Reduction of spleen size in a child with Hyperreactive Malarious Splenomegaly (HMS) treated outside the Brazilian endemic area of malaria with only one course of quinine

Muniz-Junqueira, Maria Imaculada; Moraes, Mário A. P.; Marsden, Philip Davis

doi:10.1590/S0037-86821992000400008

Abstracts

We report the clinical picture, treatment and evolution of a child with hyperreactive malarious splenomegaly treated outside the endemic area of malaria. The patient presented gross splenomegaly, proceeded from an area where malaria is endemic, showed increased immunoglobulins levels, high antimalarial antibody titres and hepatic sinusoidal lymphocytosis. The child did not return to an area where malaria is endemic and showed a favorable response to only one course of quinine. The response of this patient to limited antimalarial therapy suggests the importance of reinfection with malaria in the development and maintenance of this syndrome.

Hyperreactive malarious splenomegaly (HMS); Chronic malaria; Short antimalarial therapy

Relatamos o caso clínico, tratamento e evolução de uma criança com a síndrome da esplenomegalia hiperreativa da malária tratada fora da área endêmica para a malária. A criança apresentava importante esplenomegalia, era procedente de área endêmica para malária, os níveis de imunoglobulinas e de anticorpos antimaláricos estavam elevados e observou-se linfocitose sinusoidal hepática. A criança não voltaria mais para a área endêmica de malária, pelo que foi tratada com apenas um curso de quinino apresentando resposta clínica favorável. Esta resposta a um único curso de terapia curativa antimalárica sugere a importância da reinfecção com o parasitada malária no desenvolvimento e na manutenção desta síndrome.

Esplenomegalia hiperreativa da malária; Malária crônica; Tratamento curativo antimalárico

CASE REPORT

Reduction of spleen size in a child with Hyperreactive Malarious Splenomegaly (HMS) treated outside the Brazilian endemic area of malaria with only one course of quinine

Maria Imaculada Muniz-Junqueira; Mário A. P. Moraes; Philip Davis Marsden

^{Adress to correspondence} Adress to correspondence: Dra. Maria Imaculada Muniz- Junqueira Depto de Pediatria Faculdade de Ciências da Saúde/UnB 70910-900 Brasilia, DF, Brasil.

ABSTRACT

We report the clinical picture, treatment and evolution of a child with hyperreactive malarious splenomegaly treated outside the endemic area of malaria. The patient presented gross splenomegaly, proceeded from an area where malaria is endemic, showed increased immunoglobulins levels, high antimalarial antibody titres and hepatic sinusoidal lymphocytosis. The child did not return to an area where malaria is endemic and showed a favorable response to only one course of quinine. The response of this patient to limited antimalarial therapy suggests the importance of reinfection with malaria in the development and maintenance of this syndrome.

Keywords: Hyperreactive malarious splenomegaly (HMS). Chronic malaria. Short antimalarial therapy.

RESUMO

Relatamos o caso clínico, tratamento e evolução de uma criança com a síndrome da esplenomegalia hiperreativa da malária tratada fora da área endêmica para a malária. A criança apresentava importante esplenomegalia, era procedente de área endêmica para malária, os níveis de imunoglobulinas e de anticorpos antimaláricos estavam elevados e observou-se linfocitose sinusoidal hepática. A criança não voltaria mais para a área endêmica de malária, pelo que foi tratada com apenas um curso de quinino apresentando resposta clínica favorável. Esta resposta a um único curso de terapia curativa antimalárica sugere a importância da reinfecção com o parasitada malária no desenvolvimento e na manutenção desta síndrome.

Palavras-chave: Esplenomegalia hiperreativa da malária. Malária crônica. Tratamento curativo antimalárico.

Full text available only in PDF format.

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Recebido para publicação em 09/04/92.

Departamento de Pediatria, de Patologia e de Clínica Médica, da Faculdade de Ciências da Saúde da Universidade de Brasília, Brasília, DF, Brasil.

