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Harper R, Ley B, Kabir MA, Matulis G, von Seidlein L, Alam MS, Adhikari B, Okech BA, Williams AL, Price RN, von Fricken ME. The PreQuine Platform: A novel diagnostic tool for measuring glucose-6-phosphate dehydrogenase (G6PD) activity and hemoglobin concentration. PLoS One 2024; 19:e0297918. [PMID: 38728310 PMCID: PMC11086878 DOI: 10.1371/journal.pone.0297918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 05/12/2024] Open
Abstract
Quantitative diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency is essential for the safe administration of 8-aminoquinoline based radical cure for the treatment of Plasmodium vivax infections. Here, we present the PreQuine Platform (IVDS, USA), a quantitative biosensor that uses a dual-analyte assay for the simultaneous measurement of Hemoglobin (Hgb) levels and G6PD enzyme activity within the same sample. The platform relies on a downloadable mobile application. The device requires 10μl of whole blood and works with a reflectance-based meter. Comparing the G6PD measurement normalized by Hgb of 12 samples from the PreQuine Platform with reference measurements methods (spectrophotometry, Pointe Scientific, USA and hemoglobin meter, HemoCue, Sweden) showed a positive and significant agreement with a slope of 1.0091 and an intercept of -0.0379 under laboratory conditions. Next steps will be to conduct field trials in Bangladesh, Cambodia, and the USA to assess diagnostic performance, user friendliness and acceptance.
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Affiliation(s)
- Robert Harper
- In Vitro Diagnostic Solutions, Cherry Hill, New Jersey, United States of America
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Md Alamgir Kabir
- In Vitro Diagnostic Solutions, Cherry Hill, New Jersey, United States of America
| | - Graham Matulis
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
| | - Lorenz von Seidlein
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Bipin Adhikari
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Bernard A. Okech
- Department of Preventive Medicine and Biostatistics, F. Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Alan L. Williams
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Michael E. von Fricken
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- One Health Center of Excellence, University of Florida, Gainesville, Florida, United States of America
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Xuan-Rong Koh D, Zailani MAH, Raja Sabudin RZA, Muniandy S, Muhamad Hata NAA, Mohd Noor SNB, Zakaria N, Othman A, Ismail E. Prevalence and molecular heterogeneity of glucose-6-phosphate dehydrogenase (G6PD) deficiency in the Senoi Malaysian Orang Asli population. PLoS One 2023; 18:e0294891. [PMID: 38085718 PMCID: PMC10715666 DOI: 10.1371/journal.pone.0294891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked genetic disorder characterized by reduced G6PD enzyme levels in the blood. This condition is common in populations exposed to malaria; an acute febrile disease caused by Plasmodium parasites. G6PD-deficient individuals may suffer from acute hemolysis following the prescription of Primaquine, an antimalarial treatment. The population at risk for such a condition includes the Senoi group of Orang Asli, a remote indigenous community in Malaysia. This study aimed to elucidate the G6PD molecular heterogeneity in this subethnic group which is important for malaria elimination. A total of 662 blood samples (369 males and 293 females) from the Senoi subethnic group were screened for G6PD deficiency using a quantitative G6PD assay, OSMMR2000-D kit with Hb normalization. After excluding the family members, the overall prevalence of G6PD deficiency in the studied population was 15.2% (95% CI: 11-19%; 56 of 369), with males (30 of 172; 17.4%) outnumbering females (26 of 197; 13.2%). The adjusted male median (AMM), defined as 100% G6PD activity, was 11.8 IU/gHb. A total of 36 participants (9.6%; 26 male and 10 female) were deficient (<30% of AMM) and 20 participants (5.4%; 4 male and 16 female) were G6PD-intermediate (30-70% of AMM). A total of 87 samples were genotyped, of which 18 showed no mutation. Seven mutations were found among 69 genotyped samples; IVS11 T93C (47.1%; n = 41), rs1050757 (3'UTR +357A>G)(39.1%; n = 34), G6PD Viangchan (c.871G>A)(25.3%; n = 22), G6PD Union (c.1360C>T)(21.8%; n = 19), c.1311C>T(20.7%; n = 18), G6PD Kaiping (c.1388G>A)(8.0%; n = 7), and G6PD Coimbra (c.592C>T)(2.3%; n = 2). Our analysis revealed 27 hemizygote males, 18 heterozygote females, 7 homozygote females, and 2 compound heterozygote females. This study confirms the high prevalence of G6PD deficiency among the Senoi Malaysian Orang Asli, with a significant degree of molecular heterogeneity. More emphasis should be placed on screening for G6PD status and proper and safe use of Primaquine in the elimination of malaria among this indigenous population.
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Affiliation(s)
- Danny Xuan-Rong Koh
- Faculty of Science and Technology, Center of Frontier Sciences, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | | | | | - Sanggari Muniandy
- Faculty of Science and Technology, Center of Frontier Sciences, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | - Nur Awatif Akmal Muhamad Hata
- Faculty of Medicine, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Siti Noor Baya Mohd Noor
- Faculty of Medicine, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Norhazilah Zakaria
- Faculty of Medicine, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Ainoon Othman
- Faculty of Medicine and Health Sciences, Department of Pathology, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia
| | - Endom Ismail
- Faculty of Science and Technology, Department of Biological Sciences Dan Biotechnology, Universiti Kebangsaan Malaysia, Selangor, Malaysia
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Chamchoy K, Sudsumrit S, Wongwigkan J, Petmitr S, Songdej D, Adams ER, Edwards T, Leartsakulpanich U, Boonyuen U. Molecular characterization of G6PD mutations identifies new mutations and a high frequency of intronic variants in Thai females. PLoS One 2023; 18:e0294200. [PMID: 37967096 PMCID: PMC10651042 DOI: 10.1371/journal.pone.0294200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked enzymopathy caused by mutations in the G6PD gene. A medical concern associated with G6PD deficiency is acute hemolytic anemia induced by certain foods, drugs, and infections. Although phenotypic tests can correctly identify hemizygous males, as well as homozygous and compound heterozygous females, heterozygous females with a wide range of G6PD activity may be misclassified as normal. This study aimed to develop multiplex high-resolution melting (HRM) analyses to enable the accurate detection of G6PD mutations, especially among females with heterozygous deficiency. Multiplex HRM assays were developed to detect six G6PD variants, i.e., G6PD Gaohe (c.95A>G), G6PD Chinese-4 (c.392G>T), G6PD Mahidol (c.487G>A), G6PD Viangchan (c.871G>A), G6PD Chinese-5 (c.1024C>T), and G6PD Union (c.1360C>T) in two reactions. The assays were validated and then applied to genotype G6PD mutations in 248 Thai females. The sensitivity of the HRM assays developed was 100% [95% confidence interval (CI): 94.40%-100%] with a specificity of 100% (95% CI: 88.78%-100%) for detecting these six mutations. The prevalence of G6PD deficiency was estimated as 3.63% (9/248) for G6PD deficiency and 31.05% (77/248) for intermediate deficiency by phenotypic assay. The developed HRM assays identified three participants with normal enzyme activity as heterozygous for G6PD Viangchan. Interestingly, a deletion in intron 5 nucleotide position 637/638 (c.486-34delT) was also detected by the developed HRM assays. G6PD genotyping revealed a total of 12 G6PD genotypes, with a high prevalence of intronic variants. Our results suggested that HRM analysis-based genotyping is a simple and reliable approach for detecting G6PD mutations, and could be used to prevent the misdiagnosis of heterozygous females by phenotypic assay. This study also sheds light on the possibility of overlooking intronic variants, which could affect G6PD expression and contribute to enzyme deficiency.
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Affiliation(s)
- Kamonwan Chamchoy
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sirapapha Sudsumrit
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jutamas Wongwigkan
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Songsak Petmitr
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Duantida Songdej
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Emily R. Adams
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Thomas Edwards
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ubolsree Leartsakulpanich
- National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Usa Boonyuen
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Adissu W, Brito M, Garbin E, Macedo M, Monteiro W, Mukherjee SK, Myburg J, Alam MS, Bancone G, Bansil P, Pal S, Sharma A, Zobrist S, Bryan A, Chu CS, Das S, Domingo GJ, Hann A, Kublin J, Lacerda MVG, Layton M, Ley B, Murphy SC, Nosten F, Pereira D, Price RN, Talukdar A, Yilma D, Gerth-Guyette E. Clinical performance validation of the STANDARD G6PD test: A multi-country pooled analysis. PLoS Negl Trop Dis 2023; 17:e0011652. [PMID: 37824592 PMCID: PMC10597494 DOI: 10.1371/journal.pntd.0011652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 10/24/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Screening for G6PD deficiency can inform disease management including malaria. Treatment with the antimalarial drugs primaquine and tafenoquine can be guided by point-of-care testing for G6PD deficiency. METHODS AND FINDINGS Data from similar clinical studies evaluating the performance of the STANDARD G6PD Test (SD Biosensor, South Korea) conducted in Bangladesh, Brazil, Ethiopia, India, Thailand, the United Kingdom, and the United States were pooled. Test performance was assessed in a retrospective analysis on capillary and venous specimens. All study sites used spectrophotometry for reference G6PD testing, and either the HemoCue or complete blood count for reference hemoglobin measurement. The sensitivity of the STANDARD G6PD Test using the manufacturer thresholds for G6PD deficient and intermediate cases in capillary specimens from 4212 study participants was 100% (95% Confidence Interval (CI): 97.5%-100%) for G6PD deficient cases with <30% activity and 77% (95% CI 66.8%-85.4%) for females with intermediate activity between 30%-70%. Specificity was 98.1% (95% CI 97.6%-98.5%) and 92.8% (95% CI 91.6%-93.9%) for G6PD deficient individuals and intermediate females, respectively. Out of 20 G6PD intermediate females with false normal results, 12 had activity levels >60% on the reference assay. The negative predictive value for females with G6PD activity >60% was 99.6% (95% CI 99.1%-99.8%) on capillary specimens. Sensitivity among 396 P. vivax malaria cases was 100% (69.2%-100.0%) for both deficient and intermediate cases. Across the full dataset, 37% of those classified as G6PD deficient or intermediate resulted from true normal cases. Despite this, over 95% of cases would receive correct treatment with primaquine, over 87% of cases would receive correct treatment with tafenoquine, and no true G6PD deficient cases would be treated inappropriately based on the result of the STANDARD G6PD Test. CONCLUSIONS The STANDARD G6PD Test enables safe access to drugs which are contraindicated for individuals with G6PD deficiency. Operational considerations will inform test uptake in specific settings.
