Hepatomegaly in acute falciparum malaria in children

The characteristics of hepatomegaly in acute falciparum malaria were studied in 114 children presenting consecutively with the disease. Hepatomegaly was more common than splenomegaly and was significantly more frequent in younger than in older children. In children with hepatomegaly at presentation, there was an equal sex distribution, a negative correlation between liver size and age, and a positive correlation between liver enlargement and the reported duration of symptoms at presentation. Symptoms attributable directly to liver involvement were relatively uncommon. There was no correlation between liver and spleen size, presenting core temperature, or peripheral parasite density. Tender hepatomegaly and tender splenomegaly were rare during the acute illness; tenderness resolved within 72 h after commencement of antimalarial therapy. Complete resolution of hepatomegaly occurred in 41% of children after recovery from the acute illness (by days 7 or 14), varying degrees of resolution occurred in 48% and no reduction or an increase in liver size occurred in the remainder. In children with hepatomegaly who failed to clear parasitaemia by days 7 or 14, persistent hepatomegaly was common. These results suggest that hepatomegaly, like splenomegaly, may be assessed as a possible malariometric index of the intensity of transmission in children in an endemic area.