Neuraminidase also increases instances of epithelial binding through its cleavage of N-acetylneuraminic acid, glycolipids, glycoproteins, and oligosaccharides. Invasion
Initial colonization of the nasopharynx is typically asymptomatic, but invasion occurs when the bacteria spreads to other parts of the body including the lungs, blood, and brain. Interactions between Phosphorylcholine (ChoP) components on colonized epithelial cells allow for docking of choline binding proteins (CBPs), most notably CbpA. Colonization of the respiratory tract, and thus pneumonia cannot occur without CpbA. The pneumococcus moves across the mucosal barrier by integrating itself with the polymeric immunoglobulin receptor (pIgR), which is used by mucosal epithelial cells to transport IgA and IgM to the apical surface. Following its cleavage at the apical surface, pIgR, and subsequently the pneumococcus, move back to the basolateral surface allowing invasion of the upper respiratory tract. The pneumococcus then moves to invade the lower respiratory tract, evading the mucociliary escalator with the assistance of neuraminidase. == References ==
Juvenile myelomonocytic leukemia (JMML) is a serious chronic leukemia (cancer of the blood) that affects children mostly aged 4 and younger. The name JMML now encompasses all diagnoses formerly referred to as juvenile chronic myeloid leukemia (JCML), chronic myelomonocytic leukemia of infancy, and infantile monosomy 7 syndrome. The average age of patients at diagnosis is 2 years old. The World Health Organization has included JMML in the category of myelodysplastic and myeloproliferative disorders. Signs and symptoms
The following symptoms are typical ones which lead to testing for JMML, though children with JMML may exhibit any combination of them: pallor, fever, infection, bleeding, cough, poor weight gain, a maculopapular rash (discolored but not raised, or small and raised but not containing pus), lymphadenopathy (enlarged lymph nodes), moderate hepatomegaly (enlarged liver), marked splenomegaly (enlarged spleen), leukocytosis (high white blood cell count in blood), absolute monocytosis (high monocyte count in blood), anemia (low red blood cell count in blood), and thrombocytopenia (low platelet count in blood). Most of these conditions are common, nonspecific signs and symptoms.