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Butt N, Ahmed E. Falciparum malaria associated acute kidney injury with polyneuropathy and intra-arterial thrombosis (stroke). Eur J Med Res 2022; 27:2. [PMID: 34991710 PMCID: PMC8734130 DOI: 10.1186/s40001-021-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is still major problem in developing countries, such as Pakistan. Besides fever, body ache and vomiting it can present with acute kidney injury, proteinuria, hematuria and cerebral manifestations which are more common with falciparum malaria. Neurological manifestations are rare presentation of malaria and should be consider in patients who are admitting with features of neuropathy and stroke. CASE PRESENTATION We describe an unusual case of falciparum malaria, complicated by acute kidney injury who developed Polyneuropathy and intra-arterial thrombosis in middle cerebral artery territory. Our patient recovered his renal functions during admission and recovered his power and sensation in his limbs as well after 1 month. CONCLUSION Malaria cause neurological manifestations including axonal and sensory neuropathy, cerebral venous and arterial thrombosis, PMNS, cerebellar signs and symptoms, psychosis, etc. With prompt diagnosis and early treatment they can be cure and regain their motor and sensory functions to normal level.
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Affiliation(s)
- Nausheen Butt
- Sindh Institute of Urology and Transplant, Karachi, Sindh, Pakistan.
| | - Ejaz Ahmed
- Sindh Institute of Urology and Transplant, Karachi, Sindh, Pakistan
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2
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Agarwal N. Post-malaria neurological syndrome manifesting as new onset psychosis with generalized encephalopathy: an analysis of two cases in children. Trop Doct 2021; 52:168-170. [PMID: 34918609 DOI: 10.1177/00494755211055365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-malaria neurological syndrome(PMNS) is a rare heterogenous syndrome heralded by the appearance of new neurological or psychiatric manifestations emerging in the post-infectious phase after clearance of malaria parasitaemia. Most cases of PMNS have been described in adults. Only seven cases have been reported in children. We describe two further cases of possible PMNS who presented with prominent psychiatric manifestations evolving into generalized encephalopathy after complete recovery from malaria. Both patients were treated with antivirals and antibiotics without clinical improvement. One patient received pulse corticosteroids and had a remarkable and rapid clinical improvement. The other recovered without specific treatment.
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Affiliation(s)
- Neha Agarwal
- Department of Pediatrics, 30076GSVM Medical College, Kanpur, India
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3
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Chiabi A, Djimafo ANM, Nguefack S, Mah E, Nguefack Dongmo F, Angwafo F. Severe malaria in Cameroon: Pattern of disease in children at the Yaounde Gynaeco-Obstetric and Pediatric hospital. J Infect Public Health 2020; 13:1469-1472. [DOI: 10.1016/j.jiph.2020.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/28/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022] Open
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Panda PK, Sharawat IK, Panda PK. Case Report: An Adolescent Girl with Isolated Neuropsychiatric Features and Apparent Post-Malaria Neurological Syndrome. Am J Trop Med Hyg 2020; 102:1030-1032. [PMID: 32067632 DOI: 10.4269/ajtmh.19-0791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The post-malaria neurological syndrome (PMNS) is an unusual and relatively underreported complication of malaria, which usually occurs after the resolution of acute febrile illness and the patient is free from parasitemia. The clinical spectrum of the PMNS varies from acute-onset cerebellar ataxia to significant encephalopathy with focal deficits resembling acute disseminated encephalomyelitis. Uncommon presentations of PMNS include Guillain-Barre syndrome, postural tremor, or even isolated neuropsychiatric features. Although in a significant proportion of PMNS cases clinical resolution occurs with conservative treatment only, corticosteroids have been used in an attempt to hasten recoveries. Here, we present a case of a 12-year-old girl with acute onset, isolated neuropsychiatric features, following Plasmodium falciparum malaria. Neuroimaging, clinical examination, and cerebrospinal fluid studies were within normal limits. The child recovered completely after treatment with methylprednisolone pulse therapy. This case report illustrates the need for creating awareness about this uncommon complication of malaria. In view of the uncommon complication, early diagnosis and prompt treatment might help in the early resolution of symptoms.
