Barbara Zdziarska

Demodex folliculorum and Demodex brevis in healthy and immunocompromised patients

Abstract Purpose: To examine the proportion of Demodex folliculorum and D. brevis in the eyelashes of healthy and immunocompromised patients. Methods: Eyelashes were taken from 95 patients at the Pomeranian Medical University, Clinic of Haematology, and from 1091 healthy controls. Results: Demodex folliculorum and D. brevis were found in 22.9% of controls and in 20% of immunocompromised patients. In neither the control group nor the immunocompromised patients did we observe a correlation between the proportion of symptoms of blepharitis and the presence of Demodex spp. – symptoms including burning sensations, loss of eyelashes, sensitivity to light, smoke and dust, dacryorrhea (excessive flow of tears), and foreign body eye sensation. A correlation between itching eyes and Demodex spp. infection was found only in the control group. A correlation between the proportion of cylindrical dandruff in eyelashes and the occurrence of Demodex spp was found in both the control group and immunocompromised patients. Conclusion: Proportions of D. folliculorum and D. brevis, and also symptoms of blepharitis were similar in the control group and immunocompromised patients. Immunosuppression did not seem to increase the rate of Demodex spp. infection.

Role of Demodex folliculorum in the pathogenesis of blepharitis.

Editor, T he ectoparasite Demodex folliculorum (Simon 1843) is most common parasite of humans. In the eye, D. folliculorum is found in the eyelash follicle. The aim of this study was to examine the prevalence of D. folliculorum in the eyelashes in patients with haematologic disorders. Eyelashes were collected from 95 patients of the Clinic of Haematology Pomeranian Medical University, Szczecin, Poland, and from 1091 healthy controls. There were 47 (49%) women and 48 (51%) men in the patients group (age range: 58.6 ± 13.1) and 759 (69.6%) women and 332 (30.4%) men in the control group (age range: 58.6 ± 13.0). From each patient, we aseptically collected two lashes from the upper right eyelid and two lashes from the upper left eyelid. The collected material was used in preparations examined using light microscopy (magnified 100 times). Infection of the examined subjects was confirmed by the detection of adult and larval forms of D. folliculorum. Demodex folliculorum is found in 21.8% of healthy controls and 18.9% of haematologic patients (Fig. 1; Table 1). In the control group, D. folliculorum occurred in 22.3% of women and in 20.8% of men. In patients with haematologic disorders, D. folliculorum occurred in 17.5% of women and in 25% of men. A much lower rate of infestation of D. folliculorum (12%) was found in immunosuppressed patients with rheumatoid arthritis (Ciftci et al. 2006). On the other hand, in patients with final-stage renal failure (ESRF) on dialysis treatment, D. folliculorum found in 44.4% of patients (Karincaoglu et al. 2005). In our study, the percentage of D. folliculorum infestation in haematologic patients ranged from 16% of patients with acute leukaemia, MPS and other haematologic diseases, and 21.7% with multiple myeloma, to about 24.1% in patients with nonHodgkin’s lymphoma and CLL. Seyhan et al. (2004) found D. folliculorum in the skin of patients with acute lymphocytic leukaemia (12%), acute myelocytic leukaemia (32%), chronic lymphocytic leukaemia (4%), chronic myelocytic leukaemia (10%), Hodgkin’s lymphoma (4%) and nonHodgkin’s lymphoma (38%). Demodex folliculorum seem to be a mediator of chronic blepharitis; some recommend that mites be sought in cilia of chronic blepharitis patients (Czepita et al. 2007). Elevated subjective symptoms of the ocular surface were caused by increased levels of D. folliculorum. Itching, burning, foreign body sensation, crusting and redness of the lid margin, and blurry vision are the main symptoms. Signs include disorders of eyelashes, lid margin inflammation, meibomian gland dysfunction, blepharoconjunctivitis and blepharokeratitis (Czepita et al. 2007). In the control group, the most common symptoms related to D. folliculorum infestation included sensitivity to light, dacryorrhea and itching of the eyelids; loss of eyelashes was the least common. In the group of haematology patients, dacryorrhea was most frequent, without any reports of sensitivity to smoke, light, foreign body sensation under the eyelids or loss of eyelashes. A 61.7% of D. folliculorum-infected patients in the ophthalmology clinic reported itching, and 59.1% reported red eyes (Inceboz et al. 2009). In our study, we found that D. folliculorum infestation was correlated with cylindrical dandruff in the lash roots, both in the control group and in haematologic patients. In patients with D. folliculorum infestation in eyelashes, we found trichiasis, meibomian gland dysfunction with lipid tear deficiency and conjunctival inflammation (Czepita et al. 2007). The prevalence of D. folliculorum in patients with haematologic diseases was similar to that of the control group. Demodicosis may cause itchiness in the eyelids and cylindrical dandruff in the lash roots.

