Question

• Name and list the structure, reservoir, life cycle, hosts, diagnosis, transmission, prevention, treatment for each listed below
  • Lymphangitis
  • Lymphadenitis
  • Eosinphilia
  • Granulomatous
  • Periodicity
  • Calabar swelling
  • Hermaphroditic

Answer 1

°What is lymphangitis?

Lymphangitis is an inflammation of the lymphatic system, which is a major component of your immune system.

Your lymphatic system is a network of organs, cells, ducts, and glands. The glands are also called nodes and can be found throughout your body. They are most apparent under your jaw, in your armpits, and in your groin.

Organs that make up the lymphatic system include your:

• tonsils, which are located in your throat
• spleen, an organ in your abdomen that purifies your blood, among other functions
• thymus, an organ in your upper chest that helps white blood cells develop

Immune cells called lymphocytes mature within your bone marrow and then travel to your lymph nodes and other organs within the lymphatic system to help protect your body against viruses and bacteria. The lymphatic system also filters a whitish-clear fluid called lymph, which contains bacteria-killing white blood cells.

Lymph travels through your body along lymphatic vessels and collects fats, bacteria, and other waste products from cells and tissues. Your lymph nodes then filter these harmful materials out of the fluid and produce more white blood cells to fight off the infection.

Infectious lymphangitis occurs when viruses and bacteria invade the vessels of your lymphatic system, typically through an infected cut or wound. Tender red streaks often radiate from the wound toward the nearest lymph glands. Other symptoms include fever, chills, and a general sense of illness.

If it’s treated quickly, lymphangitis often goes away with no ill effects. If left untreated, complications can occur, and the condition can become very serious.

Lymphangitis is sometimes incorrectly called blood poisoning. It’s also sometimes mistaken for thrombophlebitis, which is a clot in a vein.

What causes lymphangitis?

Infectious lymphangitis occurs when bacteria or viruses enter the lymphatic channels. They may enter through a cut or wound, or they may grow from an existing infection.

The most common infectious cause of lymphangitis is acute streptococcal infection. It may also be the result of a staphylococcal (staph) infection. Both of these are bacterial infections.

Lymphangitis may occur if you already have a skin infection and it’s getting worse. This might mean that bacteria will soon enter your bloodstream. Complications such as sepsis, a life-threatening condition of body-wide inflammation, can occur as a result.

Conditions that increase your risk of lymphangitis include:

• diabetes
• immunodeficiency, or loss of immune function
• chronic steroid use
• chickenpox

A cat or dog bite or a wound made in fresh water can also become infected and lead to lymphangitis. Gardeners and farmers may develop the condition if they get sporotrichosis, a soil-borne fungal infection.

There are also noninfectious causes of lymphangitis. Inflammation of lymph vessels can occur due to malignancy: Breast, lung, stomach, pancreas, rectal, and prostate cancers are common types of tumors that can lead to lymphangitis. Lymphangitis has also been seen in those with Crohn’s disease.

How is lymphangitis diagnosed?

To diagnose lymphangitis, your doctor will perform a physical exam. They’ll feel your lymph nodes to check for swelling.

Your doctor may also order tests such as a biopsy to reveal the cause of the swelling or a blood culture to see if the infection is present in your blood.

How is the condition treated?

Treatment should begin immediately to keep the condition from spreading. Your doctor may recommend the following:

• antibiotics, if the cause is bacterial — in the form of oral medication or intravenous antimicrobial therapy, which involves antibiotics given directly into your veins
• pain medication
• anti-inflammatory medication
• surgery to drain any abscesses that may have formed
• surgical debridement, or removal, of a node if it’s causing obstruction

You can aid healing and ease the pain by using a hot compress at home. Run hot water over a washcloth or towel and apply it to the tender area. Do this three times a day. The warmth will promote blood flow and encourage healing. For the same reason, you might also want to take warm showers, positioning the showerhead over the infected area.

If possible, keep the infected area elevated. This helps reduce swelling and slows the spread of infection.

For mild pain relief, you can take over-the-counter medicines such as acetaminophen (Tylenol) or ibuprofen (Advil). Ask your doctor about using these drugs if you have liver or kidney disease or if you’ve ever had a stomach ulcer or gastrointestinal bleeding, such as bleeding in your intestines.

°

What is lymph node inflammation?

Lymph nodes are small, oval-shaped organs that contain immune cells to attack and kill foreign invaders, such as viruses. They’re an important part of the body’s immune system. Lymph nodes are also known as lymph glands.

Lymph nodes are found in various parts of the body, including the neck, armpits, and groin. They’re linked by lymphatic vessels, which carry lymph throughout the body. Lymph is a clear fluid containing white blood cells (WBCs) and dead and diseased tissue for disposal. The primary function of lymph nodes is to harbor the body’s disease-fighting cells and to filter lymph before it reenters circulation.

When you’re sick and your lymph nodes send out disease-fighting cells and compounds, they may become inflamed or painful. The condition of having inflamed lymph nodes is referred to as lymphadenitis.

What causes lymph node inflammation?

