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Clinical Sequelae Associated with Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018.
Am J Trop Med Hyg. 2020 07; 103(1):485-493.AJ

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.

Authors+Show Affiliations

1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.3Columbia University Mailman School of Public Health, New York, New York.4International Organization for Migration, Geneva, Switzerland.4International Organization for Migration, Geneva, Switzerland.4International Organization for Migration, Geneva, Switzerland.4International Organization for Migration, Geneva, Switzerland.5School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda. 6Infectious Disease Research Collaboration, Kampala, Uganda.2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia. 7Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 8Division of Global Health Protection, Center for Global Health, CDC, Atlanta, Georgia.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 9New York State Department of Health, Albany, New York.10Idaho Department of Health and Welfare, Boise, Idaho.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 11Washington State Department of Health, Tumwater, Washington.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 12California Department of Public Health, Sacramento, California.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 12California Department of Public Health, Sacramento, California.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 13Arizona Department of Health Services, Phoenix, Arizona.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 13Arizona Department of Health Services, Phoenix, Arizona.14Utah Department of Health, Salt Lake City, Utah.1Epidemic Intelligence Service, CDC, Atlanta, Georgia. 14Utah Department of Health, Salt Lake City, Utah.15Pennsylvania Department of Human Services, Harrisburg, Pennsylvania.15Pennsylvania Department of Human Services, Harrisburg, Pennsylvania.16South Carolina Department of Health and Environmental Control, Columbia, South Carolina.17Family Medicine Residency of Idaho, Boise, Idaho.17Family Medicine Residency of Idaho, Boise, Idaho.2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia. 18University of Minnesota, Minneapolis, Minnesota.2Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32372751

Citation

Zambrano, Laura Divens, et al. "Clinical Sequelae Associated With Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018." The American Journal of Tropical Medicine and Hygiene, vol. 103, no. 1, 2020, pp. 485-493.
Zambrano LD, Jentes E, Phares C, et al. Clinical Sequelae Associated with Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018. Am J Trop Med Hyg. 2020;103(1):485-493.
Zambrano, L. D., Jentes, E., Phares, C., Weinberg, M., Kachur, S. P., Basnet, M. S., Klosovsky, A., Mwesigwa, M., Naoum, M., Nsobya, S. L., Samson, O., Goers, M., McDonald, R., Morawski, B., Njuguna, H., Peak, C., Laws, R., Bakhsh, Y., Iverson, S. A., ... Marano, N. (2020). Clinical Sequelae Associated with Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018. The American Journal of Tropical Medicine and Hygiene, 103(1), 485-493. https://doi.org/10.4269/ajtmh.19-0534
Zambrano LD, et al. Clinical Sequelae Associated With Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018. Am J Trop Med Hyg. 2020;103(1):485-493. PubMed PMID: 32372751.
* Article titles in AMA citation format should be in sentence-case
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, Y1 - 2020/04/30/ PY - 2020/5/7/pubmed PY - 2020/8/29/medline PY - 2020/5/7/entrez SP - 485 EP - 493 JF - The American journal of tropical medicine and hygiene JO - Am J Trop Med Hyg VL - 103 IS - 1 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. SN - 1476-1645 UR - https://www.unboundmedicine.com/medline/citation/32372751/Clinical_Sequelae_Associated_with_Unresolved_Tropical_Splenomegaly_in_a_Cohort_of_Recently_Resettled_Congolese_Refugees_in_the_United_States_Multiple_States_2015_2018_ L2 - https://ajtmh.org/doi/10.4269/ajtmh.19-0534 DB - PRIME DP - Unbound Medicine ER -