Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among malaria patients in Upper Myanmar

Abstract

BackgroundGlucose-6-phosphate dehydrogenase (G6PD; EC 1.1.1.49) deficiency is one of the most common X-linked recessive hereditary disorders in the world. Primaquine (PQ) has been used for radical cure of P. vivax to prevent relapse. Recently, it is also used to reduce P. falciparum gametocyte carriage to block transmission. However, PQ metabolites oxidize hemoglobin and generate excessive reactive oxygen species which can trigger acute hemolytic anemia in malaria patients with inherited G6PD deficiency.MethodsA total of 252 blood samples collected from malaria patients in Myanmar were used in this study. G6PD variant was analysed by a multiplex allele specific PCR kit, DiaPlexC™ G6PD Genotyping Kit [Asian type]. The accuracy of the multiplex allele specific PCR was confirmed by sequencing analysis.ResultsPrevalence and distribution of G6PD variants in 252 malaria patients in Myanmar were analysed. Six different types of G6PD allelic variants were identified in 50 (7 females and 43 males) malaria patients. The predominant variant was Mahidol (68%, 34/50), of which 91.2% (31/34) and 8.8% (3/34) were males and females, respectively. Other G6PD variants including Kaiping (18%, 9/50), Viangchan (6%, 3/50), Mediterranean (4%, 2/50), Union (2%, 1/50) and Canton (2%, 1/50) were also observed.ConclusionsResults of this study suggest that more concern for proper and safe use of PQ as a radical cure of malaria in Myanmar is needed by combining G6PD deficiency test before PQ prescription. Establishment of a follow-up system to monitor potential PQ toxicity in malaria patients who are given PQ is also required.

Prevalence and molecular characterization of glucose-6-phosphate dehydrogenase deficiency in the Lue ethnic group of northern Thailand

“…As a result, G6PD deficient red blood cells are at risk of oxidative stress destruction when triggered by infections, stressors, or the intake of some foods and drugs 2 , 3 . Most individuals with G6PD deficiency are clinically asymptomatic, but some G6PD mutations could lead to mild and severe manifested phenotypes such as neonatal jaundice, acute or chronic hemolytic anemia, neonatal hyperbilirubinemia, and/or favism 4 , 5 . There have been at least 140 point mutation in the G6PD gene that have been detected by molecular characterization globally 6 .…”

The Genotyping of Glucose 6 Phosphate Dehydrogenase deficiency (G6PD-d) in Malaria Endemic South Central Timor, East Nusa Tenggara, Eastern Indonesia

“…This study findings 9.4% G6PD-d prevalence with variant Vanua Lava 10.884 T>C were dominant (WHO classifies in to class II with severe deficiency <10% the enzyme activity). This study result relevant with the previous study of G6PD-d prevalence in Asia among malaria patients from public health centre in Myanmar was 19.8% (50/252), and at the endemic malaria population areas in Sri Lanka 10.9% (225/2059), showing the prevalence; however, very different to the result of variant genotyping for G6PD-d the most dominant are variant Mahidol 487 G>A and Kaiping 1388 G>A, the varied in of G6PD-d we notion caused of the different of region and the ethnic status [14,15]. Unfortunately, this study resulted with the prevalence more higher than the previous study in the same island and showed that the prevalence of G6PD-d was 5.9% (104/2033); however, this study still significant consisted with the variant genotyping were Vanua Lava 10.884 T>C was dominant, caused the same of region and ethnicity [3].…”

“…However, from the previous study, in Indonesia, it was showed that there was significance between G6PD-d with malaria infection p ≤ 0.001 [3,16]. We would conclude from the theory and previous study that the individual with G6PD-d would perhaps more prove vulnerable and very sensitive to antimalarial PQ therapy in terms of risk of anaemia haemolytic and the variant genotyping [15,17]. Authors suggest that G6PD-d induced haemolytic anaemia within 14 days after drug administration of PQ; to prevent this side effect, screening of G6PD-d is necessary prior to drug administration of PQ in malaria patients.…”

Quality of Malaria Treatment Provided under ‘Better Health Together’ Project in Ethnic Communities of Myanmar: How Are We Performing?

“…According to narrative reports from EHOs, ICMVs had concerns about prescribing primaquine to people with unknown G6PD status. G6PD deficiency is common in Myanmar, 19.8% of people with malaria have G6PD deficiency [20]. NMCP recommends G6PD deficiency screening before primaquine administration.…”