The immunity features and defects against primary cytomegalovirus infection post-splenectomy indicate an immunocompromised status: A PRISMA-compliant meta-analysis

Challenges in Diagnosing Post-Splenectomy Cytomegalovirus Mononucleosis

Cytomegalovirus (CMV) infection is often asymptomatic. However, in certain individuals, it can cause non-specific signs and symptoms that maybe hard to recognise. The condition may therefore be overlooked or misdiagnosed, leading to prolonged illness and serious sequelae. In this case report, we present a rare instance of CMV infection in an HIV-negative patient who had a remote history of splenectomy and was experiencing prolonged fever and markedly elevated white blood cell (WBC) count.

LEARNING POINTS

The clinical presentation of CMV infection in a post-splenectomy patient can be intricate and deceptive, involving non-specific symptoms such as prolonged fever and a markedly elevated WBC count.The decision on treatment among individuals without apparent risk factors (such as AIDS, transplant, or cancers) led to in-depth deliberations and discussion.Post-splenectomy patients with CMV infection may exhibit prolonged illness, potentially leading to severe consequences if left untreated.

Pathological changes of the spleen in mice infected with influenza against the background of the use of saponin tauroside Sx1

Background. It is well known that viral infections are able to cause an imbalance of the interferon system and inhibition of cellular and phagocytic reactions of the body. One of the possible solutions of the flu treatment problem may be the application of immunomodulators of native plant origin since the influenza virus possesses a suppressive effect on cellular immunity and the interferon system.

The aim. To evaluate the effect of saponin tauroside Sx1 obtained from Crimean ivy leaves on histological changes in the spleen of mice infected with influenza A/WSN/1/33(H1N1) virus.

Material and methods. We used 78 male BALB/c mice weighing 16–18 g which were divided into the groups: control (K; n = 12); healthy animals treated with saponin (KS; n = 22); animals infected with influenza virus A/WSN/1/33(H1N1) (V; n = 22); infected animals treated with saponin tauroside Sx1 twice a day for 3 days (SV; n = 22). Histological studies of the spleen were performed on the 4th (subgroups V, SV, KS) and 14th day (2V, 2SV, 2KS).

Results. The spleen tissue of the KS subgroup demonstrated hyperplasia of the white pulp in the form of lymphoid nodules expansion. On the 4th day in the KS subgroup a statistically significant increase in the total area of the lymphoid nodules by 3.9 times compared to the K subgroup was observed. In subgroup V, there was a sharp decrease in the area of white pulp and in 2V the lymphoid nodules zones were practically indistinguishable. Applied correction in the SV and 2SV subgroups significantly ceased the damaging effect of the virus: the lymphoid nodules area increased by 2.7 times in the 2SV subgroup compared to 2V.

Conclusion. Infection with the H1N1 influenza virus leads to compensatory activation of the immune response, however, on the 14th day, a pronounced depletion of the splenic white pulp occurred. The introduction of saponin tauroside Sx1 enhanced the functional activity of the spleen due to an increase of the white pulp area. 

Al-hijamah (the triple S treatment of prophetic medicine) significantly increases CD4/CD8 ratio in thalassemic patients via increasing TAC/MDA ratio: a clinical trial

Beta thalassemia is associated with decreased immunity possibly due to iron overload. Al-hijamah (Hijamah) is wet cupping therapy (WCT) of prophetic medicine. Prophet Muhammad Peace be upon him said: "The best among your treatments is Al-hijamah". Al-hijamah is a promising excretory treatment to clear blood of causative pathological substances. Al-hijamah is a three-step technique (skin suction, scarification and suction) i.e. triple S technique). Recently, we introduced Al-hijamah as a novel iron excretion therapy (through pressure-dependent filtration then excretion via the skin dermal capillaries) that significantly decreased serum iron overload and related oxidative stress using a physiological excretory mechanism (Taibah mechanism). Iron overload was reported to impair both humoral immunity and cell mediated immunity in patients with beta thalassemia. In this study, twenty patients having β-thalassemia major (maintained on iron chelation therapy) underwent a single session of Al-hijamah (30-60 minutes) using 4-5 sucking cups only. Another age and sex-matched control group of thalassemic patients received iron chelation therapy only. Al-hijamah enhanced the immunity of thalassemic patients in the form of increased CD4⁺ T cell count, from 124.10±36.98 to 326.20±57.94 cells/mm³, and an increased CD8⁺ T cell count from 100.30±36.98 to 272.40±46.37 cells/mm³. CD4/CD8 ratio significantly increased from 1.29 to 1.7 (P<0.001). There was a significant increase of ten times (P<0.001) in serum TAC/MDA ratio (reflects increased antioxidant capacity vs decreased oxidative load and stress) induced by Al-hijamah. After Al-hijamah, both CD4⁺ and CD8⁺ T cell counts significantly increased and positively correlated with TAC/MDA ratio (r = 0.246) and (r = 0.190), respectively. Moreover, CD4/CD8 ratio positively correlated with TAC/MDA after Al-hijamah (r = 0.285). In conclusion, Al-hijamah significantly increased CD4/CD8 ratio in thalassemic patients via increasing TAC/MDA ratio. Our study strongly recommends medical practice of Al-hijamah in hospitals for its immune potentiating effects in agreement with the evidence-based Taibah mechanism. Al-hijamah should be generalized for treating other immune-deficiency conditions. Al-hijamah-induced bloody excretion is so minimal and never aggravates the anaemic status.

Splenic pregnancy treated with transcatheter embolization and methotrexate

BACKGROUND

Primary splenic pregnancy is a rare entity, usually treated with splenectomy.

CASE PRESENTATION AND REVIEW OF THE LITERATURE

We report the first case of conservative management of splenic pregnancy with selective embolization and intramuscular methotrexate administration. Postoperative treatment was uneventful. We have further systematically reviewed the literature upon the treatment options in case of splenic pregnancy. It has been evident that most cases were treated with spleenectomy, especially in case of active hemorrhage. Spleen preservation is rarely achieved, only in cases of hemodynamically stable, uncomplicated patients.

CONCLUSION

Splenic selective embolization could be a treatment option in case of uncomplicated splenic pregnancy with the benefit of splenic preservation.