Vergara+Rosemary

Hakim Magoro is a seven year old boy from Mozambique in Sub-Saharan Africa. He lives with his mother, father, and two younger sisters in a small rural village. As a child he was a healthy but recently contracted malaria. This occurrence is common in Sub-Saharan Africa as mosquitoes carrying the disease prosper in the conditions of high temperature and humidity.
 * Patient Profile **

Hakim’s younger sister, age 5, was in an accident a year ago which required a blood transplant. Since her blood transfusion, her health has decreased. She has become much more vulnerable to diseases which she should have been protected against. In a follow up visit, she was diagnosed with HIV most likely stemming from the blood transfusion but the exact origins of the disease are not known. Their parents brought Hakim and Esari to the clinic. Within the last few days, there has been a lump growing on Hakim’s face. It has grown to the size of a golf ball within a three week time frame. The lump is hard, located on the left side of the face near the lower jaw. They are worried because Esari has begun to show a similar bump on the right side of her face, the size of a large pimple, resembling the initial stages displayed by Hakim’s growth.

Upon examination, the doctor suspected the growth was a tumor. She tested both Esari and Hakim for Epstein-Barr Virus. EBV is an easily transmitted hepatitis virus, mostly known as the “kissing disease” for being passed through the exchange of bodily fluids and for causing mononucleosis. In the majority of the population, this virus usually remains latent without resulting in any major complications. However, in immunocompromised people such as those with malaria or HIV/AIDS, EBV can lead to serious complications such as cancer. In this case, both Hakim and Esari tested positive for EBV. The doctor diagnosed both children with Burkitt’s lymphoma.
 * Diagnosis with Cancer **

Burkitt’s lymphoma is a non-Hodgkin’s form of cancer and is the fastest growing cancer in people5. Non-Hodgkin’s lymphomas affect cells in the immune system and differ from Hodgkin lymphomas from a lack of giant binucleate cells. It is an aggressive form of cancer which is most common in young boys ages 5 to 10. It is also known as small non-cleaved lymphoma, and makes up about 40 percent of non-Hodgkin lymphoma cases in the United States but almost 98 percent in Africa3.
 * Burkitt’s Lymphoma Profile **

Burkitt’s lymphoma cases are expressed differently depending on the patient population. This difference is seen in geographical region, gender and race. In Africa, Burkitt’s lymphoma makes up almost all non-Hodgkin lymphomas cases and more than half of all cancer cases diagnosed in children. In these cases, the lymphoma usually develops in the jaw and facial bones2. In the United States, Burkitt’s lymphoma is mostly seen starting in the abdomen2. This tumor can grow and block bowel movements causing complications such as pain and vomiting. This cancer is also more common in Caucasians than Africans and twice more common in boys than girls2.

It is important to treat Burkitt’s lymphomas quickly. Not only does it grow rapidly, it can spread to other parts of the body such as in or near the brain5. The fact that this cancer affects the B cells in the immune system would explain why this cancer is mostly present in people with weakened immune systems such as those with HIV/ AIDS, infected with malaria, diagnosed with congenital defects or on immune suppression drugs after an organ transplant5. Normally the immune system can resist attack but with an immunocompromised system the B cells, especially when associated with EBV, can live longer and accumulate more mutations. This also can explain why the cancer can grow so quickly. As part of the immune system, B cells are all over the body and are made to attack an infection or danger. Tumors of Burkitt’s lymphomas are usually clumps of B cells which is characteristic of B cells going towards the site of danger. In this case though it causes more harmful effects than positive ones. Overall, prospects are good for patients with Burkitt’s lymphoma as long as they address the issue in a timely manner and seek medical attention. The next steps for Hakim and Esira include further tests to solidify the diagnosis and getting treatment for their cancer if they do each have Burkitt’s lymphoma.