Abstract Background The hyper-reactive malarial splenomegaly syndrome HMS is a leading cause of massive splenomegaly in malaria-endemic countries. HMS is caused by a chronic antigenic stimulation derived from the malaria parasite. The syndrome is fatal if left untreated. The aim of this study is to systematically review the literature about HMS, particularly focussing on case definition, epidemiology and management.
|Published (Last):||2 October 2006|
|PDF File Size:||14.66 Mb|
|ePub File Size:||14.73 Mb|
|Price:||Free* [*Free Regsitration Required]|
Elhassan,1 and Ibrahim M. This study was carried out in Khartoum, Sudan. Sudan is considered to be one of the countries where HMS is quite prevalent. The objective of the study was to determine the incidence of HMS in patients who reported to the Omdurman Tropical Diseases Hospital OMTDH in Sudan and to investigate the basic laboratory and immunological characteristics of this condition in these patients.
A cross-sectional study was carried out in OMTDH, and all patients with enlarged spleens were included in the study. Thirty-one out of 9.
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 findings of this study suggest that HMS is one of the significant causes of tropical splenomegaly in Sudan. Introduction Hyperreactive Malarial Splenomegaly HMS is characterized by massive enlargement of the spleen in the tropics.
The condition is prevalent in certain malarious regions of the Old World, mainly in Africa [ 1 — 5 ]. HMS seems to be associated with a high mortality; however, the natural history of HMS is not well documented. Whether HMS is responsible for this high mortality is a fact that still needs to be established [ 6 ]. Clinical Features. Symptoms of splenomegaly consist primarily of left upper quadrant pain with or without signs of hypersplenism dominating the clinical presentation of HMS.
Early in the syndrome, the pain may be episodic and exacerbated by physical activity, which over time progresses in intensity and becomes persistent and debilitating. Haemolytic episodes associated with acute febrile illness or pregnancy can precipitate the course of HMS and, on occasion, be associated with sudden death. Physical examination usually reveals massive splenomegaly of the spleen often extending across the midline to the right side of the abdomen or downward to the left iliac fossa.
The spleen is generally firm and nontender with a prominent notch and regular contour. Hepatomegaly, most commonly of the left lobe, often coexists and tends to parallel the size of the spleen. 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. Hyperreactive malaria splenomegaly is only found in malaria endemic areas [ 9 ].
Malaria in Sudan is endemic and characterized by seasonal transmission in most parts of the country [ 10 ]. 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. This study aims to elucidate the prevalence and immunological characteristics of HMS in Sudanese patients.
The unusual immunological features of HMS, as described earlier, might contribute to our understanding of the mechanisms involved in pathogenicity and immunity to malaria.
Methods 2. Study Design A cross-sectional study was carried out from January to December All patients patients presented to the outpatient clinic with enlarge spleen were included in the study. Ethical approval of this study was obtained from the ethical committee at the Institute of Endemic Diseases, University of Khartoum. Informed consent was obtained from all adults and in case of children from their parents or guardians.
Patients with severe diseases were excluded from this study. 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.
Finally, the form included history of malaria in terms of number of attacks during the year, last clinical attack, and treatment received that was compiled for each patient. Total and differential white cell counts were carried out for all patients to exclude leukemia. Urine and stool samples were examined to exclude schistosomiasis brucellosis using the Widal test kit Hansard Diagnostic Limited, UK.
Furthermore, the immunological parameters in established HMS were measured and compared with mild malaria patients and control groups. Sera from 33 patients with parasitologically confirmed mild malaria from highly endemic areas in central Sudan were used as positive controls for immunological assays. Patients were interviewed, and a full clinical history was obtained using specially designed forms which included the name, sex, age, tribe, and address. All cases with HMS were treated with chloroquine mg weekly, in accordance with local treatment protocol, and they were instructed to report to the study team at the hospital for followup once a month for 3 months.
Blood Sampling Ten mL of peripheral blood was collected from each patient by venipuncture into EDTA vacutainers; blood samples were collected into plain sterile containers to separate serum within 12 h of collection.
Films were considered negative after examination of oil fields without detection of malaria parasites. Ten mL of peripheral blood was collected from each patient by venipuncture into EDTA vacutainers; blood samples were collected into plain sterile containers to separate serum within 12 h of collection. Polymerase Chain Reaction PCR PCR analysis was carried out on samples collected from all patients for detection of malaria parasites; the primers specific for the polymorphic regions block 2 of merozoite surface protein 1 MSP1 and block 3 of MSP2 were designed and described previously.
The two genes were amplified using nested PCR. An initial amplification of the outer regions of the two genes was followed by a nested PCR with allelic family specific primer pairs [ 13 ].
Serum samples from 31 healthy Sudanese donors were included as controls in the analysis. This antigen was synthesized according to protocol established by [ 15 , 16 ]. The peptide was conjugated with bovine serum albumin BSA. Cutoff was determined as the mean plus 2 standard deviations of the optical density OD values obtained with sera from 10 European donors with no history of malaria exposure. Thirty-three sera from parasitologically confirmed P.
Treatment All patients with HMS were treated with chloroquine mg weekly in accordance with the standard treatment protocol and were instructed to report to the study team at the health centers for followup once a month for 3 consecutive months.
Statistical Analysis Data entries were performed using the Excel program. The PASW All statistical tests were two-sided; a level of was used to indicate statistical significance. Results 3. HMS Patients The age of patients ranged from 10 to 70 years; mean age was years. During the study period, 31 out of 9. The clinical, haematological, and immunological characteristics of the patients are shown in Table 1. The mean spleen size was.
The mean liver size was. The mean Hb level was. The WBC count was.
Hyperreactive Malarial Splenomegaly Syndrome—Can the Diagnostic Criteria Be Improved?
Abstract 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. 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. 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.
Immunological Characteristics of Hyperreactive Malarial Splenomegaly Syndrome in Sudanese Patients
Received Dec 29; Accepted Apr This article has been cited by other articles in PMC. Abstract Background The hyper-reactive malarial splenomegaly syndrome HMS is a leading cause of massive splenomegaly in malaria-endemic countries. HMS is caused by a chronic antigenic stimulation derived from the malaria parasite.
Tropical splenomegaly syndrome
Elhassan,1 and Ibrahim M. This study was carried out in Khartoum, Sudan. Sudan is considered to be one of the countries where HMS is quite prevalent. The objective of the study was to determine the incidence of HMS in patients who reported to the Omdurman Tropical Diseases Hospital OMTDH in Sudan and to investigate the basic laboratory and immunological characteristics of this condition in these patients. A cross-sectional study was carried out in OMTDH, and all patients with enlarged spleens were included in the study. Thirty-one out of 9.