BACKGROUND: Plasmodium vivax occurs as a latent infection of liver and a patent infection of red blood cells. Radical cure requires both blood schizontocidal and hypnozoitocidal chemotherapies. The hypnozoitocidal therapies available are primaquine and tafenoquine, 8-aminoquinoline drugs that can provoke threatening acute hemolytic anemia in patients having an X-linked G6PD-deficiency. Heterozygous females may screen as G6PD-normal prior to radical cure and go on to experience hemolytic crisis. METHODS & FINDINGS: This study examined G6PD phenotypes in 1928 female subjects living in malarious Sumba Island in eastern Indonesia to ascertain the prevalence of females vulnerable to diagnostic misclassification as G6PD-normal. All 367 (19%) females having <80% G6PD normal activity were genotyped. Among those, 103 (28%) were G6PD wild type, 251 (68·4%) were heterozygous, three (0·8%) were compound heterozygotes, and ten (2·7%) were homozygous deficient. The variants Vanua Lava, Viangchan, Coimbra, Chatham, and Kaiping occurred among them. Below the 70% of normal G6PD activity threshold, just 18 (8%) were G6PD-normal and 214 (92%) were G6PD-deficient. Among the 31 females with <30% G6PD normal activity were all ten homozygotes, all three compound heterozygotes, and just 18 were heterozygotes (7% of those). CONCLUSIONS: In this population, most G6PD heterozygosity in females occurred between 30% and 70% of normal (69·3%; 183/264). The prevalence of females at risk of G6PD misclassification as normal by qualitative screening was 9·5% (183/1928). Qualitative G6PD screening prior to 8-aminoquinoline therapies against P. vivax may leave one in ten females at risk of hemolytic crisis, which may be remedied by point-of-care quantitative tests.
BACKGROUND:Plasmodium vivax occurs as a latent infection of liver and a patent infection of red blood cells. Radical cure requires both blood schizontocidal and hypnozoitocidal chemotherapies. The hypnozoitocidal therapies available are primaquine and tafenoquine, 8-aminoquinoline drugs that can provoke threatening acute hemolytic anemia in patients having an X-linked G6PD-deficiency. Heterozygous females may screen as G6PD-normal prior to radical cure and go on to experience hemolytic crisis. METHODS & FINDINGS: This study examined G6PD phenotypes in 1928 female subjects living in malarious Sumba Island in eastern Indonesia to ascertain the prevalence of females vulnerable to diagnostic misclassification as G6PD-normal. All 367 (19%) females having <80% G6PD normal activity were genotyped. Among those, 103 (28%) were G6PD wild type, 251 (68·4%) were heterozygous, three (0·8%) were compound heterozygotes, and ten (2·7%) were homozygous deficient. The variants Vanua Lava, Viangchan, Coimbra, Chatham, and Kaiping occurred among them. Below the 70% of normal G6PD activity threshold, just 18 (8%) were G6PD-normal and 214 (92%) were G6PD-deficient. Among the 31 females with <30% G6PD normal activity were all ten homozygotes, all three compound heterozygotes, and just 18 were heterozygotes (7% of those). CONCLUSIONS: In this population, most G6PD heterozygosity in females occurred between 30% and 70% of normal (69·3%; 183/264). The prevalence of females at risk of G6PD misclassification as normal by qualitative screening was 9·5% (183/1928). Qualitative G6PD screening prior to 8-aminoquinoline therapies against P. vivax may leave one in ten females at risk of hemolytic crisis, which may be remedied by point-of-care quantitative tests.
Authors: Ronnatrai Rueangweerayut; Germana Bancone; Emma J Harrell; Andrew P Beelen; Supornchai Kongpatanakul; Jörg J Möhrle; Vicki Rousell; Khadeeja Mohamed; Ammar Qureshi; Sushma Narayan; Nushara Yubon; Ann Miller; François H Nosten; Lucio Luzzatto; Stephan Duparc; Jörg-Peter Kleim; Justin A Green Journal: Am J Trop Med Hyg Date: 2017-07-27 Impact factor: 2.345
Authors: Agus Setyadi; Eggi Arguni; Enny Kenangalem; Afdhal Hasanuddin; Daniel A Lampah; Kamala Thriemer; Nicholas M Anstey; Paulus Sugiarto; Julie A Simpson; Ric N Price; Nicholas M Douglas; Jeanne R Poespoprodjo Journal: Malar J Date: 2019-04-02 Impact factor: 2.979
Authors: Katherine E Battle; Tim C D Lucas; Michele Nguyen; Rosalind E Howes; Anita K Nandi; Katherine A Twohig; Daniel A Pfeffer; Ewan Cameron; Puja C Rao; Daniel Casey; Harry S Gibson; Jennifer A Rozier; Ursula Dalrymple; Suzanne H Keddie; Emma L Collins; Joseph R Harris; Carlos A Guerra; Michael P Thorn; Donal Bisanzio; Nancy Fullman; Chantal K Huynh; Xie Kulikoff; Michael J Kutz; Alan D Lopez; Ali H Mokdad; Mohsen Naghavi; Grant Nguyen; Katya Anne Shackelford; Theo Vos; Haidong Wang; Stephen S Lim; Christopher J L Murray; Ric N Price; J Kevin Baird; David L Smith; Samir Bhatt; Daniel J Weiss; Simon I Hay; Peter W Gething Journal: Lancet Date: 2019-06-19 Impact factor: 79.321
Authors: Leanne J Robinson; Rahel Wampfler; Inoni Betuela; Stephan Karl; Michael T White; Connie S N Li Wai Suen; Natalie E Hofmann; Benson Kinboro; Andreea Waltmann; Jessica Brewster; Lina Lorry; Nandao Tarongka; Lornah Samol; Mariabeth Silkey; Quique Bassat; Peter M Siba; Louis Schofield; Ingrid Felger; Ivo Mueller Journal: PLoS Med Date: 2015-10-27 Impact factor: 11.069