Splenomegaly and Malaria in the Central Highlands of South Vietnam

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  • Walter Reed Army Institute of Research, Washington, D. C. 20012

Studies on the prevalence and etiology of splenomegaly were accomplished at three hamlets of a geographically remote village in South Vietnam. The percent of children and adolescents with enlarged spleen ranged from 70 to 90. Several with Class 4 or 5 spleen enlargement were observed. Single or mixed malaria infections were demonstrated in 19 of 42 splenomegalic children. In contrast to previous highland surveys. Plasmodium malariae infections were found in five. Thirty-three of these children, chosen without regard to spleen size, were selected for further study at base camp. Microhematocrit values ranged from 30 to 44%, and five of the 33 children had anemia secondary to iron deficiency. Some of the nonanemic children exhibited hematologic abnormalities that included target cells and bone-marrow erythrohyperplasia. Parasitologic studies for leishmaniasis were negative, although five of 25 children had positive fluorescent-antibody tests for Leishmania donovani antibody. Comparison of malaria complement-fixation (CF) tests and blood-film examinations were made in 16 children. Positive reactions were demonstrated in 15, whereas only seven had demonstrable parasitemia. Moreover, the CF tests indicated mixed Plasmodium infections in 11 children, compared with only two mixed infections demonstrated by blood-film examinations. The results indicated that malaria infections were the primary cause for splenomegaly in those examined, although the beta-thalassemia trait was not excluded as a contributory factor.

Author Notes

Present address: Division of Preventive Medicine, U.S. Army Hospital, Fort Ord, California 93941.