Table 2.
Biological and radiological features of PMNS post P. falciparum, P. vivax or mixed infection
| CSF (WBC/%L) | CSF protein (g/L) | CRP (mg/L) | EEG | MRI | MRI matching ADEM or AIE | |
|---|---|---|---|---|---|---|
| P. falciparum infection | ||||||
| Case 1 | 32/90 | 1.05 | N | Abnormal | N | – |
| Case 2 | 82/87 | 2.41 | N | Abnormal | Limbic and hippocampal hypersignal | ADEM plausible |
| Case 3 | 173/89 | 1.88 | 40 | Abnormal | N | – |
| Case 4 | NA | NA | N | NA | NA | |
| Nguyen [4] (N = 22) | > 5 in 8/lymphocytic predominance | > 0.5 in 13 | NA | NA | NA | |
| O’Brien [6] | NA | NA | NA | NA | WM lesions in CH, brainstem, cerebellum, thalamus and basal ganglia | ADEM plausible |
| Zambito [7] | 20/100 | 0.86 | NA | Abnormal | N | – |
| Mizuno [8] | 10/100 | 0.83 | 27 | Abnormal | N | – |
| Nayak [9] | N/N | 0.66 | NA | NA | NA | |
| Prendki [10] | 76/100 | 0.52 | 163 | Abnormal | N | – |
| Prendki [10] | 26/91 | 1.88 | 9 | Abnormal | N | – |
| Falchook [11] | NA | NA | N | NA | Pons, posterior internal capsule, thalamus, corona radiata, and periventricular hypersignal | ADEM unlikely |
| Matias [12] | N/N | 1.83 | N | Abnormal | Extensive demyelinating lesions (subcortical WM and cerebellum) | ADEM or dysimmune plausible |
| Markley [13] | 20/100 | 0.92 | NA | Abnormal | N | – |
| Forestier [14] | 43/95 | 1.2 | N | Abnormal | N | – |
| Rakoto.[15] | 31/98 | 2 | N | NA | NA | |
| Pace [16] | NA | NA | 8 | NA | Brainstem and spinal cord high signal and swelling | ADEM plausible |
| Caetano [17] | 123/100 | 1.88 | NA | Normal | N | |
| Mohsen [18] | 22/100 | 1.4 | NA | Abnormal | Subcortical unilateral frontal and temporal, and cerebellar hypersignal with gadolinium enhancement | ADEM unlikely but not impossible |
| Schnorf [19] | 10/95 | 0.6 | NA | Abnormal | Peri and supraventricular and cerebellar hypersignal | ADEM plausible |
| Schnorf [19] | 80/87 | 1.8 | NA | Abnormal | N | |
| Agrawal [20] | 5/100 | 1.12 | NA | NA | Asymmetric supraventricular, semi-ovale center, genu of corpus callosum WM hypersignal | NA |
| Rachita [21] | 7/100 | 1.25 | NA | NA | Multifocal asymmetric diffuse WM hypersignal with small mass effect | ADEM |
| Lawn [22] | N/N | 0.89 | N | NA | N | – |
| Lawn [22] | 59/100 | 2.89 | N | Abnormal | N | – |
| Total abnormal | 25/42 | 33/42 | 5/14 | 14/15 | 9/21 | |
| % abnormal [95% CI] | 59.5 [44.5–72.9] | 78.6 [64.1–88.3] | 35.7 [16.3–61.3] | 93.3 [70.2–98.8] | 42.8 [24.5–63.5] | |
| Mean WBC/%L (SD) | 48a/96a (46)/(5.1) | 1.4b (0.6) | 49.4c (64.9) | |||
| Median WBC/%L (min–max) | 31a/100a (5–173)/(87–100) | 1.2b (0.5–2.9) | 27c (8–163) | |||
| P. vivax infection | ||||||
| Goyal [23] | 70/NA | 0.5 | NA | NA | Diffuse periventricular, deep and subcortical WM hypersignal | |
| Sidhu [24] | NA | NA | NA | NA | Subcortical, cortical, left parietal periventricular regions and pons hypersignal | |
| Kochar [25] | NA | NA | NA | NA | NA | |
| Kasundra [26] | 10/100 | 0.65 | NA | NA | T1-weighted isointense and T2 and fluid-attenuated inversion recovery high signal in bilateral cerebellar hemispheres including vermis | |
| Mixed infection | ||||||
| Koibuchi [27] | 30/NA | 0.46 | 52 | NA | Asymmetric spotty mottled cortical and subcortical lesions | |
| Mani [28] | NA | NA | NA | Multifocal confluent areas of demyelination in the corpus callosum and periventricular region, myelitis | ||
Meningitis is defined in the CSF by CSF WBC ≥ 5/mL. CSF Protein ≥ 0.5 g/L is considered abnormal. CRP normal value ≤ 5 mg/L
CSF cerebrospinal fluid, WBC white blood count, %L proportion of lymphocytes, CRP c-reactive protein, WM white matter, NA not available, N normal, ADEM acute disseminated encephalomyelitis, AIE autoimmune encephalitis, LP lumbar puncture, SD standard deviation, [95% CI] 95% confidence interval
aCalculated on abnormal and available figured data, n = 17
bCalculated on abnormal and available figured data, n = 20
cCalculated on abnormal and available figured data, n = 5