Neurological manifestations following cured malaria: don’t forget post-malaria neurological syndrome

Abstract

Introduction: Cerebral malaria which occurs during the active infection is the most common neurological complication of malaria. Other complications including post-malaria neurological syndrome (PMNS) can rarely occur following complete recovery from the disease. We report a case of post-malaria neurological syndrome in a Tunisian patient.
 Case presentation: A 26-year-old Tunisian man with no past medical history was admitted in 2016 for a muscle weakness of the 4 limbs, seizures, tetraparesis and myoclonus which appeared after he returned from Côte d’Ivoire where he had been treated three weeks ago for Plasmodium falciparum malaria with favorable outcome. Blood smears for malaria were negative. Brain MRI showed multiple hypersignal cerebral lesions. Investigations didn’t show any infectious, metabolic, toxic, vascular or tumoral etiology. Thus, the diagnosis of PMNS was considered. The patient was treated with methylprednisolone with favorable outcome. Two years later, he was completely asymptomatic.
 Conclusion: PMNS should be considered in patients with neurological symptoms occurring within two months of cured acute disease in which blood smears for malaria are negative and other etiologies have been ruled out. In most cases, the disease is self-limited while in severe cases corticosteroid therapy should be prescribed with favorable outcome.
 Keywords: Post-malaria neurological syndrome; immunologic; corticosteroid.

Diagnosis of cerebral malaria: Tools to reduce Plasmodium falciparum associated mortality

“…The use of MRI in malaria research studies is relatively new and was limited to single case studies for a long time ( Bellazreg et al., 2021 ; Schubert et al., 2021 ), before gradually becoming more available in endemic areas. A study of 24 adults demonstrated that brain swelling and increased volume is common in CM due to iRBC sequestration in the brain ( Looareesuwan et al., 1995 ).…”

Post-malarial neurological syndrome in a Gambian adult residing in the Gambia: a case report and a review of literature

“…One such was a case series that involved 10 patients in Thailand [ 34 ]. In a case report from Tunisia, the patient presented with tetraparesis [ 36 ]. Bilateral facial nerve palsy which is considered a feature of AIDP has been reported in India [ 37 ] and in South Korean [ 38 ].…”

“…Brain CT scan was normal in some cases including [ 36 , 42 , 43 , 49 – 51 ]. In some other cases the CT scan was abnormal.…”

“…MRI was normal in some cases including [ 23 , 42 , 49 and 51 ]. Most of the abnormal cases showed white matter intensities [ 36 , 43 , 49 , 52 – 57 ]. However the sites differed like cerebellar and white matter [ 47 , 49 , 52 , 53 and 56 ] periventricular [ 52 , 53 ] and bilateral hypocampi [ 57 ].…”

Non communicable diseases persist despite being overshadowed by Covid-19 globally

“…31 HPV/HIV confection in Kenya 32 , and first line HIV treatment failure in Ethiopia 33 , conclude the HIV papers. We have a series of papers on malaria 34 , septic shock 35 , and wound infection with MRSA 36 concluding the infections disease section.…”