three cases, but did not eliminate transfusion dependence for the remaining patients. Three splenectomy cases exhibited clustered Leder-negative mononuclear elements: two of these patients experienced disease progression to refractory anemia with excess blasts in transformation or acute myelogenous leukemia during post-splenectomy follow-up, whereas none of the three splenectomy patients without clustered mononuclear elements did. We conclude that splenomegaly in MDS usually reflects the sequelae of dyspoiesis rather than evidence of a proliferative phase, that clustering of Leder-negative large cells may correlate with either a substantial monocytic component or, possibly, increased risk of disease progression, and that the spleen can provide diagnostic as well as prognostic information in MDS patients with splenomegaly.
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Affiliation(s)
- M D Kraus
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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18
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Sailler L, Duchayne E, Marchou B, Brousset P, Pris J, Massip P, Corberand J, Arlet P. [Etiological aspects of reactive hemophagocytoses: retrospective study in 99 patients]. Rev Med Interne 1998; 18:855-64. [PMID: 9499986 DOI: 10.1016/s0248-8663(97)81959-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We describe the causes of reactive hemophagocytic process in a retrospective study including 99 patients. The main diagnosis were: lymphomas (18 cases), pyogenic bacteria infections (15 cases), herpes virus infections (12 cases), other infections (multiple, parasitic, fungal, mycobacterial, unidentified) (11 cases), acute hepatitis (five cases), systemic lupus erythematosus (three cases). We also found numerous other diseases involving the reticuloendothelial system. The cause remained undetermined in 16 cases. Lymphoma accounted for 64% of the cases in previously healthy patients who had been febrile for more than 10 days at the time of the diagnosis of reactive hemophagocytic process, and for 31% in HIV-positive patients. Lymphomas were rare (5%) in non HIV-positive, immunosuppressed patients. In this setting and in previously healthy patients who had been febrile for less than 10 days, infectious diseases were widely dominant (respectively 60% and 86% of the cases). Those were mainly due to pyogenic bacteria and to herpes virus. A rapidly fatal evolution occurred in some cases of lymphomas-related hemophagocytic process. These data support the choice of aggressive investigations in order to diagnose lymphoma in previously healthy patients presenting with reactive hemophagocytic process who have been febrile for more than 10 days, and in selected HIV-patients. Such a procedure is not recommended in the other cases.
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Affiliation(s)
- L Sailler
- Service de médecine interne B, CHU Rangueil, Toulouse, France
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19
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Schettert IT, Cardinalli IA, Ozello MC, Vassallo J, Lorand-Metze I, de Souza CA. Hemophagocytic syndrome: pitfalls in its diagnosis. SAO PAULO MED J 1997; 115:1548-52. [PMID: 9609074 DOI: 10.1590/s1516-31801997000500007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The hemophagocytic syndrome (HS) is characterized by a clinical picture of fever, hepatosplenomegaly, lymphadenopathy and peripheral pancytopenia. The morphologic hallmark of this syndrome is the phagocytosis of hematopoietic elements by morphologically normal macrophages. HS is considered rare and may be a primary disease or associated to viral, infection, neoplasias or autoimmune diseases. Treatment is controversial and its evolution is often fatal. Anatomo-pathological evaluation shows the phenomenon of hemophagocytosis in several organs, especially the hematopoietic tissues. We describe a case of HS, discuss its possible causes, its clinical and pathologic features, its pathophysiology and therapeutic possibilities.
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Affiliation(s)
- I T Schettert
- Department of Internal Medicine Faculty of Medicine, State University of Campinas, Brazil
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20
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Cortés P, Cardeñosa N, Muñoz C, Durán I, Leta R, Roca-Cusachs A, Gállego M. Hemophagocytic Syndrome Associated With Visceral Leishmaniasis in an Immunocompetent Patient. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0196-4399(97)84244-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Nadrid A, Pousse H, Laradi-Chebil S, Khelif A, Bejaoui M, Besbes A, Radhouane M, Guediche MN. [Infantile visceral leishmaniasis: difficult diagnosis in cases complicated by hemophagocytosis]. Arch Pediatr 1996; 3:881-3. [PMID: 8949350 DOI: 10.1016/0929-693x(96)87578-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hemophagocytosis has already been reported in cases of visceral leishmaniasis and thus may complicate search for diagnosis. CASE REPORT A previously healthy 2 year-old boy was referred for fever and splenomegaly with pancytopenia. An initial diagnosis of kala-azar was refuted because of absence of biological inflammatory syndrome, negativity of bone-marrow aspiration and splenic ponction and of specific serology. After three months of clinical deterioration and apparition of active hemophagocytosis, both bone marrow aspiration and specific serology for visceral leishmaniasis became positive. The boy was given sodium stibogluconate for 20 days; he improved gradually with complete and definitive remission. CONCLUSION Diagnosis of visceral leishmaniasis may be difficult, even in countries where this condition is relatively frequent; the association with hemophagocytosis is possible and does not constitute a poor factor of prognosis if specific therapy is proposed.
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Affiliation(s)
- A Nadrid
- Service de pédiatrie, hôpital F-Bourguiba, Monastir, Tunisie
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Abstract
Childhood histiocytoses are a rare and diverse group of histiocytic disorders. This review will focus on clinical, pathological and immunopathological features of these syndromes. The pathogenesis of Langerhans' cell histiocytosis or class I histiocytosis, a proliferative disorder of the Langerhans' cell, remains enigmatic. Approaches to treatment are as varied as the clinical presentations, ranging from a fatal leukaemia-like disorder to solitary lytic lesions of bone. Recent findings indicate that Langerhans' cell histiocytosis is a clonal histiocytic disease. The two major class II histiocytoses are familial erythrophagocytic lymphohistiocytosis and the reactive haemophagocytic syndromes. The clinicopathological similarities between these two entities suggest that they share a common immunological feature in which uncontrolled cytokine release from activated T-cells leads macrophages to a haemophagocytosing state.
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Affiliation(s)
- J L Stéphan
- Unité d'Hématologie et Oncologie Pédiatrique, Hôpital Nord, Centre Hospitalier Universitaire, Saint Etienne, France
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