Hypoglycaemia in Sudanese children with cerebral malaria

Atabani, G.; Saeed, B. O.; elSeed, B. A.; Bayoumi, Mahmoud; Hadi, Namazi; Abu-Zeid, Yousif A.; Bayoumi, Riad

doi:10.1136/pgmj.66.774.326-a

Cited by 3 publications

(2 citation statements)

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“…Plasma glucose concentration reflects the balance between glucose supply and glucose use in children with severe illness including malaria. Inadequate glucose supply and fasting have been implicated in a number of studies in children with severe malaria [ 11 , 30 ] but others examining glucose kinetics conclude that gluconeogenesis and endogenous glucose production is preserved or even increased [ 28 , 31 ] but glucose supply however, is disproportionately derived from glycogenolysis. Zijlmans and colleagues recently demonstrated that even after 16 hours of fasting glycogenolysis contributed to 35-40% of the glucose production [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Hypoglycaemia in severe malaria, clinical associations and relationship to quinine dosage

et al. 2010

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BackgroundHypoglycaemia is an independent risk factor for death in severe malaria and a recognized adverse treatment effect of parenteral quinine. In 2006 our hospital changed quinine treatment policy from 15 mg/kg loading (plus 10 mg/kg 12-hourly) to 20 mg/kg loading (plus 10 mg/kg 8-hourly) to comply with new WHO guidelines. This presented us with the opportunity to examine whether there was any dose relationship of quinine and hypoglycaemia occurrence.MethodsRetrospective case notes review of all children admitted to hospital with severe falciparum malaria between April 2002 - July 2009, before and after the introduction of the new WHO quinine regimen. Four-hourly bedside glucose levels were measured until intravenous quinine was discontinued. Clinical events immediately preceding or concurrent with each episode of hypoglycaemia (glucose < = 3.0 mmol/l) were recorded.Results954 children received the old quinine regime and 283 received the new regime. We found no evidence of an increased prevalence of hypoglycaemia (< = 3.0 mmol/L) on the new regime compared to former (15% vs. 15%); similar findings were noted for profound hypoglycaemia (< 2.2 mmols/L) 8% v 5%, P = 0.07. Episodes were co-incident with disease severity markers: coma (57%), circulatory failure (38%) and respiratory distress (21%) but less commonly with seizures (10%). Disruption of maintenance fluids and/or blood transfusion concurred with 42% of the hypoglycaemia episodes. Post admission hypoglycaemia increased odds of fatal outcome (24%) compared to euglycaemic counterparts (8%), odds ratio = 3.45 (95% confidence interval = 2.30-5.16) P < 0.01.ConclusionThere was no evidence to indicate a dose relationship between quinine and occurrence of hypoglycaemia. Hypoglycaemia concurred with severity features, disruption of glucose infusion and transfusion. Careful glucose monitoring should be targeted to these complications where resources are limited.

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Section: Discussionmentioning

confidence: 99%

Hypoglycaemia in severe malaria, clinical associations and relationship to quinine dosage

et al. 2010

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“…Infections with Plasmodium spp. in mice [52] and humans [53][54][55][56] induce hypoglycemia, which is often predictive of severe pathology and a fatal outcome. In mice, hypoglycemia has been causally linked to hyperinsulinemia [57].…”

Section: Insulin Signaling and Its Impact On Malaria Transmissionmentioning

confidence: 99%

The insulin signaling cascade from nematodes to mammals: Insights into innate immunity of Anopheles mosquitoes to malaria parasite infection

Luckhart

Riehle

2007

Developmental & Comparative Immunology

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As revealed over the past twenty years, the insulin signaling cascade plays a central role in regulating immune and oxidative stress responses that affect the life spans of mammals and two model invertebrates, the nematode Caenorhabitis elegans and the fruit fly Drosophila melanogaster. In mosquitoes, insulin signaling regulates key steps in egg maturation and immunity and likely affects aging, although the latter has yet to be examined in detail. Reproduction, immunity and aging critically influence the capacity of mosquitoes to effectively transmit malaria parasites. Current work has demonstrated that molecules from the invading parasite and the blood meal elicit functional responses in female mosquitoes that are regulated through the insulin signaling pathway or by crosstalk with interacting pathways. Defining the details of these regulatory interactions presents significant challenges for future research, but will increase our understanding of mosquito/malaria parasite transmission and of the conservation of insulin signaling as a key regulatory nexus in animal biology. Keywordsinsulin; Anopheles; Plasmodium; mosquito; malaria; aging; oxidative stress; innate immunity; nitric oxide; transforming growth factor; β In all well-studied metazoans, metabolism, growth, and longevity are coordinately regulated via a nexus that involves signaling cascades activated by insulin and insulin-like growth factors (IGF). Although these pathways differ in downstream physiological effects and some of their signaling proteins, the proteins themselves and their scaffolding interactions are largely conserved among model organisms ( Fig. 1), particularly in the nematode Caenorhabditis elegans, the fruit fly Drosophila melanogaster, and the mouse Mus musculus. This review will examine our current understanding of how the insulin and IGF signaling cascades (ISC) regulate immunity in these diverse model organisms. In addition, we will explore how recent Correspondence to: Shirley Luckhart. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errorsmaybe discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Key targets of daf-16 regulation include genes for mitochondrial manganese superoxide dismutase (MnSOD) and glutathione S-transferase, which are closely linked to aging in C. elegans and other organisms, and genes for numerous C-type lectins, which play critical roles in cell adhesion and pathogen recognition [5]. Downregulation of these gene targets in daf-16 mutants would be predicted to enhance oxidative stress, which has been linked directly to aging in C. elegans [6,7], and decrease pathogen recognition [8]. Conversely, rescue of downregulated MnSOD...

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Status of Fluid Balance in Malaria

Molyneux¹

2014

Encyclopedia of Malaria

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Hypoglycaemia in Sudanese children with cerebral malaria

Cited by 3 publications

References 4 publications

Hypoglycaemia in severe malaria, clinical associations and relationship to quinine dosage

Hypoglycaemia in severe malaria, clinical associations and relationship to quinine dosage

The insulin signaling cascade from nematodes to mammals: Insights into innate immunity of Anopheles mosquitoes to malaria parasite infection

Status of Fluid Balance in Malaria

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