World Health Organization , 2022. World Malaria Report 2022. Geneva, Switzerland: WHO.
Dvorin JD , 2017. Getting your head around cerebral malaria. Cell Host Microbe 22: 586–588.
Wang W , Qian H , Cao J , 2015. Stem cell therapy: a novel treatment option for cerebral malaria? Stem Cell Res Ther 6: 141.
van Hensbroek MB , Palmer A , Jaffar S , Schneider G , Kwiatkowski D , 1997. Residual neurologic sequelae after childhood cerebral malaria. J Pediatr 131: 125–129.
Idro R , Carter JA , Fegan G , Neville BGR , Newton CRJC , 2006. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 91: 142–148.
Oluwayemi OI , Brown BJ , Oyedeji OA , Adegoke SA , Adebami OJ , Oyedeji GA , 2013. Clinical and laboratory predictors of outcome in cerebral malaria in suburban Nigeria. J Infect Dev Ctries 7: 600–607.
Nickerson JP , Tong KA , Raghavan R , 2009. Imaging cerebral malaria with a susceptibility-weighted MR sequence. AJNR Am J Neuroradiol 30: e85–e86.
Molyneux ME , Taylor TE , Wirima JJ , Borgstein A , 1989. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. QJM 71: 441–459.
Njim T , Tanyitiku BS , 2019. Prognostic models for the clinical management of malaria and its complications: a systematic review. BMJ Open 9: e030793.
World Health Organization , 2012. Management of Severe Malaria: A Practical Handbook, 3rd edition. Geneva, Switzerland: WHO.
Krishna S et al., 1994. Lactic acidosis and hypoglycaemia in children with severe malaria: pathophysiological and prognostic significance. Trans R Soc Trop Med Hyg 88: 67–73.
Nadjm B , Mtove G , Amos B , Hildenwall H , Najjuka A , Mtei F , Todd J , Reyburn H , 2013. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. Am J Trop Med Hyg 89: 232–237.
Roe JK , Pasvol G , 2009. New developments in the management of malaria in adults. QJM 102: 685–693.
Ramos S et al., 2022. A hypometabolic defense strategy against malaria. Cell Metab 34: 1183–1200.e12.
Madrid L et al., 2017. Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique. Malar J 16: 184.
Bila R , Varo R , Madrid L , Sitoe A , Bassat Q , 2018. Continuous glucose monitoring in resource-constrained settings for hypoglycaemia detection: looking at the problem from the other side of the coin. Biosensors (Basel) 8: 43.
Nhampossa T et al., 2016. Hypoglycemia and risk factors for death in 13 years of pediatric admissions in Mozambique. Am J Trop Med Hyg 94: 218–226.
Barennes H , Sayavong E , Pussard E , 2016. High mortality risk in hypoglycemic and dysglycemic children admitted at a referral hospital in a non malaria tropical setting of a low income country. PLoS One 11: e0150076.
Willcox ML , Forster M , Dicko MI , Graz B , Mayon-White R , Barennes H , 2010. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for “hypoglycaemia”? Trop Med Int Health 15: 232–240.
Wiens MO , Pawluk S , Kissoon N , Kumbakumba E , Ansermino JM , Singer J , Ndamira A , Larson C , 2013. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS One 8: e66698.
Wiens MO et al., 2015. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models. BMJ Open 5: e009449.
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Hypoglycemia, defined as a blood glucose < 2.2 mmol/L, is associated with death in pediatric cerebral malaria (CM). The optimal duration of glucose monitoring in CM is unknown. We collected data from 1,674 hospitalized Malawian children with CM to evaluate the association between hypoglycemia and death or neurologic disability in survivors. We assessed the optimal duration of routine periodic measurements of blood glucose. Children with hypoglycemia at admission had a 2.87-fold higher odds (95% CI: 1.35–6.09) of death and, if they survived, a 3.21-fold greater odds (95% CI: 1.51–6.86) of sequelae at hospital discharge. If hypoglycemia was detected at 6 hours but not at admission, there was a 7.27-fold higher odds of death (95% CI: 1.85–8.56). The presence of newly developed hypoglycemia after admission was not independently associated with neurological sequelae in CM survivors. Among all new episodes of blood sugar below a treatment threshold of 3.0 mmol/L, 94.7% occurred within 24 hours of admission. In those with blood sugar below 3.0 mmol/L in the first 24 hours, low blood sugar persisted or recurred for up to 42 hours. Hypoglycemia at admission or 6 hours afterward is strongly associated with mortality in CM. Children with CM should have 24 hours of post-admission blood glucose measurements. If a blood glucose less than the treatment threshold of 3.0 mmol/L is not detected, routine assessments may cease. Children who have blood sugar values below the treatment threshold detected within the first 24 hours should continue to have periodic glucose measurements for 48 hours post-admission.