1. Alecrim WD, Alecrim MG, Albuquerque BC, McNeill M, Dourado H, Prata A, Marsden PD. Esplenomegalia tropical no Rio Ituxi, Amazonas, Brasil. Revista do Instituto de Medicina Tropical de São Paulo 24 (supl):54-57, 1982.
2. Baruzzi RG, Franco LJ, Jardim JR, Masuda A, Naspitz C, Paiva ER, Ferreira-Novo N. The association between splenomegaly and malaria in Indians from the Alto Xingu, Central Brasil. Revista do Instituto de Medicina Tropical de São Paulo 18:322-348, 1976.
3. Crane GG. Hyperreactive malarious splenomegaly (Tropical Splenomegaly Syndrome). Parasitology Today 2:4-9, 1986.
4. Crane GG, Pitney WR, Hobbs JR and Gunn C. Immunoglobulins levels in the Kaiapit and Upper Watut areas of New Guinea with special reference to thetropical splenomegaly syndrome. Transactions of the Royal Society of Tropical Medicine and Hygiene 65:795-807, 1971.
5. Crane GG, Pryor DS,, Vivian Wells J. Tropical splenomegaly syndrome in New Guinea II. Long term results of splenectomy. Transactions of the Royal Society of Tropical Medicine and Hygiene 66:733-742, 1972.
6. Greenwood BM. Asymptomatic malaria infections - Do they matter? Parasitology Today 3:206-214, 1987.
7. Marsden PD. Chronic malaria and Brazil. Revista da Sociedade Brasileira de Medicina Tropical 23:193- 196, 1990.
8. Marsden PD, Connor DH, Voller A, Kelly A, Schofield FD, Hutt MSR. Splenomegaly in New Guinea. Bulletin of the World Health Organization 36:901-911, 1967.
9. Marsden PD, Crane GG. Thetropical splenomegaly. A current appraisal. Revistado Instituto de Medicina Tropical de São Paulo 18:54-70, 1976.
10. Marsden PD, Hamilton PJS. Splenomegaly in the tropics. British Medical Journal 1:99-102, 1969.
11. Marsden PD, Hutt MSR, Wilk NE, Voller A, Blackman V, Shah KK, Connor DH, Hamilton PJS, Banwell JG and Lunn HF. An investigation of tropical splenomegaly at Mulago hospital, Kampala, Uganda. British Medical Journal 1:89-92, 1965.
12. Sagoe AS. Tropical splenomegaly syndrome: longterm proguanil therapy correlated with spleen size, serum IgM, and lymphocyte transformation. British Medical Journal 3:378-382, 1970.
13. Stuiver PC, Ziegler JL, Wood JB, Morrow RH, Hutt MSR, Clinical trial of malaria prophylaxis in tropical splenomegaly syndrome. British Medical Journal 1:426-429, 1971.
14. Vanier TM, Hutt MSR, Cook GC. Childhood splenomegaly in Uganda, and its relation to malaria. British Medical Journal 2:649-653, 1968.
15. Watson-Williams EJ, Allan NC. Idiopathic tropical splenomegaly syndrome in Ibadan. British Medical Journal 4:793-796, 1968.

Adress to correspondence:

Dra. Maria Imaculada Muniz- Junqueira

Depto de Pediatria

Faculdade de Ciências da Saúde/UnB

70910-900

Brasilia, DF, Brasil.

Publication Dates

Publication in this collection
19 Apr 2013
Date of issue
Dec 1992

History

Received
09 Apr 1992
Accepted
09 Apr 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alecrim WD, Alecrim MG, Albuquerque BC, McNeill M, Dourado H, Prata A, Marsden PD. Esplenomegalia tropical no Rio Ituxi, Amazonas, Brasil. Revista do Instituto de Medicina Tropical de São Paulo 24 (supl):54-57, 1982.

[2] 2. Baruzzi RG, Franco LJ, Jardim JR, Masuda A, Naspitz C, Paiva ER, Ferreira-Novo N. The association between splenomegaly and malaria in Indians from the Alto Xingu, Central Brasil. Revista do Instituto de Medicina Tropical de São Paulo 18:322-348, 1976.

[3] 3. Crane GG. Hyperreactive malarious splenomegaly (Tropical Splenomegaly Syndrome). Parasitology Today 2:4-9, 1986.

[4] 4. Crane GG, Pitney WR, Hobbs JR and Gunn C. Immunoglobulins levels in the Kaiapit and Upper Watut areas of New Guinea with special reference to thetropical splenomegaly syndrome. Transactions of the Royal Society of Tropical Medicine and Hygiene 65:795-807, 1971.

[5] 5. Crane GG, Pryor DS,, Vivian Wells J. Tropical splenomegaly syndrome in New Guinea II. Long term results of splenectomy. Transactions of the Royal Society of Tropical Medicine and Hygiene 66:733-742, 1972.

[6] 6. Greenwood BM. Asymptomatic malaria infections - Do they matter? Parasitology Today 3:206-214, 1987.

[7] 7. Marsden PD. Chronic malaria and Brazil. Revista da Sociedade Brasileira de Medicina Tropical 23:193- 196, 1990.

[8] 8. Marsden PD, Connor DH, Voller A, Kelly A, Schofield FD, Hutt MSR. Splenomegaly in New Guinea. Bulletin of the World Health Organization 36:901-911, 1967.

[9] 9. Marsden PD, Crane GG. Thetropical splenomegaly. A current appraisal. Revistado Instituto de Medicina Tropical de São Paulo 18:54-70, 1976.

[10] 10. Marsden PD, Hamilton PJS. Splenomegaly in the tropics. British Medical Journal 1:99-102, 1969.

[11] 11. Marsden PD, Hutt MSR, Wilk NE, Voller A, Blackman V, Shah KK, Connor DH, Hamilton PJS, Banwell JG and Lunn HF. An investigation of tropical splenomegaly at Mulago hospital, Kampala, Uganda. British Medical Journal 1:89-92, 1965.

[12] 12. Sagoe AS. Tropical splenomegaly syndrome: longterm proguanil therapy correlated with spleen size, serum IgM, and lymphocyte transformation. British Medical Journal 3:378-382, 1970.

[13] 13. Stuiver PC, Ziegler JL, Wood JB, Morrow RH, Hutt MSR, Clinical trial of malaria prophylaxis in tropical splenomegaly syndrome. British Medical Journal 1:426-429, 1971.

[14] 14. Vanier TM, Hutt MSR, Cook GC. Childhood splenomegaly in Uganda, and its relation to malaria. British Medical Journal 2:649-653, 1968.

[15] 15. Watson-Williams EJ, Allan NC. Idiopathic tropical splenomegaly syndrome in Ibadan. British Medical Journal 4:793-796, 1968.