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10.1186/s12936-015-1015-6

http://scihub22266oqcxt.onion/10.1186/s12936-015-1015-6
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suck abstract from ncbi


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pmid26626013
      Malar+J 2015 ; 14 (ä): 487
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  • Early hyperreactive malarial splenomegaly and risk factors for evolution into the full-blown syndrome: a single-centre, retrospective, longitudinal study #MMPMID26626013
  • Bisoffi Z ; Leoni S ; Buonfrate D ; Lodesani C ; Eseme FE ; Monteiro GB ; Marocco S ; Guerriero M
  • Malar J 2015[Dec]; 14 (ä): 487 PMID26626013 show ga
  • BACKGROUND: The hyperreactive malarial splenomegaly (HMS) represents a chronic, potentially fatal complication of malaria. Case definition includes: gross splenomegaly, high level of anti-malarial antibody and IgM, response to long-term anti-malarial prophylaxis. In this study, a large series of patients not fully meeting the case definition was tentatively classified as early hyperreactive malarial splenomegaly (e-HMS). The main research questions was: does "e-HMS" tend to evolve to the full-blown syndrome? And if so, what are the main factors influencing this evolution? METHODS: Retrospective, longitudinal study. The patient database was searched to retrieve all potentially eligible patients. e-HMS was defined by splenomegaly of any size (with or without raised IgM), high anti-malarial antibody titre and exclusion of other causes of splenomegaly. The clinical outcome at following visits was analysed in relation to re-exposure to malaria, and to treatment (only part of the patients with e-HMS were treated with a single anti-malarial treatment and advised to follow an effective anti-malarial prophylaxis, if re-exposed). The association of the outcome with the main independent variables was first assessed with univariate analysis. A stepwise logistic regression model was then performed to study the association of the outcome with the main independent variables. RESULTS: One hundred and twenty-six subjects with e-HMS were retrieved. Eighty-one had at least one follow-up visit. Of 46 re-exposed to malaria for a variable period, 21 (46 %) had progressed, including 10/46 (22 %) evolving to full-blown HMS, while of 29 patients not re-exposed, 24 (93 %) had improved or cured and five (7 %) progressed (p < 0.001). At logistic regression re-exposure was confirmed as a major risk factor of progression (OR 9.458, CI 1.767-50.616) while treatment at initial visit was protective (OR 0.187, CI 0.054-0.650). CONCLUSION: e-HMS should be regarded as a clinical condition predisposing to HMS. Although the case definition may include false positives, e-HMS should be treated just as the full-blown syndrome. A single anti-malarial treatment is probably adequate, followed by effective prophylaxis for patients exposed again to malaria transmission.
  • |Adult [MESH]
  • |Antibodies, Protozoan/blood [MESH]
  • |Antimalarials/administration & dosage [MESH]
  • |Female [MESH]
  • |Humans [MESH]
  • |Immunoglobulin M/blood [MESH]
  • |Longitudinal Studies [MESH]
  • |Malaria/*complications/drug therapy [MESH]
  • |Male [MESH]
  • |Middle Aged [MESH]
  • |Retrospective Studies [MESH]
  • |Risk Factors [MESH]
  • |Splenomegaly/*epidemiology/*pathology [MESH]


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