Basis of a monocytic and macrophagic leukemoid test monocytic and macrophagic infiltrates in the struck fabrics make a monocytosis in peripheral blood, slightly increased percent of monocytes and promonocytes in marrow.
Epidemiology In literature data on prevalence of various forms of a monocytic and macrophagic leukemoid test did not meet.
Etiology and pathogeny Monocytic and macrophagic leukemoid tests can arise at bacterial and viral infections, parasitic invasions. Their development is possible at rheumatism, Beck's sarcoidosis, diseases of hypersensitivity of lungs and at other processes relating to pathology of cell-bound immune complexes. Not only characteristic changes in peripheral blood and marrow, but also formation of macrophagic and lymphocytic infiltrates (granulomas) in various sites of the struck bodies are inherent in this type of leukemoid tests. Macrophagic reactions in the form of a histiocytosis of sine of lymph nodes and a spleen carry isolated, at a panniculitis — system character.
Classification Monocytic and macrophagic leukemoid tests subdivide into forms with the known and unknown reason of their development. Distinguish options at various infections, a thicket at the tuberculosis and parasitic diseases, processes relating to pathology of cell-bound immune complexes from the first; macrophagic reaction in the form of a histiocytosis of sine in lymph nodes, a spleen and a general disease of a panniculitis (Krischen's syndrome — Weber).
Approximate formulation of the diagnosis: 1. A monocytic and macrophagic leukemoid test against rheumatism with macrophagic and lymphocytic granulomas in the struck fabrics and a monocytosis in a gemogramma and a miyelogramma. 2. A monocytic and macrophagic leukemoid test at tuberculosis with a monocytosis in blood, small increase in quantity of monocytes and promonocytes in marrow and macrophagic and lymphocytic granulomas in the struck fabrics.
Clinic Monocytic and macrophagic leukemoid tests can develop at any infection, but to a thicket accompany the course of tuberculosis. They are characterized by the monocytosis in peripheral blood which is a little raised by quantity of monocytes and promonocytes in marrow (2 — 4%) and existence in the struck fabrics of monocytic and macrophagic infiltrates (granulomas). Believe that a macrophagic and lymphocytic hillock (granulomas) at tuberculosis possess the leading role in overcoming of an infection. In a tubercular hillock along with macrophages (epithelial cells), ordinary on the morphology, macrophagic multinucleate cells of Langkhans are found. At patients with an immunity depression tubercular hillocks are not formed and then process gains miliary character with development in fabrics of the necrotic centers.
Monocytic and macrophagic leukemoid tests can meet at diseases of cell-bound immune complexes (rheumatism, Beck's sarcoidosis, diseases of hypersensitivity of lungs, etc.). At these processes the macrophagic and lymphocytic granulomas in fabrics which are combined quite often with a monocytosis of peripheral blood quite often are found. At so-called diseases of hypersensitivity of lungs of a granuloma are generally localized in interalveolar partitions that is followed by their thickening and reduction of the sizes of alveolar cavities. As a result heavy respiratory insufficiency develops. At such nature of defeat rigid or bronchial breath, sometimes crepitant rattles are noted. Macrophagic and lymphocytic substrate of granulomas differs from нейтрофильно-плазмоклеточно-лимфоцитарных infiltrates at a usual inflammation.
Bacterial and viral infections, parasitic invasions can be the reasons of development of macrophagic reaction in lymph nodes and a spleen — a so-called histiocytosis of sine. However the infectious agent who caused this reaction is not always possible to establish. Clinically the histiocytosis of sine of lymph nodes proceeds with increase in all nodes or their separate groups, lymph nodes have a dense consistence, are often painful; the disease is followed by increase in a spleen.
The histiocytosis of sine in a spleen is characterized by increase in its sizes owing to the expressed macrophagic reaction, a resistant and recurrent hyperthermia.
A peculiar macrophagic reaction with preferential localization of process in hypodermic cellulose was called a panniculitis. Now it is considered as the general disease proceeding with education in hypodermic cellulose gradually fibroziruyushchikhsya and the cicatrizing nodes on considerable sites of a trunk and extremities, and also with development of pleurisy, a pericardis, increase in a spleen and liver. The panniculitis can complicate the course of rheumatism, pancreatitis, sometimes it is provoked by an injury.
Verification of the diagnosis Various forms of a monocytic and macrophagic leukemoid test are diagnosed on the basis of clinical and morphological features of peripheral blood, marrow and granulomas. Also research of a histologic picture of a bioptat of a lymph node is important. Resort to it also in cases much of the expressed lymphadenopathy at a histiocytosis of sine for an exception of metastasises of cancer in lymph nodes.
Treatment At identification of a contagium the directed differentiated antibacterial therapy in sufficient doses is applied. Detection of parasitic invasions is the indication for purpose of the corresponding highly effective antivermicular drugs. At rheumatism, Beck's sarcoidosis, so-called diseases of hypersensitivity the easy and other processes relating to pathology of cell-bound immune complexes the corresponding treatment is carried out. At a histiocytosis of sine in a spleen effective can be a splenectomy.