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Affiliation(s)
- Wondimagegn Adissu
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Marcelo Brito
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Eduardo Garbin
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Marcela Macedo
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Wuelton Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | - Jane Myburg
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pooja Bansil
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Sampa Pal
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Abhijit Sharma
- Diagnostics, PATH, Seattle, Washington, United States of America
| | | | - Andrew Bryan
- Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Cindy S. Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Santasabuj Das
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Amanda Hann
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - James Kublin
- Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Marcus V. G. Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, Brazil
| | - Mark Layton
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Sean C. Murphy
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
- Center for Emerging and Reemerging Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Dhélio Pereira
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
- Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil
| | - Ric N. Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | | | - Daniel Yilma
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
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Glucose-6-Phosphate Dehydrogenase (G6PD) Measurement Using Biosensors by Community-Based Village Malaria Workers and Hospital Laboratory Staff in Cambodia: A Quantitative Study. Pathogens 2023; 12:pathogens12030400. [PMID: 36986323 PMCID: PMC10056797 DOI: 10.3390/pathogens12030400] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Vivax malaria can relapse after an initial infection due to dormant liver stages of the parasite. Radical cure can prevent relapses but requires the measurement of glucose-6-phosphate dehydrogenase enzyme (G6PD) activity to identify G6PD-deficient patients at risk of drug-induced haemolysis. In the absence of reliable G6PD testing, vivax patients are denied radical curative treatment in many places, including rural Cambodia. A novel Biosensor, ‘G6PD Standard’ (SD Biosensor, Republic of Korea; Biosensor), can measure G6PD activity at the point of care. The objectives of this study were to compare the G6PD activity readings using Biosensors by village malaria workers (VMWs) and hospital-based laboratory technicians (LTs), and to compare the G6PD deficiency categorization recommended by the Biosensor manufacturer with categories derived from a locally estimated adjusted male median (AMM) in Kravanh district, Cambodia. Participants were enrolled between 2021 and 2022 in western Cambodia. Each of the 28 VMWs and 5 LTs received a Biosensor and standardized training on its use. The G6PD activities of febrile patients identified in the community were measured by VMWs; in a subset, a second reading was done by LTs. All participants were tested for malaria by rapid diagnostic test (RDT). The adjusted male median (AMM) was calculated from all RDT-negative participants and defined as 100% G6PD activity. VMWs measured activities in 1344 participants. Of that total, 1327 (98.7%) readings were included in the analysis, and 68 of these had a positive RDT result. We calculated 100% activity as 6.4U/gHb (interquartile range: 4.5 to 7.8); 9.9% (124/1259) of RDT-negative participants had G6PD activities below 30%, 15.2% (191/1259) had activities between 30% and 70%, and 75.0% (944/1259) had activities greater than 70%. Repeat measurements among 114 participants showed a significant correlation of G6PD readings (rs = 0.784, p < 0.001) between VMWs and LTs. Based on the manufacturer’s recommendations, 285 participants (21.5%) had less than 30% activity; however, based on the AMM, 132 participants (10.0%) had less than 30% activity. The G6PD measurements by VMWs and LTs were similar. With the provisions of training, supervision, and monitoring, VMWs could play an important role in the management of vivax malaria, which is critical for the rapid elimination of malaria regionally. Definitions of deficiency based on the manufacturer’s recommendations and the population-specific AMM differed significantly, which may warrant revision of these recommendations.
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Djigo OKM, Gomez N, Ould Ahmedou Salem MS, Basco L, Ould Mohamed Salem Boukhary A, Briolant S. Performance of a Commercial Multiplex Allele-Specific Polymerase Chain Reaction Kit to Genotype African-Type Glucose-6-Phosphate Dehydrogenase Deficiency. Am J Trop Med Hyg 2023; 108:449-455. [PMID: 36535256 PMCID: PMC9896312 DOI: 10.4269/ajtmh.21-1081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/03/2022] [Indexed: 12/23/2022] Open
Abstract
8-Aminoquinoline antimalarial drugs (primaquine, tafenoquine) are required for complete cure of Plasmodium vivax malaria, but they are contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. In the absence of spectrophotometry, which is a gold standard for measuring G6PD activity, G6PD genotyping is one of the alternatives to establish a database and distribution map of G6PD enzyme deficiency in Mauritania, which has become a new epicenter of P. vivax malaria in West Africa. The aim of our study was to assess the performance of multiplex allele-specific polymerase chain reaction (PCR) (African-type Diaplex C™ G6PD kit) against PCR-restriction fragment length polymorphism and sequencing. Of 146 mutations associated with G6PD A- genotypes in 177 blood samples from Mauritanian patients, all but two samples were identified correctly using multiplex allele-specific PCR (100% sensitivity and 99% specificity; "almost perfect agreement" between allele-specific PCR and PCR-restriction fragment length polymorphism/sequencing, with a kappa coefficient of 0.977). Despite a suboptimal PCR protocol for dried blood spots and the inability of the commercial assay to predict unequivocally the G6PD enzyme level in heterozygous females, the African-type Diaplex C™ G6PD genotyping kit seemed to be a valuable screening tool for male subjects and for research purposes in resource-limited countries where spectrophotometer and DNA sequencing are not available.
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Affiliation(s)
- Oum Kelthoum Mamadou Djigo
- Unité de Recherche “Génomes et Milieux” (Jeune Equipe Associée à l’Institut de Recherche pour le Développement), Faculté des Sciences et Techniques, Université de Nouakchott, Nouakchott, Mauritania
| | - Nicolas Gomez
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs–Infections Tropicales et Méditerranéennes, Marseille, France
- Institut Hospitalo-Universitaire–Méditerranée Infection, Marseille, France
- Unité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
| | - Mohamed Salem Ould Ahmedou Salem
- Unité de Recherche “Génomes et Milieux” (Jeune Equipe Associée à l’Institut de Recherche pour le Développement), Faculté des Sciences et Techniques, Université de Nouakchott, Nouakchott, Mauritania
| | - Leonardo Basco
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs–Infections Tropicales et Méditerranéennes, Marseille, France
- Institut Hospitalo-Universitaire–Méditerranée Infection, Marseille, France
| | - Ali Ould Mohamed Salem Boukhary
- Unité de Recherche “Génomes et Milieux” (Jeune Equipe Associée à l’Institut de Recherche pour le Développement), Faculté des Sciences et Techniques, Université de Nouakchott, Nouakchott, Mauritania
| | - Sébastien Briolant
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs–Infections Tropicales et Méditerranéennes, Marseille, France
- Institut Hospitalo-Universitaire–Méditerranée Infection, Marseille, France
- Unité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
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7
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Nuinoon M, Krithong R, Pramtong S, Sasuk P, Ngeaiad C, Chaimusik S, Kanboonma J, Sarakul O. Prevalence of G6PD deficiency and G6PD variants amongst the southern Thai population. PeerJ 2022; 10:e14208. [PMID: 36248708 PMCID: PMC9559062 DOI: 10.7717/peerj.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme essential for NADPH production and protecting cells, especially red blood cells, from free radicals. The oxidative stress from drugs, chemicals, and infections can induce red blood cell hemolysis in G6PD deficiency patients, causing a genetic disorder. Objectives This study aims to provide more information on G6PD deficiency prevalence and the G6PD variants in the southern Thai population. Methods Five hundred and twenty healthy subjects in 14 provinces in the southern part of Thailand participated in the study. EDTA-blood samples were collected for a hematological parameters study, G6PD deficiency screening, and a molecular study for G6PD mutation. G6PD deficiency screening was tested using a fluorescent spot test. The types of G6PD mutation were identified by the allele-specific PCR method. Results The prevalence of G6PD deficiency in southern Thailand was 6.1% (14/228) in males and 9.6% (28/292) in females. Two homozygous and 26 heterozygous G6PD deficiencies were found in females. G6PD Viangchan (871G>A) was the most common variant with 43%, followed by G6PD Mahidol (487G>A), 24% with an allele frequency of 0.025 and 0.012, respectively. Uncharacterized mutations existed in three samples. The study volunteers had anemia in 36.6% (107/292) females and 7.5% (17/228) males. Among G6PD deficiency subjects, only ten partial G6PD deficiency females had mild anemia. Conclusions This study suggests that the prevalence of G6PD deficiency in southern Thailand aligns with that of other parts of Thailand. Newborn screening for G6PD deficiency is recommended for personal information and medical reference to prevent acute hemolysis from oxidative stressors.
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Affiliation(s)
- Manit Nuinoon
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand,Hematology and Transfusion Science Research Center (HTSRC), Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Rungnapha Krithong
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Suputcha Pramtong
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Piyawit Sasuk
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Chompunuch Ngeaiad
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Sathanan Chaimusik
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Jiraporn Kanboonma
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Orawan Sarakul
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand,Hematology and Transfusion Science Research Center (HTSRC), Walailak University, Thasala, Nakhon Si Thammarat, Thailand
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Shenkutie TT, Nega D, Hailu A, Kepple D, Witherspoon L, Lo E, Negash MT, Adamu A, Gebremichael SG, Gidey B, Tasew G, Feleke SM, Kebede T. Prevalence of G6PD deficiency and distribution of its genetic variants among malaria-suspected patients visiting Metehara health centre, Eastern Ethiopia. Malar J 2022; 21:260. [PMID: 36076204 PMCID: PMC9461287 DOI: 10.1186/s12936-022-04269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) is cytosolic enzyme, which has a vital role for the integrity and functioning of red blood cells. Lower activity of this enzyme leads to the occurrence of acute haemolytic anaemia after exposure to oxidative stressors like primaquine. Primaquine is an important drug for the radical cure of Plasmodium vivax and blocking transmission of Plasmodium falciparum, and thereby enhancing malaria elimination. However, there is a need to identify G6PD deficient individuals and administer the drug with caution due to its haemolytic side effects. The main objective of this study is to determine the prevalence of G6PD deficiency among malaria-suspected individuals. Methods A facility-based cross-sectional study was conducted from September 2020 to September 2021 in Metehara Health Centre, Eastern Ethiopia. A structured questionnaire was used to collect the socio-demographic and clinical information of the study participants. Capillary and venous blood samples were collected based on standard procedures for onsite screening, dried blood spot preparation, and malaria microscopy. The G6PD enzyme activity was measured by careSTART™ G6PD biosensor analyzer. Data was entered and analysed by SPSS. Results A total of 498 study participants were included in the study, of which 62% (309) were males. The overall prevalence of G6PD deficiency based on the biosensor screening was 3.6% (18/498), of which 2.9% and 4.8% were males and females, respectively. Eleven of the G6PD deficient samples had mutations confirmed by G6PD gene sequencing analysis. Mutations were detected in G267 + 119C/T, A376T, and ChrX:154535443. A significant association was found in sex and history of previous malaria infection with G6PD deficiency. Conclusions The study showed that the G6PD deficient phenotype exists in Metehara even if the prevalence is not very high. G267 + 119C/T mutation is the predominant G6PD variant in this area. Therefore, malaria patient treatment using primaquine should be monitored closely for any adverse effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04269-5.
