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There is a considerable volume of evidence linking Epstein-Barr virus (EBV) etiologically with Burkitt's lymphoma (BL). BL has satisfied the Henle-Koch criteria. Thus BL patients have significantly higher EBV antibody titres than normal or tumour controls. EBV DNA and EBV-determined nuclear antigen (EBNA) have been demonstrated in a high proportion (greater than 90%) of endemic BL tissues. EBV can transform and immortalize human B-lymphocytes and is known to cause lymphoreticular tumours in New World monkeys. The fact that endemic BL is almost invariably associated with EBV while this is rarely true of the non-endemic form suggests disease heterogeneity in spite of morphological uniformity. The role of malaria as a co-factor in causing immunosuppression and promoting proliferation of EBV-transformed cell is discussed. The identification of specific chromosomal abnormalities in both endemic and non-endemic BL underscores the importance of a suitable genetic background.
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PMID:Etiology of endemic Burkitt's lymphoma. 610 Feb 85

The relationship between viruses and naturally occurring cancers, such as hepatocellular carcinoma and genital cancers, is of great importance to Africa. On the other hand, lymphomas, leukaemias and immunodeficiencies, although of less immediate public health importance, constitute an area of outstanding interest for research and their association with the Epstein-Barr virus (EBV) and the newly discovered human retroviruses merits world-wide attention. EBV-related malignancies in Africa include both Burkitt's lymphoma (BL) and nasopharyngeal carcinoma (NPC). Whether X-linked polyclonal lymphoproliferations exist in Africa remains an open question. The interrelationship between EBV, holoendemic malaria and genetic factors (oncogenes) has been deciphered in recent years, to make BL a kind of Rosetta stone for the understanding of multistage carcinogenesis. Although the role of EBV in the causation of NPC is not well understood, the viral capsid antigen (VCA) IgA test already allows both early detection of NPC in high-incidence areas and differential diagnosis in low-incidence areas. The question whether an EBV vaccine would be of value in African countries, in relation to EBV-associated malignancies, remains an open one. The diseases associated with the recently discovered human retroviruses (human T-lymphocyte leukaemia viruses: HTLVs) represent a new area for both research and public health assessment. Limited information is available today on the geographical distribution, age prevalence and association with disease in Africa of the different members of the retrovirus family (HTLV-1, HTLV-2, LAV/HTLV-3). The proportion of HTLV-related T-cell malignancies in different parts of Africa as well as the importance of immunodeficiencies caused by the different members of the retrovirus family remain to be determined. Typical acquired immunodeficiency syndrome (AIDS) appears to exist in Central Africa, especially Zaire, and HTLVs could be of public health importance if they cause severe forms of viral, bacterial or parasitic diseases through impairment of cell-mediated immunity. Africa, is and will long remain a continent of crucial importance with regard to the role of viruses in human malignancies and especially in haematopoietic proliferative disorders.
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PMID:Virus-associated lymphomas, leukaemias and immunodeficiencies in Africa. 610 Feb 86

Both Epstein-Barr virus and malaria have been implicated as possible factors in Burkitt's lymphoma. To examine this implication a cross-sectional serological survey of an urban and a rural population in Ghana was conducted. Malaria was more prevalent in the rural areas, but there was no difference in antiviral capsid antigen (VCA) antibody titres between urban and rural dwellers. There was also no correlation between anti-malaria antibody titres and anti-VCA antibody titres. Thus malaria does not seem to influence immunological response to Epstein-Barr virus infection, as measured by anti-VCA antibodies. These results suggest that if Epstein-Barr virus infection and malaria are important in the aetiology of Burkitt's lymphoma, they produce their effects independently. The survey also showed that those in rural areas seroconverted earlier than those in urban areas, and that antibody levels were consistently higher in females than in males in every age-group. Case-control studies and screening programmes involving anti-VCA levels will therefore have to take these two findings into account.
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PMID:Malaria, sex, and place of residence as factors in antibody response to Epstein-Barr virus in Ghana, West Africa. 611 82

