[Leish-l] spleen

[Anthony Bryceson]

Who says that splenectomy cures VL?
I last reviewed the literature in 1984 ("Therapy in Man" in Leishmaniasis in Biology and Medicine. Eds W Peters, R Killick-Kendrick, Academic Press, London, 1987, p 893), and there was not much to review (Napier 1949, Wang and Wu 1959, Das and Sen Gupta 1950,  Sen Gupta and Chatterji 1961). I concluded that "splenectomy may cure VL without further chemotherapy in about 1 in 5 cases, and in a greater proportion with the aid of further chemotherapy, despite apparent unresponsiveness previously. The operation carries a mortality and may be followed by fatal septicaemia or further relapse". In 1984. Rees et al reported 5 cases in children in Nairobi, 3 improved and 2 died.

Is there a more recent review or collection of published cases?

There is still something of a mystery about the spleen in VL. The concentration of parasites is greatest there and parasites seem to remain longer in the spleen than in other organs following chemotherapy. What is the nature of the attraction? Is it immunological as "David et al" suggest, or due to cells that cannot respond as Farrokh suggests? Splenectomy might be of benefit in either instance, and it removes an  immunosuppressive antigenic load.  Suppression of antigenic load permitting the emergence of an immune response is the rationale for prolonged treatment of DCL.  

I have two suggestions:
1. Someone collects all published and unpublished case reports  and writes a review that includes indications, risks and precautions, bearing in mind that failed cases may not be reported, 
2. An immunologist and a parasitologist be invited to join the physician and surgeon, whenever splenectomy is being considered for a patient with unresponsive VL.

Best wishes
Anthony



On 21 Aug 2013, at 13:52, Carlos Costa wrote:

> Dear leishimmunologists,
> 
> Do you have any guess on why splenectomy cures kala-azar? Would it be the absence of spleen-derived IL-10?
> 
> All my best,
> 
> Carlos.
> 
> -- 
> Carlos H. N. Costa, MD, DSc.
> Coordenador
> Laboratório de Leishmanioses - LabLeish
> Universidade Federal do Piauí
> Instituto de Doenças Tropicais Natan Portella
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> Telephones: +55 86 3222-4377 (W),  +55 86 3221-3062 (W), +55 86 3237-1075 (R). 
> 
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