Ultrastructure of the hepatic sinusoids in the tropical splenomegaly syndrome

[Hepatic viscerotomy (its contribution to the study of regional nosology)]

As a part of a routine yellow fever surveillance program going on in the south of Bahia State, Brazil, liver fragments were obtained through postmortem viscerotomy from 702 individuals who died after presenting acute febrile illness from 1981 up till 1991. Instead of being only screened for the presence of yellow fever, the liver tissue was thoroughly evaluated by histopathology. More than a third of the cases exhibited marked and diffuse steatosis occurring in malnourished infants and young children. Hepatic fibrosis, granulomatous disease compatible with disseminated tuberculosis, advanced schistosomiasis, chronic alcoholic injury, chronic hepatitis and cirrhosis were also frequently observed. A miscellaneous group of hepatic pathological processes were also recognized, which included such diverse entities as Hodgkin's disease, glycogenosis, sickle-cell disease, hepatocarcinoma, etc. Only 124 (17.7%) cases showed normal hepatic histology. The wide possibility of histological diagnoses strongly indicates that the material obtained by viscerotomy can be further explored by an interested pathologist, to help in the understanding of nosology and epidemiology, concerning remote geographic areas where viscerotomy is being routinely performed.

Hyperreactive malarious splenomegaly (tropical splenomegaly syndrome)

Hyperreactive malarious splenomegaly (HMS), formerly known as tropical splenomegaly syndrome (TSS), was recognized some 20 years ago as an entity distinct from the splenic enlargement resulting directly from malarial parasitaemia. Its basis appears to be a disturbance in the T-lymphocyte control of the humoral response to recurrent malaria, possibly linked to particular HLA Class II antigens. Gross overproduction of IgM antibodies leads to the formation of high molecular weight immune complexes, persistent gross splenomegaly recurrent episodes of profound anaemia and increased susceptibility to infections. Those with gross disease experience a high mortality, which constitutes a major public health problem in communities where the syndrome affects a majority of adults.

Massive splenomegaly in Northern Zambia. I. Analysis of 344 cases

Massive splenomegaly is common in Northern Zambia. Nearly 40% of 344 patients were diagnosed as Tropical Splenomegaly Syndrome of malarial origin. Portal hypertension, lymphoreticular and haemopoietic malignancies, and schistosomiasis accounted for another 46%. The common causes of splenomegaly show differences of frequency within Zambia and also between Zambia and other African countries.