Case report: rare case of infiltration of small lymphocytic B-cell lymphoma in the thyroid gland of female patient with B-cell chronic lymphocytic leukemia (CLL-B/SLL-B)

The article presents a case of 57-year-old woman with the infiltration of rare small lymphocytic B cell lymphoma in the thyroid gland. Initially, the patient was followed-up due to chronic lymphocytic B-cell leukemia diagnosed on the basis of histopathological examination of cervical lymph node. Eight months later, general symptoms occurred along with lymphocytosis and exacerbation of lesions in lymph nodes, and therefore, chemotherapy was started according to COP regimen. After four chemotherapy cycles, further progression of the disease was observed during chemotherapy. Computed tomography (CT) performed at that time showed generalized lymphadenopathy and the presence of an irregular area in left thyroid lobe. On palpation, the thyroid was asymmetrical, with enlarged left lobe and palpable lymph node packages on the left side of the neck. The levels of thyroid hormones and anti-thyroid antibodies were normal. Ultrasound examination of the thyroid gland showed non-homogeneous hypoechogenic structure of the left lobe and complete focal remodeling. Cytological examination of left-lobe lesion obtained during fine needle aspiration biopsy showed multiple small lymphoid cells, suggestive of small lymphocytic lymphoma. To confirm this diagnosis, flow cytometry of the biopsy material sampled from the left lobe was performed showing B cellimmunophenotype: CD19+/CD20+/CD22 dim/FMC-7, CD23+/CD5+, sCD79b-+, CD38-, CD10-, kappa and lambda-/weak reaction. The results of flow cytometry of the thyroid bioptate and blood were nearly identical, confirming leukemic nature of the infiltration in left thyroid lobe. Cytogenetic findings included the presence of 17p deletion (TP53 gene). The patient received immunochemotherapy with alemtuzumab. The progression of the disease occurred in the sixth week of therapy. The treatment was discontinued after 8 weeks due to worsening of patient’s general status. The patient died 15 months after the diagnosis.

Potential leukemic cells engraftment after hematopoietic stem cell transplantation from unrelated donors with undiagnosed chronic leukemia

BACKGROUND Donor-related neoplasms are a potential complication of treatment strategies involving stem cell transplantation. Although mechanisms for detection of short-term complications after these procedures are well developed, complications with delayed onset, notably transmission of chronic diseases such as chronic myeloid leukemia (CML), have been difficult to assess. Consequently, we studied the potential of human CML cells to engraft hematopoietic tissues after intravenous implantation in mice. METHODS Human peripheral blood cells, collected from CML patients presenting with moderately increased white blood cells count before treatment, were transplanted into sub-lethally irradiated, immunodeficient mice. Five weeks after transplantation the nuclear cells were isolated from the murine bone marrow, spleen, and peripheral blood and were used to quantitatively detect human CD45 antigen by flow cytometry; qRT-PCR was used to detect the BCR-ABL1 fusion gene, and the human or murine beta-glucuronidase housekeeping gene was used to examine human-murine chimerism. RESULTS We found that all evaluated animals had donor chimerism at the selected interval after transplant and the presence of a specific BCR-ABL1 fusion gene transcript was also detected. CONCLUSIONS Our results suggest that the risk of neoplasm transmission cannot be eliminated during hematopoietic stem cell transplantation from undiagnosed CML donors with borderline leukocytosis. The obtained data confirms the potential of leukemic cells to viably engraft the hematopoietic organs post-transplantation in an immunosuppressed recipient.

T-cell lymphoblastic leukemia with t(11;22)(q24;q12) and EWSR1 rearrangement

![Figure][1] A 35-year-old woman with a medical history of hypothyroidism after stabilization of the thoracic spine because of scoliosis and after Lyme disease was referred for possible leukemia. Laboratory tests showed leukocytosis (white blood cells, 65 × 109/L), anemia (hemoglobin, 9.2 g/