Tropical Splenomegaly Syndrome Follow-up

  • Author: Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP; Chief Editor: Robert J Arceci, MD, PhD   more...
 
Updated: May 9, 2012
 

Further Inpatient Care

  • Because of the extended length of treatment often needed, monitoring for adverse effects is crucial.
  • Splenectomy is contraindicated, because of increased infection-associated mortality. However, if the patient's spleen was previously removed, guidelines for the care of asplenic patients should be followed (see Asplenia). Guidelines include the following:
    • Antibiotic prophylaxis
    • Education
    • Aggressive management of suspected episodes of fever
    • Appropriate immunizations
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Further Outpatient Care

  • Regular visits are essential to monitor the patient's clinical improvement and to document decreases in splenomegaly.
  • If chloroquine is used, monitor the patient for ophthalmologic effects with slit lamp, funduscopic, and visual field examinations.
  • At regular intervals, perform cardiovascular monitoring with ECG and echocardiography, along with other tests as indicated.
  • Further workup may be indicated to look for myopathy and peripheral neuritis.
  • Liver function tests may be performed regularly if the patient is receiving proguanil.
  • Resolution of splenomegaly is accompanied by an improvement of pancytopenia.
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Inpatient & Outpatient Medications

  • Antimalarials are the mainstays of treatment (see Medication). These drugs often need to be continued long-term (months to years). However, the exact length of treatment has not been ascertained.
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Transfer

  • Depending on the facilities available at the hospital, indications for transfer may be few. Medication can easily be started after the diagnosis is established.
  • Supportive care, including blood transfusions and antibiotic therapy if indicated, is now commonplace in most hospitals.
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Deterrence/Prevention

  • For travelers to endemic areas, antimalarial prophylaxis is essential to minimize the risk of hyperreactive malarial syndrome (HMS).
  • Prophylaxis for residents of endemic areas is controversial and has not been shown to prevent HMS.
  • A study in Africa determined that the RTS,S/AS02D malaria vaccine was safe, well tolerated, and immunogenic in young infants.[25]
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Complications

  • Complications include infections that may be serious and that may result in death.
  • Trapping of hematopoietic elements in the enlarged spleen may cause thrombocytopenia, anemia, and neutropenia, with resultant problems.
  • A predisposition to develop malignancy remains unproven.
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Prognosis

  • HMS is a chronic disease that can be fatal because of infections and bleeding complications.
  • Appropriate treatment with antimalarial medications can result in a good outcome.
  • Splenectomy should be avoided because it increases the risk of fulminant infections.
  • The risk of malignancy is ill defined.
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Patient Education

  • The importance of antimalarial prophylaxis during visits to endemic areas should be emphasized to travelers.
  • Symptoms should be promptly attended to and evaluated, even if they occur in travelers who received prophylaxis and even if they appear months after they left the endemic area.
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Contributor Information and Disclosures
Author

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP  Associate Professor of Pediatric Hematology and Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Coauthor(s)

Mundeep K Kainth, DO  Resident Physician, Department of Pediatrics, The Children's Hospital at Albany Medical Center

Mundeep K Kainth, DO is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

J Martin Johnston, MD  Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Hematology/Oncology, The Children's Hospital at Memorial University Medical Center; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital

J Martin Johnston, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD  Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society

Disclosure: Nothing to disclose.

Helen SI Chan, MBBS, FRCP(C), FAAP  Associate Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto Faculty of Medicine, Canada

Helen SI Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD  King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Mudra Kumar, MD, MBBS, to the original writing and development of this article.

References

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Young patient with hepatomegaly and massive splenomegaly.
 
 
 
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