Table 1. Patient records and Plasmodium detection.
| Age, Sexa, Ethnicityb | Reason for splenectomy | Body Temp (°C) | Spleen weight (grams)c | Total plasma IgM (mg/dL) | Plasmodium detection at surgery | Time to commencement of prior treatment | Malaria treatment after surgeryh | First detected Plasmodium infection in the following 12 months | Patient IDi | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Peripheral RDT | Microscopyd | PCR | ||||||||||||||
| Peripheral blood | Spleen blood | Spleen histology | Peripheral blood | Spleen | Month | Microscopy | PCR | |||||||||
| 32, M, NP | trauma | 36.8 | 228 (N) | 108 | neg | neg | neg | neg | neg | neg | - | UT | - | - | - | 19* |
| 22, F, H | trauma | 36.4 | 490 (S) | N/A | HRP2+Pan+ | neg | neg | neg | neg | Pf | 3 days (DHP+PQ)f | DHP+PQ | - | - | - | 12 |
| 39, M, NP | trauma | 36.4 | 142 (N) | <37.0 | neg | neg | neg | Pf | neg | Pf e | - | UT | - | - | - | 11# |
| 41, F, H | splenomegaly | 36.3 | 1,918 (SS) | 4200 | neg | neg | neg | Pf | neg | Pf e | - | UT | 1 | PvJ | N/A | 20#^ |
| 16, M, H | trauma | N/A | 690 (S) | 320 | neg | neg | Pf (a) | US | Pf | Pf | - | IV-ART, DHP | 11 | PvJ | N/A | 3^ |
| 41, M, H | trauma | 36.8 | 785 (S) | 1,200 | neg | neg | Pf (a) | Pf | Pf | Pf | - | T | 12 | PfJ | N/A | 9^ |
| 20, M, L | trauma | 37.3 | 761 (S) | 265 | neg | Pf (a) | Pf (a) | US | Pf | Pf | 9.5 hours (IV-ART) | IV-ART | N/A | N/A | N/A | 8 |
| 19, F, H | trauma | 36.6 | 424 (S) | 318 | neg | Pf (a) | Pf (a) | US | Pf | Pf | - | T | 2 | neg | Mix Pf Pv | 13 |
| 12, F, L | trauma | 36.0 | 704 (S) | N/A | neg | Pf (a) | Pf (a) | Pf | N/A | Pf | - | T | N/A | N/A | N/A | 14^ |
| 20, M, H | trauma | 36.3 | 658 (S) | 269 | HRP2+Pan+ | Pf (a,g) | Pf (a,g) | Pf | Pf | Pf | <1 month (DHP+PQ)g | DHP+PQ | 2–4 | PvJ | N/A | 7^ |
| 15, M, L | trauma | 36.2 | 335 (S) | 190 | HRP2+Pan+ | Pf (a,g) | Pf (a,g) | Pf | Pf | Pf | 3 days (DHP+PQ)f | DHP+PQ | 2 | PfJ | N/A | 5^ |
| 30, M, NP | trauma | 36.8 | 438 (S) | 164 | HRP2+Pan+ | Pf (a) | Pf (a) | Pf | Pf | Pf | - | IV-ART, DHP+PQ | 8 | PvJ | N/A | 10^ |
| 15, M, H | trauma | 36.6 | 358 (S) | 282 | HRP2+Pan+ | Pf (a,g) | Pf (a,g) | Pf | Pf | Pf | - | T | 2 | neg | Pf | 17*^ |
| 40, M, NP | trauma | 36.0 | 263 (S) | 360 | HRP2+Pan+ | Pf (a,g) | Pf (a,g) | Pf | Pf | Pf | - | T | 1 | PvJ | N/A | 15^ |
| 28, M, L | trauma | 36.2 | 454 (S) | 616 | neg | neg | neg | N/A | Mix Pf Pv | Mix Pf Pv | - | T | 2–3 | PvJ | N/A | 21 |
| 16, F, H | splenomegaly | 36.9 | 1,250 (SS) | 221 | neg | neg | neg | Pv | Pv | Pv | - | T | 1 | PvJ | N/A | 16^ |
| 46, M, L | trauma | 37.0 | 279 (S) | 72.4 | neg | neg | neg | Pv | Pv | Pv | - | DHP+PQf | 1 | PvJ | N/A | 4*^ |
| 25, F, NP | trauma | 36.9 | 80 (N) | <37.0 | N/A | neg | neg | Pv | Pv | Pv | - | UT | N/A | N/A | N/A | 22^ |
| 19, M, NP | trauma | 36.0 | 130 (N) | <37.0 | neg | neg | neg | Pv | Pv | Pv | - | UT | N/A | N/A | N/A | 18*^ |
| 24, F, NP | trauma | 36.5 | 300 (S) | 96.0 | neg | neg | Pv (a) | Pv | Pm | Pv | - | DHP+PQ | 11 | PvJ | N/A | 2^ |
| 35, M, H | trauma | 36.0 | 211 (N) | <37.0 | neg | neg | Pv (a) | US | Pv | Pv | <1 month (DHP+PQ)g | IV-ART, DHP+PQf | 2 | neg | Pv | 6 |
| 36, M, H | trauma | 36.5 | 446 (S) | 153 | neg | Pv (a) | Pv (a,g) | Pv | Pv | Pv | - | IV-ART | 1 | PvJ | N/A | 1^ |
aM, male; F, female.
bH, highland Papuan; L, lowland Papuan; NP, non-Papuan.
cN, normal (<250 g); S, splenomegaly (250–1,000 g); SS, severe splenomegaly (>1,000 g).
dParasites in blood smears were staged into: a, asexual stages; g, gametocytes.
ePositive by histology and by real-time PCR only.
f1-day PQ dose (Pf).
g14-day PQ dose (Pv or mix).
hDHP, dihydroartemisinin-piperaquine; IV-ART, intravenous artesunate; PQ, primaquine; T, unknown treatment; UT, untreated.
iRefer to the following patient IDs when referred to in text and figures.
jSymptomatic malaria.
Total plasma IgM concentrations 2 standard deviations (SD) greater than the population mean (327 [SD = 385] mg/dL, n = 54 Timika matched-controls tested in parallel), a diagnostic criterion for hyperreactive malarial splenomegaly.
There were no differences in parameters assessed between those who did or did not receive prior antimalarial treatment, therefore all patients were pooled for analysis.
Some patients received transfusion (*<60 minutes; #>60 minutes) prior to sample collection. Transfused bloods were Plasmodium-negative by microscopy.
^Patients in previously published cohort [29].
None of the patients were seropositive for human immunodeficiency virus, and none had fever (≥37.5°C) or other malaria symptoms at surgery.
Refer to S4 Table for patient-automated blood counts.
Patients 18 and 22 died within 1 week after splenectomy due to multiple traumatic injuries. Patient 8 was lost to follow-up.
Missing data–patient 3 body temperature (not recorded); patient 12 IgM data (heparin blood not available); patient 14 IgM and PCR data (peripheral blood not available–peripheral RDT and slide results from hospital); patient 22 RDT result (not performed); PCR result at first recurrence (not tested for those with first recurrence identified from health facility records).
IgM, immunoglobulin M; N/A, not available (missing); Pf, P. falciparum; Pm, P. malariae; Pv, P. vivax; RDT, Rapid Diagnostic Test; US, unreadable slide.