Hyperreactive malarious splenomegaly (tropical splenomegaly syndrome)

Hyperreactive malarious splenomegaly (HMS), formerly known as tropical splenomegaly syndrome (TSS), was recognized some 20 years ago as an entity distinct from the splenic enlargement resulting directly from malarial parasitaemia. Its basis appears to be a disturbance in the T-lymphocyte control of the humoral response to recurrent malaria, possibly linked to particular HLA Class II antigens. Gross overproduction of IgM antibodies leads to the formation of high molecular weight immune complexes, persistent gross splenomegaly recurrent episodes of profound anaemia and increased susceptibility to infections. Those with gross disease experience a high mortality, which constitutes a major public health problem in communities where the syndrome affects a majority of adults.     

Immunological studies in tropical splenomegaly syndrome in Uganda

An immunological evaluation carried out in eight patients with the tropical splenomegaly syndrome showed no evidence of impairment in cellular or humoral immunity, though raised levels of macroglobulins were noted in four patients. Hence gross immunological deficiency cannot be associated with the intense lymphoreticular proliferation observed in this disorder.     

The clinical diagnosis of splenomegaly.

Assessing for the presence of splenomegaly is an important component of the physical examination. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. We review the literature comparing various physical examination techniques with noninvasive imaging modalities and conclude that palpation and percussion of the spleen are complementary but frequently insensitive and that further studies are needed to evaluate the efficacy of specific diagnostic methods.     

Tropical ulcers.

We present 87 cases of chronic leg ulcers. The ages and sexes of the patients, and the symptomatology and complications, are described. The term "tropical ulcer" is inappropriate for these cases--though the term may be appropriate for certain rare acute ulcers colonized by Vincent's bacilli. For most persistent leg ulcers in the tropics, however, a general term of chronic ulcer is better--because it stimulates one to look for the cause and to treat the patient accordingly.