Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria.
Primaquine and tafenoquine are the only licensed drugs with activity against Plasmodium vivax hypnozoites but cause haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Malaria also causes haemolysis, leading to the replacement of older erythrocytes with low G6PD activity...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-05-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0010406 |
| _version_ | 1797953971738902528 |
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| author | Benedikt Ley Mohammad Shafiul Alam Ari Winasti Satyagraha Ching Swe Phru Kamala Thriemer Dagimawie Tadesse Tamiru Shibiru Asrat Hailu Mohammad Golam Kibria Mohammad Sharif Hossain Hisni Rahmat Jeanne R Poespoprodjo Wasif Ali Khan Julie A Simpson Ric N Price |
| author_facet | Benedikt Ley Mohammad Shafiul Alam Ari Winasti Satyagraha Ching Swe Phru Kamala Thriemer Dagimawie Tadesse Tamiru Shibiru Asrat Hailu Mohammad Golam Kibria Mohammad Sharif Hossain Hisni Rahmat Jeanne R Poespoprodjo Wasif Ali Khan Julie A Simpson Ric N Price |
| author_sort | Benedikt Ley |
| collection | DOAJ |
| description | Primaquine and tafenoquine are the only licensed drugs with activity against Plasmodium vivax hypnozoites but cause haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Malaria also causes haemolysis, leading to the replacement of older erythrocytes with low G6PD activity by reticulocytes and young erythrocytes with higher activity. Aim of this study was to assess the impact of acute malaria on G6PD activity. Selected patients with uncomplicated malaria were recruited in Bangladesh (n = 87), Indonesia (n = 75), and Ethiopia (n = 173); G6PD activity was measured at the initial presentation with malaria and a median of 176 days later (range 140 to 998) in the absence of malaria. Among selected participants (deficient participants preferentially enrolled in Bangladesh but not at other sites) G6PD activity fell between malaria and follow up by 79.1% (95%CI: 40.4 to 117.8) in 6 participants classified as deficient (<30% activity), 43.7% (95%CI: 34.2 to 53.1) in 39 individuals with intermediate activity (30% to <70%), and by 4.5% (95%CI: 1.4 to 7.6) in 290 G6PD normal (≥70%) participants. In Bangladesh and Indonesia G6PD activity was significantly higher during acute malaria than when the same individuals were retested during follow up (40.9% (95%CI: 33.4-48.1) and 7.4% (95%CI: 0.2 to 14.6) respectively), whereas in Ethiopia G6PD activity was 3.6% (95%CI: -1.0 to -6.1) lower during acute malaria. The change in G6PD activity was apparent in patients presenting with either P. vivax or P. falciparum infection. Overall, 66.7% (4/6) severely deficient participants and 87.2% (34/39) with intermediate deficiency had normal activities when presenting with malaria. These findings suggest that G6PD activity rises significantly and at clinically relevant levels during acute malaria. Prospective case-control studies are warranted to confirm the degree to which the predicted population attributable risks of drug induced haemolysis is lower than would be predicted from cross sectional surveys. |
| first_indexed | 2024-04-10T23:11:29Z |
| format | Article |
| id | doaj.art-c0fa27907a7b4859b496ae2c39de2422 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-04-10T23:11:29Z |
| publishDate | 2022-05-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-c0fa27907a7b4859b496ae2c39de24222023-01-13T05:32:50ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352022-05-01165e001040610.1371/journal.pntd.0010406Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria.Benedikt LeyMohammad Shafiul AlamAri Winasti SatyagrahaChing Swe PhruKamala ThriemerDagimawie TadesseTamiru ShibiruAsrat HailuMohammad Golam KibriaMohammad Sharif HossainHisni RahmatJeanne R PoespoprodjoWasif Ali KhanJulie A SimpsonRic N PricePrimaquine and tafenoquine are the only licensed drugs with activity against Plasmodium vivax hypnozoites but cause haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Malaria also causes haemolysis, leading to the replacement of older erythrocytes with low G6PD activity by reticulocytes and young erythrocytes with higher activity. Aim of this study was to assess the impact of acute malaria on G6PD activity. Selected patients with uncomplicated malaria were recruited in Bangladesh (n = 87), Indonesia (n = 75), and Ethiopia (n = 173); G6PD activity was measured at the initial presentation with malaria and a median of 176 days later (range 140 to 998) in the absence of malaria. Among selected participants (deficient participants preferentially enrolled in Bangladesh but not at other sites) G6PD activity fell between malaria and follow up by 79.1% (95%CI: 40.4 to 117.8) in 6 participants classified as deficient (<30% activity), 43.7% (95%CI: 34.2 to 53.1) in 39 individuals with intermediate activity (30% to <70%), and by 4.5% (95%CI: 1.4 to 7.6) in 290 G6PD normal (≥70%) participants. In Bangladesh and Indonesia G6PD activity was significantly higher during acute malaria than when the same individuals were retested during follow up (40.9% (95%CI: 33.4-48.1) and 7.4% (95%CI: 0.2 to 14.6) respectively), whereas in Ethiopia G6PD activity was 3.6% (95%CI: -1.0 to -6.1) lower during acute malaria. The change in G6PD activity was apparent in patients presenting with either P. vivax or P. falciparum infection. Overall, 66.7% (4/6) severely deficient participants and 87.2% (34/39) with intermediate deficiency had normal activities when presenting with malaria. These findings suggest that G6PD activity rises significantly and at clinically relevant levels during acute malaria. Prospective case-control studies are warranted to confirm the degree to which the predicted population attributable risks of drug induced haemolysis is lower than would be predicted from cross sectional surveys.https://doi.org/10.1371/journal.pntd.0010406 |
| spellingShingle | Benedikt Ley Mohammad Shafiul Alam Ari Winasti Satyagraha Ching Swe Phru Kamala Thriemer Dagimawie Tadesse Tamiru Shibiru Asrat Hailu Mohammad Golam Kibria Mohammad Sharif Hossain Hisni Rahmat Jeanne R Poespoprodjo Wasif Ali Khan Julie A Simpson Ric N Price Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria. PLoS Neglected Tropical Diseases |
| title | Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria. |
| title_full | Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria. |
| title_fullStr | Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria. |
| title_full_unstemmed | Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria. |
| title_short | Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria. |
| title_sort | variation in glucose 6 phosphate dehydrogenase activity following acute malaria |
| url | https://doi.org/10.1371/journal.pntd.0010406 |
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