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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Approximately 90% of mortality due to malaria is in African children, but criteria to guide the recognition and management of severe malaria have not been validated in them. Findings are presented from a prospective study of all children admitted to the pediatric ward of a Kenyan district hospital with a primary diagnosis of malaria. The authors calculated the frequency and mortality rate for each of the clinical and laboratory criteria in the World Health Organization (WHO) definition of severe malaria, and then used logistic-regression analysis to identify the variables with the greatest prognostic value. 1844 children of mean age 26.4 months were seen. Not included were 18 children who died on admission and 4 who died of other causes. The mortality rate was 3.5% and 84% of the deaths occurred within 24 hours of admission. Impaired consciousness carried a relative risk of 3.3; respiratory distress, 3.9; hypoglycemia, 3.3; and jaundice, 2.6. 54 of the 64 children who died had impaired consciousness, respiratory distress, or both. This bedside index thus identified 84.4% of the fatal cases compared to only 79.7% identified by current WHO criteria. The presence of impaired consciousness or respiratory distress can therefore identify which African children with malaria are at high risk of dying.
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PMID:Indicators of life-threatening malaria in African children. 772 3

The kinetics of Plasmodium berghei infection and the development of lactic acidosis, hypoglycemia, and anemia were defined in young Wistar rats. This model of metabolic dysfunction, which is similar to that of severe human malaria, was used to test the hypothesis that dichloroacetate, a treatment for lactic acidosis, prolonged survival in rats receiving a single antimalarial dose of quinine (20 mg/kg). Rats with hyperlactatemia (lactate > 5 mmol/liter, N = 183) were randomized to receive either dichloroacetate (100 mg/kg, N = 99) or saline (N = 84) and were monitored for outcome (survival or death) for 50 hr. Logistic regression modeling adjusting for baseline venous lactate concentration demonstrated that dichloroacetate increases survival rates in rats with venous lactate concentrations between 5 and 8.9 mmol/liter (odds ratio > 2.2, P < 0.021). This is the first demonstration that specific intervention to treat lactic acidosis can prolong survival and suggests that dichloroacetate may be useful as adjunctive therapy in the management of lactic acidosis complicating severe falciparum malaria.
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PMID:Plasmodium berghei infection: dichloroacetate improves survival in rats with lactic acidosis. 775 43

We report specific dyslipidemia in Gabonese children aged 18 months to 4 years old treated with Halfan for malaria. This is observed in addition to the hypoglycemia typically associated with malaria. C-HDL (high density lipoprotein) fell on day 0 (D0), then increased during the treatment. Triglycerides (TG), total cholesterol (TC) and non-esterified fatty acids (NEFA) rose on D0. CT continued to rise evenly throughout the treatment, whereas TG declined. The differences with respect to normal values are significantly different as assessed by the Student test. We report metabolic variation and tolerance to Halfan.
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PMID:[Lipid profile during specific malaria therapy in Gabonese children]. 778 Jun 73

1. Quinine is a front-line antimalarial drug but is prescribed most commonly in nonmalarious countries for cramps. Postural hypotension, hearing loss and hyperinsulinaemic hypoglycaemia occur in malaria and overdose but little is known of quinine kinetics and toxicity in the elderly. 2. We studied 12 non-insulin-dependent diabetics and 10 non-diabetic controls aged 51-79 years. Subjects attended on two occasions > 7 days apart. On each test day, subjects were given a 600 Cal meal at 18.00 h (0 h) and, on one occasion, quinine sulphate 600 mg at 22.00 h (4 h). Venous blood samples for glucose, insulin and quinine assay were drawn pre-prandially and then regularly over the next 38 h. Supine and erect blood pressures were taken and audiometry was performed at 4, 6, 8 and 14 h. A one-compartment open pharmacokinetic model was fitted to serum quinine concentrations. 3. Absorption and elimination half-times, volume of distribution and oral clearance of quinine were comparable in the two groups (P > 0.2) and there was a mean absorption lag-time of approximately 1 h. Basal and immediate post-prandial (< 4 h) serum glucose and insulin concentrations on both test days were similar in the diabetics and also in the non-diabetics, but quinine produced a mean reduction in serum glucose of 1.0 mmol l-1 from 3-5 h post-dose in both groups without affecting serum insulin concentrations. Quinine administration did not alter postural blood pressure changes or produce significant hearing loss in either group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The pharmacokinetics and pharmacodynamics of quinine in the diabetic and non-diabetic elderly. 782 21