Financial support: This work was supported by internal funding through
Authors’ addresses: Kennedy M. Chastang, Howard University, Washington, DC, USA, E-mail: kennedy.chastang@bison.howard.edu. Rami Imam, The George Washington University School of Medicine, Washington, DC, E-mail: ramiimam@gwmail.gwu.edu. Meredith G. Sherman, Global Health Initiative, Children’s National Medical Center, Washington, DC, E-mail: msherman@childrensnational.org. Ronke Olowojesiku, Department of Pediatrics, Children’s National Medical Center, Washington, DC, E-mail: rolowojesi@childrensnational.org. Amina M. Mukadam, University of Washington, Seattle, WA, E-mail: amukadam@uw.edu. Karl B. Seydel, Michigan State University, East Lansing, MI, and Blantyre Malaria Project, Blantyre, Malawi, E-mail: seydel@msu.edu. Alice M. Liomba, Blantyre Malaria Project, Blantyre, Malawi, E-mail: wanguialice@gmail.com. John R. Barber, Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, DC, E-mail: jbarber@childrensnational.org. Douglas G. Postels, Blantyre Malaria Project, Blantyre, Malawi, and Division of Neurology, Children’s National Medical Center, Washington, DC, E-mail: dpostels@childrensnational.org.
World Health Organization , 2022. World Malaria Report 2022. Geneva, Switzerland: WHO.
Dvorin JD , 2017. Getting your head around cerebral malaria. Cell Host Microbe 22: 586–588.
Wang W , Qian H , Cao J , 2015. Stem cell therapy: a novel treatment option for cerebral malaria? Stem Cell Res Ther 6: 141.
van Hensbroek MB , Palmer A , Jaffar S , Schneider G , Kwiatkowski D , 1997. Residual neurologic sequelae after childhood cerebral malaria. J Pediatr 131: 125–129.
Idro R , Carter JA , Fegan G , Neville BGR , Newton CRJC , 2006. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 91: 142–148.
Oluwayemi OI , Brown BJ , Oyedeji OA , Adegoke SA , Adebami OJ , Oyedeji GA , 2013. Clinical and laboratory predictors of outcome in cerebral malaria in suburban Nigeria. J Infect Dev Ctries 7: 600–607.
Nickerson JP , Tong KA , Raghavan R , 2009. Imaging cerebral malaria with a susceptibility-weighted MR sequence. AJNR Am J Neuroradiol 30: e85–e86.
Molyneux ME , Taylor TE , Wirima JJ , Borgstein A , 1989. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. QJM 71: 441–459.
Njim T , Tanyitiku BS , 2019. Prognostic models for the clinical management of malaria and its complications: a systematic review. BMJ Open 9: e030793.
World Health Organization , 2012. Management of Severe Malaria: A Practical Handbook, 3rd edition. Geneva, Switzerland: WHO.
Krishna S et al., 1994. Lactic acidosis and hypoglycaemia in children with severe malaria: pathophysiological and prognostic significance. Trans R Soc Trop Med Hyg 88: 67–73.
Nadjm B , Mtove G , Amos B , Hildenwall H , Najjuka A , Mtei F , Todd J , Reyburn H , 2013. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. Am J Trop Med Hyg 89: 232–237.
Roe JK , Pasvol G , 2009. New developments in the management of malaria in adults. QJM 102: 685–693.
Ramos S et al., 2022. A hypometabolic defense strategy against malaria. Cell Metab 34: 1183–1200.e12.
Madrid L et al., 2017. Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique. Malar J 16: 184.
Bila R , Varo R , Madrid L , Sitoe A , Bassat Q , 2018. Continuous glucose monitoring in resource-constrained settings for hypoglycaemia detection: looking at the problem from the other side of the coin. Biosensors (Basel) 8: 43.
Nhampossa T et al., 2016. Hypoglycemia and risk factors for death in 13 years of pediatric admissions in Mozambique. Am J Trop Med Hyg 94: 218–226.
Barennes H , Sayavong E , Pussard E , 2016. High mortality risk in hypoglycemic and dysglycemic children admitted at a referral hospital in a non malaria tropical setting of a low income country. PLoS One 11: e0150076.
Willcox ML , Forster M , Dicko MI , Graz B , Mayon-White R , Barennes H , 2010. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for “hypoglycaemia”? Trop Med Int Health 15: 232–240.
Wiens MO , Pawluk S , Kissoon N , Kumbakumba E , Ansermino JM , Singer J , Ndamira A , Larson C , 2013. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS One 8: e66698.
Wiens MO et al., 2015. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models. BMJ Open 5: e009449.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 268 | 268 | 29 |
Full Text Views | 979 | 979 | 3 |
PDF Downloads | 166 | 166 | 3 |