Post-malaria Neurological Syndrome Research Articles

An imported malaria case with repeated episodes of neurological syndromes resulting from different Plasmodium species

BackgroundImported cerebral malaria (CM) cases in non-endemic areas are often misdiagnosed, which delays treatment. Post-malaria neurological syndrome (PMNS) after recovery from severe malaria can also complicate diagnosis.CaseWe report an imported malaria case from West Africa with two sequential episodes with neurological syndromes within about a month. The first episode was diagnosed as CM with microscopy-positive Plasmodium falciparum infection. The second episode, occurring a month after the recovery from the first CM episode, was consistent with PMNS, since malaria parasites were not detected by microscopy in peripheral blood smears. However, this diagnosis was complicated by the detection of Plasmodium vivax in peripheral blood by PCR, suggesting a potential cause of the second episode by P. vivax.ConclusionThis study suggests that PMNS often occurs after severe falciparum malaria. Concurrent P. vivax infection with pathogenic biomass being predominantly extravascular further complicates accurate diagnosis.

Post-malaria neurological syndrome (PMNS): a rare case report with brain biopsy findings

Post-malaria neurological syndrome (PMNS) is a rare, self-limiting condition that presents with a wide range of neurological manifestations after clearance of malarial infection, especially \U0001d617\U0001d62d\U0001d622\U0001d634\U0001d62e\U0001d630\U0001d625\U0001d62a\U0001d636\U0001d62e f\U0001d622\U0001d62d\U0001d624\U0001d62a\U0001d631\U0001d622\U0001d633\U0001d636\U0001d62e, most patients recover without residual deficits. Here we present a case of a 29-year-old, male with a recent history of malaria treated successfully, who presented due to a generalized tonic-clonic seizure, without any other neurological symptoms, the examination and labs were unremarkable, he underwent a computer tomography (CT) scan and Magnetic resonant imaging (MRI) which both showed two areas of vasogenic edema involving the subcortical white matter of left frontal and right posterior parasagittal regions, all autoimmune screens, infection workup from blood and CSF were negative, he underwent a brain biopsy that showed intense perivascular inflammation with neuronal loss and gliosis, findings are nonspecific and can be seen in a variety of condition. The patient’s condition improved, and he was discharged without any complications.

A Case of Post-Malaria Neurological Syndrome Presenting With Cortical Tremor.

A Case of Post-Malaria Neurological Syndrome Presenting With Cortical Tremor.

Post-malaria neurological syndrome - chronic ailments of the acute parasitic infection. (P14-10.005)

Post-malaria neurological syndrome - chronic ailments of the acute parasitic infection. (P14-10.005)

Post Malaria Neurological Syndrome: Unknown, Underestimated, or Underdiagnosed? First Report Done in Gambia

Post-malaria neurological syndrome (PMNS) is a rare self-limiting neurological complication that can occur after recovery from malaria, usually severe falciparum malaria. It is characterized by a myriad of neuropsychiatric manifestations including mild neurological deficit to severe encephalopathy. PMNS is a debated entity, is a rare complication of severe malaria that might be underreported. It can develop up to 2 months after clearance of parasitemia. Clinical features can be variable. Most cases are self-limited, but more severe cases may benefit from steroid therapy. There are several neurological syndromes that can occur following complete recovery from malaria, in particular Plasmodium falciparum. These PMNS include, delayed cerebellar ataxia (DCA), acute inflammatory demyelinating polyneuropathy (AIDP) and acute disseminated encephalomyelitis (ADEM). In 2021 according to WHO report, the African region was home to 95% of all malaria cases and 96% of deaths. Paradoxically, reports of post malaria neurological syndrome in west Africa sub region are practically null, it is not clear if it is due to lack of knowledge regarding the disease, underdiagnosis or combination of factors, the first case of post malaria neurological syndrome in Gambia is described below. The objective is to show that cases exist, but due to lack of knowledge by health personnel they are overwhelmingly underdiagnosed.

Des troubles neurologiques après traitement du paludisme

Delayed cerebellar ataxia (DCA) and post-malaria neurologic syndrome (PMNS) are both rare neurological complications of malaria. We report the cases of two patients, one who developed DCA and the other PMNS, respectively 5 and 15 days after Plasmodium falciparum malaria. No specific treatment was initiated, and complete recovery was spontaneous.

Post-malaria neurological syndrome manifesting as new onset psychosis with generalized encephalopathy: an analysis of two cases in children.

Post-malaria neurological syndrome(PMNS) is a rare heterogenous syndrome heralded by the appearance of new neurological or psychiatric manifestations emerging in the post-infectious phase after clearance of malaria parasitaemia. Most cases of PMNS have been described in adults. Only seven cases have been reported in children. We describe two further cases of possible PMNS who presented with prominent psychiatric manifestations evolving into generalized encephalopathy after complete recovery from malaria. Both patients were treated with antivirals and antibiotics without clinical improvement. One patient received pulse corticosteroids and had a remarkable and rapid clinical improvement. The other recovered without specific treatment.

