Clinical Spectrum of Primaquine-induced Hemolysis in Glucose-6-Phosphate Dehydrogenase Deficiency: A 9-Year Hospitalization-based Study From the Brazilian Amazon

Brito-Sousa, José Diego; Santos, Thalie C.; Ávalos, Sara; Fontecha, Gustavo; Melo, Gisely Cardoso de; Val, Fernando; Siqueira, André Machado; Alecrim, Graca C.; Bassat, Quique; Lacerda, Marcus Vinícius Guimarães

doi:10.1093/cid/ciz122

Cited by 47 publications

(46 citation statements)

References 7 publications

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“…In neighbouring Myanmar the prevalence ranges from 4% to 12% in the general population 9 and nearly 13% in males living in eastern Myanmar along the Thailand border 10, 11 . A substantial proportion of populations are thus at risk for primaquine induced haemolysis if G6PD deficiency is not diagnosed before treatment 12 or if primaquine is taken incorrectly.…”

Section: Introductionmentioning

confidence: 99%

The impact of using primaquine without prior G6PD testing: a case series describing the obstacles to the medical management of haemolysis

Chu¹,

Bancone²,

Soe³

et al. 2019

Wellcome Open Res

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Radical cure of Plasmodium vivax malaria in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals employs weekly primaquine dosing. This is the only recommended regimen for this patient sub-group. If national malaria programs mandate daily primaquine dosing (the recommended regimen for G6PD normal individuals), then G6PD testing before prescription is necessary to avoid iatrogenic haemolysis in G6PD deficient individuals. In this case series, two P. vivax infected patients with unknown G6PD status from two different countries were prescribed primaquine as per national malaria program guidelines. During treatment both patients presented to the clinic with symptoms of anaemia after taking primaquine incorrectly. The clinical management of the iatrogenic severe haemolysis that occurred in these patients demonstrates the various adverse effects primaquine can cause, that other common medical treatments also have haemolytic potential, and how the diagnosis of G6PD deficiency can be elusive during acute haemolysis. Health care providers should provide careful instructions about primaquine dosing, be watchful for haemolysis, and have a high index of suspicion for G6PD deficiency in the presence of haemolysis if the G6PD status is previously unknown.

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Section: Introductionmentioning

confidence: 99%

The impact of using primaquine without prior G6PD testing: a case series describing the obstacles to the medical management of haemolysis

Chu¹,

Bancone²,

Soe³

et al. 2019

Wellcome Open Res

View full text Add to dashboard Cite

show abstract

“…The prevalence of G6PD de ciency varies across Latin America and Caribbean countries, with the African variant presenting a wide range in these regions 63 . Primaquine is a strong oxidative drug and may cause severe acute hemolysis in G6PD de cient individuals receiving malaria treatment 64 . Currently, G6PD de ciency is not screened before treatment for either disease.…”

Section: Discussionmentioning

confidence: 99%

Should We Care About Plasmodium Vivax and HIV Coinfection? A Systematic Review and a Cases Series From the Brazilian Amazon

Del-Tejo

Cubas-Vega

Caraballo-Guerra

et al. 2020

Preprint

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Background. Malaria and HIV are two important public health issues. However, data on HIV-Plasmodium vivax co-infection (HIV/PvCo) is scarce, with most of the available data related to P. falciparum in the African region. It is unclear whether HIV can change the clinical course of Plasmodium vivax (Pv) malaria, and thereby increase the risk of complications. In this study, a systematic review of the HIV/PvCo is presented, including new cases from the Brazilian Amazon. Methods. Medical records from a tertiary care center in the Western Brazilian Amazon (2009 to 2018) were reviewed to identify HIV/PvCo hospitalized patients. Demographic, clinical and laboratory characteristics, and outcomes are reported. We also performed a systematic review of published studies on HIV/PvCo. Metadata, number of HIV/PvCo cases, demographic, clinical, and outcome data were extracted if available. Results. A total of 1048 vivax malaria patients were hospitalized in the 10-year period; 21 (2.0%) were HIV/PvCo cases, of which nine (42.9%) had AIDS-defining illnesses. For eleven (52.4%) patients, this was their first malaria infection. Seven (33.3%) patients were unaware of their HIV status and were diagnosed at hospitalization. Severe malaria criteria were found in 5 (23.8%) patients. One patient died. The systematic review provided 17 articles (12 cross-sectional or longitudinal studies and 5 case report studies). A higher prevalence of studies involved cases in African and Asian countries (35.3% and 29.4%, respectively), and the prevalence of reported co-infections ranged from 0.1 to 60%. Cases of severe malaria-HIV coinfection were not reported. Conclusion. Reports of HIV/PvCo are scarce in the literature, with only a few studies describing clinical and laboratory outcomes. Systematic screening for both co-infections are not performed, and therefore, a realistic prevalence of HIV/PvCo is absent. This study showed a low prevalence of HIV/PvCo, despite local malaria and HIV high prevalence. Even though relatively small, this is the largest case series to describe HIV/PvCo.