Lymph node inflammation can occur for a variety of reasons. Any infection or virus, including the common cold, can cause your lymph nodes to swell. Cancer can also cause lymph node inflammation. This includes blood cancer, such as leukemiaand lymphoma.

How is lymph node inflammation diagnosed?

A doctor typically diagnoses lymph node inflammation through a physical examination. The doctor will feel around the location of various lymph nodes to check for swelling or sensitivity. They may also ask you about any associated symptoms, such as those listed above.

Your doctor may order blood tests to check for infections. They may order imaging tests as well, such as X-rays or CT scans. These can look for tumors or sources of infection.

Because a wide range of conditions can cause lymph node inflammation, your doctor may request a biopsy. A lymph node biopsy is a short procedure in which the doctor removes a sample of lymph tissue. A pathologist will test this sample. This type of doctor examines tissue samples and interprets lab results. A biopsy is often the most reliable way to determine why lymph node inflammation has occurred.

How is lymph node inflammation treated?

Treatment for lymph node inflammation depends on its cause. In some cases, treatment may not be necessary. For example, treatment is unlikely to be recommended for:

• healthy adults whose bodies are already conquering the infection
• children, whose active immune systems can result in frequent swelling

If treatment is required, it can vary from self-treatment to surgery and other therapies.

Self-treatment

Your doctor is likely to advise using a fever-reducing painkiller, such as ibuprofen (Advil, Motrin), along with a warm compress. Elevating the swollen area can also help relieve inflammation.

Medication

In other cases, a course of antibiotics may be used to help the body fight the infection that’s causing lymph node swelling.

°

Eosinophilia

An eosinophil is a type of white blood cell. The term eosinophilia refers to conditions in which abnormally high amounts of eosinophils are found in either the blood or in body tissues.

When does eosinophilia occur?

Eosinophilia occurs in a wide range of conditions. Its commonest causes in the UK are allergic diseases such as asthmaand hay fever, whereas worldwide the main cause is parasitic infection. It can also occur in relation to common skin diseases, medicine reactions, and parasitic infections. Other rarer causes include:

• lung diseases, eg Loeffler's syndrome
• vasculitis (inflammation of blood vessels), eg Churg-Strauss syndrome
• some tumours, eg lymphoma
• liver cirrhosis
• some antibody deficiencies; not typically AIDS
• other rarer skin diseases, eg dermatitis herpetiformis
• uknown causes, labelled hypereosinophilic syndrome.

How does eosinophilia occur?

Increased numbers of eosinophils are produced to fight off allergic disease or parasitic infections. This is helpful in combating parasitic infections but not in cases of allergic diseases as they accumulate in tissues and cause damage. For example, in asthma, eosinophilia causes damage to the airways of the lung.

eosinophilia?

The symptoms of eosinophilia are those of the underlying condition. For example, eosinophilia due to asthma is marked by symptoms such as wheezing and breathlessness, whereas parasitic infections may lead to abdominal pain, diarrhoea, fever, or cough and rashes.

Medicine reactions often give rise to skin rashes, and they often occur after taking a new drug.

Rarer symptoms of eosinophilia can include weight loss, night sweats, lymph node enlargement, other skin rashes, and numbness and tingling due to nerve damage.

How is eosinophilia diagnosed?

Eosinophilia in the bloodstream is diagnosed from a simple blood test. Tissue eosinophilia is diagnosed by the examination of the relevant tissue. For example, a piece of skin tissue can be removed (a skin biopsy) and examined under a microscope.

What can your doctor do?

Once a diagnosis has been made your family doctor can help to establish the cause of the condition. Simple skin or blood tests may be performed to confirm specific allergies, such as pollen or dust mite allergy. Parasitic infection can be determined by analysing blood and stool samples.

You may also be asked whether you are taking any new medicines in case it is the result of a side effect, and about foreign travel for possible parasitic infection.

A pet dog can occasionally be a source of a parasitic infection called Toxocara canis.

Treatment

Treatment tackles the underlying cause of the condition, whether it is an allergy, a medicine reaction, or a parasitic infection. These treatments are usually effective, and fairly non-toxic.

Treatment for hypereosinophilic syndrome is oral corticosteroid therapy, usually starting with prednisolone (eg Deltacortril) at single daily doses of 30-60mg. If this is not effective, a chemotherapeutic agent is administ

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Chronic granulomatous disease (CGD) is a rare inherited primary immune deficiency disorder that affects certain white blood cells (neutrophils, monocytes, macrophages, eosinophils). The disorder is characterized by an inability to resist infections caused by certain types of bacteria and fungal species and a tendency to develop chronic inflammation. Life-threatening recurrent fungal and bacterial infections affecting the skin, lungs, and bones may occur along with swollen areas of inflamed tissues known as granulomas that can be widely distributed. Symptoms usually begin in infancy or childhood. Individuals with mild forms of the disorder may not develop symptoms until the teens or adulthood. Chronic granulomatous disease is a genetic disorder and is caused by inherited defects in an important enzyme in white blood cells that manufactures oxidants for microbial killing.

