Table 3.
Main clinical and diagnostic findings, treatment, and outcomes data
| 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) |
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
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)
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)
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)
dGhana1 (1.8); Sri Lanka 42 (76.4); Unknown 12 (21.8)
**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)
*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