G6PD deficiency in Plasmodium falciparum and Plasmodium vivax malaria-infected Cambodian patients

Abstract

BackgroundGlucose-6-phosphate-dehydrogenase deficiency (G6PDd) rates are unknown in malaria-infected Cambodian patients. These data are key to a rational drug policy for malaria elimination of Plasmodium falciparum and Plasmodium vivax.MethodsFrom September 2010–2012, a two-year survey of G6PDd and haemoglobinopathies assessed by quantitative enzyme activity assay and haemoglobin electrophoresis, respectively, was conducted in malaria-infected patients presenting to 19 health centres throughout Cambodia.ResultsA total of 2,408 confirmed malaria patients of mean age 26.7 (range 2–81) years were recruited from mostly western Cambodia (n = 1,732, 71.9%); males outnumbered females by 3.9:1. Plasmodium falciparum was present in 1,443 (59.9%) and P. vivax in 965 (40.1%) patients. Mean G6PD activity was 11.6 (CI 95%: 11.4-11.8) U/g Hb, G6PDd was present in 13.9% of all patients (335/2,408) and severe G6PDd (including WHO Class I and II variants) was more common in western (158/1,732, 9.1%) versus eastern (21/414, 5.1%) Cambodia (P = 0.01). Of 997/2,408 (41.4%) had a haemoglobinopathy. Mean haemoglobin concentrations were inversely related to age: 8.1 g/dL < five years, 8.7 g/dL five to 14 years, and 10.4 g/dL >15 years (P <0.001).ConclusionsG6PDd prevalence, anaemia and haemoglobinopathies were common in malaria-infected patients. The deployment of primaquine in Cambodia should be preceded by primaquine safety studies paralleled with evaluations of easy to use tests to detect G6PDd.

Validation of the rapid test Carestart(tm) G6PD among malaria vivax-infected subjects in the Brazilian Amazon

“…Participants with G6PDd showed lower levels of hemoglobin than participants with normal G6PD. Although a previous study on the Cambodian population found that G6PDd was associated with lower hemoglobin levels (33) , we could discern no clear relationship between G6PDd and hemoglobin levels in the present study. However, in another study, Satyagraha et al (34) found that G6PDd was associated with higher hemoglobin levels, whereas, in contrast, other studies have found no correlation between G6PDd and hemoglobin levels (35) (36) .…”

“…There is no clear explanation to account for the low sensitivity to malaria infection. The level of enzyme activity does not seem to be the main factor responsible: this study and previous studies have shown no signifi cant difference in enzyme activity between individuals with and without malaria infection (20) (33) . This may be due to intrinsic characteristics of the parasite that somehow affect the chemistry of Carestart™ G6PD, leading to a decrease in sensitivity.…”

An optimised age-based dosing regimen for single low-dose primaquine for blocking malaria transmission in Cambodia

“…In Cambodia, approximately 90 % of G6PDd is due to the Viangchan variant, which has a median enzyme activity of 0.8 U/gHb (~7 % of the population median of 12 U/gHb), placing it at the severe end of the G6PDd spectrum [39, 40]. AHA induced by 15 mg of daily PQ alone was well tolerated in healthy Cambodian Air Force men who had a mean baseline haemoglobin concentration of approximately 14 g/dL and which fell by a mean of 21 % on day (D)7, persisting to D15 [37].…”

Association of glucose-6-phosphate dehydrogenase deficiency and malaria: a systematic review and meta-analysis

“…However, nine studies whose data either cannot be extracted, overlapped, or combined with the rest of the data, and thus were excluded. Among the 30 included studies, the species of Plasmodium are only Plasmodium falciparum in 17 studies3571011181920212223242526272829, only Plasmodium vivax in one study30, and combined species ( P. falciparum with P. vivax, P. falciparum with P. malariae, P. vivax with P. malariae , and P. falciparum with P. vivax and P. malariae ) in eight studies1415313233343536. Jalloh 200432, Tantular 199936, and Kruatrachue 196215 reported separate data for P. vivax which meta-analyzed with that of Leslie 201030.…”