Clinical and epidemiologic features of Burkitt's lymphoma are reviewed. Epidemiologic studies suggest that simultaneous infection with Epstein-Barr (E-B) virus and malaria may be involved as etiologic agents. On the other hand we have found that in the Amazon region of Brazil and Peru both malaria and E-B virus infection is common among children, yet Burkitt's lymphoma is rare. The possibility exists that other concomitant etiologic agents and genetic factors are also involved. Several investigators suggested the possible involvement of Reo 3 virus. We have found antibodies against Yaba virus. A laboratory worker who accidentally inoculated himself with Yaba virus developed a histiocytoma which when inoculated into Asiatic monkeys produced typical Yaba tumors. This was the first case that Koch's postulates were fulfilled in a virus induced neoplasm in man. Therapeutically, the best clinical results were obtained in those patients who were treated with small doses of cyclophosphamide. On the basis of somewhat inadequate follow-up studies, it is estimated that "five year cures" were obtained in about 10% of the patients.
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PMID:Burkitt's lymphoma. 627 88

Epstein-Barr virus genome-positive Burkitt's lymphoma is endemic in Africa and Papua New Guinea and in both countries the tumour is restricted to regions with holoendemic malaria. The present work has compared groups of healthy indigenous individuals living in malarious and non-malarious regions of Papua New Guinea for Epstein-Barr virus-specific T-cell-mediated immunity using the in vitro regression assay. Residents of the malarious region (55 tested), when compared with either residents of the non-malarious area (35 tested) or Caucasian controls (27 tested) showed a significant (p less than 0.0001) impairment of virus-specific T-cell immunity but no obvious disturbance (p greater than 0.05) of anti-viral antibody titres. These results may be important in explaining the postulated role of malarial infection as a co-factor in the pathogenesis of Burkitt's lymphoma.
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PMID:A comparison of Epstein-Barr virus-specific T-cell immunity in malaria-endemic and -nonendemic regions of Papua New Guinea. 630 50

Different aetiological factors of Burkitt's disease, or Burkitt's lymphoma (BL) are considered in an analytical, then synthetical point of view, according to present admitted facts. Epidemiologic data are recalled in order to assign a place to the disease. Relations with Epstein-Barr virus (E.B.V.) are well-known by comparative pathology (connections between animal tumors and herpetic virus), virologic and serologic studies; the role of E.B.V. is based on the presence of viral genomas and nuclear antigens in tumoral cells of B.L.; there are B.L. without E.B.V., but constantly improved study of anti-E.B.V. antibodies, and viral markers, will may be decrease their number. Connections with malaria caused by Plasmodium falciparum are recognized. Discovery of chromosomal aberrations is a new important stage. At the present time, it is generally guessed that: a) the initiation of malignant process might be induced by E.B.V. b) an external agent might cause the promotion of cellular division. c) chromosomal abnormality might be responsible for the malignant transformation.
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PMID:[Etiological factors in Burkitt's disease]. 631 Mar 11

A prospective study of the socio-economic status and physical growth of seventy-six children aged 3-10 years, with Burkitt's lymphoma (BL), has revealed that most of the patients were from the lowest socio-economic classes. Majority of the fathers were farmers, labourers or petty traders. The BL children were, as a group, significantly lighter in weight and shorter than controls. It is postulated that although the weights were probably adversely affected by the illness itself, the shorter heights which were most likely present before the onset of the illness, indicated chronic undernutrition. This, together with a low level of immunization would predispose the children to frequent infections, including malaria. Frequent infections would thus condition the reticuloendothelial system to be more susceptible to the lymphoproliferative properties of the EB virus, resulting in malignant changes such as Burkitt's lymphoma.
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PMID:Observations on some aetiological factors in Burkitt's lymphoma. 631 86