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Affiliation(s)
- Tassew Tefera Shenkutie
- Department of Medical Laboratory Sciences, Debre Berhan University, Debre Berhan, Ethiopia. .,Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia. .,Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Desalegn Nega
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Kepple
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA
| | - Logan Witherspoon
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA.,School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Meshesha Tsigie Negash
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Aderaw Adamu
- Department of Medical Laboratory Sciences, Wollo University, Dessie, Ethiopia
| | | | - Bokretsion Gidey
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sindew M Feleke
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tadesse Kebede
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
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9
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Rocca M, Temiz Y, Salva ML, Castonguay S, Gervais T, Niemeyer CM, Delamarche E. Rapid quantitative assays for glucose-6-phosphate dehydrogenase (G6PD) and hemoglobin combined on a capillary-driven microfluidic chip. LAB ON A CHIP 2021; 21:3573-3582. [PMID: 34341817 DOI: 10.1039/d1lc00354b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Rapid tests for glucose-6-phosphate dehydrogenase (G6PD) are extremely important for determining G6PD deficiency, a widespread metabolic disorder which triggers hemolytic anemia in response to primaquine and tafenoquine medication, the most effective drugs for the radical cure of malaria caused by Plasmodium parasites. Current point-of-care diagnostic devices for G6PD are either qualitative, do not normalize G6PD activity to the hemoglobin concentration, or are very expensive. In this work we developed a capillary-driven microfluidic chip to perform a quantitative G6PD test and a hemoglobin measurement within 2 minutes and using less than 2 μL of sample. We used a powerful microfluidic module to integrate and resuspend locally the reagents needed for the G6PD assay and controls. We also developed a theoretical model that successfully predicts the enzymatic reactions on-chip, guides on-chip reagent spotting and allows efficient integration of multiple assays in miniaturized formats with only a few nanograms of reagents.
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Affiliation(s)
- Marco Rocca
- IBM Research Europe - Zurich, 8803 Rüschlikon, Switzerland.
- Institute for Biological Interfaces (IBG-1) - Karlsruhe Institute of Technology (KIT), 76344 Eggenstein-Leopoldshafen, Germany
| | - Yuksel Temiz
- IBM Research Europe - Zurich, 8803 Rüschlikon, Switzerland.
| | - Marie L Salva
- IBM Research Europe - Zurich, 8803 Rüschlikon, Switzerland.
- Institute for Biological Interfaces (IBG-1) - Karlsruhe Institute of Technology (KIT), 76344 Eggenstein-Leopoldshafen, Germany
| | - Samuel Castonguay
- Department of Engineering Physics, Polytechnique Montréal, Montréal, Québec, Canada
| | - Thomas Gervais
- Department of Engineering Physics, Polytechnique Montréal, Montréal, Québec, Canada
- Institut du Cancer de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Christof M Niemeyer
- Institute for Biological Interfaces (IBG-1) - Karlsruhe Institute of Technology (KIT), 76344 Eggenstein-Leopoldshafen, Germany
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10
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Zobrist S, Brito M, Garbin E, Monteiro WM, Clementino Freitas S, Macedo M, Soares Moura A, Advani N, Kahn M, Pal S, Gerth-Guyette E, Bansil P, Domingo GJ, Pereira D, Lacerda MVG. Evaluation of a point-of-care diagnostic to identify glucose-6-phosphate dehydrogenase deficiency in Brazil. PLoS Negl Trop Dis 2021; 15:e0009649. [PMID: 34383774 PMCID: PMC8384181 DOI: 10.1371/journal.pntd.0009649] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/24/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme deficiency, prevalent in many malaria-endemic countries. G6PD-deficient individuals are susceptible to hemolysis during oxidative stress, which can occur from exposure to certain medications, including 8-aminoquinolines used to treat Plasmodium vivax malaria. Accordingly, access to point-of-care (POC) G6PD testing in Brazil is critical for safe treatment of P. vivax malaria. Methodology/Principal findings This study evaluated the performance of the semi-quantitative, POC STANDARD G6PD Test (SD Biosensor, Republic of Korea). Participants were recruited at clinics and through an enriched sample in Manaus and Porto Velho, Brazil. G6PD and hemoglobin measurements were obtained from capillary samples at the POC using the STANDARD and HemoCue 201+ (HemoCue AB, Sweden) tests. A thick blood slide was prepared for malaria microscopy. At the laboratories, the STANDARD and HemoCue tests were repeated on venous samples and a quantitative spectrophotometric G6PD reference assay was performed (Pointe Scientific, Canton, MI). G6PD was also assessed by fluorescent spot test. In Manaus, a complete blood count was performed. Samples were analyzed from 1,736 participants. In comparison to spectrophotometry, the STANDARD G6PD Test performed equivalently in determining G6PD status in venous and capillary specimens under varied operating temperatures. Using the manufacturer-recommended reference value thresholds, the test’s sensitivity at the <30% threshold on both specimen types was 100% (95% confidence interval [CI] venous 93.6%–100.0%; capillary 93.8%–100.0%). Specificity was 98.6% on venous specimens (95% CI 97.9%–99.1%) and 97.8% on capillary (95% CI 97.0%–98.5%). At the 70% threshold, the test’s sensitivity was 96.9% on venous specimens (95% CI 83.8%–99.9%) and 94.3% on capillary (95% CI 80.8%–99.3%). Specificity was 96.5% (95% CI 95.0%–97.6%) and 92.3% (95% CI 90.3%–94.0%) on venous and capillary specimens, respectively. Conclusion/Significance The STANDARD G6PD Test is a promising tool to aid in POC detection of G6PD deficiency in Brazil. Trial registration This study was registered with ClinicalTrials.gov (identifier: NCT04033640). G6PD deficiency affects an estimated 500 million people worldwide and is prevalent in many malaria-endemic settings. People with G6PD deficiency are at risk of hemolysis when exposed to certain medications, including 8-aminoquinoline drugs used to treat Plasmodium vivax malaria. Increased access to testing for G6PD deficiency at or near the point of care is critical for expanding the safe treatment of P. vivax malaria. In this study, we aimed to evaluate the performance of a point-of-care, semi-quantitative test for G6PD deficiency, the STANDARD G6PD Test, in a malaria-endemic setting in Brazil. The test was evaluated on both capillary and venous blood samples across a broad range of operating temperatures. The findings show that the STANDARD G6PD Test performed equivalently to the reference test in its ability to diagnose G6PD deficiency at the point of care. The STANDARD G6PD Test is a promising tool to aid in detecting G6PD deficiency at the point of care in Brazil.
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Affiliation(s)
- Stephanie Zobrist
- Diagnostics, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Marcelo Brito
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Eduardo Garbin
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | - Marcela Macedo
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Aline Soares Moura
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
| | - Nicole Advani
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Maria Kahn
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Sampa Pal
- Diagnostics, PATH, Seattle, Washington, United States of America
| | | | - Pooja Bansil
- Diagnostics, PATH, Seattle, Washington, United States of America
| | | | - Dhelio Pereira
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
- Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil
| | - Marcus VG Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, Brazil
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11
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Djigo OKM, Ould Khalef Y, Ould Ahmedou Salem MS, Gomez N, Basco L, Briolant S, Ould Mohamed Salem Boukhary A. Assessment of CareStart G6PD rapid diagnostic test and CareStart G6PD biosensor in Mauritania. Infect Dis Poverty 2021; 10:105. [PMID: 34353361 PMCID: PMC8340529 DOI: 10.1186/s40249-021-00889-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The elimination of Plasmodium vivax malaria requires 8-aminoquinolines, which are contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency due to the risk of acute haemolytic anaemia. Several point-of-care devices have been developed to detect G6PD deficiency. The objective of the present study was to evaluate the performance of two of these devices against G6PD genotypes in Mauritania. METHODS Outpatients were screened for G6PD deficiency using CareStart™ rapid diagnostic test (RDT) and CareStart™ G6PD biosensor in Nouakchott, Mauritania, in 2019-2020. African-type and Mediterranean-type G6PD genotypes commonly observed in Africa were determined by polymerase chain reaction-restriction fragment length polymorphism and sequencing. Qualitative variables were compared using Fisher's exact test. RESULTS Of 323 patients (74 males and 249 females), 5 males and 2 homozygous females had the African-type A- genotype: A-(202) in 3 males and 2 females and G6PD A-(968) in 2 males. Among heterozygous females, 13 carried G6PD A-(202), 12 G6PD A-(968), and 3 G6PD A-(542) variants. None had the Mediterranean-type G6PD genotype. Eight had a positive G6PD RDT result, including all 7 hemizygous males and homozygous females with A- or A-A- (0.12 to 2.34 IU/g haemoglobin, according to G6PD biosensor), but RDT performed poorly (sensitivity, 11.1% at the cut-off level of < 30%) and yielded many false negative tests. Thirty-seven (50.0%) males and 141 (56.6%) females were anaemic. The adjusted median values of G6PD activity were 5.72 and 5.34 IU/g haemoglobin in non-anaemic males (n = 35) and non-anaemic males and females (n = 130) with normal G6PD genotypes using G6PD biosensor, respectively. Based on the adjusted median of 5.34 IU/g haemoglobin, the performance of G6PD biosensor against genotyping was as follows: at 30% cut-off, the sensitivity and specificity were 85.7% and 91.7%, respectively, and at 80% cut-off, the sensitivity was 100% while the specificity was 64.9%. CONCLUSIONS Although this pilot study supports the utility of biosensor to screen for G6PD deficiency in patients, further investigation in parallel with spectrophotometry is required to promote and validate a more extensive use of this point-of-care device in areas where P. vivax is highly prevalent in Mauritania.
