The Hyperreactive Malarial Splenomegaly Syndrome in a European: Has the Treatment a Modulatory Effect on the Immune System?

Abstract

Correspondence 157 species (table I)'. Serum (rose bengal-positive, Wright 1:160, immunofluorescence 1:160) and CSF (rose bengal-positive, immunofluorescence 1:64) Brucella serology were positive and the patient was treated with daily rifampin, 900 mg, plus doxycycline, 200 mg, for 8 weeks with complete recovery. Brucellosis and tuberculosis are still endemic in our country. When the central nervous system is involved, the clinical picture and CSF analysis (elevation of protein, decreased glucose, and lymphocytic pleocytosis) may appear similar [6]. Fortunately, CSF and blood serology in neurobrucellosis are rarely negative, especially when a complete battery of tests is available, such as rose bengal and Wright agglutination, Coombs' test, and indirect immunofluorescence (as is the case in our hospital) or ELISA [7]. However, in the absence of these examinations, a correct diagnosis may be difficult [8]. Increased (>9 units/l) ADA in CSF has been reported to have a sensitivity of 1 and specificity of O.99 in the diagnosis of tuberculous meningitis [9]. However, patients with neurobrucellosis were not included in the control groups. False-positive results have been reported in cases of purulent meningitis [9, 10], but that condition could hardly be confused with tuberculous meningitis. However,neurobrucellosis can easily be mistaken for tuberculous meningitis. On the basis of our data, we think that physicians in countries where brucellosis and tuberculosis are endemic should take care when interpreting increased ADA in CSF, at least until neurobrucellosis can be definitively excluded.

The hyper-reactive malarial splenomegaly: a systematic review of the literature

“…Chloroquine seems to still be partially effective, even if P. falciparum resistance has developed. Possibly this regimen acts not only as an anti-malarial, but also as an immunomodulating and immunosuppressant therapy [ 47 , 96 ], as it is suggested by the regression of the spleen size even in patients with lymphoproliferative disorders [ 60 ]. The choice of the drug should consider the local pattern of P. falciparum drug susceptibility, as well as the availability and cost of the different regimens.…”

Hyperreactive Malarial Splenomegaly Syndrome—Can the Diagnostic Criteria Be Improved?

“…The choice of drug may have been guided by the suggestion (from the early 1990s) that chloroquine has an immunological effect on HMSS in addition to its antimalarial properties. 6 Although historical reports have implicated chronic (as opposed to recurrent) malaria in many cases of HMSS, 7,8 the possibility of subclinical malarial infection was not appreciated in these cases and the diagnosis would have been impossible because of the lack, until recently, of a sensitive diagnostic tool.…”

Splénomégalie palustre hyper-réactive

“…Une équipe a proposé une explication au défaut de lymphocytes T suppresseurs par l'apparition d'autoanticorps dirigés contre ces cellules au cours de l'infection palustre [19][20][21].…”

“…En dehors des études réalisées en zones endémiques, la SPH est aussi décrite chez des patients originaires de zones endémiques expatriés en Occident [35,40,41] ainsi que chez des sujets européens ayant séjourné de faç on prolongée en région impaludée [10,16,21,35,[42][43][44][45].…”

“…L'utilisation prolongée de la chloroquine a été un temps préconi-sée dans le cadre de la SPH plus pour ses effets immunomodulateurs [21,63,64] que pour ses effets anti-parasitaires désormais réduits par la résistance à cette molécule.…”