Pleomorphic Bacteria as a Cause of Hodgkin’s Disease (Hodgkin’s lymphoma):

A Review of the Literature

Hodgkin’s disease (HD) is widely considered a neoplastic disease. However, for more than a century some investigators have considered HD an infectious disease, caused by pleomorphic bacteria closely related to the mycobacteria that cause tuberculosis. A recent report showing “intracellular bacteria” in HD, as well as a previous electron microscopic study showing intra- and extracellular “microorganism-like structures,” adds credence to the idea that bacteria are associated with HD. This communication provides a review of the largely forgotten literature pertaining to the complex microbiology of HD. Microphotographs of cell wall deficient and mycoplasma-like intracellular and extracellular forms, observed in vivo in acid-fast stained microscopic tissue sections of HD, are also presented, as previously reported.

Bacteria in Hodgkin’s Disease
Hodgkin’s disease was first described in 1832 by Thomas Hodgkins. For more than a century HD was not considered a cancer, but was widely regarded as a bacterial and infectious disease, possibly related to tuberculosis.

The cause of HD is unknown. However, over the past century there have been various reports implicating “pleomorphic” bacteria, possibly derived from the so-called “acid-fast” (red-staining) mycobacteria that cause tuberculosis. Pleomorphic bacteria are capable of assuming different shapes and sizes. Bacteria observed and cultured from HD are most commonly described as intermittently acid-fast round coccus forms resembling common staphylococci; and rod-shaped bacteria known as corynebacteria (also called “diphtheroid” bacteria and “propionibacteria”) [1-8].

Hodgkin’s Disease Coexisting with Other Cancers
HD is considered a form of cancer affecting the lymphatic system, usually beginning as a painless swelling of lymph glands (nodes). Later stages of the disease include fever, persistent fatigue, weight loss, itching, and night sweats. Some of these clinical signs resemble those of tuberculosis (TB).

A definitive diagnosis of HD is made by the pathologist based on the type of cell found on biopsy. A distinct kind of cell (the so-called “Reed-Sternberg cell”) is a hallmark of this cancer. Carl Sternberg himself claimed in 1898 that HD was caused by TB bacteria; and Dorothy Reed noted the frequent association of tuberculosis, even finding TB and HD in the same lymph node, as quoted by Stewart [4].

HD and tuberculosis can coexist in the same patient. A recent report of a Polish case concluded “the association between HD and TB must be considered, especially in countries where the latter is endemic. The diagnosis may be difficult due to similarities in the clinical course, laboratory tests and imaging procedures” [9].

HD can also coexist with sarcoidosis, a disease often affecting the lungs and lymph nodes and long thought to also have a close relationship with TB and TB bacteria [10]. Lymph nodes draining cancer can occasionally show evidence of sarcoidosis.

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