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Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
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5
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Yadava SK, Laleker A, Fazili T. Post-malaria neurological syndrome: a rare neurological complication of malaria. Infection 2019; 47:183-193. [PMID: 30666615 PMCID: PMC7100559 DOI: 10.1007/s15010-019-01267-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/04/2019] [Indexed: 11/27/2022]
Abstract
Background Post-malaria neurological syndrome (PMNS) is a rare self-limiting neurological complication that can occur after recovery from malaria, usually severe falciparum malaria. It is characterized by a myriad of neuropsychiatric manifestations including mild neurological deficit to severe encephalopathy. PMNS was first described in 1996 and since then there have been 48 cases reported in the English literature. We report another case of PMNS in a 24-year-old healthy male and present a review of the disease entity. Method We searched PMNS-related journal articles and case reports in the English literature, using PubMed and Google search engines. A total of forty-nine cases meeting the diagnostic criteria of PMNS were selected in this review. Conclusion PMNS is a rare complication of severe malaria that might be underreported. It can develop up to 2 months after clearance of parasitemia. Clinical features can be variable. Most cases are self-limited, but more severe cases may benefit from steroid therapy.
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Affiliation(s)
- Sanjay K Yadava
- Department of Medicine, Division of Infectious Disease, SUNY Upstate Medical Center, Syracuse, NY, USA.
| | - Ashley Laleker
- Department of Medicine, Division of Infectious Disease, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Tasaduq Fazili
- Department of Medicine, Division of Infectious Disease, SUNY Upstate Medical Center, Syracuse, NY, USA
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6
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Tamzali Y, Demeret S, Haddad E, Guillot H, Caumes E, Jauréguiberry S. Post-malaria neurological syndrome: four cases, review of the literature and clarification of the nosological framework. Malar J 2018; 17:387. [PMID: 30367650 PMCID: PMC6204022 DOI: 10.1186/s12936-018-2542-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/22/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Post-malaria neurological syndrome (PMNS) is a debated entity, defined by neurological complications following a post-malaria symptom-free period and a negative blood smear. Four cases of PMNS are hereby reported and a review the literature performed to clarify the nosological framework of this syndrome. METHODS A French teaching hospital infectious diseases database was investigated for all PMNS cases occurring between 1999 and 2016 and the PubMed database for cases reported by other institutions after 1997. A case was defined by the de novo appearance of neurological signs following a post-malaria symptom-free period, a negative blood smear, and no bacterial or viral differential diagnoses. RESULTS Four patients from the database and 48 from PubMed, including 4 following Plasmodium vivax infection were found matching the definition. In the institution, the estimated PMNS incidence rate was 1.7 per 1000 malaria cases overall. Of the 52 patients (mean age 33 years), 65% were men. Malaria was severe in 85% of cases, showed neurological involvement in 53%, and treated with quinine in 60%, mefloquine in 46%, artemisinin derivatives in 41%, antifolic drugs in 30%, doxycycline in 8% and other types in 8%. The mean symptom-free period was 15 days. PMNS signs were confusion (72%), fever (46%), seizures (35%), cerebellar impairment (28%), psychosis (26%), and motor disorders (13%). Cerebrospinal fluid analyses showed high protein levels in 77% (mean 1.88 g/L) and lymphocytic meningitis in 59.5% (mean 48 WBC/mm3) of cases. Electroencephalograms were pathological in 93% (14/15) of cases, and brain MRIs showed abnormalities in 43% (9/21) of cases with white matter involvement in 100%. Fourteen patients were treated with steroids. The 18 patients with follow-up data showed no sequelae. The mean time to recovery was 17.4 days. CONCLUSION PMNS is a rare entity englobing neurological signs after severe or non-severe malaria. It appears after a symptom-free period. PMNS occurred following treatment of malaria with a wide range of anti-malarials. The disease is self-limiting and associated with good outcome. MRI patterns underline a possible link with acute disseminated encephalomyelitis (ADEM) or auto-immune encephalitis. Plasmodium falciparum and Plasmodium vivax should be added to the list of pathogens causing ADEM.
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Affiliation(s)
- Yanis Tamzali
- Infectious and Tropical Diseases Unit, APHP, Pitié Salpêtrière Hospital, 75013, Paris, France
| | - Sophie Demeret
- Neurology Department, APHP, Pitié Salpêtrière Hospital, 75013, Paris, France
| | - Elie Haddad
- Infectious and Tropical Diseases Unit, APHP, Pitié Salpêtrière Hospital, 75013, Paris, France
| | - Hélène Guillot
- Infectious and Tropical Diseases Unit, APHP, Pitié Salpêtrière Hospital, 75013, Paris, France
| | - Eric Caumes
- Infectious and Tropical Diseases Unit, APHP, Pitié Salpêtrière Hospital, 75013, Paris, France
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health (UMRS 1136), Paris, France
| | - Stéphane Jauréguiberry
- Infectious and Tropical Diseases Unit, APHP, Pitié Salpêtrière Hospital, 75013, Paris, France.