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Affiliation(s)
- Oum Kelthoum Mamadou Djigo
- Unité de Recherche "Génomes et Milieux" (Jeune Equipe Associée à l'Institut de Recherche pour le Développement), Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouakchott, Mauritania
| | - Yacoub Ould Khalef
- Service de Pédiatrie, Centre Hospitalier Mère et Enfant, Nouakchott, Mauritania
| | - Mohamed Salem Ould Ahmedou Salem
- Unité de Recherche "Génomes et Milieux" (Jeune Equipe Associée à l'Institut de Recherche pour le Développement), Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouakchott, Mauritania
| | - Nicolas Gomez
- IHU, Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Unité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées (IRBA), Marseille, France
| | - Leonardo Basco
- IHU, Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Sébastien Briolant
- IHU, Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Unité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées (IRBA), Marseille, France
| | - Ali Ould Mohamed Salem Boukhary
- Unité de Recherche "Génomes et Milieux" (Jeune Equipe Associée à l'Institut de Recherche pour le Développement), Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouakchott, Mauritania.
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12
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Chemoprotective antimalarials identified through quantitative high-throughput screening of Plasmodium blood and liver stage parasites. Sci Rep 2021; 11:2121. [PMID: 33483532 PMCID: PMC7822874 DOI: 10.1038/s41598-021-81486-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/05/2021] [Indexed: 12/20/2022] Open
Abstract
The spread of Plasmodium falciparum parasites resistant to most first-line antimalarials creates an imperative to enrich the drug discovery pipeline, preferably with curative compounds that can also act prophylactically. We report a phenotypic quantitative high-throughput screen (qHTS), based on concentration–response curves, which was designed to identify compounds active against Plasmodium liver and asexual blood stage parasites. Our qHTS screened over 450,000 compounds, tested across a range of 5 to 11 concentrations, for activity against Plasmodium falciparum asexual blood stages. Active compounds were then filtered for unique structures and drug-like properties and subsequently screened in a P. berghei liver stage assay to identify novel dual-active antiplasmodial chemotypes. Hits from thiadiazine and pyrimidine azepine chemotypes were subsequently prioritized for resistance selection studies, yielding distinct mutations in P. falciparum cytochrome b, a validated antimalarial drug target. The thiadiazine chemotype was subjected to an initial medicinal chemistry campaign, yielding a metabolically stable analog with sub-micromolar potency. Our qHTS methodology and resulting dataset provides a large-scale resource to investigate Plasmodium liver and asexual blood stage parasite biology and inform further research to develop novel chemotypes as causal prophylactic antimalarials.
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13
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Nguyen TT, Nguyen XX, Ronse M, Nguyen QT, Ho PQ, Tran DT, Gerrets R, Thriemer K, Ley B, Marfurt J, Price RN, Grietens KP, Gryseels C. Diagnostic Practices and Treatment for P. vivax in the InterEthnic Therapeutic Encounter of South-Central Vietnam: A Mixed-Methods Study. Pathogens 2020; 10:pathogens10010026. [PMID: 33396538 PMCID: PMC7824694 DOI: 10.3390/pathogens10010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 01/13/2023] Open
Abstract
Malaria elimination in the Greater Mekong Sub-Region is challenged by a rising proportion of malaria attributable to P. vivax. Primaquine (PQ) is effective in eliminating the parasite's dormant liver stages and can prevent relapsing infections, but it induces severe haemolysis in patients with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, highlighting the importance of testing enzyme activity prior to treatment. A mixed-method study was conducted in south-central Vietnam to explore the factors that affect acceptability of G6PD testing, treatment-seeking behaviors, and adherence to current regimens. The majority of respondents (75.7%) were unaware of the different parasite species and rather differentiated malaria by perceived severity. People sought a diagnosis if suspected of malaria fever but not if they perceived their fevers as mild. Most respondents agreed to take prescribed medication to treat asymptomatic infection (94.1%) and to continue medication even if they felt better (91.5%). Health professionals did not have G6PD diagnostic tools nor the means to prescribe PQ safely. Adherence to treatment was linked to trust in public providers, who were perceived to make therapeutic decisions in the interest of the patient. Greater focus on providing acceptable ways of assessing G6PD deficiency will be needed to ensure the timely elimination of malaria in Vietnam.
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Affiliation(s)
- Thuan Thi Nguyen
- National Institute of Malariology, Parasitology and Entomology (NIMPE), 34 Trung Van, Trung Van Ward, Nam Tu Liem District, Hanoi 10000, Vietnam; (X.X.N.); (Q.T.N.); (P.Q.H.); (D.T.T.)
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; (M.R.); (K.P.G.); (C.G.)
- Correspondence: ; Tel.: +324-9679-1347
| | - Xa Xuan Nguyen
- National Institute of Malariology, Parasitology and Entomology (NIMPE), 34 Trung Van, Trung Van Ward, Nam Tu Liem District, Hanoi 10000, Vietnam; (X.X.N.); (Q.T.N.); (P.Q.H.); (D.T.T.)
| | - Maya Ronse
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; (M.R.); (K.P.G.); (C.G.)
| | - Quynh Truc Nguyen
- National Institute of Malariology, Parasitology and Entomology (NIMPE), 34 Trung Van, Trung Van Ward, Nam Tu Liem District, Hanoi 10000, Vietnam; (X.X.N.); (Q.T.N.); (P.Q.H.); (D.T.T.)
| | - Phuc Quang Ho
- National Institute of Malariology, Parasitology and Entomology (NIMPE), 34 Trung Van, Trung Van Ward, Nam Tu Liem District, Hanoi 10000, Vietnam; (X.X.N.); (Q.T.N.); (P.Q.H.); (D.T.T.)
| | - Duong Thanh Tran
- National Institute of Malariology, Parasitology and Entomology (NIMPE), 34 Trung Van, Trung Van Ward, Nam Tu Liem District, Hanoi 10000, Vietnam; (X.X.N.); (Q.T.N.); (P.Q.H.); (D.T.T.)
| | - Rene Gerrets
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Postbus 15718, 1001 NE Amsterdam, The Netherlands;
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, Paasheuvelweg 25, 1105 BP Amsterdam, The Netherlands
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Rocklands Drive Casuarina, Darwin Northern Territory 0810, Australia; (K.T.); (B.L.); (J.M.); (R.N.P.)
| | - Benedikt Ley
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Rocklands Drive Casuarina, Darwin Northern Territory 0810, Australia; (K.T.); (B.L.); (J.M.); (R.N.P.)
| | - Jutta Marfurt
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Rocklands Drive Casuarina, Darwin Northern Territory 0810, Australia; (K.T.); (B.L.); (J.M.); (R.N.P.)
| | - Ric N. Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Rocklands Drive Casuarina, Darwin Northern Territory 0810, Australia; (K.T.); (B.L.); (J.M.); (R.N.P.)
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Koen Peeters Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; (M.R.); (K.P.G.); (C.G.)
| | - Charlotte Gryseels
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; (M.R.); (K.P.G.); (C.G.)
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14
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Ryan K, Tekwani BL. Current investigations on clinical pharmacology and therapeutics of Glucose-6-phosphate dehydrogenase deficiency. Pharmacol Ther 2020; 222:107788. [PMID: 33326820 DOI: 10.1016/j.pharmthera.2020.107788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/19/2022]
Abstract
Glucose-6-phospate dehydrogenase (G6PD) deficiency is estimated to affect more than 400 million people world-wide. This X-linked genetic deficiency puts stress on red blood cells (RBC), which may be further augmented under certain pathophysiological conditions and drug treatments. These conditions can cause hemolytic anemia and eventually lead to multi-organ failure and mortality. G6PD is involved in the rate-limiting step of the pentose phosphate pathway, which generates reduced nicotinamide adenine dinucleotide phosphate (NADPH). In RBCs, the NADPH/G6PD pathway is the only source for recycling reduced glutathione and provides protection from oxidative stress. Susceptibility of G6PD deficient populations to certain drug treatments and potential risks of hemolysis are important public health issues. A number of clinical trials are currently in progress investigating clinical factors associated with G6PD deficiency, validation of new diagnostic kits for G6PD deficiency, and evaluating drug safety, efficacy, and pathophysiology. More than 25 clinical studies in G6PD populations are currently in progress or have just been completed that have been examined for clinical pharmacology and potential therapeutic implications of G6PD deficiency. The information on clinical conditions, interventions, purpose, outcome, and status of these clinical trials has been studied. A critical review of ongoing clinical investigations on pharmacology and therapeutics of G6PD deficiency should be highly important for researchers, clinical pharmacologists, pharmaceutical companies, and global public health agencies. The information may be useful for developing strategies for treatment and control of hemolytic crisis and potential drug toxicities in G6PD deficient patients.
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Affiliation(s)
- Kaitlyn Ryan
- Department of Infectious Diseases, Division of Drug Discovery, Southern Research, 2000 9(th) Avenue South, Birmingham, AL 35205, United States of America.
| | - Babu L Tekwani
- Department of Infectious Diseases, Division of Drug Discovery, Southern Research, 2000 9(th) Avenue South, Birmingham, AL 35205, United States of America.
