compared with a rate of 6–20% in cerebral malaria. Data on the prevalence of HMS is scant, but in areas with intense transmission of malaria. malarial splenomegaly. SIR—Hyper-reactive malarial splenomegaly (HMS) is a form of severe malaria, with a mortality rate that exceeds 50%,1,2 compared with . ABSTRACT. Hyper-reactive malarial splenomegaly (HMS) or Tropical splenomegaly syndrome(TSS), occurs in areas of high transmission of.

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Is this more frequent than it appears? This particular aspect was described in a study showing a progressive enlargement of the liver after splenectomy in a patient with negative thick blood films. The largest cohort of patients under lifelong chloroquine prophylaxis showed an improvement of all, with a partial regression of splenomegaly and an increase of haemoglobin level over a period of months.

Tropical splenomegaly syndrome – Wikipedia

East Afr Med J. Five years later, she returned to clinic complaining that her abdominal pain had never improved and had recently become more severe.

Despite a comparatively large amount of literature on malaria, only a few papers deal with this particular mlaarial. All treated patients with no further exposure improved.

Finally, the form included history of malaria splenomegalu terms of number of attacks during the year, last clinical attack, and treatment received that was compiled for each patient. Giornale di Malattie Infettive e Parassitarie. Validation of PCR for detection and characterization of parasitaemia in massive splenomegaly attributed clinically to malaria infection.

However, the occurrence of HMS in tribal and family clusters suggests host genetic factors involvement in the control of the IgM overproduction seen in these patients. The underlying mechanism causing anaemia is the plasma volume expansion and the spleen sequestration along with an increased haemolysis. Splenectomy is potentially associated with high mortality, therefore it should be strictly limited to cases that do not respond to medical treatment [ 9497 ]. Massive splenomegaly responsive to proguanil and with features of hairy cell leukaemia.


The diagnostic criteria for HMSS were last amended inbefore the advent of molecular tests for malaria.

Immunological Characteristics of Hyperreactive Malarial Splenomegaly Syndrome in Sudanese Patients

The pathogenesis of tropical splenomegaly syndrome—the role of immune complexes. Chloroquine was restarted but changed to proguanil mg once daily OD after 3 weeks.

Background Hyper-reactive malarial splenomegaly HMS represents one of the leading causes of massive splenomegaly in malaria-endemic countries [ 1 ].

Immunohistochemical demonstration of Plasmodium falciparum antigen in liver cells. She was treated with a 3-day course of oral quinine mg three times daily and subsequently started on chloroquine mg once weekly, which she took for a month.

A year-old man was referred to a hospital for investigation of splenomegaly and pancytopenia. Sera from 33 patients with parasitologically confirmed mild malaria from highly endemic areas in central Sudan were used as positive controls for immunological assays. Finally, the reported treatment outcome of studies with more than 10 recruited subjects was summarized. Tropical splenomegaly syndrome in a nontropical setting.

Thirteen were not retrieved.

She was treated with quinine for 1 week and was subsequently given 6 months of choloroquine mg weekly and proguanil mg dailywith complete resolution of her splenomegaly. Retrieved from ” https: In six studies out of 21 a short course of treatment as for an acute malaria episode was administered [ 174243 hyperrsactive, 668182 ].


De Cock et al.

Hyperreactive Malarial Splenomegaly Syndrome—Can the Diagnostic Criteria Be Improved?

Splenectomy in tropical splenomegaly syndrome—a five year follow-up. This study was carried out in Khartoum, Sudan. Immunoglobulin G IgG C anticircumsporozoite CSP antibody levels were higher in the HMS patients although the difference was not statistically significant, when compared with a group of patients with mild malaria.

The hyperreactive malarial splenomegaly syndrome in a European: The mean spleen size was. Malarial serology was positive but serum IgM was not raised. Spleen not palpable even on deep inspiration. A year-old Nigerian man presented with lethargy and abdominal pain.

Thirty-nine patients were followed up for at least two weeks after treatment median six weeks showing improvement or a complete recovery.

Actually, HMS and lymphoproliferative disorders are often clinically indistinguishable. The search was carried out in March The aim of this study is to systematically review the literature about HMS, particularly focussing on case definition, epidemiology and management.

It shows dilated sinusoids lined with reticulum cells. He was treated with proguanil mg daily and chloroquine mg twice weekly for a year, followed by atovaquone—proguanil for over 3 years, again with no improvement. Giornale Italiano di Medicina Tropicale. The spleen is massively enlarged. N Engl J Med. The most frequent peri-operative complications described were major bleeding and infections.