Introdução: A síndrome neurológica pós-malária (SNPM) é uma complicação rara que acomete indivíduos previamente infectados pelo Plasmodium falciparum ou Plasmodium vivax. As manifestações neurológicas são vastas, tendo múltiplos diagnósticos diferenciais, incluindo patologias de mau prognóstico. A fisiopatologia ainda é incerta, sendo relacionada a mecanismos autoimunes ou até mesmo ao uso de antimaláricos, o que reforça a necessidade de mais estudos para esclarecer a correlação entre PMNS e o uso desses medicamentos. Objetivo: Realizar uma revisão bibliográfica acerca das causas, apresentação clínica e diagnóstico da SNPM. Materiais e Métodos: Revisão integrativa nas plataformas PubMed e Scielo, utilizando os descritores do Decs e do MeSH, limitando-se a produções de 2017 a 2021. Foram buscados os termos: “síndrome neurológica pós-malária”, “sistema nervoso e malária” e “malária cerebral”. Resultados: A SNPM é significativamente mais frequente em pacientes com a forma grave da doença. Tem início cerca de 15 dias após a eliminação total do parasita, mas pode se manifestar em até 2 meses após o quadro de aparasitemia, fato que a diferencia da malária cerebral. A clínica inclui febre, confusão, convulsões, psicose, mioclonia, afasia, tremores e sintomas cerebelares. Na maioria dos casos há alterações no encefalograma e acometimento de substância branca na ressonância magnética, sugerindo encefalomielite disseminada aguda (EDA) ou encefalite autoimune. Na análise do líquor, pode haver pleocitose linfocítica e hiperproteinemia. Conclusão: A SNPM, apesar de rara e autolimitada, deve ser considerada entre os diagnósticos diferenciais devido à sua possível subnotificação, especialmente entre aqueles pacientes com histórico recente de recuperação de malária que, posteriormente, evoluíram para um quadro neurológico. Ademais, a similaridade clínica entre SNPM e EDA – outra complicação neurológica da malária – demonstra a importância de serem criados critérios diagnósticos bem definidos, principalmente nas regiões endêmicas desta patologia. Ainda, apesar da suspeita que a mefloquina usada no tratamento para malária seja um fator de risco para SNPM, faltam estudos conclusivos que esclareçam se há associação entre esses dois fatores. Isto reforça a necessidade de maior investigação para alternativas farmacológicas no tratamento da malária, uma doença notadamente negligenciada no Brasil.
Publicado
2021-03-01
Como Citar
Poloni, M. C., Passoni, L. C. de L., Silva, H. V. B. A. da, Medeiros, V. R. de, & Mioranza, S. de L. (2021). SÍNDROME NEUROLÓGICA PÓS-MALÁRIA: UMA REVISÃO INTEGRATIVA. Revista Multidisciplinar Em Saúde, 2(1), 72. https://doi.org/10.51161/rems/746
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