Clinical sequelae associated with unresolved tropical splenomegaly in a cohort of recently resettled congolese refugees in the United States—Multiple States, 2015–2018

Laura Divens Zambrano, Emily Jentes, Christina Phares, Michelle Weinberg, S. Patrick Kachur, Mukunda Singh Basnet, Alexander Klosovsky, Moses Mwesigwa, Marwan Naoum, Samuel Lubwama Nsobya, Olivia Samson, Matthew Goers, Robert McDonald, Bozena Morawski, Henry Njuguna, Corey Peak, Rebecca Laws, Yasser Bakhsh, Sally Ann Iverson, Carla BezoldHayder Allkhenfr, Roberta Horth, Jun Yang, Susan Miller, Michael Kacka, Abby Davids, Margaret Mortimer, William Stauffer, Nina Marano

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)485-493
Number of pages9
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume103
Issue number1
DOIs
StatePublished - Jul 2020

Bibliographical note

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.

PubMed: MeSH publication types

  • Journal Article

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