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15
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Yu F, Zhang S, Chen B, Zhou Y, Ma C, Yang S, Tang Y, Huang D, Xie X, Xiao Q, Wang L. Evaluation of the Diagnostic Accuracy of the CareStart™ Glucose-6-Phosphate Dehydrogenase Deficiency Rapid Diagnostic Test among Chinese Newborns. J Trop Pediatr 2020; 66:495-503. [PMID: 32040187 DOI: 10.1093/tropej/fmaa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Previous studies have shown that the CareStart™ G6PD Deficiency rapid diagnostic test has high diagnostic accuracy on G6PD deficiency in Africa and Thailand, but not in China. As there are regional differences of G6PD genotype distribution, we are attending to verify the effectiveness of the kit in Chinese population. The study cohort included 247 newborns admitted to our hospital for jaundice. The quantitative detection of G6PD enzyme activity and G6PD gene mutations analysis was used to classify the status of G6PD deficiency. The performance of CareStart™ assays was verified by calculating the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) based on the corrected G6PD deficiency status. In male newborns, the sensitivity of the CareStart™ assay was 98.9%, the specificity was 94.2% and the AUC was 0.97. In female newborns, the sensitivity was 58.5% when the cutoff value of residual enzyme activity was 100%; however, the sensitivity was 100% when the cutoff value was 60%. Therefore, the CareStart™ test can effectively screen G6PD deficiency in male newborns and female infants with less than 60% residual enzyme activity, female infants with residual enzyme activities of 60-100% are more likely to be missed diagnosed among Chinese newborns.
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Affiliation(s)
- Fengting Yu
- Department of Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Sufen Zhang
- Department of Clinical Laboratory, Zhuhai Municipal Maternal and Child Healthcare Hospital, Zhuhai Institute of Medical Genetics, Zhuhai, Guangdong, China
| | - Binhuan Chen
- Department of Nephrology, The Fifth Hospital Affiliated, Sun Yat-sen University, Guangzhou, China
| | - Yuqiu Zhou
- Department of Clinical Laboratory, Zhuhai Municipal Maternal and Child Healthcare Hospital, Zhuhai Institute of Medical Genetics, Zhuhai, Guangdong, China
| | - Chengjie Ma
- Department of Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Siyuan Yang
- Department of Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yunxia Tang
- Department of Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Dan Huang
- Department of Infectious Diseases, Peking University Ditan Teaching, Hospital, Beijing, China
| | - Xiaohui Xie
- Department of Infectious Diseases, Peking University Ditan Teaching, Hospital, Beijing, China
| | - Qizhi Xiao
- Department of Clinical Laboratory, Zhuhai Municipal Maternal and Child Healthcare Hospital, Zhuhai Institute of Medical Genetics, Zhuhai, Guangdong, China
| | - Linghang Wang
- Department of Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Wide range of G6PD activities found among ethnic groups of the Chittagong Hill Tracts, Bangladesh. PLoS Negl Trop Dis 2020; 14:e0008697. [PMID: 32925910 PMCID: PMC7514097 DOI: 10.1371/journal.pntd.0008697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/24/2020] [Accepted: 08/11/2020] [Indexed: 01/13/2023] Open
Abstract
The proportion of Plasmodium vivax malaria among all malarias is increasing worldwide. Treatment with 8-aminoquinolines remain the only radical cure. However, 8-aminoquinolines can cause severe hemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. The population of the multi-ethnic Chittagong Hill Tracts (CHT) carry the highest malaria burden within Bangladesh. As in many countries the national treatment guidelines recommend 8-aminoquinoline based radical cure without routine G6PD deficiency (G6PDd) testing to guide treatment. Aim of this study was to determine the need for routine testing within a multi-ethnic population by assessing the prevalence of G6PDd among the local population. Participants from 11 ethnicities were randomly selected and malaria status was assessed by microscopy, rapid diagnostic test (RDT) and polymerase chain reaction (PCR). G6PD status was determined by spectrophotometry and G6PD genotyping. The adjusted male median (AMM) was defined as 100% G6PD activity, participants were categorized as G6PD deficient (<30% activity), G6PD intermediate (30% to 70% activity) or G6PD normal (>70% activity). Median G6PD activities between ethnicities were compared and the association between G6PD activity and malaria status was assessed. 1002 participants were enrolled and tested for malaria. G6PD activity was measured by spectrophotometry in 999 participants and host G6PD genotyping undertaken in 323 participants. Seven participants (0.7%) had peripheral parasitaemia detected by microscopy or RDT and 42 by PCR (4.2%). Among 106 participants (32.8%) with confirmed genotype, 99 (93.4%) had the Mahidol variant. The AMM was 7.03U/gHb with 90 (9.0%) G6PD deficient participants and 133 (13.3%) with intermediate G6PD activity. Median G6PD activity differed significantly between ethnicities (p<0.001), proportions of G6PD deficient individuals ranged from 2% to 26% but did not differ between participants with and without malaria. The high G6PDd prevalence and significant variation between ethnicities suggest routine G6PDd testing to guide 8-aminoquinoline based radical in the CHT and comparable settings.
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17
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Abstract
PURPOSE OF REVIEW This is a review of tafenoquine, a new antimalarial drug. Here we examine the recent literature supporting the use of tafenoquine and summarize the opportunities and challenges for its well tolerated use worldwide. RECENT FINDINGS Tafenoquine was recently approved by the US Food and Drug Administration for the treatment of dormant liver stage (hypnozoite) in Plasmodium vivax and for malaria prophylaxis. Single-dose tafenoquine provides equivalent efficacy to 14 days of primaquine for radical cure in P. vivax, and it can be dosed weekly to prevent malaria. However, tafenoquine can only be used in patients with normal G6PD activity and is contraindicated in children and during pregnancy or in lactating mothers with infants of deficient or unknown G6PD status. SUMMARY Tafenoquine's long half-life allows a single dose to achieve radical cure, and weekly dosing for chemoprophylaxis to provide an exciting therapeutic option for patient care and as a new weapon for malaria control/eradication programs. Global implementation of tafenoquine will require the development and validation of a robust, low-cost diagnostic to reliably identify G6PD-deficient individuals. In addition, studies on tafenoquine safety in children are needed.
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18
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Devine A, Howes RE, Price DJ, Moore KA, Ley B, Simpson JA, Dittrich S, Price RN. Cost-Effectiveness Analysis of Sex-Stratified Plasmodium vivax Treatment Strategies Using Available G6PD Diagnostics to Accelerate Access to Radical Cure. Am J Trop Med Hyg 2020; 103:394-403. [PMID: 32372747 PMCID: PMC7356471 DOI: 10.4269/ajtmh.19-0943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Tafenoquine has been licensed for the single-dose radical cure of Plasmodium vivax in adults; however, it is only recommended in patients with > 70% of normal glucose-6-phosphate dehydrogenase (G6PD) activity. Because this may hinder widespread use, we investigated sex-based treatment strategies in which all adult patients are tested with a qualitative G6PD rapid diagnostic test (RDT). Glucose-6-phosphate dehydrogenase normal males are prescribed tafenoquine in all three strategies, whereas G6PD normal females are prescribed either a low-dose 14-day primaquine regimen (PQ14, total dose 3.5 mg/kg) or a high-dose 7-day primaquine regimen (PQ7, total dose 7 mg/kg), or referred to a healthcare facility for quantitative G6PD testing before prescribing tafenoquine. Patients testing G6PD deficient are prescribed a weekly course of primaquine for 8 weeks. We compared the cost-effectiveness of these three strategies to usual care in four countries using a decision tree model. Usual care in Ethiopia does not include radical cure, whereas Afghanistan, Indonesia, and Vietnam prescribe PQ14 without G6PD screening. The cost per disability-adjusted life-year (DALY) averted was expressed through incremental cost-effectiveness ratios (ICERs). Compared with usual care, the ICERs for a sex-based treatment strategy with PQ7 for females from a healthcare provider perspective were $127 per DALY averted in Vietnam, $466 in Ethiopia, $1,089 in Afghanistan, and $4,443 in Indonesia. The PQ14 and referral options cost more while averting fewer DALYs than PQ7. This study provides an alternative cost-effective mode of rolling out tafenoquine in areas where initial testing with only a G6PD RDT is feasible.
