Diagnosing and treating hemophagocytic lymphohistiocytosis in the tropics: Systematic review from the indian subcontinent

Abstract

Objective. Suicide is one of the causes of late mortality among childhood cancer survivors. The aim of our study was to analyse the risk of suicide among childhood cancer survivors compared with that of the general population of Slovenia. Patients and methods. This retrospective study included patients with childhood cancer registered at the Cancer Registry of Slovenia between 1978-2008, with an observation period of 1978-2010. Childhood cancer patients and control subjects from the general population of Slovenia were matched by sex, year and age at the beginning of follow-up and time of follow-up in years. Data on the general population of Slovenia were obtained from the Statistical Office of the Republic of Slovenia. Results. A total of 1647 patients were recorded in the Cancer Registry as having cancer during childhood, with 3 patients committing suicide. All three were male. Their age at diagnosis of cancer was 12, 13 and 2 years old; their age at suicide was 19, 32 and 28 years old. The mechanism of death was asphyxiation in all three deaths. The calculation of the expected number of suicides in the group of individuals with childhood cancer from the general Slovene population revealed the number of 3.16 persons. Conclusion. The comparison of the observed and expected probability showed that there was no statistically significant difference in the suicide rate between childhood cancer survivors and the general population of Slovenia.

Haemophagocytic lymphohistiocytosis

“…Patients with refractory disease are treated with antithymocyte globulin, rituximab or alemtuzumab for remission induction. 2 In India HLH is under-reported and associated with a high mortality. 2,5,6,8,12 In a large series of HLH patients from south India, 8 the authors have noted less mortality and have attributed this to a high incidence of secondary HLH, early diagnosis and early institution of immunomodulatory treatment.…”

“…3 While primary HLH is familial or hereditary, secondary HLH can be caused by causes like infections, malignancy and collagen vascular disease. 2 EBV is an important cause of HLH. Salmonella, tuberculosis, malaria and leishmaniasis are other tropical infections which can trigger infection-associated haemophagocytosis.…”

“…In the tropics, infections remain the most common triggers of HLH. 2 Familial HLH is usually associated with mutations in the perforin gene. 1,8 Perforin staining in cytotoxic cells by flow cytometry has been used as a screening test to identify children with familial HLH, who can then be subjected to genetic analysis.…”

“…1 HLH can develop due to various aetiologies like genetic causes, infect ions, co llagen vascular diseases, malignancy and or metabolic disorders. 2,3 This entity is diagnosed as per criteria listed in Table 1.…”

Hemophagocytic lymphohistiocytosis secondary to infections: a tertiary care experience

“…and this trend is reflected in HLH prevalence also. 1 Very small information is available regarding HLH from our country. High index of suspicion is required for early diagnosis.…”