Postmalaria neurological syndrome: a case report

ObjectiveWe set out to test the discriminative power of an age-adjusted upper reference limit for cerebrospinal fluid total protein (CSF-TP) in identifying clinically relevant causes of albuminocytological dissociation (ACD).MethodsWe reviewed the charts of 2627 patients who underwent a lumbar puncture at a tertiary care centre over a 20-year period. Samples with CSF-TP above 45 mg/dL (0.45 g/L) were included. Samples with white cell count >5×109/L, red cell count >50×109/L and glucose <2.5 mmol/L (45 mg/dL) were excluded as were samples with incomplete data and those taken from paediatric patients (ie, age <18 years old). Patients with CSF-TP elevated above 45 mg/dL were considered to have ‘pseudo’ ACD unless their CSF-TP was in excess of age-adjusted norms in which case they were considered to have ‘true’ ACD. Adjustment for sex was not applied to the age-adjusted norms although the importance of gender has been previously described.ResultsThe presence of ACD was associated with a broad range of neurological diagnoses. Among all 2627 patients with ACD, a clinical diagnosis explaining CSF-TP elevation was identified in 57% of cases. ‘True’ ACD was associated with a suitable diagnosis in 75% of cases, whereas patients with ‘pseudo’ ACD showed an appropriate diagnosis in only 51% of cases. Use of an age-adjusted upper reference limit favoured the detection of polyneuropathy patients (13.5% proportionate increase) and excluded a larger number of patients with isolated headache (10.7% proportionate decrease; p<0.0001).ConclusionsElevated CSF-TP is a common finding, with a range of underlying causes. Use of an age-adjusted upper reference limit for the CSF-TP value improves diagnostic specificity and helps to avoid overdiagnosis of ACD.

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Protein Export into Malaria Parasite–Infected Erythrocytes: Mechanisms and Functional Consequences

Spillman¹,

Beck

Goldberg

2015

Annu. Rev. Biochem.

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Phylum Apicomplexa comprises a large group of obligate intracellular parasites of high medical and veterinary importance. These organisms succeed intracellularly by effecting remarkable changes in a broad range of diverse host cells. The transformation of the host erythrocyte is particularly striking in the case of the malaria parasite Plasmodium falciparum. P. falciparum exports hundreds of proteins that mediate a complex cellular renovation marked by changes in the permeability, rigidity, and cytoadherence properties of the host erythrocyte. The past decade has seen enormous progress in understanding the identity and function of these exported effectors, as well as the mechanisms by which they are trafficked into the host cell. Here we review these advances, place them in the context of host manipulation by related apicomplexans, and propose key directions for future research.

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Postmalaria neurological syndrome: a case report

Cited by 3 publications

References 9 publications

Acute disseminated encephalomyelitis, a rare post-malaria neurological complication: Case report and review of the literature

Acute disseminated encephalomyelitis, a rare post-malaria neurological complication: Case report and review of the literature

Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre

Protein Export into Malaria Parasite–Infected Erythrocytes: Mechanisms and Functional Consequences

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