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Affiliation(s)
- Angela Devine
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia;,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia;,Address correspondence to Angela Devine, Division of Global and Tropical Health, Menisci School of Health Research, Charles Darwin University, P. O. Box 41096, Casuarina NT 0811, Australia. E-mail:
| | - Rosalind E. Howes
- Malaria and Fever Programme, Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland;,Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David J. Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia;,Victorian Infectious Diseases Reference Laboratory Epidemiology Unit at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - Kerryn A. Moore
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;,Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Benedikt Ley
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sabine Dittrich
- Malaria and Fever Programme, Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland;,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Ric N. Price
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia;,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom;,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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19
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Pfeffer DA, Ley B, Howes RE, Adu P, Alam MS, Bansil P, Boum Y, Brito M, Charoenkwan P, Clements A, Cui L, Deng Z, Egesie OJ, Espino FE, von Fricken ME, Hamid MMA, He Y, Henriques G, Khan WA, Khim N, Kim S, Lacerda M, Lon C, Mekuria AH, Menard D, Monteiro W, Nosten F, Oo NN, Pal S, Palasuwan D, Parikh S, Pitaloka Pasaribu A, Poespoprodjo JR, Price DJ, Roca-Feltrer A, Roh ME, Saunders DL, Spring MD, Sutanto I, Ley-Thriemer K, Weppelmann TA, von Seidlein L, Satyagraha AW, Bancone G, Domingo GJ, Price RN. Quantification of glucose-6-phosphate dehydrogenase activity by spectrophotometry: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003084. [PMID: 32407380 PMCID: PMC7224463 DOI: 10.1371/journal.pmed.1003084] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 04/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The radical cure of Plasmodium vivax and P. ovale requires treatment with primaquine or tafenoquine to clear dormant liver stages. Either drug can induce haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, necessitating screening. The reference diagnostic method for G6PD activity is ultraviolet (UV) spectrophotometry; however, a universal G6PD activity threshold above which these drugs can be safely administered is not yet defined. Our study aimed to quantify assay-based variation in G6PD spectrophotometry and to explore the diagnostic implications of applying a universal threshold. METHODS AND FINDINGS Individual-level data were pooled from studies that used G6PD spectrophotometry. Studies were identified via PubMed search (25 April 2018) and unpublished contributions from contacted authors (PROSPERO: CRD42019121414). Studies were excluded if they assessed only individuals with known haematological conditions, were family studies, or had insufficient details. Studies of malaria patients were included but analysed separately. Included studies were assessed for risk of bias using an adapted form of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Repeatability and intra- and interlaboratory variability in G6PD activity measurements were compared between studies and pooled across the dataset. A universal threshold for G6PD deficiency was derived, and its diagnostic performance was compared to site-specific thresholds. Study participants (n = 15,811) were aged between 0 and 86 years, and 44.4% (7,083) were women. Median (range) activity of G6PD normal (G6PDn) control samples was 10.0 U/g Hb (6.3-14.0) for the Trinity assay and 8.3 U/g Hb (6.8-15.6) for the Randox assay. G6PD activity distributions varied significantly between studies. For the 13 studies that used the Trinity assay, the adjusted male median (AMM; a standardised metric of 100% G6PD activity) varied from 5.7 to 12.6 U/g Hb (p < 0.001). Assay precision varied between laboratories, as assessed by variance in control measurements (from 0.1 to 1.5 U/g Hb; p < 0.001) and study-wise mean coefficient of variation (CV) of replicate measures (from 1.6% to 14.9%; p < 0.001). A universal threshold of 100% G6PD activity was defined as 9.4 U/g Hb, yielding diagnostic thresholds of 6.6 U/g Hb (70% activity) and 2.8 U/g Hb (30% activity). These thresholds diagnosed individuals with less than 30% G6PD activity with study-wise sensitivity from 89% (95% CI: 81%-94%) to 100% (95% CI: 96%-100%) and specificity from 96% (95% CI: 89%-99%) to 100% (100%-100%). However, when considering intermediate deficiency (<70% G6PD activity), sensitivity fell to a minimum of 64% (95% CI: 52%-75%) and specificity to 35% (95% CI: 24%-46%). Our ability to identify underlying factors associated with study-level heterogeneity was limited by the lack of availability of covariate data and diverse study contexts and methodologies. CONCLUSIONS Our findings indicate that there is substantial variation in G6PD measurements by spectrophotometry between sites. This is likely due to variability in laboratory methods, with possible contribution of unmeasured population factors. While an assay-specific, universal quantitative threshold offers robust diagnosis at the 30% level, inter-study variability impedes performance of universal thresholds at the 70% level. Caution is advised in comparing findings based on absolute G6PD activity measurements across studies. Novel handheld quantitative G6PD diagnostics may allow greater standardisation in the future.
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Affiliation(s)
- Daniel A. Pfeffer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- * E-mail:
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Rosalind E. Howes
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Patrick Adu
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Pooja Bansil
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Yap Boum
- Médecins sans Frontières Epicentre, Mbarara Research Centre, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Marcelo Brito
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil
| | - Pimlak Charoenkwan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Archie Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia
- Telethon Kids Institute, Nedlands, Australia
| | - Liwang Cui
- Department of Entomology, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Zeshuai Deng
- Department of Cell Biology and Medical Genetics, Kunming Medical University, Kunming, Yunnan Province, China
| | - Ochaka Julie Egesie
- Department of Hematology and Blood Transfusion, Faculty of Medical Sciences, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Fe Esperanza Espino
- Department of Parasitology, Research Institute for Tropical Medicine, Department of Health, Alabang, Muntinlupa City, Philippines
| | - Michael E. von Fricken
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, United States of America
| | - Muzamil Mahdi Abdel Hamid
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Yongshu He
- Department of Cell Biology and Medical Genetics, Kunming Medical University, Kunming, Yunnan Province, China
| | - Gisela Henriques
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wasif Ali Khan
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Nimol Khim
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Saorin Kim
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Marcus Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Didier Menard
- Malaria Genetics and Resistance Group, Institut Pasteur, Paris, France
| | - Wuelton Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nwe Nwe Oo
- Department of Medical Research, Lower Myanmar, Yangon, Myanmar
| | - Sampa Pal
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Duangdao Palasuwan
- Oxidation in Red Cell Disorders and Health Research Unit, Department of Clinical Microscopy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Sunil Parikh
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | | | - David J. Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | | | - Michelle E. Roh
- Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, San Francisco, United States of America
| | - David L. Saunders
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- US Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Michele D. Spring
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Kamala Ley-Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Thomas A. Weppelmann
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Lorenz von Seidlein
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gonzalo J. Domingo
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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20
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Commons RJ, McCarthy JS, Price RN. Tafenoquine for the radical cure and prevention of malaria: the importance of testing for G6PD deficiency. Med J Aust 2020; 212:152-153.e1. [PMID: 32036613 PMCID: PMC7064913 DOI: 10.5694/mja2.50474] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Robert J Commons
- Menzies School of Health ResearchDarwinNT
- WorldWide Antimalarial Resistance NetworkDarwinNT
- Ballarat Health ServicesBallaratVIC
| | - James S McCarthy
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- University of QueenslandBrisbaneQLD
| | - Ric N Price
- Menzies School of Health ResearchDarwinNT
- Centre for Tropical Medicine and Global HealthNuffield Department of Clinical MedicineUniversity of OxfordOxfordUK
- Mahidol UniversityBangkokThailand
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21
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Phommasone K, van Leth F, Peto TJ, Landier J, Nguyen TN, Tripura R, Pongvongsa T, Lwin KM, Kajeechiwa L, Thwin MM, Parker DM, Wiladphaingern J, Nosten S, Proux S, Nguon C, Davoeung C, Rekol H, Adhikari B, Promnarate C, Chotivanich K, Hanboonkunupakarn B, Jittmala P, Cheah PY, Dhorda M, Imwong M, Mukaka M, Peerawaranun P, Pukrittayakamee S, Newton PN, Thwaites GE, Day NPJ, Mayxay M, Hien TT, Nosten FH, Cobelens F, Dondorp AM, White NJ, von Seidlein L. Mass drug administrations with dihydroartemisinin-piperaquine and single low dose primaquine to eliminate Plasmodium falciparum have only a transient impact on Plasmodium vivax: Findings from randomised controlled trials. PLoS One 2020; 15:e0228190. [PMID: 32023293 PMCID: PMC7001954 DOI: 10.1371/journal.pone.0228190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Mass administrations of antimalarial drugs (MDA) have reduced the incidence and prevalence of P. falciparum infections in a trial in the Greater Mekong Subregion. Here we assess the impact of the MDA on P. vivax infections. Methods Between May 2013 and July 2017, four villages in each Myanmar, Vietnam, Cambodia and Lao PDR were selected based on high prevalence of P. falciparum infections. Eight of the 16 villages were randomly assigned to receive MDA consisting of three-monthly rounds of three-day courses of dihydroartemisinin-piperaquine and, except in Cambodia, a single low-dose of primaquine. Cross-sectional surveys were conducted at quarterly intervals to detect Plasmodium infections using ultrasensitive qPCR. The difference in the cumulative incidence between the groups was assessed through a discrete time survival approach, the difference in prevalence through a difference-in-difference analysis, and the difference in the number of participants with a recurrence of P. vivax infection through a mixed-effect logistic regression. Results 3,790 (86%) residents in the intervention villages participated in at least one MDA round, of whom 2,520 (57%) participated in three rounds. The prevalence of P. vivax infections fell from 9.31% to 0.89% at month 3 but rebounded by six months to 5.81%. There was no evidence that the intervention reduced the cumulative incidence of P.vivax infections (95% confidence interval [CI] Odds ratio (OR): 0.29 to 1.36). Similarly, there was no evidence of MDA related reduction in the number of participants with at least one recurrent infection (OR: 0.34; 95% CI: 0.08 to 1.42). Conclusion MDA with schizontocidal drugs had a lasting effect on P. falciparum infections but only a transient effect on the prevalence of P. vivax infections. Radical cure with an 8-aminoquinoline will be needed for the rapid elimination of vivax malaria.
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Affiliation(s)
- Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - Thomas J. Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Institut de Recherche pour le Développement (IRD), Institut national de la santé et de la recherche médical (INSERM), Aix-Marseille Université · SESSTIM, Marseille, France
| | - Thuy-Nhien Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Rupam Tripura
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet Province, Lao People’s Demographic Republic
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daniel M. Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Department of Population Health and Disease Prevention, University of California, Irvine, California, United States of America
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Chea Nguon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Huy Rekol
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Cholrawee Promnarate
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Worldwide Antimalarial Resistance Network (WWARN) Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Podjanee Jittmala
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Mehul Dhorda
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Worldwide Antimalarial Resistance Network (WWARN) Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sasithon Pukrittayakamee
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Royal Society of Thailand, Dusit, Bangkok, Thailand
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Guy E. Thwaites
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People’s Demographic Republic
| | - Tran Tinh Hien
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Francois H. Nosten
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Frank Cobelens
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - Arjen M. Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- * E-mail:
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22
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Wojnarski B, Lon C, Sea D, Sok S, Sriwichai S, Chann S, Hom S, Boonchan T, Ly S, Sok C, Nou S, Oung P, Kong N, Pheap V, Thay K, Dao V, Kuntawunginn W, Feldman M, Gosi P, Buathong N, Ittiverakul M, Uthaimongkol N, Huy R, Spring M, Lek D, Smith P, Fukuda MM, Wojnarski M. Evaluation of the CareStart™ glucose-6-phosphate dehydrogenase (G6PD) rapid diagnostic test in the field settings and assessment of perceived risk from primaquine at the community level in Cambodia. PLoS One 2020; 15:e0228207. [PMID: 32004348 PMCID: PMC6994100 DOI: 10.1371/journal.pone.0228207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Primaquine is an approved radical cure treatment for Plasmodium vivax malaria but treatment can result in life-threatening hemolysis if given to a glucose-6-phosphate dehydrogenase deficient (G6PDd) patient. There is a need for reliable point-of-care G6PD diagnostic tests. Objectives To evaluate the performance of the CareStart™ rapid diagnostic test (RDT) in the hands of healthcare workers (HCWs) and village malaria workers (VMWs) in field settings, and to better understand user perceptions about the risks and benefits of PQ treatment guided by RDT results. Methods This study enrolled 105 HCWs and VMWs, herein referred to as trainees, who tested 1,543 healthy adult male volunteers from 84 villages in Cambodia. The trainees were instructed on G6PD screening, primaquine case management, and completed pre and post-training questionnaires. Each trainee tested up to 16 volunteers in the field under observation by the study staff. Results Out of 1,542 evaluable G6PD volunteers, 251 (16.28%) had quantitative enzymatic activity less than 30% of an adjusted male median (8.30 U/g Hb). There was no significant difference in test sensitivity in detecting G6PDd between trainees (97.21%), expert study staff in the field (98.01%), and in a laboratory setting (95.62%) (p = 0.229); however, test specificity was different for trainees (96.62%), expert study staff in the field (98.14%), and experts in the laboratory (98.99%) (p < 0.001). Negative predictive values were not statistically different for trainees, expert staff, and laboratory testing: 99.44%, 99.61%, and 99.15%, respectively. Knowledge scores increased significantly post-training, with 98.7% willing to prescribe primaquine for P.vivax malaria, an improvement from 40.6% pre-training (p < 0.001). Conclusion This study demonstrated ability of medical staff with different background to accurately use CareStart™ RDT to identify G6PDd in male patients, which may enable safer prescribing of primaquine; however, pharmacovigilance is required to address possible G6PDd misclassifications.
