Relapses after Withdrawal of Proguanil Treatment in Tropical Splenomegaly Syndrome

After the remission of symptoms and reduction in spleen size while on proguanil therapy four patients with the tropical splenomegaly syndrome defaulted from treatment. The withdrawal of proguanil caused a recrudescence of original symptoms, splenomegaly, and a return of the initially raised serum IgM. Complete return to normal values was again effected with proguanil therapy.The role of the spleen in the tropical splenomegaly syndrome in the production of the raised serum IgM is discussed. These patients should be educated as to the nature of their disease and the importance of continued medical treatment.     

Idiopathic Tropical Splenomegaly Syndrome in Ibadan

Follow-up of 33 patients with idiopathic splenomegaly, 25 for a period ranging from 14 to 80 months after starting treatment with proguanil 100 mg. daily, showed that there was an excellent response of the splenomegaly, anaemia, and hepatomegaly, together with a definite gain in weight. Every patient improved, though a maximum result was not attained until after at least one year''s treatment.Therapy with proguanil is considered superior to and safer than splenectomy. Malaria seems unlikely to have a causal role in the aetiology of the disease, which is probably a manifestation of a disorder of the normal immune mechanism. Idiopathic splenomegaly has a close relation with the type of chronic lymphatic leukaemia seen in Nigeria, and it is possible that the two diseases have a similar aetiological factor.     

Clinical Trial of Malaria Prophylaxis in Tropical Splenomegaly Syndrome

A controlled, randomized, double-blind trial of malaria prophylaxis in tropical splenomegaly syndrome showed a significant reduction in spleen size and an improvement of anaemia and symptoms in patients treated with antimalarials compared with control subjects receiving placebo. This study confirms the observations from West Africa and provides further indirect evidence for a malarial aetiology of tropical splenomegaly syndrome.     

Tropical Splenomegaly Syndrome in a Rwandan Kindred in Uganda

Twenty members of an immigrant Rwandan kindred were all found to have tropical splenomegaly syndrome compared with 29 out of 50 matched neighbour controls. Splenomegaly among the controls tended to cluster within families. IgM levels were significantly raised in the kindred compared with the control subjects without splenomegaly but were similar to those of neighbours with splenic enlargement. We advance a hypothesis that tropical splenomegaly syndrome results from the production of circulating immune complexes in individuals genetically predisposed to produce an IgM antibody response.     

Observations on Trichomonas vaginalis infections in Zambia

Microscopy and culture of high vaginal swabs from an ante-natal clinic showed that 38.5% of the women harboured Trichomonas vaginalis; the corresponding figure from a gynaecology clinic was 31.4%. The incorporation of the culture method together with direct microscopy as a diagnostic technique in a routine laboratory is emphasized. Urine microscopy in out-patients, in-patients and medical examinees indicates that T. vaginalis in both males and females is not a rare infestation but the prevalence rate of 4.8% in males is considered an underestimate. Asymptomatic and symptomatic trichomoniasis was evident during the study. The age group in which the infection is most common is noted; this evidence suggests that venereal transmission need not be the only source of infection. The role of urinary schistosomiasis as a possible cause of urethritis is discussed.     

Further Observations on the Pathogenesis of Acne

The composition of the lipid of the forehead skin surface and the sebum excretion rate were determined in 217 subjects and controls. Acne was associated with an increase in serum excretion rate and in the squalene and wax and sterol esters in surface lipid. The changes in sebum excretion rate and squalene were statistically significant only in women, but acne in men was associated with a significant decrease in the free fatty acid content or surface lipid.The increased amounts of squalene and wax esters may lead to pilosebaceous obstruction in acne subjects. The increased sebum excretion rate in acne may ensure increased production of sebaceous triglyceride substrate available for lipolysis to irritant free fatty acids, which may then mediate the inflammatory changes of acne.