Twelve cases of cerebral malaria due to plasmodium falciparum, treated with loading dose of quinine (20 mg/kg salt in 500 ml of 5% glucose infused IV in 4 hrs) are compared with eleven age and sex matched cases treated with conventional dose of 10 mg/kg. The parasite clearance rate was significantly faster in loading dose group. There was no difference in recovery time: the interval between the initiation of treatment to full recovery of consciousness in both groups. One patient had pretreatment hypoglycaemia and two cases in the conventional dose group developed hypoglycaemia during therapy. One patient died in conventional dose group due to multi-organ failure. Two litres blood exchange transfusion was also tried for this case. Mild cinchonism occurred in two cases after loading dose while this was observed only in one case in conventional dose group. There was no significant hypotension or ECG changes in any patient. Loading dose of quinine seems to be well tolerated and may clear parasitaemia faster in case of malaria due to Plasmodium falciparum (PF).
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PMID:Experience on loading dose--quinine therapy in cerebral malaria. 786 10

Cerebral malaria is one of the major and deadly complications of malaria. In Cameroon, recent reports indicate that severe cases of malaria are increasingly more prevalent, particularly in children. The present study aims at describing the clinical presentation and laboratory findings of cerebral malaria in children in Yaounde. All patients admitted in the paediatric ward of Yaounde Central Hospital with malaria, who presented neurological signs and were tested positive for Plasmodium in their peripheral blood were recruited into the study. 36 cases were enrolled in all, making up 2.7% of all admissions. The patients' median age was 4.5 years. 52.8% were on malaria prophylaxis. Convulsions and coma with preceding hyperthermia were present in more than 90% of the patients. Blood parasites level median was 1.3% on admission. One patient had hypoglycaemia on admission and two others had it later on after admission; 16.7% had neurological sequels at discharge and two children died (5.6%). Delay in diagnosis and initiation of treatment with quinine adversely affected the prognosis of cerebral malaria in the study group.
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PMID:[Cerebral malaria in children in Yaounde, Cameroon. Clinical, paraclinical and developmental aspects]. 784 Jun 87

Infection of mice with blood-stage Plasmodium yoelii and P. chabaudi malaria induced hypoglycaemia in normal mice and normalized the hyperglycaemia of mice made moderately diabetic with streptozotocin (STZ). Injection of parasite supernatants induced hypoglycaemia accompanied by hyperinsulinaemia in normal mice, and in STZ-diabetic mice induced a profound drop in blood glucose and restored insulin secretion; however, severely diabetic mice (two injections of STZ) remained hyperglycaemic with no change in insulin levels. We conclude that malaria infection and parasite-derived molecules lower blood glucose concentration, but only in the presence of some residual pancreatic function. Diabetic mice were less anaemic, exerted a significant control of parasitaemia, and showed enhanced phagocytic activity compared with normal mice.
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PMID:Blood-stage malaria infection in diabetic mice. 788 67

Hypoglycemia has been reported to occur in the patients and animals infected with various species of plasmodium (1). The use of quinine has been associated with significant decrease in blood sugar level, thus worsening the prognosis (2). In such a situation cautious thinking of possible drug interaction which may, further, aggravate the hypoglycemia is mandatory. But the data of the drug interaction of the combination of quinine and doxycycline in the treatment of chloroquine or multi-drug resistant falciparum malaria are not available. This study was aimed to find out whether this combination can cause more hypoglycemia when compared to quinine alone.
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PMID:Study on modification of hypoglycaemic effect of quinine by doxycycline in albino rats. 788 1

Severe hypoglycemia developed during nonlethal Plasmodium chabaudi and lethal P. yoelii blood stage malaria infection in mice, always in association with hyperinsulinemia. Supernatants of lethal P. yoelii incubated overnight induced hypoglycemia and hyperinsulinemia in normal mice. In murine malaria, hypoglycemia may be largely secondary to increased insulin secretion.
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PMID:Hypoglycemia and hyperinsulinemia in rodent models of severe malaria infection. 792 99

Between 1981 and 1992, 196 Thai adults with severe falciparum malaria were treated with a quinine loading dose regimen. Nineteen patients died (10%) and 6 developed late hypoglycaemia. There was no serious cardiovascular or nervous system toxicity. Although there was no evidence of high grade resistance, and no change in the mortality rate, in recent years an increasing proportion of patients had a delayed clinical and parasitological response to treatment. Since 1988, 78% (29/37) of patients with cerebral malaria were unconscious for > 72 h compared with 41% (11/27) between 1981 and 1987 (P = 0.002). In the past 2 years parasite clearance times have exceeded 96 h in 33% (26/78) of patients compared with 14% (15/102) previously (P = 0.006). Quinine remains an effective treatment for severe multi-drug resistant falciparum malaria in this area, but there is now evidence of a decline in the immediate therapeutic response, and its efficacy will need close monitoring as resistance increases further.
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PMID:Quinine in severe falciparum malaria: evidence of declining efficacy in Thailand. 797 79


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