Diagnosis Of TSS : Tropical Splenomegaly Syndrome Symptoms,Signs

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Results

TROPICAL SPLENOMEGALY SYNDROME

Symptomatology

Related topics

Etiology Pathogenesis and Epidemiological Factors

Dr Vishal Dublish, Dr Ira Shah

Symptomatology:

Abdominal distention - waxing and waning.
Chronic, dragging pain sensations
Fever is rare, if present it suggests different diagnosis.
Weakness, lethargy
Hernia, leg swellings
Skin and respiratory tract infections
Bleeding episodes - very rare

Signs:

Splenomegaly (moderate to massive & firm and regular). It is the hallmark of HMS.
Splenic bruit may be present
Hepatomegaly
Pallor (without tachycardia)
Abdominal vein dilatation
Cardiomegaly, flow murmurs because of hypervolemia.
Malnutrition
Jaundice may be present, Ascitis uncommon.
Lymphadenopathy absent, parotid enlargement may be seen.

Differential diagnosis:

Kala Azar
Malaria
Histiocytosis
Sickle cell anemia, Thalassemia
Tuberculosis
Infectious mononucleosis
Leukemia, lymphoma, myelofibrosis
Postnecrotic cirrhosis.

Lab studies:

Anemia (normocytic normochromic). Coombs test is negative
Leukopenia
Mild thrombocytopenia
Peripheral smear - malarial parasite not detectable. Increased reticulocyte count.
IgM against malaria increased >2 standard deviation above local mean.
High titers of cold agglutinins, rheumatoid factor, antinuclear factor and cryoproteins.
Phytohemagglutination stimulation test - to differentiate HMS from lymphomas and chronic lymphocytic leukemia.

Histologic findings:

Hepatic sinusoidal lymphocytosis
No malarial pigmentation in macrophages.
Spleen - Kupffer cell hypertrophy and hyperplasia.

Complications:

Infections especially of skin and gastrointestinal tract
Hypersplenism
Predisposition to development of malignancy
Congestive cardiac failure.

Criteria for diagnosis
Major criteria:

Gross splenomegaly
Presence of antimalarial antibodies
Clinical and immunologic response to antimalarials.
Hepatic sinusoidal lymphocytosis
Normal cellular and humoral responses to antigenic challenge
Normal phytohemagglutination response
Hypersplenism
Lymphocytic proliferation
Familial occurrence.

Last updated on 01-07-2006 Vol 3 Issue 7 Art # 24

See Expertise Views For Questions On"Tropical Splenomegaly"

How to cite this url:

Dublish V,Shah I.Tropical Splenomegaly Syndrome.Pediatric Oncall [serial online] 2006 [cited 2006 July 1];3. Art # 24. Available from:

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