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Affiliation(s)
- Bertha Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- The George Washington University, School of Nursing, Washington, DC, United States of America
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Darapiseth Sea
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Somethy Sok
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | | | | | - Sohei Hom
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Sokna Ly
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Chandara Sok
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Samon Nou
- Chenda Polyclinic (CPC), Phnom Penh, Cambodia
| | - Pheaktra Oung
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Nareth Kong
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vannak Pheap
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | - Khengheang Thay
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vy Dao
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | | | - Mitra Feldman
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Panita Gosi
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nillawan Buathong
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mali Ittiverakul
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Michele Spring
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Philip Smith
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mark M. Fukuda
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mariusz Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- * E-mail:
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23
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Phommasone K, van Leth F, Imwong M, Henriques G, Pongvongsa T, Adhikari B, Peto TJ, Promnarate C, Dhorda M, Sirithiranont P, Mukaka M, Peerawaranun P, Day NPJ, Cobelens F, Dondorp AM, Newton PN, White NJ, von Seidlein L, Mayxay M. The use of ultrasensitive quantitative-PCR to assess the impact of primaquine on asymptomatic relapse of Plasmodium vivax infections: a randomized, controlled trial in Lao PDR. Malar J 2020; 19:4. [PMID: 31900172 PMCID: PMC6942400 DOI: 10.1186/s12936-019-3091-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trials to assess the efficacy of the radical cure of Plasmodium vivax malaria with 8-aminoquinolines require that most post-treatment relapses are identified, but there is no consensus on the optimal duration of follow-up in either symptomatic or asymptomatic vivax malaria. The efficacy of a 14-day course of primaquine on the cumulative incidence of recurrent asymptomatic P. vivax infections detected by ultrasensitive quantitative PCR (uPCR) as a primary endpoint was assessed. METHODS A randomized, placebo-controlled, single-blind trial was conducted in four villages of the Lao PDR during 2016-2018 nested in a larger project evaluating mass drug administrations (MDA) with dihydroartemisinin-piperaquine (DP) and a single low-dose primaquine to clear Plasmodium falciparum infections. In the nested sub-study, eligible participants with mono- or mixed P. vivax infections detected by uPCR were randomized to receive either 14 days of primaquine (0.5 mg/kg/day) or placebo during the last round of MDA (round 3) through directly observed therapy. Participants were checked monthly for 12 months for parasitaemia using uPCR. The primary outcome was cumulative incidence of participants with at least one recurrent episode of P. vivax infection. RESULTS 20 G6PD-normal participants were randomized in each arm. 5 (29%) of 20 participants in the placebo arm experienced asymptomatic, recurrent P. vivax infections, resulting in a cumulative incidence at month 12 of 29%. None of the 20 participants in the intervention arm had recurrent infections (p = 0.047 Fisher's exact test). Participants with recurrent P. vivax infections were found to be parasitaemic for between one and five sequential monthly tests. The median time to recurrence of P. vivax parasitaemia was 178 days (range 62-243 days). CONCLUSIONS A 14-day course of primaquine in addition to a DP-MDA was safe, well-tolerated, and prevented recurrent asymptomatic P. vivax infections. Long follow-up for up to 12 months is required to capture all recurrences following the treatment of asymptomatic vivax infection. To eliminate all malarias in settings where P. vivax is endemic, a full-course of an 8-aminoquinolines should be added to MDA to eliminate all malarias. Trial registration This study was registered with ClinicalTrials.gov under NCT02802813 on 16th June 2016. https://clinicaltrials.gov/ct2/show/NCT02802813.
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Affiliation(s)
- Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Department of Global Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Mallika Imwong
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Gisela Henriques
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet, Savannakhet Province, Lao PDR
| | - Bipin Adhikari
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas J Peto
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Mehul Dhorda
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- WWARN Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | | | - Mavuto Mukaka
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Nicholas P J Day
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Frank Cobelens
- Department of Global Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Arjen M Dondorp
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
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White D, Keramane M, Capretta A, Brennan JD. A paper-based biosensor for visual detection of glucose-6-phosphate dehydrogenase from whole blood. Analyst 2020; 145:1817-1824. [DOI: 10.1039/c9an02219h] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Paper-based, colorimetric, visual detection of G6PD from whole blood without need for equipment.
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Affiliation(s)
- Dawn White
- Biointerfaces Institute
- McMaster University
- Canada
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25
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Pengboon P, Thamwarokun A, Changsri K, Kaset C, Chomean S. Evaluation of quantitative biosensor for glucose-6-phosphate dehydrogenase activity detection. PLoS One 2019; 14:e0226927. [PMID: 31860695 PMCID: PMC6924682 DOI: 10.1371/journal.pone.0226927] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022] Open
Abstract
Neonatal jaundice is a common and severe disease in premature infants with Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency. The World Health Organization (WHO) has recommended screening for G-6-PD deficiency in newborns for early recognition as well as to prevent unwanted outcomes in a timely manner. The present study aimed to assess a point-of-care, careSTARTTM G6PD biosensor as a quantitative method for the diagnosis of G-6-PD deficiency. Factors influencing the evaluation of G-6-PD enzyme activity were examined in 40 adults, including ethylenediaminetetraacetic acid (EDTA) anticoagulant, hematocrit concentration, storage temperature and time. Analytic performance of the careSTARTTM G6PD biosensor was evaluated in 216 newborns and compared with fluorescent spot test (FST) and standard quantitative G-6-PD enzyme activity (SGT) assay. The results of factors affecting the G-6-PD enzyme activity showed that the activity determined from finger-prick was not statistically different from venous blood (p = 0.152). The G-6-PD value was highly dependent on the hematocrit and rose with increasing hematocrit concentration. Its activity was stable at 4°C for 3 days. Reliability analysis between the careSTARTTM G6PD biosensor and SGT assay showed a strong correlation with a Pearson's correlation coefficient of 0.82 and perfect agreement by intraclass correlation coefficient (ICC) of 0.90. Analysis of the area under the Receiver Operating Curve (AUC) illustrated that the careSTARTTM G6PD biosensor had 100% sensitivity, 96% specificity, 73% positive predictive value (PPV), 100% negative predictive value (NPV) and 97% accuracy at 30% of residual activity. While the diagnostic ability for identifying G-6-PD deficiency had 78% sensitivity, 89% specificity, 56% positive predictive value (PPV), 96% negative predictive value (NPV) and 88% accuracy when stratified by gender. The careSTARTTM G6PD biosensor is an attractive option as a point-of-care quantitative method for G-6-PD activity detection. Quantification of G-6-PD enzyme activity in newborns is the most effective approach for the management of G-6-PD deficiency to prevent severe jaundice and acute hemolysis.
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Affiliation(s)
- Pairat Pengboon
- Graduate Program in Medical Technology, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Areenuch Thamwarokun
- Graduate Program in Biomedical Sciences, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Khaimuk Changsri
- Department of Medical Technology, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Chollanot Kaset
- Department of Medical Technology, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Sirinart Chomean
- Department of Medical Technology, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
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26
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Ley B, Winasti Satyagraha A, Rahmat H, von Fricken ME, Douglas NM, Pfeffer DA, Espino F, von Seidlein L, Henriques G, Oo NN, Menard D, Parikh S, Bancone G, Karahalios A, Price RN. Performance of the Access Bio/CareStart rapid diagnostic test for the detection of glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002992. [PMID: 31834890 PMCID: PMC6910667 DOI: 10.1371/journal.pmed.1002992] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/08/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To reduce the risk of drug-induced haemolysis, all patients should be tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency (G6PDd) prior to prescribing primaquine (PQ)-based radical cure for the treatment of vivax malaria. This systematic review and individual patient meta-analysis assessed the utility of a qualitative lateral flow assay from Access Bio/CareStart (Somerset, NJ) (CareStart Screening test for G6PD deficiency) for the diagnosis of G6PDd compared to the gold standard spectrophotometry (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42019110994). METHODS AND FINDINGS Articles published on PubMed between 1 January 2011 and 27 September 2019 were screened. Articles reporting performance of the standard CSG from venous or capillary blood samples collected prospectively and considering spectrophotometry as gold standard (using kits from Trinity Biotech PLC, Wicklow, Ireland) were included. Authors of articles fulfilling the inclusion criteria were contacted to contribute anonymized individual data. Minimal data requested were sex of the participant, CSG result, spectrophotometry result in U/gHb, and haemoglobin (Hb) reading. The adjusted male median (AMM) was calculated per site and defined as 100% G6PD activity. G6PDd was defined as an enzyme activity of less than 30%. Pooled estimates for sensitivity and specificity, unconditional negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated comparing CSG results to spectrophotometry using a random-effects bivariate model. Of 11 eligible published articles, individual data were available from 8 studies, 6 from Southeast Asia, 1 from Africa, and 1 from the Americas. A total of 5,815 individual participant data (IPD) were available, of which 5,777 results (99.3%) were considered for analysis, including data from 3,095 (53.6%) females. Overall, the CSG had a pooled sensitivity of 0.96 (95% CI 0.90-0.99) and a specificity of 0.95 (95% CI 0.92-0.96). When the prevalence of G6PDd was varied from 5% to 30%, the unconditional NPV was 0.99 (95% CI 0.94-1.00), with an LR+ and an LR- of 18.23 (95% CI 13.04-25.48) and 0.05 (95% CI 0.02-0.12), respectively. Performance was significantly better in males compared to females (p = 0.027) but did not differ significantly between samples collected from capillary or venous blood (p = 0.547). Limitations of the study include the lack of wide geographical representation of the included data and that the CSG results were generated under research conditions, and therefore may not reflect performance in routine settings. CONCLUSIONS The CSG performed well at the 30% threshold. Its high NPV suggests that the test is suitable to guide PQ treatment, and the high LR+ and low LR- render the test suitable to confirm and exclude G6PDd. Further operational studies are needed to confirm the utility of the test in remote endemic settings.
