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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Tropical splenomegaly syndrome – Wikipedia

Blood film microscopy was negative for malaria but serology was strongly positive. Most other authors opted for long-term treatment following, in some cases only, a short anti-malarial course [ 8485 ]. Hyperreactive malarial splenomegaly in Maarial. Giornale Italiano di Medicina Tropicale. Diagn Microbiol Infect Dis. The results obtained in the current study confirm that high levels of anti-CSP antibodies are one of the immunological characteristics seen in HMS in stable as well as unstable malaria transmission areas.

Methods The search strategy was based on the following database sources: A case of hyper-reactive malarial splenomegaly. Rovere PA, Bisoffi Z. She received 4 months of weekly chloroquine mg, but her splenomegaly and cell counts did not improve. Sera from 33 patients with parasitologically confirmed mild malaria from highly endemic areas in central Sudan were used as positive controls for immunological assays.

The hyper-reactive malarial splenomegaly: a systematic review of the literature

Tropical splenomegaly syndrome and the role of chloroquine prophylaxis. Her splenomegaly and anemia completely resolved within 2 months. He was treated with a short course of mefloquine followed by 6 months of chloroquine and proguanil, after which his clinical and hematological abnormalities were resolved.

Total and differential hyperractive cell counts were carried out for all patients to exclude leukemia. Some authors have hypothesized that HMS could be considered as a pre-malignant state that could evolve to chronic lymphocytic or hairy cell leukaemia or splenic lymphoma with villous lymphocytes, as a result of a multi-step process with a single clone selection in a set of deregulated polyclonal splenomegqly of lymphocytes [ 21 – 23 ].


Immunological Characteristics of Hyperreactive Malarial Splenomegaly Syndrome in Sudanese Patients

An initial splenomgealy of the outer regions of the two genes was followed by a nested PCR with allelic family specific primer pairs [ 13 ]. Clinical trial of malaria prophylaxis in tropical splenomegaly syndrome.

This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. On the other hand, the full response to a short course of anti-malarial therapy indicates that the eradication of the infection is mlarial sufficient to cure HMS [ 284243 ]. Condition may show features of hypersplenism in severe form like anemia and thrombocytopenia.

Possibly this regimen acts not only as an anti-malarial, but also as an immunomodulating and immunosuppressant therapy [ 4796 ], as it is suggested by the regression of the spleen size even in patients with lymphoproliferative disorders [ 60 ]. HMS is caused by a chronic antigenic stimulation derived from the malaria parasite. Chronic malaria with HMSS hyperresctive hemolysis; possible reinfection.

Currently there is no available information on the prevalence and incidence of HMS in Sudan, apart from recently published data in the eastern part of the country which indicated that HMS is a major cause of splenomegaly in this part. The findings of this study suggest that HMS is one of the significant causes of tropical splenomegaly in Sudan. Ann Trop Med Parasitol.

Cryoglobulinaemia in tropical splenomegaly syndrome. Epidemiology, malarial antibody and immunoglobulin levels. The mean Hb level was.

Journal of Tropical Medicine

Most patients had lived for at least five years in an endemic area. All statistical tests were two-sided; a level of was used to indicate statistical significance. Thirty-one out of 9.


Examination showed gross 25 cm splenomegaly. Cryoglobulinaemia and circulating immune complexes in tropical splenomegaly syndrome. Cook GC, Zumla A, editors. East Afr Med J.

All papers identified were assessed by two reviewers SL and DB who independently screened the titles and abstracts, using the criteria mentioned above. Bagshawe [ 13 ]. Antimalaria antibody titers were found to be strongly positive and serum IgM was raised.

The most common prescription, just as in endemic countries, was chloroquine alone [ 54838588 ], or in combination with doxycycline [ 46 ], with proguanil [ 428589 ] or with primaquine [ 90 ], or preceded by a short course of quinine [ 198388 ] or halofantrine [ 83 ]. Bcl-2 and immunoglobulin gene rearrangements in patients with malaria related chronic splenomegaly. Malarial serology was positive and serum IgM was 7.

It is not clear whether a mere withdrawal of exposure, without treatment, could be sufficient to obtain HMS resolution: Immunological characteristics of hyperreactive malarial splenomegaly syndrome in sudanese patients. The mean spleen size was. Patients with severe diseases were excluded from this study. Table 2 Treatment outcome: Additional search terms used were: Thirty-nine patients were followed up for at least two weeks after treatment median six weeks showing improvement or a complete recovery.

Spleen grade Description of the spleen grade 0. Acta Med Acad Sci Hung. Treatment of suspected hyper-reactive malarial splenomegaly HMS in pregnancy with mefloquine.

Tropical splenomegaly syndrome in a nontropical setting. Spleen palpable more than halfway to umbilicus, but not below a line horizontally running through it. Sixty-three papers described cases observed or studies conducted in endemic areas. The spleen is massively enlarged.