TY - JOUR
T1 - Clinical sequelae associated with unresolved tropical splenomegaly in a cohort of recently resettled congolese refugees in the United States—Multiple States, 2015–2018
AU - Zambrano, Laura Divens
AU - Jentes, Emily
AU - Phares, Christina
AU - Weinberg, Michelle
AU - Kachur, S. Patrick
AU - Basnet, Mukunda Singh
AU - Klosovsky, Alexander
AU - Mwesigwa, Moses
AU - Naoum, Marwan
AU - Nsobya, Samuel Lubwama
AU - Samson, Olivia
AU - Goers, Matthew
AU - McDonald, Robert
AU - Morawski, Bozena
AU - Njuguna, Henry
AU - Peak, Corey
AU - Laws, Rebecca
AU - Bakhsh, Yasser
AU - Iverson, Sally Ann
AU - Bezold, Carla
AU - Allkhenfr, Hayder
AU - Horth, Roberta
AU - Yang, Jun
AU - Miller, Susan
AU - Kacka, Michael
AU - Davids, Abby
AU - Mortimer, Margaret
AU - Stauffer, William
AU - Marano, Nina
N1 - Funding Information:
Financial support: This investigation was funded directly through the Division of Global Migration and Quarantine within the National Center for Emerging and Zoonotic Infectious Diseases at the U.S. Centers for Disease Control and Prevention.
Publisher Copyright:
Copyright © 2020 by The American Society of Tropical Medicine and Hygiene.
PY - 2020/7
Y1 - 2020/7
N2 - Tropical splenomegaly is often associated with malaria and schistosomiasis. In 2014 and 2015, 145 Congolese refugees in western Uganda diagnosed with splenomegaly during predeparture medical examinations underwent enhanced screening for various etiologies. After anecdotal reports of unresolved splenomegaly and complications after U.S. arrival, patients were reassessed to describe long-term clinical progression after arrival in the United States. Post-arrival medical information was obtained through medical chart abstraction in collaboration with state health partners in nine participating states. We evaluated observed splenomegaly duration and associated clinical sequelae between 130 case patients from eastern Congo and 102 controls through adjusted hierarchical Poisson models, accounting for familial clustering. Of the 130 case patients, 95 (73.1%) had detectable splenomegaly after arrival. Of the 85 patients with records beyond 6 months, 45 (52.9%) had persistent splenomegaly, with a median persistence of 14.7 months (range 6.0–27.9 months). Of the 112 patients with available results, 65 (58.0%) patients had evidence of malaria infection, and the mean splenomegaly duration did not differ by Plasmodium species. Refugees with splenomegaly on arrival were 43% more likely to have anemia (adjusted relative risk [aRR]: 1.43, 95% CI: 1.04–1.97). Those with persistent splenomegaly were 60% more likely (adjusted relative risk [aRR]: 1.60, 95% CI: 1.15–2.23) to have a hematologic abnormality, particularly thrombocytopenia (aRR: 5.53, 95% CI: 1.73–17.62), and elevated alkaline phosphatase (aRR: 1.57, 95% CI: 1.03–2.40). Many patients experienced persistent splenomegaly, contradicting literature describing resolution after treatment and removal from an endemic setting. Other possible etiologies should be investigated and effective treatment, beyond treatment for malaria and schistosomiasis, explored.
AB - Tropical splenomegaly is often associated with malaria and schistosomiasis. In 2014 and 2015, 145 Congolese refugees in western Uganda diagnosed with splenomegaly during predeparture medical examinations underwent enhanced screening for various etiologies. After anecdotal reports of unresolved splenomegaly and complications after U.S. arrival, patients were reassessed to describe long-term clinical progression after arrival in the United States. Post-arrival medical information was obtained through medical chart abstraction in collaboration with state health partners in nine participating states. We evaluated observed splenomegaly duration and associated clinical sequelae between 130 case patients from eastern Congo and 102 controls through adjusted hierarchical Poisson models, accounting for familial clustering. Of the 130 case patients, 95 (73.1%) had detectable splenomegaly after arrival. Of the 85 patients with records beyond 6 months, 45 (52.9%) had persistent splenomegaly, with a median persistence of 14.7 months (range 6.0–27.9 months). Of the 112 patients with available results, 65 (58.0%) patients had evidence of malaria infection, and the mean splenomegaly duration did not differ by Plasmodium species. Refugees with splenomegaly on arrival were 43% more likely to have anemia (adjusted relative risk [aRR]: 1.43, 95% CI: 1.04–1.97). Those with persistent splenomegaly were 60% more likely (adjusted relative risk [aRR]: 1.60, 95% CI: 1.15–2.23) to have a hematologic abnormality, particularly thrombocytopenia (aRR: 5.53, 95% CI: 1.73–17.62), and elevated alkaline phosphatase (aRR: 1.57, 95% CI: 1.03–2.40). Many patients experienced persistent splenomegaly, contradicting literature describing resolution after treatment and removal from an endemic setting. Other possible etiologies should be investigated and effective treatment, beyond treatment for malaria and schistosomiasis, explored.
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U2 - 10.4269/ajtmh.19-0534
DO - 10.4269/ajtmh.19-0534
M3 - Article
C2 - 32372751
AN - SCOPUS:85087913103
SN - 0002-9637
VL - 103
SP - 485
EP - 493
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 1
ER -