G320(P) Post-malaria neurological syndrome: the first irish paediatric case. (12th March 2018)

• Record Type: Journal Article
• Authors: Almuntaser, S; Costello, A; Lynch, B; Leonard, J; Gavin, P
• Is Part Of: Archives of disease in childhood. Volume 103(2018)Supplement 1
• Page Start: A130
• Page End: A130
• Publication Date: 2018-03-12
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2018-rcpch.310
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Post-malaria neurological syndrome (PMNS) is described as a rare post-infectious encephalopathy occurring within two months of resolved malaria infection and with an aparasitaemia. PMNS encompasses three separate neurological syndromes: A delayed cerebellar syndrome, an acute demyelinating polyneuropathy (GBS) and an acute disseminated encephalopathy (ADEMs). Here, we report the first Irish paediatric case of falciparum PMNS, in a patient of African origin, born and living in Ireland. A 15 year old boy presented with a 3 day history of progressive encephalopathy, features of raised ICP and seizures on a background of falciparum malaria treated six weeks previously. PMNS was diagnosed after further investigations and an aparasitaemia. He was sedated and intubated for 2 days and commenced on antimicrobials, antimalarial and steroids. His investigations results as following: MRI brain: Cerebral oedema and optic neuritis, EEG: Severe encephalopathy. Serial thick and thin films: No malaria parasites Falciparum Protein Antigen (RDT): Positive (Can remain positive for 6 weeks after malaria). CSF Studies: Protein 1383 g/dl, 16 WBCs/dl, 100% mononuclear cells). PCRs: negative for HSV, Adenovirus, Coxsackie, EBV, CMV, Meningococcus, Pneumococcus. By day 6 of admission he had made a full recovery with no neurological deficits. Methods: Using Google and PubMed, we searched for relevant case reports and journal articles describing neurological syndromes occurring post infection with falciparum malaria in the paediatric population. Results: Whilst the prevalence of PMNS (plasmodium falciparum) is 0.12% in adults, the prevalence in children remains unknown. In 1996, a Vietnamese study conducted over 4 years reported 23 patients with PMNS following full recovery from falciparum malaria. Of these, only 3 were children. A 2015 case report describes a further two children with falciparum PMNS. There have been no further paediatric cases reported to date worldwide. Conclusion: In conclusion, PMNS is an increasingly recognised, but rare complication of malaria that must be differentiated from relapsing or recurrent malaria, and post-infectious neurological syndromes, e.g. ADEM. In particularly severe cases, steroids have been given as an adjunctive therapy to speed recovery however PMNS is a self-limiting condition that resolves within 2–14 days and requires no specific treatment.