An Investigation of Tropical Splenomegaly at Mulago Hospital, Kampala, Uganda

Abstract

Idiopathic, cryptogenic, or tropical splenomegaly, as it is variously termed, is often encountered at the Mulago Hospital in Kampala. Trowell (1950) reported several cases in which no good reason could be found for gross splenomegaly, and discussed the current theories of aetiology. Leather (1961) made the important observation that many cases had a mild portal hypertension in the absence of any evidence of cirrhosis on liver biopsy. Of the 41 cases he investigated 29 showed sinusoidal infiltrates by lymphocytes, histiocytes, and plasma cells, an appearance that had been noted elsewhere in the tropics by Fawdry (1955) from Aden, and by Chaudhuri et al. (1956) from India.The present report describes a series of cases of marked splenomegaly admitted to the New Mulago Hospital, Kampala, in which combined clinical, haematological, parasitological, and pathological investigations were carried out to assess the cause and effect of the large spleens. Materials and MethodsOver a period of eight months 64 patients with marked splenomegaly were investigated in the New Mulago Hospital, Kampala.Routine haematological investigations were prepared by standard techniques (Dacie, 1956). In five patients the red-cell survival and splenic uptake were estimated, using 5Cr-tagged red cells (Mollison and Veall, 1955), and the sites of red-cell destruction were assessed by the method of Hughes Jones and Szur (1957 BudtzOlsen, 1952;Atkinson and Sherlock, 1954). Splenic puncture specimens were examined for malaria parasites and leishmaniae. Initially, random peripheral thick blood was examined for malaria parasites and trypanosomes, but in the latter part of the study a minimum of 10 consecutive daily blood films were examined for malaria parasites by two observers.Stools were examined by the formol-ether-concentration technique (Ridley and Hawgood, 1956) for ova, cysts, and parasites. Rectal snips were examined for schistosome ova.Sera from 40 patients were examined by a fluorescent antibody technique (Voller, 1964) for the presence of malarial antibodies. Control sera from patients without splenomegaly were also examined. The antigen used was Plasmodium bastianellii.

Haematological Effects of the Idiopathic Splenomegaly Seen in Uganda

“…The patients with splenoniegaly that have been invegtigated seenied to be typical of those already described from Uganda (Marsden et al, 1965), and from soirie other parts of the tropics (Fawdry, 1955 ;Chaudhuri, Saha, Basu, Mukherjee and Chaudhuri, 1956) in that the main fuiding was hepatic sinusoidal infiltration with lymphocytes; this histological change in liver biopsies was present in all but two patients. Care was taken to exclude the known causes of splenic enlargement; in particular none of the patients appeared to have hepatic cirrhosis, a haemoglobinopathy or bilharzia.…”

A Comparative Study of Hypersplenism in Reactive and Congestive Splenomegaly

“…It is equally possible that thc diffcrence detected rcflects greater lymphocytc production in patients with reactive splenomcgaly which in this series was attributed to idiopathic tropical splenomcgaly. If, as has been postulated, idiopathic tropical splcnomegaly reflects an abnormal immune response to malaria (Marsden et al, 1965), increased production of lyniphocytcs could occur. In support of this contcntion, 48% of our patients with idiopathic tropical splenomegaly had, on somc occasion, a lymphocyte count of greater than 3000/pl comparcd with only 14% of those with congestivc splcnonicgaly ; lymphocytic proliferation is histologically pronounced both in the liver (Marsden t t al, 1965) and splecn (Paliwoda & Hutt, 1968)…”

“…Rcactive splenoriiegaly was due in two patients to visceral leishmaniasis, the parasites being demonstrated in the splenic aspirate. The remaining 27 patients had idiopathic tropical splenomegaly (Pitney, 1968); tlic diagnosis was made largely by a process of exclusion supported in most instances by the characteristic liver histology (Marsden et al, 1965). In addition to the investigation5 already indicated, the pcriyheral blood and in some instances tlic bone marrow was examincd, and agglutination tests to detect brucellosis were carried out.…”

Cold Haemagglutinins Associated with Splenomegaly in New Guinea

“…Massive splenomegaly of uncertain cause has been reported from Northern Africa, Uganda and the Sudan, as well as from New Guinea [4,9,11]. It occurs in regions where malaria is endemic, but not in malaria-free areas in the same country [7].…”