title: An outbreak of an infection associated with circulating activated monocytes and hemophagocytes in children in Bombay, India.
abstract: From May 1985 to December 1989, while doing blood counts on hospitalized children in Bombay, over 300 blood smears showed an impressive number of activated monocytes (AMs) and hemophagocytes (HPs). Many AMs resembled macrophages. The AM-HPs were visible in blood for 1-10 days, accompanied by a neutrophilia and a marked thrombocytopenia. Clinical features associated with these smears were fever, unresponsiveness to antibiotics, symptoms referable to the CNS and respiratory and/or gastrointestinal tracts, and bleeding. Ninety percent of affected children were under 2 years of age. The illness resolved completely or was fatal in 30%, with bleeding or respiratory failure, within 2 weeks. Children older than 2 years had underlying illness and high fever, and 40% died. Surgical candidates had obstructive gastrointestinal pathologic findings, from the stomach to the ileum. Babies under 1 month of age died, with clinical signs of deterioration and bleeding. Bone marrows were unremarkable. Few or no AM-HPs were seen. The fibrin split product tests were positive. Liver function test results were normal. Autopsies on six cases revealed edema and bleeding or thrombosis in the lungs, brain, and gastrointestinal tract. Only one neonate had a mild histiocytic infiltration in the lungs and liver. Features in common with and differences from virus-associated hemophagocytic syndromes are discussed.
authors.affiliation: B.J. Wadia Hospital for Children, Parel, Bombay, India.
authors.forename: Z
authors.initials: Z
authors.lastname: Currimbhoy
mesh_terms: D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000378:metabolism; D004196:Disease Outbreaks; D004660:Encephalitis / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005334:Fever / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D005767:Gastrointestinal Diseases / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D006470:Hemorrhage / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D009000:Monocytes / Q000378:metabolism; D010586:Phagocytes; D013921:Thrombocytopenia / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D014777:Virus Diseases / Q000097:blood / Q000453:epidemiology* / Q000401:mortality
chemical_list: D016207:Cytokines