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Plasma glutamine and glutamate concentrations in Gabonese children with Plasmodium falciparum infection
T Planche1, A Dzeing, A C Emmerson
1Department of Infectious Diseases, St George's Hospital Medical School, Cranmer Terrace, London, UK.
Insights
Low plasma glutamine levels are linked to poor outcomes in critical illness. This study found higher glutamine levels in children who died from malaria, suggesting supplementation may not be beneficial.
Area of Science:
- Biochemistry
- Infectious Diseases
- Critical Care Medicine
Background:
- Low plasma glutamine is associated with adverse outcomes and infections in critical illness, neonates, and burn patients.
- Understanding glutamine's role in malaria is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between plasma glutamine/glutamate levels and malaria severity/outcome.
- To explore potential implications for glutamine supplementation in malaria treatment.
Main Methods:
- A prospective, two-hospital study involving 239 Gabonese patients.
- Measured plasma glutamine and glutamate in children with uncomplicated, moderate, and severe malaria, febrile controls, and healthy controls.
- Correlated findings with disease severity markers like plasma lactate.
Main Results:
- Plasma glutamine was lower in uncomplicated and moderate malaria compared to healthy controls.
- Plasma glutamine levels were within the normal range in severe malaria and febrile controls.
- Significantly higher plasma glutamine levels were observed in children who died from malaria compared to survivors.
- No significant differences in plasma glutamate levels were found between groups.
Conclusions:
- A positive correlation between plasma glutamine and lactate in severe malaria suggests potential impaired gluconeogenesis.
- Glutamine supplementation is likely not indicated for severe Plasmodium falciparum infections.
- Further research may clarify glutamine's complex role in malaria pathogenesis.
Background:
Low plasma glutamine levels in critical illness, neonates and burns patients are associated with poor outcome and increased risk of intercurrent infection.
Aim:
To investigate the relationship between plasma glutamine/glutamate levels and severity/outcome of malaria.
Design:
Two-hospital prospective study, with both febrile and healthy controls.
Methods:
We measured plasma glutamine and glutamate concentrations in 239 Gabonese patients: 145 children with malaria (86 with severe, 36 with moderate and 23 with uncomplicated disease), 42 healthy children, 44 febrile controls and eight healthy adults, and related findings to conventional markers of disease severity such as plasma lactate.
Results:
Median (IQR) plasma glutamine was lower in uncomplicated falciparum malaria and in moderate malaria than in healthy controls: 353 (287-474) and 379 (293-448) vs. 485 (428-531) micromol/l, respectively; p<0.01 for both malaria groups vs. controls. In contrast, plasma glutamine was within the normal range in those with severe malaria and in febrile control children: 431 (342-525) and 472 (338-547) micromol/l, respectively. Furthermore, plasma glutamine was significantly higher in the children who died with malaria than in survivors: 514 (374-813) (n=12) vs. 399 (316-475) micromol/l (n=133), respectively; p=0.001. There were no significant differences in plasma glutamate concentrations between any of the study groups.
Discussion:
In severe malaria, there was a positive correlation between plasma glutamine and lactate levels (p=0.009, r=0.281). This correlation may reflect impaired gluconeogenesis. Glutamine supplementation is probably not justified in severe P. falciparum infection.
