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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.