G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients
Abstract Background The incidence of malaria in the Americas has decreased markedly in recent years. Honduras and the other countries of Mesoamerica and the island of Hispaniola have set the goal of eliminating native malaria by the year 2020. To achieve this goal, Honduras has recently approved nat...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-11-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12936-018-2564-2 |
| _version_ | 1818041538065727488 |
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| author | Sara Avalos Rosa E. Mejia Engels Banegas Cesar Salinas Lester Gutierrez Marcela Fajardo Suzeth Galo Alejandra Pinto Angel Mejia Gustavo Fontecha |
| author_facet | Sara Avalos Rosa E. Mejia Engels Banegas Cesar Salinas Lester Gutierrez Marcela Fajardo Suzeth Galo Alejandra Pinto Angel Mejia Gustavo Fontecha |
| author_sort | Sara Avalos |
| collection | DOAJ |
| description | Abstract Background The incidence of malaria in the Americas has decreased markedly in recent years. Honduras and the other countries of Mesoamerica and the island of Hispaniola have set the goal of eliminating native malaria by the year 2020. To achieve this goal, Honduras has recently approved national regulations to expand the possibilities of a shortened double dose primaquine (PQ) treatment for vivax malaria. Considering this new shortened anti-malarial treatment, the high frequency of G6PDd genotypes in Honduras, and the lack of routinely assessment of the G6PD deficiency status, this study aimed at investigating the potential association between the intake of PQ and haemolysis in malaria-infected G6PDd subjects. Methods This was a prospective cohort and open-label study. Participants with malaria were recruited. Plasmodium vivax infection was treated with 0.25 mg/kg of PQ daily for 14 days. Safety and signs of haemolysis were evaluated by clinical criteria and laboratory values before and during the 3rd and 7th day of PQ treatment. G6PD status was assessed by a rapid test (CareStart™) and two molecular approaches. Results Overall 55 participants were enrolled. The frequency of G6PD deficient genotypes was 7/55 (12.7%), where 5/7 (71.4%) were hemizygous A− males and 2/7 (28.6%) heterozygous A− females. Haemoglobin concentrations were compared between G6PD wild type (B) and G6PDd A− subjects, showing a significant difference between the means of both groups in the 3rd and 7th days. Furthermore, a statistically significant difference was evident in the change in haemoglobin concentration between the 3rd day and the 1st day for both genotypes, but there was no statistical difference for the change in haemoglobin concentration between the 7th day and the 1st day. Besides these changes in the haemoglobin concentrations, none of the patients showed signs or symptoms associated with severe haemolysis, and none needed to be admitted to a hospital for further medical attention. Conclusions The findings support that the intake of PQ during 14 days of treatment against vivax malaria is safe in patients with a class III variant of G6PDd. In view of the new national regulations in the shortened treatment of vivax malaria for 7 days, it is advisable to be alert of potential cases of severe haemolysis that could occur among G6PD deficient hemizygous males with a class II mutation such as the Santamaria variant, previously reported in the country. |
| first_indexed | 2024-12-10T08:32:00Z |
| format | Article |
| id | doaj.art-fef6c4479dd342a685866980571053a6 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-10T08:32:00Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-fef6c4479dd342a685866980571053a62022-12-22T01:56:04ZengBMCMalaria Journal1475-28752018-11-0117111110.1186/s12936-018-2564-2G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patientsSara Avalos0Rosa E. Mejia1Engels Banegas2Cesar Salinas3Lester Gutierrez4Marcela Fajardo5Suzeth Galo6Alejandra Pinto7Angel Mejia8Gustavo Fontecha9Microbiology Research Institute, National Autonomous University of HondurasPan American Health OrganizationNational Department of Surveillance, Ministry of HealthNational Department of Surveillance, Ministry of HealthNational Department of Surveillance, Ministry of HealthNational Department of Surveillance, Ministry of HealthNational Department of Surveillance, Ministry of HealthMicrobiology Research Institute, National Autonomous University of HondurasMicrobiology Research Institute, National Autonomous University of HondurasMicrobiology Research Institute, National Autonomous University of HondurasAbstract Background The incidence of malaria in the Americas has decreased markedly in recent years. Honduras and the other countries of Mesoamerica and the island of Hispaniola have set the goal of eliminating native malaria by the year 2020. To achieve this goal, Honduras has recently approved national regulations to expand the possibilities of a shortened double dose primaquine (PQ) treatment for vivax malaria. Considering this new shortened anti-malarial treatment, the high frequency of G6PDd genotypes in Honduras, and the lack of routinely assessment of the G6PD deficiency status, this study aimed at investigating the potential association between the intake of PQ and haemolysis in malaria-infected G6PDd subjects. Methods This was a prospective cohort and open-label study. Participants with malaria were recruited. Plasmodium vivax infection was treated with 0.25 mg/kg of PQ daily for 14 days. Safety and signs of haemolysis were evaluated by clinical criteria and laboratory values before and during the 3rd and 7th day of PQ treatment. G6PD status was assessed by a rapid test (CareStart™) and two molecular approaches. Results Overall 55 participants were enrolled. The frequency of G6PD deficient genotypes was 7/55 (12.7%), where 5/7 (71.4%) were hemizygous A− males and 2/7 (28.6%) heterozygous A− females. Haemoglobin concentrations were compared between G6PD wild type (B) and G6PDd A− subjects, showing a significant difference between the means of both groups in the 3rd and 7th days. Furthermore, a statistically significant difference was evident in the change in haemoglobin concentration between the 3rd day and the 1st day for both genotypes, but there was no statistical difference for the change in haemoglobin concentration between the 7th day and the 1st day. Besides these changes in the haemoglobin concentrations, none of the patients showed signs or symptoms associated with severe haemolysis, and none needed to be admitted to a hospital for further medical attention. Conclusions The findings support that the intake of PQ during 14 days of treatment against vivax malaria is safe in patients with a class III variant of G6PDd. In view of the new national regulations in the shortened treatment of vivax malaria for 7 days, it is advisable to be alert of potential cases of severe haemolysis that could occur among G6PD deficient hemizygous males with a class II mutation such as the Santamaria variant, previously reported in the country.http://link.springer.com/article/10.1186/s12936-018-2564-2G6PDPrimaquineHaemolysisHonduras |
| spellingShingle | Sara Avalos Rosa E. Mejia Engels Banegas Cesar Salinas Lester Gutierrez Marcela Fajardo Suzeth Galo Alejandra Pinto Angel Mejia Gustavo Fontecha G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients Malaria Journal G6PD Primaquine Haemolysis Honduras |
| title | G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients |
| title_full | G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients |
| title_fullStr | G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients |
| title_full_unstemmed | G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients |
| title_short | G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients |
| title_sort | g6pd deficiency primaquine treatment and risk of haemolysis in malaria infected patients |
| topic | G6PD Primaquine Haemolysis Honduras |
| url | http://link.springer.com/article/10.1186/s12936-018-2564-2 |
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