Miller Fisher syndrome/acute motor axonal neuronopathy overlap an atypical manifestation of malaria: a case report

Khwaja Saifullah Zafar, P. S. Singh, Manoj Kumar

Abstract


Various types of neurological manifestations are described in P. falciparum/vivax malaria of which Guillian Barre syndrome and its variant like Miller Fisher Syndrome (MFS) and Acute Motor Axonal Neuronopathy (AMAN). We are reporting such an unusual case who presented with five days history of fever and weakness of three days duration. On investigations it turned out to be acute MFS/AMAN overlap with peripheral blood showing mixed infection having heavy parasitaemia of P. falciparum and P. vivax combine. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with Artemisinin based Combination Therapy (ACT) and other supportive measures.


Keywords


Malaria, Atypical manifestations, Miller Fisher syndrome, Acute motor axonal neuronopathy

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References


Rao A, Kumar MK, Joseph T, Bulusu G. Cerebral malaria: insights from host-parasite protein-protein interactions. Malar J. 2010;9:155.

Sharma A, Khanduri U. How benign is benign tertian malaria? J Vector Borne Dis. 2009;46(2):141-4.

Islam N, Qamruddin K. Unusual complications in benign tertian malaria. Trop Geogr Med. 1995;47(3):141-3.

Makkar RP, Monga SM, Gupta AK. Plasmodium vivax malaria presenting with severe thrombocytopenia. Braz J Infect Dis. 2002;6(5):263-5.

Nautiyal A, Singh S, Parameswaran G, DiSalle M. Hepatic dysfunction in a patient with Plasmodium vivax infection. Med Gen Med. 2005;7(1):8.

Prakash J, Singh AK, Kumar NS, Saxena RK. Acute renal failure in Plasmodium vivax malaria. J Assoc Physicians India. 2003;51:265-7.

Beg MA, Khan R, Baig SM, Gulzar Z, Hussain R, Smego RA Jr. Cerebral involvement in benign tertian malaria. Am J Trop Med Hyg. 2002;67(3):230-2.

Lomar AV, Vidal JE, Lomar FP, Barbas CV, de Matos GJ, Boulos M. Acute respiratory distress syndrome due to vivax malaria: case report and literature review. Braz J Infect Dis. 2005;9(5):425-30.

Singh UK, Kumar R, Sharma VK. Increased urinary frequency as a presentation of Plasmodium falciparum malaria. Paediatr Infect Dis J. 1994;13(11):1024.

Kochar DK, Shubhakaran, Kumawat BL. Neuropsychiatric manifestations in malaria. J Assoc Physicians India. 1998;46:886-90.

Arya TVS, Prasad RN. Falciparum malaria presenting as Guillian Barre syndrome. Br Med J. 1986;292:1430.

Drago SD, D’Sa N, Golapalli U, Jagasia B, Paidhungat AJ. Guillian barrey syndrome in a case of falciparum malaria. J Assoc Physicians India. 1997;45:161.

Padmini P, Maheshwari MC. P. vivax malaria complicated by peripheral neuropathy with electrophysiological studie. J Assoc Physicians India. 1980;28:153-6.

Kochar DK, Shubhakaran, Kumawat BL, Kochar SK, Halwai M, Makkar RK, et al. Cerebral malaria in Indian adults. A prospective study of 441 patients. J Assoc Physicians India. 2002;50:234-41.

Wijesundere A. Guillain-Barré syndrome in Plasmodium falciparum malaria. Postgrad Med J. 1992;68(799):376-7.

Sokrab TE, Eltahir A, Idris MN, Hamid M. Guillain-Barré syndrome following acute falciparum malaria. Neurology. 2002;59(8):1281-3.

Daviel H, Conner, Herber JM. Parasite infection of the peripheral nervous system. In: Dyck, Thomas, eds. Peripheral Neuropathy. 2nd ed. Philadelphia: WB Saunders Co; 1993: 1338-1390.

Garg RK, Karak B, Misra S. Neurological manifestations of malaria: an update. Neurol India. 1999;47(2):85-91.

Kanjalkar M, Karnad DR, Narayana RV, Shah PU. Guillain-Barre syndrome following malaria. J Infect. 1999;38(1):48-50.