March 2015

A monthly means to inform and inspire our TEAM

March 2015
Vol. 6, No. 3

Burkitt Lymphoma Cases Do Not Read Books before They Present

Burkitt Lymphoma (BL) was introduced to the world classically as facial swelling. However, Dr. Denis Burkitt realized, as he studied his many cases, that the tumor often erupted in other body organs, most commonly those in the abdomen. Many cases involving the face also involved the abdomen, although some involved just one site. Recently, many investigators have noted that the classical facial tumor presentation is reducing, while the preponderance of abdominal cases is increasing.

Less well-appreciated is that BL, like all diseases in medicine, does not read medical textbooks before presenting. It has protean manifestations, and some of them outrightly exceed medical textbook content. It is easier to recognize the swelling of the tumor in an unusual place in the body as BL if it occurs in conjunction with a more typical location. Examples of unusual locations are arms or legs, tumor lumps in the skin, and swelling of testes in boys.

These unusual presentations are routinely noted in the EMBLEM study. A recent patient presented with typical facial swelling (see photos below). Atypically, she also had a greatly swollen right forearm and a large ball of tumor in her right axilla. Chemotherapy reaches the whole body, and the treatment is the same no matter where in the body the tumor appears. After being given standard chemotherapy, our patient is now on the road to full recovery.

Girl with a swolen face.

Face and arm swollen

Same girl after treatment, face is normal.

Back to Normal

Leading playtime with other BL patients

Leading playtime with other BL patients

- Dr. Esther Kawira - Editor

EMBLEM UGANDA

Microscope image of platelets attacking red blood cells infected with malaria parasites

With completion of the control enrollment, the EMBLEM Uganda team is completing data review, sample shipment, and then will devote time to working with the Kenya and Tanzania teams to help them scale up their control enrollment. During the review of their data, EMBLEM technicians at Kuluva and Lacor noted a strange phenomenon – platelets attacking red blood cells infected with malaria parasites (see photo at right). This phenomenon, never reported in African patients with asymptomatic malaria, has caused excitement in our technicians leading them to pull more slides in order to study the interaction between platelets and red blood cells infected with malaria parasites.

EMBLEM KENYA

In the month of March, 7 cases (4 males, 3 females) were spotted bringing the total spotted to 531 (338 males, 193 females). Of those spotted, 6 (3 males, 3 females) were eligible and enrolled bringing the total of cases eligible and enrolled to 211 (151 males, 60 females).

Household enumeration was completed in 55 villages and the forms were returned to the EMBLEM office and reviewed by the staff. Data entry of the households with selection of households by IMS is ongoing. The team is planning to start MPC enrollment soon.

EMBLEM TANZANIA

In March, EMBLEM Tanzania spotted 4 new cases and bringing the total cases spotted to 444 (247 males, 197 females). None of these cases turned out to be eligible as 2 of them came from outside the study region and the other 2 did not have BL. The total number of enrolled cases stands at 106 (61 males, 45 females).

The recruited Community Research Assistants (CRAs) are becoming our links in their respective villages. We send them text messages on signs of patients with BL and what to do when they spot cases. We also receive communications from them with cases they've spotted and with some consultations over the phone we are able to decide whether the "spotted children" are potential cases or not and advise on what to do with the child.

EMBLEM GOALS

Weekly meeting with a webinar.

One of EMBLEM's goals is to train, mentor, and grow the scientific experience of its local principal investigators to lead and be scientifically responsible for the EMBLEM fieldwork. Whenever possible, EMBLEM PIs join the local teams to supervise the work and satisfy themselves about compliance with EMBLEM SOPs and to receive comments from the community in their study area. The photo at right shows Dr. Peter Odada with the EMBLEM team at Nyabondo village, where he responded to questions about EMBLEM.


EMBLEM Newsletter is a monthly on-line publication based on contributions of the EMBLEM Study staff.
Editor: Dr. Esther Kawira
Reporters: EMBLEM Uganda – Esther Birungi; EMBLEM Kenya – Pam Akinyi Were; EMBLEM Tanzania – Herry Dhudha