Neutrophile Alkaline Phosphatase Changes in Tularemia , Sandfly Fever , Q Fever

With the technical assistance of Sophie Shepel and Ray F. Long T DECADES AGO, Wachstein’ called attention to an increase in alkaline phosphatase (AP) activity of human neutrophilic leukocytes during bacterial infections. Enzyme activity within individual cells as well as the number of cells with detectable enzyme were markedly increased, an observation confirmed by others.27 Infection-induced rise in AP activity was described in neutrophiles of the marrow, peripheral blood, and exudates’ and was more pronounced in adult cells when compared to band forms.48 The increase in A.P correlated roughly in magnitude and timing with the severity of leukocytosis,1’5 although AP has been reported to remain elevated temporarily after leukocytosis subsided.2 A rise in neutrophile AP activity in many “stress” related situations led Valentine and his associates to investigate the possible influence of the pituitary-adrenal axis on this phenomenon.#{176}”#{176}It was shown that glucocorticoids or ACTH ( in the presence of a functioning adrenal cortex ) could stimulate in vivo a rise in neutrophile AP9”#{176}after an initial lag. A rapid change in the WBC, with epinephrine-induced leukocytosis or bacterial endotoxin-induced leukopenia, was shown by Trubowitz et al.1’ to be associated, respectively, with a rapid rise or fall in AP. Little is known concerning the relationship of a specific etiology of infection to accompanying patterns of neutrophile AP response. During viral illness, no rise in AP was detected in some instances,6”2 while in others a rise appeared to equal that observed during bacterial infection.7 During our extensive investigations of vaccine efficacy it became possible to study prospectively by serial collections the patterns of AP response in normal volunteers exposed to infectious microorganisms. Data were obtained during tularemia and Q fever, neither of which is associated with prominent leukocytosis, and during sandfly fever, a mild viral illness with a characteristic leukopenia. Artificial hyperthermia and endotoxin-induced fever were also studied to compare the responses of neutrophile AP during the stress of these infections to the stress of fever without concomitant infection.