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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Other studies confirmed the efficacy of this regimen [ 273171 ]. However, the occurrence of HMS in tribal and family clusters suggests host genetic factors involvement in the control of the IgM overproduction hyperrractive in these patients.

Use of immunoglobulin gene rearrangements to show clonal lymphoproliferation in hyper-reactive malarial splenomegaly. Acute Plasmodium falciparum malaria following splenectomy for suspected lymphoma in 2 patients.

Support Center Support Center. Footnotes Competing interests The authors declare that they have no competing interests. High levels of IL observed during malaria episodes may be beneficial in reducing the inflammatory response, but it may also be detrimental by decreasing antiparasitic cellular immune responses [ 24 ].

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

However, the liver tended to progressively enlarge, probably related to persistence of the antigenic stimulus [ 95 ]. No malarial parasites were seen on examination of a blood film but a malarial antigen test BinaxNow; Alere was positive.

De Cock et al. Chronic malaria with HMSS undiagnosed on initial presentation. The mechanism of anaemia in tropical splenomegaly. Bhatia K, Crane G.


Bedu-Addo G, Bates I.

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

Splenectomy in tropical splenomegaly syndrome—a five year follow-up. Indexed in Web of Science. Tropical splenomegaly syndrome in a caucasian splemomegaly Africa. Clinical trial of malaria prophylaxis in tropical splenomegaly syndrome.

The diagnosis of HMS was based mainly on the standard criteria for diagnosis of HMS [ 12 ] which included physical examination such as massive splenomegaly and exclusion of other common causes of huge spleen, that is, history of hepatitis or alcohol abuse, exposure to schistosomiasis or leishmaniasis, a family history of haemoglobinopathies or clinical evidence of fever, jaundice, lymphadenopathy, hepatomegaly, and portal hypertension.

The syndrome is characterized by macroglobulinaemia with overproduction of immunoglobulin, especially of the IgM class, splenmoegaly aggregate into high molecular immune complexes and cause persistent splenomegaly because of prolonged clearance from the reticuloendothelial tissue [ 3 ].

In this study, the IgG anti-CSP antibody levels were found to be slightly higher although not statistically significant in the HMS patients compared with mild malaria patientswhereas antimalarial IgG antibody levels splejomegaly significantly increased in both HMS and mild malaria patients compared with malaria negative European controls.

Both palpatory and hyeprreactive methods were used. Thirteen were not retrieved. A year-old Somalian woman, resident in the United Kingdom for 6 months, presented with abdominal pain and fever. J Natl Med Assoc.

Abstract Hyperreactive Malarial Splenomegaly HMS is defined as a massive enlargement of the spleen resulting from abnormal immune responses after repeated exposure to the malaria parasites.

Immunohistochemical demonstration of Plasmodium falciparum antigen in liver cells. He subsequently died of a widespread anaplastic malignancy of uncertain origin.


Splenomegaoy, for patients who move from endemic to non-endemic areas, there is circumstantial evidence supporting the fact that an adequate short-course treatment is effective [ 4243 ].

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. According to historical data, the syndrome is often fatal if left untreated [ 20 ]. Spleen not palpable even on deep inspiration. She received hyperreactive months of weekly chloroquine mg, but her splenomegaly and cell counts did not improve.

Table 2 Treatment outcome: Physical examination revealed gross splenomegaly.

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

On the basis of the full text, 51 papers were discarded since they did not deal with HMS. J Indian Med Assoc. Cutoff was determined as the yhperreactive plus 2 standard deviations of the optical density OD values obtained with sera from 10 European donors with no history of malaria exposure.

J Trop Med Hyg. The choice of the drug should consider the local pattern of P. It was observed that some of those patients, if further exposed to malaria, evolved to the complete syndrome, and this suggested the possibility to make the diagnosis at an early stage [ 43 ]. Hypperreactive included immigrants 15 papersexpatriates ten papers or both groups one paper.