Tropical Splenomegaly-Marsden et al.MEDICALJOURNAL falciparum in the peripheral blood of these patients is note- worthy in view of the frequency with which this parasite is encountered in blood-film surveys in Uganda.Clinically these patients do not show any specific diagnostic features apart from marked splenomegaly and a lesser degree of hepatomegaly with evidence of secondary hypersplenism and a short red-cell life.Holzbach et al. (1964) have shown that increased red-cell sequestration in the spleen correlates with an increase in splenic size regardless of the underlying cause of the splenomegaly.The association of haemolytic anaemia in preg- nancy with splenomegaly, hepatic sinusoidal changes, and a raised malarial antibody titre has also been noted at Mulago (Gebbie et al., 1965, in preparation).Finally, it must be men- tioned that the specificity of the malaria antibody test used here is still not precisely delineated.Also the scanty P. malariae parasitaemia could be a result rather than the cause of this marked splenomegaly. SummaryPatients with large spleens are common in the wards at Mulago Hospital, 64 being investigated in a period of eight months.Like previous workers, we could find no cause for many of the enlarged spleens.An unusual liver-biopsy appear- ance with sinusoidal infiltrates of lymphocytes and plasma cells was noted in many of the patients in the " idiopathic " group.Most of these patients were anaemic, and Leather's finding of an increased intrasplenic pressure mi such cases was confirmed.In a group of patients with sinusoidal infiltrates P. malariae trophozoites were found in the peripheral blood of 45 % of patients after a prolonged search and malarial antibody titres were elevated when compared with control groups.There is therefore a suggestion that P. malariae is implicated in a number of such cases in Uganda, and also that the liver biopsy may be helpful in the diagnosis of this syndrome.The relation- ship between splenomegaly, these hepatic findings, and infection with quartan malaria requires further study.ADDENDUM.-Since this paper was written eight rhesus monkeys with chronic malarial infections of one to ten years' duration have had liver biopsy specimens examined.These represented simian infections of quartan and vivax types.Only one showed histological changes resembling those described in this paper.This monkey had had the infection for the longest time-namely, 10 years-with Plasmodium inui.Studies on monkeys with long-standing infections are being continued.We are grateful to the physicians, surgeons, and obstetricians at Mulago Hospital for access to patients and general co-operation; also to Mr. R. Tunnicliffe for the photomicrographs.Financial
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Sereny et al. (1965) studied this question.