In February 1977, 306 out of 409 six- to 16-year-old Kenyan schoolchildren were found to be infected with Schistosoma mansoni. Prevalence and intensity were directly related to age and indirectly to the distance between the child's home and the transmission site, but were not related to the child's sex. Most children were treated with hycanthone in July 1977. Pretreatment blood samples were taken from 100 study children for eosinophil counts and measurements of cytotoxic anti-schistosomular antibody levels. Blood and faecal samples were re-examined five times between November 1977 and July 1979. Whole school resurveys in July 1978 and 1979 confirmed the continuation of transmission after chemotherapy. 'Reinfection' rates in the study children, incorporating both failed treatment and true reinfections, were significantly reduced in children, with both detectable antibody and eosinophil counts above 400/mm3, compared with children with neither. Children with either detectable antibodies or high eosinophil counts (mainly the latter) had intermediate reinfection rates. Neither sex, age nor pretreatment intensities influenced reinfection rates, but location of dwelling did: children from distant homes had lower rates. However, the effects of residence and 'protection' were not directly linked. The implication of these results, namely that infection can confer immune protection to reinfection after treatment, is being explored in further studies.
We describe a series of eight cases of T-cell-rich B-cell lymphoma diagnosed on liver biopsy and collected over a period of 15 years. Of seven cases that were referred from elsewhere, in only one was the correct diagnosis of B-cell lymphoma suggested. Common errors included misdiagnosis as inflammatory disease on histology, and misinterpretation as T-cell lymphoma on immunohistochemistry. However, the cases had a distinct morphological appearance and immunohistochemical profile. They showed a lymphohistiocytic or granulomatous infiltrate, usually centred on portal tracts and containing abundant small T-cells and scanty B-cell blasts. All patients had an atypical clinical presentation which favoured non-neoplastic liver disease. In seven cases liver involvement represented Stage IV disease and in one case disease was confined to the liver consistent with a primary hepatic lymphoma. Despite combination chemotherapy, the prognosis was poor with no patients surviving beyond 15 months from diagnosis. We believe T-cell-rich B-cell lymphoma to be an under-recognized subset of non-Hodgkin's lymphoma that may mimic primary liver disease.
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