Specificity of hypoglycaemia for cerebral malaria in children

Kawo, N.G.; Msengi, A.E.; Swai, A. B. M.; Chuwa, L.M.; Alberti, K. G. M. M.; McLarty, D.G.

doi:10.1016/0140-6736(90)92009-7

Cited by 47 publications

(37 citation statements)

References 24 publications

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“…This was against our expectations, as we and others have shown a relationship between fasting and the occurrence of hypoglycaemia (Bennish et al 1990;Kawo et al 1990;Haymond & Sunehag 1999;Osier et al 2003;van Thien et al 2006), The maximum duration of fasting in our study was 18 h, which is probably too short to influence the plasma glucose concentration. Healthy children are able to maintain a normal plasma glucose concentration for up to 24 h of fasting (Haymond & Sunehag 1999).…”

Section: Discussioncontrasting

confidence: 52%

Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname

Zijlmans

Kempen

Ackermans

et al. 2008

Tropical Med Int Health

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Summaryobjective To measure glucose kinetics and the influence of age, nutritional status and fasting duration in children with uncomplicated falciparum malaria (UFM) under the age of 5 years. results Plasma glucose concentration was lower in the group of very young children than in the older children (P = 0.028). There were no differences in EGP and GNG between the groups. Overall GNG contributed 56% (median, range 17-87%) to EGP, with no differences between the groups (P = 0.240).Glucose clearance was lower in the older children (P = 0.026). Glucose concentration did not differ between children with weight for length ⁄ height less than )1.3 SD and children with weight for length ⁄ height greater than )1.3 SD (P = 0.266). Plasma glucose concentration was not predicted by fasting duration (P = 0.762).conclusions Our data suggest a higher risk of hypoglycaemia in very young children with uncomplicated malaria as plasma glucose concentration was lower in this study group. Since this could not be attributed to an impaired EGP, and because glucose clearance was lower in the older children, we presume that older children were better capable of reducing glucose utilization during fasting. Studies on glucose kinetics are feasible in very young children with malaria and give more insight in the pathophysiology of hypoglycaemia.

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Section: Discussioncontrasting

confidence: 52%

Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname

Zijlmans

Kempen

Ackermans

et al. 2008

Tropical Med Int Health

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“…Although only a small percentage of patients with CM experience these disorders, the severity and duration of neurological manifestations significantly affect children, their caretakers, and the social and economic fabric of their communities. In this review, there was a time-dependent trend with regard to neurological sequelae: studies conducted during 1990-1994 reported higher levels of sequelae (14.3%; 95% CI, 5.9-22.7 43,44,[46][47][48][50][51][52][53][54]56,57 ) than studies conducted during 1962-1977 (8.0%; 95% CI, 0.0-16.0 [29][30][31][32][33][34][35][36] ) and 1980-1989 (10.6%; 95% CI, 4.8-16.3 22,24,37,38,41,42 ). Are these sequelae increasing?…”

Section: Discussionmentioning

confidence: 99%

“…22,24,[29][30][31][32][33][34][35][36][37][38][41][42][43][44]46,47,[49][50][51][52][53][54]56,57 In these studies, the pooled CM case fatality dropped to 16.9% (95% CI, 13.2-20.6; range, 0.0-38.3%; n ϭ 2,474). The prevalence of neurological sequelae among survivors was 9.8% (95% CI, 6.7-12.9; range, 0.0-28.6%; n ϭ 2,057).…”

Section: Diagnoses and Demographicsmentioning

confidence: 99%

Gaps in the childhood malaria burden in Africa: cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy

Murphy

Breman²

2001

The American Journal of Tropical Medicine and Hygiene

369

254

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Abstract. Evaluations of the African childhood malaria burden do not fully quantify the contributions of cerebral malaria (CM), CM-associated neurological sequelae, malarial anemia, respiratory distress, hypoglycemia, and pregnancy-related complications. We estimated the impact of these malaria manifestations on members of the African population Ͻ 5 years old. Calculations were based on an extensive literature review that used National Library of Medicine search engines, other bibliographic sources, and demographic data. In sub-Saharan Africa, CM annually affects 575,000 children Ͻ 5 years of age and 110,000 (ϳ19% case fatality rate [CFR]) die. Childhood survivors of CM experience developmental and behavioral impairments: each year, 9,000-19,000 children (Ͼ 2% of survivors of CM) Ͻ 5 years of age in Africa experience neurological complications lasting Ͼ 6 months. Severe malarial anemia heavily burdens hospitals with rising admission and CFRs and with treatments that are complicated by limited and sometimes contaminated blood supplies. Severe malarial anemia occurs 1.42-5.66 million times annually and kills 190,000-974,000 (Ͼ 13% CFR) children Ͻ 5 years of age annually. Respiratory distress, hypoglycemia, and overlapping clinical manifestations cause 1.12-1.99 million cases and Ͼ 225,000 (Ͼ 18% CFR) additional deaths among African children with malaria. Maternal, placental, or fetal malaria infection during pregnancy adversely affects development and survival of fetuses and newborns through low birth weight (LBW), maternal anemia, and possibly abortion and stillbirth. Between 167,000 and 967,000 cases of malaria-associated LBW occur yearly; malaria-induced LBW kills 62,000-363,000 (Ͼ 38% CFR) newborns each year. All the gaps in the burden comprise 0.4-1.7 million deaths annually, Ͼ 50% of which are due to severe malarial anemia. These malaria-induced medical problems constitute major clinical, public health, and research challenges in that they may contribute to more than double the mortality than is generally acknowledged.

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“…Hypoglycemia (blood glucose concentration Յ 2.2 mmol/L or 40 mg%) is a complication of many different pediatric illnesses and is usually associated with a poor outcome. 46,47 In adults with malaria, hypoglycemia is generally associated with quinine infusions, but in African children, pretreatment hypoglycemia is more important; 10-20% of children with CM are hypoglycemic at the time of admission to the hospital. 5,7,16,21,40,48 Quinine is a potent insulin secretagogue, 49 and insulin levels in quinine-induced hypoglycemia are inappropriately high.…”

Section: Pathophysiology Of Fatal Malariamentioning

confidence: 99%

Pathophysiology of fatal falciparum malaria in African children.

Newton¹,

Taylor²,

Whitten³

1998

Am J Trop Med Hyg

122

121

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Abstract. Children living in sub-Saharan Africa bear the brunt of the mortality from falciparum malaria, yet there is a dearth of relevant post-mortem data. Clinical studies from centers in Africa suggest that the pathophysiology of severe malaria is different in children and adults. Three overlapping clinical syndromes, metabolic acidosis manifesting as hyperpnea, cerebral malaria, and severe anemia, are responsible for nearly all the deaths in African children. Despite improvements in antimalarial treatment, there has not been a significant reduction in mortality. We review the pathology and pathophysiology of fatal falciparum malaria in African children. Many questions remain, the answers to which would facilitate the development and evaluation of new approaches to the management of this disease.Severe and complicated Plasmodium falciparum infections continue to threaten the survival of young children in sub-Saharan Africa: one in 15 children on the Kenyan coast will have experienced an episode of severe malaria before the age of five, 1 and 1% of Gambian children less than five years of age will die of malaria. 2 The annual death toll is estimated to be one million children across the continent; 90% of the annual worldwide malaria mortality. 3 Although most children die in the community, on the Kenyan coast it is estimated that more than 40% die in a hospital (Marsh K, unpublished data) and one-third of pediatric hospital admissions and one-third of pediatric hospital deaths in Malawi can be attributed to malaria. 4

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Specificity of hypoglycaemia for cerebral malaria in children

Cited by 47 publications

References 24 publications

Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname

Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname

Gaps in the childhood malaria burden in Africa: cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy

Pathophysiology of fatal falciparum malaria in African children.

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