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“…The prevalence of G6PDd varies across Latin American and Caribbean countries, with the African variant present in a wide range in this region 69 . Primaquine is a strong oxidative drug and may cause severe acute hemolysis in G6PDd individuals who take primaquine for malaria treatment 70 . G6PDd testing is currently recommended by the WHO prior to starting primaquine in the radical cure of P. vivax and P. ovale malaria 30,71 .…”

Section: Discussionmentioning

confidence: 99%

Should we care about Plasmodium vivax and HIV coinfection? A systematic review and a cases series from the Brazilian Amazon

Del-Tejo¹,

Cubas-Vega²,

Caraballo-Guerra³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background. Malaria and HIV are two important public health issues. However, evidence on HIV-Plasmodium vivax co-infection (HIV/PvCo) is scarce, with most of the available information related to P. falciparum on the African continent. It is unclear whether HIV can change the clinical course of Plasmodium vivax (Pv) malaria, and increase the risk of complications. In this study, we present a systematic review of the HIV/PvCo, and include recent cases from the Brazilian Amazon. Methods. Medical records from a tertiary care center in the Western Brazilian Amazon (2009 - 2018) were reviewed to identify HIV/PvCo hospitalized patients. Demographic, clinical and laboratory characteristics and outcomes are reported. We also performed a systematic review of published studies on HIV/PvCo. Metadata, number of HIV/PvCo cases, demographic, clinical, and outcome data were extracted. Results. A total of 1048 vivax malaria patients were hospitalized in the 10-year period; 21 (2.0%) were HIV/PvCo cases, of which nine (42.9%) had AIDS-defining illnesses. This was the first malaria episode in eleven (52.4%) patients. Seven (33.3%) patients were unaware of their HIV status and were diagnosed on hospitalization. Severe malaria was diagnosed in 5 (23.8%) patients. One patient died. The systematic review search provided 17 articles (12 cross-sectional or longitudinal studies and 5 case report studies). A higher prevalence of studies involved cases in African and Asian countries (35.3% and 29.4%, respectively), and the prevalence of reported co-infections ranged from 0.1 to 60%. Conclusion. Reports of HIV/PvCo are scarce in the literature, with only a few studies describing clinical and laboratory outcomes. Systematic screening for both co-infections is not routinely performed, and therefore, the real prevalence of HIV/PvCo is unknown. This study showed a low prevalence of HIV/PvCo, despite the high prevalence of malaria and HIV locally. Even though relatively small, this is the largest case series to describe HIV/PvCo.

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Clinical Spectrum of Primaquine-induced Hemolysis in Glucose-6-Phosphate Dehydrogenase Deficiency: A 9-Year Hospitalization-based Study From the Brazilian Amazon

Cited by 47 publications

References 7 publications

The impact of using primaquine without prior G6PD testing: a case series describing the obstacles to the medical management of haemolysis

The impact of using primaquine without prior G6PD testing: a case series describing the obstacles to the medical management of haemolysis

Should We Care About Plasmodium Vivax and HIV Coinfection? A Systematic Review and a Cases Series From the Brazilian Amazon

Should we care about Plasmodium vivax and HIV coinfection? A systematic review and a cases series from the Brazilian Amazon

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