HYPERREACTIVE MALARIA

SPLENOMEGALY
Definition and Epidemiology
Dr Kaudha Elizabeth
 Definition

• Massive Splenomegaly: Splenomegaly > or equal to

10cm below the costal margin in the mid clavicular line.

• Hyperreactive malaria splenomegaly is massive

enlargement of the spleen resulting from abnormal
immune response to repeated attacks of malaria.

• It is not species specific and was formerly called

Tropical Splenomegaly Syndrome.
 Epidemiology
• Internationally: It is restricted to natives and visitors of
the malaria belt.

• Exact and accurate assessment of the incidence of HMS

is difficult because of the prevalence of numerous
conditions that co-exist in areas with endemic malaria
and can cause splenomegaly and similar symptoms.

• Sex : More common in female ( Bedu – addo et al

2004)

• Age ; Un common in children less than 8 years,

Malaria distribution
 Mortality and Morbidity
• HMS is associated with a high mortality
rate;however its natural history is not well
documented.

• Overwhelming infections ( Skin and

respiratory infections ) are the leading
causes of death
 Risk Factors
• Genetic susceptibility
• There was significant association between
Human Leucocyte Antigen class II antigen DR2
and the severity of HMS ( Bhatia and Crane et al 1985)

• In a Rwandan immigrant family in UG, 20

relatives of an HMS pt were all found to have
HMS compared with 29 out of 50 neighbour
Rwandan sex & age matched controls)
( Zieglar & stuiver ,1972)
 Risk Factors continued

• Tribal predilections : the incidence of

HMS in the Banyarwanda was higher than
in the Baganda) ( Hamilton et al 1965 )

• In Nigeria there is a predominance of HMS

in the Fulani tribe compared with the
Hausas (Bryceson et al,1976 )
 Risk Factors continued
• Familial tendency
• In a study to investigate familial
segregation of HMS in Ghana: relatives
with splenomegaly were identified for 27%
of HMS cases compared to 6.7% of
population controls) (Ruby Martin- Peprah et al,2005
• The spleen is the largest collection of
lymphoid tissue in the body. It is normally
palpable in preterm infants, in 30% of
normal, full-term neonates, and in 5% to
10% of infants and toddlers. A spleen
easily palpable below the costal margin in
any child over the age of 3-4 years should
be considered abnormal until proven
otherwise.