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首页> 外文期刊>The American Journal of Tropical Medicine and Hygiene >Clinical Sequelae Associated with Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018
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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

机译：在2015 - 2018年在美国多个州的群组中，与最近重新安置的刚果难民的群组相关的临床后遗症。2015 - 2018年

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摘要

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.
机译：热带脾肿大通常与疟疾和血吸虫病有关。在2014年和2015年，在预先培养的体检期间诊断出患有脾肿大的乌干达西部的145名刚果难民，接受了各种病因的增强筛查。在未解决的脾肿大和并发症的轶事报告后，在抵达后，患者被重新评估以描述抵达美国后的长期临床进展。通过与九个参与国家的国家健康伙伴合作，通过医学图表抽象获得后到期后医疗信息。通过调整后的等级泊松模型，我们评估了观察到的脾肿大持续时间和相关的临床后遗症，并通过调整后的等级泊松模型，占家族聚类。在130例患者中，95（73.1％）抵达后有可检测的脾肿大。在超过6个月超过6个月的85名患者中，45名（52.9％）持续存在脾肿大，中位持续增长14.7个月（范围为6.0-27.9个月）。在112名可用结果的患者中，65名（58.0％）患者有疟疾感染的证据，并且平均脾肿大持续时间没有疟原虫物种的差异。患有血管患者的难民患有贫血症的脾脏43％（调整相对风险[ARR]：1.43,95％CI：1.04-1.97）。具有持续脾肿大的人更容易60％（调整的相对风险[ARR]：1.60,95％CI：1.15-2.23）具有血液学异常，特别是血管发育不良（ARR：5.53,95％CI：1.73-17.62）和升高的碱性磷酸酶（ARR：1.57,95％CI：1.03-2.40）。许多患者经历过持续的脾肿大，与治疗和从地方射击中移除后的分辨率相矛盾。探讨，应研究其他可能的病因，并有效地治疗，除了疟疾和血吸虫病的治疗。

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