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Hyperreactive malaria in expatriates returning from sub-Saharan Africa
J Van den Ende1, A van Gompel, E van den Enden
1Institute of Tropical Medicine, Antwerp, Belgium; University Hospital Antwerp, Edegem, Belgium. JVDE@itg.be
Tropical Medicine & International Health : TM & IH
|October 24, 2000
Summary
Hyperreactive malarial splenomegaly syndrome (HMS) may present without gross splenomegaly. Patients with subacute symptoms show high IgM and antibodies, potentially relapsing upon re-exposure to malaria.
Area of Science:
- Immunology
- Tropical Medicine
- Parasitology
Background:
- Hyperreactive malarial splenomegaly syndrome (HMS) is an extreme manifestation of malaria.
- Less pronounced forms of the syndrome exist, prompting further investigation into their characteristics and relationship to immune response.
Purpose of the Study:
- To determine if splenomegaly degree correlates with immune stimulation.
- To investigate the roles of malaria prophylaxis and recent treatment.
- To assess the efficacy of short-term antimalarial therapy.
Main Methods:
- Retrospective analysis of medical records of expatriates exposed to P. falciparum (1986-1997).
- Evaluation of subacute symptoms, malarial antibodies, serum IgM levels, spleen size, and treatment response.
- Analysis of duration of stay and prophylaxis intake.
Main Results:
- Serum IgM levels were significantly higher in patients with larger spleens.
- Chloroquine monotherapy for malaria was associated with larger spleen size.
- Short, adequate antimalarial treatment led to significant improvement or full recovery.
- Recurrences of hyperreactive response were observed in nine patients upon re-exposure.
Conclusions:
- A variant of HMS without gross splenomegaly may exist, characterized by high IgM and antibody levels.
- Patients with subacute symptoms and high IgM may relapse upon re-exposure.
- Short antimalarial therapy is effective in managing HMS and its variants.