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health (UMRS 1136), Paris, France.
- National Reference Centre for Malaria, Paris, France.
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7
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Abstract
Post-malaria neurologic syndrome (PMNS) is a rare complication following a Plasmodium falciparum infection and its pathophysiology remains unclear. This is the first report of a pediatric PMNS following an infection acquired in Africa and the fourth description of pediatric PMNS overall. Neither intrathecal synthesis of Immunoglobin G nor specific P. falciparum antibodies were found in the cerebrospinal fluid.
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8
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Nevin RL, Croft AM. Psychiatric effects of malaria and anti-malarial drugs: historical and modern perspectives. Malar J 2016; 15:332. [PMID: 27335053 PMCID: PMC4918116 DOI: 10.1186/s12936-016-1391-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
The modern medical literature implicates malaria, and particularly the potentially fatal form of cerebral malaria, with a risk of neurocognitive impairment. Yet historically, even milder forms of malaria were associated in the literature with a broad range of psychiatric effects, including disorders of personality, mood, memory, attention, thought, and behaviour. In this article, the history of psychiatric effects attributed to malaria and post-malaria syndromes is reviewed, and insights from the historical practice of malariotherapy in contributing to understanding of these effects are considered. This review concludes with a discussion of the potentially confounding role of the adverse effects of anti-malarial drugs, particularly of the quinoline class, in the unique attribution of certain psychiatric effects to malaria, and of the need for a critical reevaluation of the literature in light of emerging evidence of the chronic nature of these adverse drug effects.
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Affiliation(s)
- Remington L. Nevin
- />Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 782, Baltimore, MD 21205 USA
| | - Ashley M. Croft
- />School of Pharmacy and Biomedical Science, University of Portsmouth, James Watson Building (West), Portsmouth, Hants PO1 2FR UK
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Sengupta A, Ghosh S, Sharma S, Sonawat HM. 1H NMR metabonomics indicates continued metabolic changes and sexual dimorphism post-parasite clearance in self-limiting murine malaria model. PLoS One 2013; 8:e66954. [PMID: 23826178 PMCID: PMC3691208 DOI: 10.1371/journal.pone.0066954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/13/2013] [Indexed: 11/18/2022] Open
Abstract
Malaria, a mosquito-borne disease caused by Plasmodium spp. is considered to be a global threat, specifically for the developing countries. In human subjects considerable information exists regarding post-malarial physiology. However, most murine malarial models are lethal, and most studies deal with acute phases occurring as disease progresses. Much less is known regarding physiological status post-parasite clearance. We have assessed the physiological changes at the organ levels using (1)H NMR based metabonomics in a non lethal self-clearing murine malarial model of P. chabaudi parasites and Balb/C, far beyond the parasite clearance point. The results showed distinct metabolic states between uninfected and infected mice at the peak parasitemia, as well as three weeks post-parasite clearance. Our data also suggests that the response at the peak infection as well as recovery exhibited distinct sexual dimorphism. Specifically, we observed accumulation of acetylcholine in the brain metabolic profile of both the sexes. This might have important implication in understanding the pathophysiology of the post malarial neurological syndromes. In addition, the female liver showed high levels of glucose, dimethylglycine, methylacetoacetate and histidine after three weeks post-parasite clearance, while the males showed accumulation of branched chain amino acids, lysine, glutamine and bile acids.
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Affiliation(s)
- Arjun Sengupta
- Department of Chemical Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Soumita Ghosh
- Department of Chemical Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Shobhona Sharma
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
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10
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Rachita S, Satyasundar M, Mrutunjaya D, Birakishore R. Acute disseminated encephalomyelitis (ADEM)--a rare complication of falciparum malaria. Indian J Pediatr 2013; 80:499-501. [PMID: 22700387 DOI: 10.1007/s12098-012-0814-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 05/25/2012] [Indexed: 11/30/2022]
Abstract
A 4-y-old girl was admitted with fever and altered sensorium. Peripheral blood smear and quantified buffy coat test showed Plasmodium falciparum infection. She received antimalarial therapy and got discharged on seventh day without any neurological deficit. Seven days later she was readmitted with fever and disorientation. Neurological examination revealed coma and decerebration. The deep tendon reflexes were exaggerated and babiniski response was positive in the right lower limb. MRI of brain revealed multifocal asymmetrical T2W/FLAIR hyperintensities in cerebral hemispheres, sub cortical white matter and midbrain. There was minimal patchy enhancement on contrast study. Any feature of grey matter involvement was not observed. The child improved remarkably after the treatment with methyl prednisolone. A follow up MRI after one year showed a complete resolution of demyelinating lesions. Diagnosis of acute disseminated encephalomyelitis (ADEM) as a complication of falciparum malaria was made based on sudden onset of neurological events, MRI findings and prompt response to corticosteroid therapy.
