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Table 3 Main clinical and diagnostic findings, treatment, and outcomes data

From: Clinical presentation and immunological features of Post-Malaria Neurologic Syndrome: a case report and review of literature

 

PMNS

ADEM

AIDP

DCA

Collected cases (n)

56

12

28

55

Demographic informations

 Country of acquisition (n, %)

Africa: 29 (16.2); South and Central America: 2 (3.6); South-West Asia: 23 (41.1); India 1 (1.8)a

Africa: 5 (41.6); Australia: 1 (8.3); India: 6 (50)b

Africa 11 (29.2); South America 1 (3.6); South West Asia 3 (10.7); India 12 (46.4)c

Africa: 1 (1.8); South-West Asia: 42 (76.4); Unknown: 12 (21.8) d

 Sex (n, %)

Male: 38 (67.9)

Male: 7 (58.3)

Male: 19 (69.7)

Male: 49 (89.1)

 Age (mean, range,, median, IQR range)

34.65,(6–70), 29, (29–50),

29.45, (1–61),29, (11–48)

32.36(6–63), 32.4, (23.2–39.5)

32.3(15–54), 30, (21.5–46.2)

 Immune status (n,%)

Naive: 20 (35.7), semi-immune: 7 (12.5), unknown: 29 (51.8)

Naive: 7 (58.3); semiimmune: 5 (41.7)

Semiimmune: 4 (14.3); unknown: 24 (85.7)

Semiimmune: 24 (43.6); unknown: 31 (56.4)

Malaria infection

 Plasmodium species (n,%)

Falciparum: 54 (96.4%); Vivax: 1 (1.8); mixed Vivax and Falciparum: 1 (1.8);

Falciparum: 6 (50%); Vivax: 4 (33.3%); mixed Vivax and Falciparum: 1 (8.3)

Falciparum: 22 (78.6); Vivax: 5 (17.9), Mixed: none

Falciparum: 54 (98.2); Vivax: 1 (1.8), Mixed: none

 Severe forms (n,%)

44 (78.6)

8 (66.7)

1 (3.6), unknown 20 (71.4)

55 (100)

Post-malaria neurological syndrome: clinic and diagnostic tests

 Presentation (n,%)

Neuropsychiatric disturbances: 14 (25), in 1 (1.8) not reported; seizures: 39 (69.6); motor disturbances (including tremors and cerebellar syndrome): 38 (67.9), in 1 (1.8) not reported

Neuropsychiatric disturbances: 6 (50); seizures: 5 (41.7); motor disturbances (including tremors and cerebellar syndrome): 12 (100)

Neuropsychiatric disturbances: 0, in 22 (78.6) not reported; seizures: 0, not reported in 22 (78.6); motor disturbances (including tremors and cerebellar syndrome): 28 (100)

Neuropsychiatric disturbances: 0; seizures: 0, motor disturbances (including tremors and cerebellar syndrome): 55 (100)

 Pathological MRI (n,%)

8 (14.3); in 30 (53.6) not reported

11 (91.7)

1 (3.6); in 27 (96.4) not reported

0; in 54 (98.2) not reported

 Pathological EEG (n,%)

16 (28.6); in 37 (66.0) not reported

8 (66.7%)

In 28 (100%) not reported

0; 43 (78.2) not reported

 Pathological CSF (n; %)**

44 (84.6); in 4 (7.1) not reported

10 (100); in 2 (16.6) not reported

15 (88.2); in 11 (39.3) not reported

0; 55 (98.8) not reported

 CSF cells/uL*

25.15 (± 43.55),predominantly lymphocytes

29,45 (± 19,96), predominantly lymphocytes

0.94 (± 1.43)

1, predominantly lymphocytes

 CSF proteins mg/L

1164.2 (± 3039.16)

1563.00 (± 2080.9)

1444.12 (935.6)

400

Post-malaria neurological syndrome: treatment

 Supportive measures alone (n,%)

41 (73.2)

1 (8.3)

