MedicalResearch.com Interview with:
Dr. Matt Goers
Internal Medicine Resident at UMN
MedicalResearch.com: What is the background for this report? What are the main findings of the evaluations of refugee populations in western Uganda?
Response: In 2014, International Organization of Migration (IOM) reported an unusually high number of Congolese refugees in western Uganda had palpable, enlarged spleens detected during their routine refugee pre-departure medical examinations. Due to this trend, the IOM, with the assistance of the Centers for Disease Control and Prevention (CDC), implemented a diagnostic and treatment protocol to further evaluate and assist with management of refugees with splenomegaly during their pre-departure medical examinations.
In March and June 2015, a total of 987 U.S.-bound refugees underwent medical examinations performed as part of their routine resettlement process. Of those evaluated, 145 (14.7%) had a detectable spleen on physical examination. In fact, 84.7% (122 people) were found to have marked or massive splenomegaly during their evaluation (classified based on a prior World Health Organization ultrasonography protocol). During the work-up for this condition, less than 33% were found to have an infectious cause of their condition including 26.9% (39 people) who had malaria.
MedicalResearch.com: What are some of the recognized causes of the splenomegaly?
Response: Splenomegaly is the pathogenic enlargement of the spleen and can be associated with multiple conditions. Common causes of splenomegaly include liver cirrhosis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), leukemia, lymphoma, and hemolytic anemias (such as thalassemia). Outside of the U.S., particularly in tropical settings, certain infections can also cause splenomegaly such as malaria, leishmaniasis, schistosomiasis, extrapulmonary tuberculosis, brucellosis, echinococcosis, and other HIV-associated conditions.
MedicalResearch.com: What should readers take away from your report?
Response: Although a definitive cause could not be determined during this limited assessment, a multitude of potentially serious conditions were excluded. One potential consideration which may explain this phenomenon is malaria-associated splenomegaly or a condition called “ hyperreactive malarial splenomegaly (HMS).” Malaria-associated splenomegaly is a condition that has been shown to present in individuals following multiple prior malaria infections and has been demonstrated to occur more commonly in individuals from specific ethnic backgrounds.
All refugees with splenomegaly were treated for malaria at the time of diagnosis (with artemether-lumefantrine), and were provided with bed nets for further prevention. In addition, all refugees received predeparture anti-malarial medication, as routinely administered during IOM predeparture examinations (per CDC recommendations); thus, persons with detectable splenomegaly received two treatment courses for malaria infection before departure.
MedicalResearch.com: Is there anything else you would like to add?
Response: CDC has recommended further laboratory and radiology testing for all refugees with splenomegaly after relocation to the United States, including repeat malaria testing in symptomatic patients and additional treatment in specific circumstance. CDC has provided notification letters to State Refugee Coordinators as well as letters to clinical providers for further guidance on approaches to this condition.
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Goers M, Ope MO, Samuels A, et al. Notes from the Field. Splenomegaly of Unknown Etiology in Congolese Refugees Applying for Resettlement to the United States — Uganda, 2015. MMWR Morb Mortal Wkly Rep 2016;65:943–944. DOI:http://dx.doi.org/10.15585/mmwr.mm6535a5
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