In Burkitt's lymphoma, dental structures may provide the route for Epstein-Barr virus (EBV) in saliva to penetrate the jaws, thereby promoting tumor formation. In children, EBV could enter tooth sockets exposed following deciduous tooth loss and thereby contact jaw marrow lymphocytes stimulating neoplastic transformation. Marrow contact by EBV probably also occurs through carious teeth. Jaw tumors are rare in adults because their jaw marrow is no longer hematopoietic and so lacks the lymphoid substrate for the virus. In adults, jaw marrow lymphocytosis, as accompanies infectious mononucleosis and perhaps malaria, or which could develop around the roots of carious teeth having chronic periapical infection, could provide the substrate for EBV. EBV could then contact the jaw marrow lymphocytes when teeth are extracted and so favor jaw tumor development. Therefore, prevention of dental caries might reduce jaw tumor prevalence in Burkitt's lymphoma except among children ages 6-13 whose jaw marrow would unavoidably become infected by salivary EBV when the latter is present at the time of deciduous tooth loss.
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PMID:Circumstances favoring jaw tumors in Burkitt's lymphoma. 632 20

Insights gained by a group of American maternal and child helath (MCH) care nurses during a 1983 exchange tour to Kenya, sponsored by Professional Seminar Counsultants, are decribed. Kenya is a poor, predominantly rural country. The annual population growth rate is 4.1%, and 60% of the population is under the age of 16. The government's annual per capita health expenditure is only US$4, there is little emphasis on pediatrics as a speciality, and the linguistic diversity of the population complicates the delivery of health care services. As a result of these factors, the MCH care system in Kenya differed markedly from the systems observed in previous exchange tours to China and the USSR. Kenya's population is served by a variety of government, private, and missionary hospitals and by government health centers. The health centers are staffed by 2 nurses and 2 assistants who provide maternity, family planning, and immunization services. The staff also diagnoses and treats common illnesses. Service are provided free for patients under the age of 16, and minimal fees are collected from older patients. The largest hospital in the country is the 1600 bed, Joma Kenyatta National hospital which employs 900 nurses and serves as a refereal hospital for complicated cases and as a teaching and research center. 42% of the hospital staff nurses are registered nurses and 58% are enrolled nurses. Disease patterns in Kenya and the US are markedly different. In Kenya, infectious diseases are more common than chronic diseases, and amony children the major causes of death are starvation, measles, whooping cough, malaria, tubercluosis, and diarrhea. Marasmus and protein calorie deficiency are the 2 major types of childhood malnutrition found in Kenya. Nurses frequently provide health education services and even teach mothers how to grow nutritious foods for their children. Rh incompatibility is rare in Kenya, but ABO incompatibility is common. Othr common diseases, raraly found in temperate climates, include Burkitt's lymphoma, leprosy, and tropical ataxic neuropathies. The visiting nurses were at 1st shocked by some of the practices and customs they observed; however, as they learned more about the rationall behind these practices, shock gave way to appreciation. Children's wards lacked playthings, the walls were devoid of pictures, and the rooms were sparsely furnished. The lack of material items, however, was more than compensated for by the rich stimuli provided family members and friends, who not only visited the chilren, but performed a variety of nursing tasks. The family centered approach also provided a sense of security for the patients. A Masai paramedic explained how the custom of polygamy ensures adherence to the 2-year postpartum sexual taboo which, in turn, facilitates prolonged breast feeding. The nurses also became acquainted with the social value of adolescent circumcision rites. These rites are illegal but still performed in many rural areas. The rites are physically painful, but they provide a mechanism for easing the transition from adolescent to adult status. The rites help young people assume measningful roles in the society and provide them with clearly specified identities. As a result, adolescent suicide is rara among the rural villagers.
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PMID:Health care in Africa. 646 42

The frequency of Burkitt's lymphoma peaks in children six to nine years of age and is twice as high in males as in females. To determine if age or sex had any relationship to outcome of therapy, the authors examined the experience of 387 patients treated for Burkitt's lymphoma at the Burkitt Tumor Project, Accra, Ghana, between 1966 and 1978. No age or sex relationship could be demonstrated with overall survival. However, among children without central nervous system disease who achieved an initial remission, the relapse rates were higher for those diagnosed initially in the age interval 6-9 years than for those diagnosed at younger or older ages. This pattern was seen for each stage of the disease as well as overall. Sex did not influence relapse rate. The relationship of these findings to the Epstein-Barr virus and malaria, both suspected factors in the etiology of this disease, is discussed, but neither appears to explain our results.
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PMID:Age and sex as factors influencing remission duration in African Burkitt's lymphoma. 713 53


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