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

BackgroundMalaria still represents a major health threat, in terms of both morbidity and mortality. Complications of malaria present a diversified clinical spectrum, with neurological involvement leading to the most serious related-conditions. The authors recently encountered a case of a 60-year old Italian man presenting with confusion, language disturbances and Parkinson-like syndrome 3 weeks after complete remission from severe Plasmodium falciparum cerebral malaria. Chemical and microbiological analysis revealed aseptic meningitis, diffuse encephalitis and abnormal immune-activation. Re-infection and recrudescence of infection were excluded. Further analysis excluded paraneoplastic and autoimmune causes of encephalitis. A diagnosis of Post-Malaria Neurological Syndrome (PMNS) was finally formulated and successfully treated with high dose of steroids.MethodsA systematic research of current literature related to PMNS was performed.Results151 cases of PMNS were included, the majority of which occurred after severe P. falciparum infections. Four main clinical pattern were identified: 37% of the cases presented as “classical” PMNS, 36% presented as delayed cerebellar ataxia (DCA), 18% resembled acute inflammatory demyelinating polyneuropathy (AIDP), and 8% presented as acute disseminated encephalomyelitis (ADEM)-like form. Differentiation between different forms was not always simple, as clinical and radiological findings frequently overlap. Overall, in almost all of the tested cases, cerebrospinal fluid was found pathological; EEG revealed nonspecific encephalopathy in 30% of classical PMNS and 67% ADEM; imaging tests were found abnormal in 92% of ADEM-like forms. Pathogenesis remains unclear. An autoimmune mechanism is the most corroborated pathogenic hypothesis. Overall, the majority of PMNS cases revert without specific treatment. In most severe forms, high dose steroids, intravenous immunoglobulins, and plasmapheresis have been shown to improve symptoms.ConclusionsPMNS is a disabling complication of malaria. The overall incidence is not known, due to frequent misdiagnosis and under-reporting. Pathogenesis is not also fully understood, but rapid response to immune-modulating treatment along with similarities to auto-immune neurological disease, strongly support a dysregulated immunological genesis of this condition. The lack of randomized controlled studies regarding therapeutic approaches is a major unmet need in this setting. A systematic collection of all the PMNS cases would be desirable, in order to increase awareness of this rare condition and to prospectively investigate the most appropriate management.

Post-malaria neurological syndrome: four cases, review of the literature and clarification of the nosological framework

BackgroundPost-malaria neurological syndrome (PMNS) is a debated entity, defined by neurological complications following a post-malaria symptom-free period and a negative blood smear. Four cases of PMNS are hereby reported and a review the literature performed to clarify the nosological framework of this syndrome.MethodsA French teaching hospital infectious diseases database was investigated for all PMNS cases occurring between 1999 and 2016 and the PubMed database for cases reported by other institutions after 1997. A case was defined by the de novo appearance of neurological signs following a post-malaria symptom-free period, a negative blood smear, and no bacterial or viral differential diagnoses.ResultsFour patients from the database and 48 from PubMed, including 4 following Plasmodium vivax infection were found matching the definition. In the institution, the estimated PMNS incidence rate was 1.7 per 1000 malaria cases overall. Of the 52 patients (mean age 33 years), 65% were men. Malaria was severe in 85% of cases, showed neurological involvement in 53%, and treated with quinine in 60%, mefloquine in 46%, artemisinin derivatives in 41%, antifolic drugs in 30%, doxycycline in 8% and other types in 8%. The mean symptom-free period was 15 days. PMNS signs were confusion (72%), fever (46%), seizures (35%), cerebellar impairment (28%), psychosis (26%), and motor disorders (13%). Cerebrospinal fluid analyses showed high protein levels in 77% (mean 1.88 g/L) and lymphocytic meningitis in 59.5% (mean 48 WBC/mm3) of cases. Electroencephalograms were pathological in 93% (14/15) of cases, and brain MRIs showed abnormalities in 43% (9/21) of cases with white matter involvement in 100%. Fourteen patients were treated with steroids. The 18 patients with follow-up data showed no sequelae. The mean time to recovery was 17.4 days.ConclusionPMNS is a rare entity englobing neurological signs after severe or non-severe malaria. It appears after a symptom-free period. PMNS occurred following treatment of malaria with a wide range of anti-malarials. The disease is self-limiting and associated with good outcome. MRI patterns underline a possible link with acute disseminated encephalomyelitis (ADEM) or auto-immune encephalitis. Plasmodium falciparum and Plasmodium vivax should be added to the list of pathogens causing ADEM.

Rehabilitation of Severe Post-Malaria Neurological Syndrome

Department of Rehabilitation Medicine Singapore General Hospital Singapore. SKL reports no biomedical financial interests or potential conflicts. This article has been presented in the form of poster presentation at the International Society of Physical and Rehabilitation Medicine 2016 World Congress. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Postmalaria neurologic syndrome associated with neurexin-3α antibodies.

