<html><head></head><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space; ">Who says that splenectomy cures VL?<div>I last reviewed the literature in 1984 (<span class="Apple-style-span" style="font-size: 14px; ">"</span><span class="Apple-style-span" style="font-size: 14px; "><i>Therapy in Man" i<u>n</u> Leishmaniasis in Biology and Medicine. Eds W Peters, R Killick-Kendrick, Academic Press, London, 1987, p 893)</i></span>, 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.</div><div><br></div><div>Is there a more recent review or collection of published cases?</div><div><br></div><div>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. </div><div><br></div><div>I have two suggestions:</div><div>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 Someone collects all published and unpublished case reports and writes a review that includes indications, risks and precautions, bearing in mind that failed cases may not be reported, </div><div>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.</div><div><br></div><div>Best wishes</div><div>Anthony</div><div><br></div><div><span class="Apple-style-span" style="font-size: 14px;"><br></span></div><div><br></div><div>On 21 Aug 2013, at 13:52, Carlos Costa wrote:</div><div><div><br class="Apple-interchange-newline"><blockquote type="cite"><div dir="ltr"><div class="gmail_default" style="font-family:verdana,sans-serif;font-size:small;color:rgb(0,0,0)">Dear leishimmunologists,</div><div class="gmail_default" style="font-family:verdana,sans-serif;font-size:small;color:rgb(0,0,0)">
<br></div><div class="gmail_default" style="font-family:verdana,sans-serif;font-size:small;color:rgb(0,0,0)">Do you have any guess on why splenectomy cures kala-azar? Would it be the absence of spleen-derived IL-10?</div>
<div class="gmail_default" style="font-family:verdana,sans-serif;font-size:small;color:rgb(0,0,0)"><br></div><div class="gmail_default" style="font-family:verdana,sans-serif;font-size:small;color:rgb(0,0,0)">All my best,</div>
<div class="gmail_default" style="font-family:verdana,sans-serif;font-size:small;color:rgb(0,0,0)"><br></div><div class="gmail_default" style="font-family:verdana,sans-serif;font-size:small;color:rgb(0,0,0)">Carlos.</div>
<div><br></div>-- <br><div dir="ltr"><div style="text-align:left"><span style="font-family:verdana,sans-serif">Carlos H. N. Costa, MD, DSc.</span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">Coordenador</span></div>
<div style="text-align:left"><span style="font-family:verdana,sans-serif">Laboratório de Leishmanioses - LabLeish</span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">Universidade Federal do Piauí</span><br>
</div><div><div style="text-align:left"><span style="font-family:verdana,sans-serif">Instituto de Doenças Tropicais Natan Portella</span></div><div style="text-align:left"><font face="verdana, sans-serif">Rua Artur de Vasconcelos 151-Sul</font></div>
<div><div style="text-align:left"><span style="font-family:verdana,sans-serif">64001-450 Teresina-PI</span></div><font face="verdana, sans-serif"><div style="text-align:left">Brazil</div><div style="text-align:left">Telephones: +55 86 3222-4377 (W), <div style="text-align:center;display:inline!important">
<div style="text-align:center;display:inline!important">+55 86 3221-3062 (W), </div></div><div style="text-align:center;display:inline!important">+55 86 3237-1075 (R). </div></div><div style="text-align:left"><br></div><div style="text-align:left">
<br></div><span style="font-size:x-small"><div style="text-align:left">Aviso: As informações contidas nesta mensagem são CONFIDENCIAIS, protegidas pelo sigilo legal, por direitos autorais e destinadas exclusivamente à pessoa ou organização para a qual a mensagem foi destinada.</div>
<div style="text-align:left">Warning: This message is meant only for the intended recipient of the transmission. It is forbidden any unauthorized use, alteration, reproduction and distribution. If you are not the correct recipient, please notify us immediately by return e-mail and delete this message from your system.</div>
</span></font></div></div></div>
</div>
<br><br>--<br>
<i> This email was sent by <a href="http://icb.usp.br">icb.usp.br</a> </i>
_______________________________________________<br>Leish-l mailing list<br><a href="mailto:Leish-l@lineu.icb.usp.br">Leish-l@lineu.icb.usp.br</a><br>http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l<br><br>--<br>This email was sent by icb.usp.br<br></blockquote></div><br></div></body></html>