This is a case study of Clarissa Dalloway, the first child

Last updated: 7/29/2022

This is a case study of Clarissa Dalloway, the first child born to a couple living in an isolated fishing village in Maine. The family was descended from 17th Century settlers in the region and there was much intermarriage (of up to first cousins). Clarissa was normal until she was about 2 and 1/2 years old. At this point, she stopped eating well, often suffered from diarrhea, and lost weight. After going to the doctor's, she was found to have enlarged lymph nodes. An ultrasound and CT scan of the chest and abdomen found enlarged lymph nodes in the mesentery and para-aortic region. Her blood count showed normal lymphocyte numbers but increased neutrophils and macrophages, as well as increased levels of antibodies (IgG, IgA and IgM were all above normal). A biopsy of a lymph node showed clusters of macrophages and neutrophils with many of the macrophages being infected with Mycobacterium avium, M. avium, like Mycobacterium tuberculosis (the causative agent of tuberculosis), infects macrophages and replicates within them. Treatment of Clarissa with antibiotics but she went on to develop an enlarged spleen with lung nodules. She eventually cleared or appeared to clear the infection. At the age of 6, she developed sepsis and Salmonella typhi was cultured. This was successfully cured by antibiotic treatment. Within a few months, however, she developed meningitis and died. M. avium was found in her cerebrospinal fluid. Clarissa had three male cousins, two were brothers and both died from mycobacterial infection. Given this case study, answer the following questions. Some additional information: In staining the biopsy for various cell markers, the macrophages and neutrophils seemed to be "working" properly, but recruited NK and T-cells did not express activation markers. Given this additional information, what would you suspect may be an underlying issue (check all that apply)? The recruited NK and T-cells could not respond to the proteins being expressed by the macrophages. There was a problem with B-cells. There may be a deficiency in the signaling between the innate cells and the acquired immune cells. Since there seems to be a deficient response to M. avium (an intracellular pathogen) infection, suggests that a type of signaling induced by this stimulation is deficient.