Postmalaria neurologic syndrome associated with neurexin-3α antibodies.

Post malaria neurological syndrome in a Cameroonian child after a Plasmodium falciparum malaria infection

Post malaria neurological syndrome (PMNS) is a rare neurological complication occurring after malaria treatment, and manifests by neuropsychiatric symptoms. We report the first reported case in a Cameroonian child who presented with this syndrome, following severe Plasmodium falciparum malaria. The outcome was favorable.

Post malaria neurological syndrome in a Cameroonian child after a Plasmodium falciparum malaria infection

Post malaria neurological syndrome (PMNS) is a rare neurological complication occurring after malaria treatment, and manifests by neuropsychiatric symptoms. We report the first reported case in a Cameroonian child who presented with this syndrome, following severe Plasmodium falciparum malaria . The outcome was favorable.

A new clinical variant of the post-malaria neurological syndrome

Post-malaria neurological syndrome (PMNS) is an uncommon, monophasic illness that occurs within two months following recovery from Plasmodium falciparum (Pf) malaria. Clinical manifestations of PMNS are variable, but published cases uniformly feature neurological and/or psychiatric symptoms without long tract signs. We describe a case of severe brainstem and spinal cord inflammation with paraplegia and sphincter involvement in a 48year old woman following recovery from a Pf malarial illness. We propose that this case represents a previously unreported form of PMNS, which has features that distinguish it from acute disseminated encephalomyelitis, and that the recognised clinical spectrum of PMNS should be extended to include brainstem and spinal cord inflammation.

Post-Malaria Neurological Syndrome - A Case of Bell’s Palsy After Plasmodium Vivax Malaria

Post-malaria neurological syndrome (PMNS) is defined as the acute onset of neurological or neuropsychiatric syndrome in a patient who had recently recovered from malaria and have negative blood film at the time of onset of neurological symptoms. It is relatively rare, with various clinical symptoms. We report first case of Bell’s palsy developing on 10th day of afebrile period after successful treatment of Plasmodium vivax (P.vivax) malaria and which completely recovered in next two weeks. DOI: http://dx.doi.org/10.3126/jnps.v33i1.6893 J Nepal Paediatr Soc. 2013;33(1):66-67

Post-malaria neurological syndrome: a rare manifestation of common disease

Several systemic and neurological complications can occur with Plasmodium falciparum malaria, of which cerebral malaria is well known and is the most serious. Rarely, patients may suffer a neurological disorder that occurs after complete recovery from P. falciparum infection, an entity known as post-malaria neurological syndrome (PMNS). It is a rare and transient clinical syndrome in which patients with symptomatic malaria infection, after parasitic clearance from the peripheral blood, develop neurological symptoms within 2 months of recovery. We report a case of PMNS manifesting as bilateral common peroneal nerve palsy leading to foot drop.

Vivax Malaria Presenting with Myelitis: A Rare Complication

Neurological complications may occur with the Plasmodium falciparum infection. However, the association of neurological manifestations with vivax malaria remains doubtful. Of late, there are isolated case reports/studies which have implicated P. vivax in the pathogenesis of severe malaria which is characterized by the features of different organ dysfunctions, which were previously thought to be caused by P. falciparum alone. Though several case studies have mentioned the association of the P. vivax infection with cerebral malaria, a causal correlation has yet to be established. Dorsal cord myelitis (which leads to paraplegia) during the febrile illness, is rarely described in association with vivax malaria, though there are reports on the Post Malaria Neurological Syndrome (PMNS) and acute disseminated encephalomyelitis following vivax malaria. We are reporting a case of P. Vivax malaria which presented with myelitis, which responded well to the antimalarial treatment.

Delayed cerebellar ataxia: A rare self limiting complication of plasmodium falciparum malaria

The classic presentation of malaria with paroxysms of fever is seen only in 50-70% of the patients. The development of immunity, the increasing resistance to anti-malarial drugs, and the indiscriminate use of anti-malarial drugs have led to malaria with the presentation of unusual features. Cerebellar ataxia, extrapyramidal rigidity and various psychiatric symptoms have been described either as early manifestations of cerebral malaria or as a part of post malaria neurological syndrome. In this case report, we will discuss one such patient of falciparum malaria infection who developed midline cerebellar signs, and responded to anti-malarial treatment.

0906 A new clinical variant of the post-malaria neurological syndrome

Published cases of post-malaria neurological syndrome (PMNS) invariably report clinical and radiological encephalopathy. We report a case of brainstem and spinal cord inflammation without supratentorial involvement following recovery from Plasmodium...

062 The mischievous painter: an illustrated case of post malaria neurological syndrome

Malaria is a leading cause of global mortality and morbidity from infectious disease. The classical neurological sequelae from direct CNS invasion are often fulminant and well recognised. Only in recent...