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Affiliation(s)
- Sarangi Rachita
- Department of Pediatrics, Institute of Medical Sciences and SUM Hospital, Kalinga Nagar, Bhubaneswar, 751003 Odisha, India.
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11
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Nevin RL. Limbic encephalopathy and central vestibulopathy caused by mefloquine: a case report. Travel Med Infect Dis 2012; 10:144-51. [PMID: 22494697 DOI: 10.1016/j.tmaid.2012.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/21/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
Mefloquine is a 4-methanolquinoline anti-malarial that in recent years has fallen out of favor for use as chemoprophylaxis against infection with chloroquine-resistant Plasmodium falciparum malaria owing in part to growing concerns of side effects and potential neurotoxicity. Despite over 20 years of licensed use, the pathophysiological mechanisms underlying mefloquine's neuropsychiatric and physical side effects and the clinical significance of the drug's neurotoxicity have remained poorly understood. In this report, an adverse reaction to mefloquine chemoprophylaxis is described characterized by prodromal symptoms of anxiety with subsequent development of psychosis, short-term memory impairment, confusion and personality change accompanied by complaints of disequilibrium and vertigo, with objective findings of central vestibulopathy. It is posited that these effects represent an idiosyncratic neurotoxic syndrome of progressive limbic encephalopathy and multifocal brainstem injury caused by the drug. This case provides insights into the clinical significance of mefloquine neuronal gap junction blockade and neurotoxicity demonstrated in animal models, points to recommendations for the management of affected patients including diagnostic considerations and appropriate referrals, and highlights critical implications for the continued safe use of the medication.
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Affiliation(s)
- Remington L Nevin
- Department of Preventive Medicine, Bayne-Jones Army Community Hospital, 1585 Third Street, Fort Polk, LA 71459, USA.
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12
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Rakotoarivelo RA, Razafimahefa SH, Andrianasolo R, Fandresena FH, Razanamparany MMO, Randria MJD, Rapelanoro Rabenja F. [Post-malaria neurological syndrome complicating a Plasmodium falciparum malaria in Madagascar]. ACTA ACUST UNITED AC 2012; 105:199-201. [PMID: 22246560 DOI: 10.1007/s13149-012-0208-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/22/2011] [Indexed: 11/29/2022]
Abstract
Post-malaria neurological syndrome is a rare complication of malaria. Typically, it occurs in case of severe malaria. Here we report a case in a Malagasy patient presenting a non-severe Plasmodium falciparum malaria complicated by post-malaria neurological syndrome. The management of such a syndrome is radically different from non-severe malaria. No specific treatment is needed.
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Affiliation(s)
- R A Rakotoarivelo
- Service des maladies infectieuses, hôpital Joseph-Raseta-Befelatanana, CHU d'Antananarivo, Antananarivo, Madagascar.
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Motta LPD, Costa MAD, Gouvea MB, Tibúrcio AS, João Filho EC, Specterow M, Silva BCD, Nascimento MLFO, Ganem NS, Lyra MR. Postmalaria neurological syndrome: a case report. Rev Soc Bras Med Trop 2011; 44:787-8. [DOI: 10.1590/s0037-86822011000600027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 03/15/2011] [Indexed: 11/22/2022] Open
Abstract
Described here is a case of postmalaria neurological syndrome in a patient who presented infection by Plasmodium falciparum two months earlier. The patient received empiric use of acyclovir for herpetic meningoencephalitis, but neuropsychiatric symptoms improved only after administration of methylprednisolone.
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14
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Affiliation(s)
- J Daniel Markley
- Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298-0019, USA.
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15
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Odawara T, Matsumura T, Maeda T, Washizaki K, Iwamoto A, Fujii T. A case of post-malaria neurological syndrome (PMNS) after treatment of falciparum malaria with artesunate and mefloquine. Trop Med Health 2009. [DOI: 10.2149/tmh.2009-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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