Signs & Symptoms

Chronic granulomatous disease is characterized by a susceptibility to repeated bacterial and fungal infections. CGD can also be associated with the development of granulomatous lesions of the skin, lungs, bones, and lymph nodes formed by collections of inflammatory white blood cells. Excess gamma globulin in the blood (hypergammaglobulinemia), low levels of circulating red blood cells (anemia), an increase in white blood cells (leukocytosis) can occur as a result of repeated infections or chronic inflammation. Evidence of chronic infections may be seen in the liver, gastrointestinal tract, brain and eyes.

There is usually a history of repeated infections, including inflammation of the lymph glands (suppurative lymphadenitis), skin infections, and pneumonia. Blood studies can show evidence of chronic infection. There may also be a persistent runny nose (rhinitis), inflammation of the skin (dermatitis), and an inflammation of the mucous membranes of the mouth (stomatitis). Gastrointestinal problems can also occur, including diarrhea, abdominal pain, and perianal abscesses.

Infection of the bones (osteomyelitis), brain abscesses, obstruction of the genitourinary tract and/or gastrointestinal tract due to the formation of granulomatous tissue, and delayed growth are also symptomatic of chronic granulomatous disease. Abnormal enlargement of the liver and spleen (hepatosplenomegaly) may also occur.

Causes

Chronic granulomatous disease is a genetic disease. In CGD, mutations in any one of five different genes can cause a defect in an enzyme called phagocyte NADPH oxidase. Certain white blood cells use this enzyme to produce hydrogen peroxide, which these cells need in order to kill certain bacteria and fungi.

Genetic diseases are determined by two genes, one received from the father and one from the mother. There is a genetic form (X-linked recessive) of CGD that primarily affects males. The remaining cases of CGD are inherited as autosomal recessive traits, which can affect both males and females.

X-linked genetic disorders are conditions caused by an abnormal gene on the X chromosome and manifest mostly in males. Females that have a defective gene present on one of their X chromosomes are “carriers” for that disorder. Males have one X chromosome that is inherited from their mother and if a male inherits an X chromosome that contains a defective gene he will develop the disease.

Women who are carriers of the X-linked form of CGD usually do not display symptoms of infections because females have two X chromosomes and only one carries the defective gene. However, some X-linked CGD carriers have inflammatory conditions involving the skin, gastrointestinal tract, or less commonly, lupus or other autoimmune disorders.

Female carriers of an X-linked disorder have a 25% chance with each pregnancy to have a carrier daughter like themselves, a 25% chance to have a non-carrier daughter, a 25% chance to have a son affected with the disease and a 25% chance to have an unaffected son.

If a male with an X-linked disorder is able to reproduce, he will pass the defective gene to all of his daughters who will be carriers. A male cannot pass an X-linked gene to his sons because males always pass their Y chromosome instead of their X chromosome to male offspring.

Recessive genetic disorders occur when an individual inherits two copies of an abnormal gene for the same trait, one from each parent. If an individual receives one normal gene and one gene for the disease, the person will be a carrier for the disease but usually will not show symptoms. The risk for two carrier parents to both pass the defective gene and have an affected child is 25% with each pregnancy. The risk to have a child who is a carrier like the parents is 50% with each pregnancy. The chance for a child to receive normal genes from both parents and be genetically normal for that particular trait is 25%. The risk is the same for males and females.

All individuals carry at least 4-5 abnormal genes that are present in one copy. Parents who are close relatives (consanguineous) have a higher chance than unrelated parents to both carry the same abnormal gene, which increases the risk to have children with a recessive genetic disorder due to two copies of the same abnormal gene.

Diagnosis

A diagnosis of chronic granulomatous disease is made based upon a thorough clinical evaluation, a detailed patient history, and specialized procedures to measure oxidant production by white blood cells. In healthy individuals, the white blood cells produce a chemical oxidant that destroys bacteria. One blood test for diagnosis of CGD uses a molecule called dihydrorhodamine 123 (DHR) to determine whether or not white blood cells are making these oxidants normally. Oxidants cause the DHR to fluoresce, which is markedly reduced or absent in CGD white blood cells. This test can be performed on blood samples shipped to clinical laboratories certified to perform this test. Another blood test for CGD is called the nitroblue tetrazolium (NBT) slide test. In this test, NBT is mixed with the white blood cells, which are then activated to produce oxidants that react with NBT, turning it a deep blue color. If this reaction does not occur, then these important oxidants are not being produced by an individual’s white blood cells. If CGD is diagnosed based on defects in blood cell oxidant production, genetic testing is typically recommended to determine the specific type of CGD.

Standard Therapies

Treatment
Treatment of chronic granulomatous disease consists of continuous antibiotic therapy to help prevent infections, such as trimethoprim and sulfamethoxazole to protect against bacterial infections, and itraconazole for anti-fungal protection. Infections usually require additional antibiotics. Corticosteroid drugs are also of benefit for treating granulomatous complications. Bone marrow transplants have proven to be successful in some affected individuals with CGD.

The orphan drug, Actimmune (interferon gamma-1b), has been approved by the Food and Drug Administration (FDA) for the treatment of chronic granulomatous disease. Actimmune is distributed by Horizon Pharma.

Genetic counseling is recommended for affected individuals and their families. Other treatment is symptomatic and supportive.