13 (72.2); in 10 not reported

2 (66.7), in 51 not reported

 OTI need (n,%)

4 (7.1)

1 (8.3)

0

0

 Steroids (n,%)

15 (26.8)

11 (91.7)

2 (11.1); in 10 not reported

2 (66.7); in 51 (92.7) not reported

 IV immunoglobulin (n,%)

0

0

2 (11.1); in 10 not reported

0; in 51 (92.7) not reported

 Plasma exchange (n,%)

0

0

1 (5.3); in 9 not reported

0; in 51 (92.7) not reported

 Outcome

 Death (n,%)

1 (1.8)

0

7 (25)

3 (5.5)

 Sequelae (n,%)

0

1 (8.3)

20 (71.4)

43 (78.2)

 Complete recovery (n,%)

55 (98.2)

11 (91.7)

1 (3.6)

9 (16.4)

 Peculiarities

Multiple blood serology positivity (IgM and IgG): 5 (8.9)

Oligoclonal IgM bands on CSF: 1 (1.8)

Autoimmune antibodies positivity on blood: 4 (7.14)

Pathological PET-TC: 1 (1.8)

Pathological SPECT: 1 (1.8)

Pathological EMG/ENG: 1 (1.8)

Autonomic system disorder: 1 (1.8)

Autoimmune antibodies positivity on blood: 2 (16.6)

MRI lesions mimicking MS: 1 (8.3)

Pathological VEP: 1 (8.3)

Pathological EMG: 8 (28,6)

Monolateral 7th nerve palsy: 1 (3.6)

Autoimmune antibodies positivity on blood: 1 (1.8)

  1. PMNS post-malaria neurological syndrome; ADEM: acute disseminated encephalomyelitis, AIDP acute inflammatory demyelinating polyneuropathy, DCA delayed cerebellar ataxia, MRI Magnetic Resonance Imaging, EEG electroencephalogram, CSF cerebrospinal fluid, OTI Orotracheal Intubation, IV intravenous, VEP Visual evoked potentials, PET/TC Positron Emission Tomography/Computed Tomography, SPECT Single Photon Emission Computed Tomography, EMG/ENG eletromyo/neurography
  2. aAfrica 1 (1.8); Benin, Togo, Burkina 1 (1,8); Brazil 1 (1.8); Congo 1 (1.8); Dominican Republic 1 (1.8); Ghana 1 (1.8); Guinea 1 (1.8); Guinea and Congo 1 (1.8); India 1 (1.8); Kenya 1 (1.8); Madagascar 1 (1.8); Malawi 1 (1.8); Mali and Benin 1 (1.8), Mali 2 (3.6), Mozambique 1 (1.8); Nigeria 1 (1.8); Sierra Leone 1 (1.8), Tanzania 1 (1.8); Togo 1 (1.8); West Africa 1 (1.8); Cameroon 2 (3.6); Gambia 3 (5.4); Angola 4 (7,1); Ivory Coast 3 (5.0); Sri Lanka and Thailandia 23 (41.1)
  3. bAngola1(8.3), Ivory Coast 1 (8.3), Nigeria 1 (8.3), Sierra leone 1 (8.3), Vanatu 1 (8.3), West Africa 1 (8.3), India 6 (50)
  4. cBrazil1 (3.6); Malawi 1 (3.6), Nepal 1 (3.6), Sri Lanka 1 (3.6), Thailand 1 (3.6), Sudan 10 (25.7), India 13 (46.4)
  5. dGhana1 (1.8); Sri Lanka 42 (76.4); Unknown 12 (21.8)
  6. **CSF is defined pathological when any one of the following is present: increased cells (≥5/µL), increased protein concentration (≥450 mg/L), low glucose concentration (≤50 mg/dL and/or 2/3 of blood glucose concentration)
  7. *No data about LCR in 5 patients (8.9) in PMNS, 2 (16.7) in ADEM, 13 (46.4) in AIDP, and 54 (98.2) in DCA
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Malaria Journal

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