Tropical Splenomegaly Syndrome Treatment & Management

Updated: Oct 16, 2023
  • Author: Mundeep K Kainth, DO, MPH, FAAP; Chief Editor: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK)  more...
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Medical Care

Therapy is based on the use of antimalarial drugs. A literature review by Leoni et al indicated that a short therapy course is sufficient treatment for HMS in patients who, after exposure to malaria parasites, do not revisit areas where malaria is endemic. In such patients, according to the study, elimination of the infection effectively cures the splenomegaly. The investigators, who drew data from 89 papers, asserted that patients who continue to be exposed to malaria-endemic regions require intermittent therapy or possibly lifelong treatment. [34]  Addition of doxyxline to the antimalarial may be of benefit; Genderini et al administered dihydroartemisinin/piperaquine (320/40 mg three tablets/day for 3 days) with doxycycline 200 mg to a patient once a day for 6 weeks, with complete resolution of HMS. [33]  

A retrospective, longitudinal study by Bisoffi et al indicated that patients with early HMS should receive the same treatment as patients with the full-blown syndrome, since early HMS predisposes patients to the more advanced condition. The study found that among patients with early HMS, reexposure to malaria is a major risk factor for progression and stated that, while a single antimalarial treatment will probably prove adequate against early HMS, antimalarial prophylaxis should subsequently be used in reexposed patients. [35]


Surgical Care

Splenectomy plays no role in the treatment of hyperreactive malarial splenomegaly (HMS) and should be avoided, as it can result in fulminant and overwhelming infections with high mortality.



Appropriate consultation with oncologists and metabolic and infectious disease specialists may be sought to rule out diseases that mimic hyperreactive malarial splenomegaly (HMS).



Activity is permitted, as tolerated by the patient. A patient's activity may be limited because of severe anemia or the pressure effects of massive splenomegaly.



In regions where malaria is endemic, travelers should take precautions to prevent mosquito exposure and the development of malaria, including the following:

  • Wearing long-sleeved clothing and pants tucked into socks
  • Using N,N-diethyl-meta-toluamide (DEET) spray 25-35%
  • Using bed nets
  • Using antimalarial medications for chemoprophylaxis

For local inhabitants of endemic areas, the mosquito population can be reduced by eliminating standing water and using insecticide near the home. The local population should also follow the travelers' precautions listed above.