Bisoffi Zeno, Leoni Stefania, Angheben Andrea, Beltrame Anna, Eseme Franklyn Esoka, Gobbi Federico, Lodesani Claudia, Marocco Stefania, Buonfrate Dora
Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, 37024, Negrar, Verona, Italy.
Ospedale Dell'Angelo, Via Don Federico Tosatto, 147, 30174, Venezia Mestre, Italy.
Malar J. 2016 Apr 21;15:230. doi: 10.1186/s12936-016-1274-x.
Chronic malaria is usually defined as a long-term malarial infection in semi-immune subjects, usually without fever or other acute symptoms. The untreated infection may evolve to hyper-reactive malarial splenomegaly (HMS), a life-threatening complication. This paper describes the largest series of HMS ever observed outside endemic countries, and the clinical outcome after a single anti-malarial treatment. Contrarily to most authors, still reporting the traditional, long-term treatment, regardless possible further exposure, the patients in this series did not receive any further prophylaxis if they were not re-exposed to malaria infection.
A retrospective, longitudinal study, describing all patients with HMS diagnosed at the Centre for Tropical Diseases of Negrar, Verona, took place over a 25-year period. HMS was defined by a longitudinal spleen diameter ≥16 cm, IgM ≥ 2.5 g/L, anti-malarial antibody titre ≥160, exclusion of other causes of splenomegaly. The short-term (≤6 months) clinical outcome after a single anti-malarial treatment was analysed and so was the long-term outcome of subjects re-exposed to malaria and submitted or not to anti-malarial prophylaxis or intermittent treatment. The association of the outcome with the main independent variables was first assessed with univariate analysis. Logistic regression was also performed.
Forty-four subjects with HMS were retrieved. Of those with a short-term follow-up visit (<6 months, median 43 days) available before returning to endemic areas, 20/22 resulted improved/cured, two were unchanged. Of 22 expatriates seen at long-term follow-up after re-exposure, 18 were improved/cured, including eight out of nine who had followed an anti-malarial prophylaxis and 10/13 who had opted for the alternative of an intermittent treatment.
HMS is the most severe form of chronic malaria. A single anti-malarial treatment is probably adequate to treat HMS in the absence of re-exposure, while an adequate prophylaxis is necessary for patients exposed again to malaria transmission. Intermittent treatment would probably be the only viable approach in endemic countries.
慢性疟疾通常被定义为半免疫人群中的长期疟疾感染，通常无发热或其他急性症状。未经治疗的感染可能会发展为高反应性疟疾脾肿大（HMS），这是一种危及生命的并发症。本文描述了在非流行国家观察到的最大规模的HMS病例系列，以及单次抗疟疾治疗后的临床结果。与大多数仍报告传统长期治疗方法（而不考虑可能的再次暴露）的作者相反，本系列中的患者如果未再次暴露于疟疾感染，则未接受任何进一步的预防措施。
一项回顾性纵向研究，描述了在维罗纳内格拉尔热带病中心诊断出的所有HMS患者，研究历时25年。HMS的定义为脾脏纵向直径≥16厘米、IgM≥2.5克/升、抗疟疾抗体滴度≥160，排除其他脾肿大原因。分析了单次抗疟疾治疗后的短期（≤6个月）临床结果，以及再次暴露于疟疾且接受或未接受抗疟疾预防或间歇治疗的受试者的长期结果。首先通过单变量分析评估结果与主要独立变量的关联。还进行了逻辑回归分析。
共检索到44例HMS患者。在返回流行地区之前有短期随访（<6个月，中位43天）的患者中，20/22例病情改善/治愈，2例无变化。在再次暴露后进行长期随访的22名 expatriates 中，18例病情改善/治愈，其中包括9名接受抗疟疾预防措施的患者中的8例，以及选择间歇治疗的13名患者中的10例。
HMS是慢性疟疾最严重的形式。在无再次暴露的情况下，单次抗疟疾治疗可能足以治疗HMS，而对于再次暴露于疟疾传播的患者，适当的预防措施是必要的。在流行国家，间歇治疗可能是唯一可行的方法。