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Affiliation(s)
- Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- * E-mail:
| | | | - Hisni Rahmat
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Michael E. von Fricken
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, United States of America
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Daniel A. Pfeffer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Fe Espino
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Gisela Henriques
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nwe Nwe Oo
- Department of Medical Research (Lower Myanmar), Yangon, Republic of the Union of Myanmar
| | - Didier Menard
- Malaria Genetics and Resistance Unit, Institut Pasteur, Paris, France
| | - Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Germana Bancone
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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27
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Tafenoquine. Curr Opin Infect Dis 2019. [DOI: 10.1097/qco.0000000000000574 and 21=21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
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Abstract
The technical genesis and practice of 8-aminoquinoline therapy of latent malaria offer singular scientific, clinical, and public health insights. The 8-aminoquinolines brought revolutionary scientific discoveries, dogmatic practices, benign neglect, and, finally, enduring promise against endemic malaria. The clinical use of plasmochin-the first rationally synthesized blood schizontocide and the first gametocytocide, tissue schizontocide, and hypnozoitocide of any kind-commenced in 1926. Plasmochin became known to sometimes provoke fatal hemolytic crises. World War II delivered a newer 8-aminoquinoline, primaquine, and the discovery of glucose-6-phosphate dehydrogenase (G6PD) deficiency as the basis of its hemolytic toxicity came in 1956. Primaquine nonetheless became the sole therapeutic option against latent malaria. After 40 years of fitful development, in 2018 the U.S. Food and Drug Administration registered the 8-aminoquinoline called tafenoquine for the prevention of all malarias and the treatment of those that relapse. Tafenoquine also cannot be used in G6PD-unknown or -deficient patients. The hemolytic toxicity of the 8-aminoquinolines impedes their great potential, but this problem has not been a research priority. This review explores the complex technical dimensions of the history of 8-aminoquinolines. The therapeutic principles thus examined may be leveraged in improved practice and in understanding the bright prospect of discovery of newer drugs that cannot harm G6PD-deficient patients.
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29
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von Seidlein L, Peto TJ, Tripura R, Pell C, Yeung S, Kindermans JM, Dondorp A, Maude R. Novel Approaches to Control Malaria in Forested Areas of Southeast Asia. Trends Parasitol 2019; 35:388-398. [PMID: 31076353 DOI: 10.1016/j.pt.2019.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/27/2022]
Abstract
The emergence and spread of drug resistance in the Greater Mekong Subregion (GMS) have added urgency to accelerate malaria elimination while reducing the treatment options. The remaining foci of malaria transmission are often in forests, where vectors tend to bite during daytime and outdoors, thus reducing the effectiveness of insecticide-treated bed nets. Limited periods of exposure suggest that chemoprophylaxis could be a promising strategy to protect forest workers against malaria. Here we discuss three major questions in optimizing malaria chemoprophylaxis for forest workers: which antimalarial drug regimens are most appropriate, how frequently the chemoprophylaxis should be delivered, and how to motivate forest workers to use, and adhere to, malaria prophylaxis.
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Affiliation(s)
- Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Sciences and Global Health, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Shunmay Yeung
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Arjen Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Hounkpatin AB, Kreidenweiss A, Held J. Clinical utility of tafenoquine in the prevention of relapse of Plasmodium vivax malaria: a review on the mode of action and emerging trial data. Infect Drug Resist 2019; 12:553-570. [PMID: 30881061 PMCID: PMC6411314 DOI: 10.2147/idr.s151031] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Tafenoquine is an 8-aminoquinoline with activity against all human life cycle stages of Plasmodium vivax, including dormant liver stages – so called hypnozoites. Its long half-life of ~15 days is allowing for a single exposure regimen. It has been under development since 1980 and received approval by the US Food and Drug Administration in summer 2018 as an anti-relapse drug for P. vivax malaria in patients aged 16 years and older and for prophylaxis of malaria caused by any Plasmodium species in adults. Prior to tafenoquine administration, glucose-6-phosphate dehydrogenase (G6PD) deficiency needs to be excluded by testing. Individuals with a deficient G6PD activity are at risk of tafenoquine-induced hemolysis – as is the case for primaquine, the mainstay drug for P. vivax radical cure. A wealth of clinical studies have been conducted and are still ongoing to assess the safety, tolerability, and efficacy of tafenoquine. This review focuses on data emerging from the latest clinical trials on P. vivax radical cure with tafenoquine, the key studies for regulatory approval of tafenoquine, and elucidates the latest hypothesis on the mode of action.
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Affiliation(s)
- Aurore B Hounkpatin
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany,
| | - Jana Held
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
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Unger H, Thriemer K, Ley B, Tinto H, Traoré M, Valea I, Tagbor H, Antwi G, Gbekor P, Nambozi M, Kabuya JBB, Mulenga M, Mwapasa V, Chapotera G, Madanitsa M, Rulisa S, de Crop M, Claeys Y, Ravinetto R, D’Alessandro U. The assessment of gestational age: a comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa. BMC Pregnancy Childbirth 2019; 19:12. [PMID: 30621604 PMCID: PMC6323786 DOI: 10.1186/s12884-018-2128-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. METHODS Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. RESULTS A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS. CONCLUSIONS In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.
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Affiliation(s)
- Holger Unger
- Department of Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, UK
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Australia
| | - Kamala Thriemer
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Benedikt Ley
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Maminata Traoré
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | - Gifty Antwi
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | | | | | | | | | - Victor Mwapasa
- Department of Public Health, College of Medicine, Blantyre, Malawi
| | | | | | - Stephen Rulisa
- University of Rwanda, School of Medicine and Pharmacy, Kigali, Rwanda
| | | | - Yves Claeys
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D’Alessandro
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
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Spectrophotometry assays to determine G6PD activity from Trinity Biotech and Pointe Scientific G6PD show good correlation. BMC Res Notes 2018; 11:855. [PMID: 30514365 PMCID: PMC6278131 DOI: 10.1186/s13104-018-3964-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 11/29/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Spectrophotometry kits from Pointe Scientific (PS; USA) were compared to kits from Trinity Biotech (Trinity; Ireland) in 50 venous blood samples from purposively selected individuals in Bangladesh. Repeatability and inter-assay variability were assessed by Students t-test, Bland-Altman plot and Pearson correlation coefficient (r). The median glucose-6-phosphate dehydrogenase (G6PD) activity of all G6PD normal participants was calculated per assay and defined as 100% activity. Performance was calculated considering 30% and 70% cut off activities and Trinity as reference. RESULTS The intra-assay correlation of Trinity (r = 0.9841, p < 0.001) and PS (r = 0.9833, p < 0.001) did not differ significantly (p = 0.904). Both assays were closely correlated (r = 0.9799, p < 0.001), with a mean difference of 0.1 U/gHb (95% limit of agreement: - 1.32 to 1.57). At 30% cut off PS had a sensitivity of 100% (95% confidence interval (95 CI) 59.0-100.0) and specificity of 100% (95% CI 91.8 to 100.0), at 70% cut-off of 100% (95% CI 79.4-100.0) and 97.1% (95% CI 84.7-99.9) respectively. The G6PD assay from PS is a reliable alternative to the assay from Trinity.
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Schlagenhauf P, Grobusch MP, Hamer DH, Asgeirsson H, Jensenius M, Eperon G, Rothe C, Isenring E, Fehr J, Schwartz E, Bottieau E, Barnett ED, McCarthy A, Kelly P, Schade Larsen C, van Genderen P, Stauffer W, Libman M, Gautret P. Area of exposure and treatment challenges of malaria in Eritrean migrants: a GeoSentinel analysis. Malar J 2018; 17:443. [PMID: 30497487 PMCID: PMC6267801 DOI: 10.1186/s12936-018-2586-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/21/2018] [Indexed: 12/03/2022] Open
Abstract
Background Recent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea. A descriptive analysis of GeoSentinel cases of malaria in Eritrean migrants was done together with a literature review to elucidate key attributes of malaria in this group with a focus on possible areas of acquisition of malaria and treatment challenges. Results A total of 146 cases were identified from the GeoSentinel database from 1999 through September 2017, with a marked increase in 2014 and 2015. All patients originated from Eritrea and the main reporting GeoSentinel sites were in Norway, Switzerland, Sweden, Israel and Germany. The majority of patients (young adult males) were diagnosed with malaria following arrival in the host country. All patients had a possible exposure in Eritrea, but may have been exposed in documented transit countries including Ethiopia, Sudan and possibly Libya in detention centres. Most infections were due to Plasmodium vivax (84.2%), followed by Plasmodium falciparum (8.2%). Two patients were pregnant, and both had P. vivax malaria. Some 31% of the migrants reported having had malaria while in transit. The median time to onset of malaria symptoms post arrival in the host country was 39 days. Some 66% of patients were hospitalized and nine patients had severe malaria (according to WHO criteria), including five due to P. vivax. Conclusions The 146 cases of mainly late onset, sometimes severe, P. vivax malaria in Eritrean migrants described in this multi-site, global analysis reflect the findings of single-centre analyses identified in the literature search. Host countries receiving asylum-seekers from Eritrea need to be prepared for large surges in vivax and, to a lesser extent, falciparum malaria, and need to be aware and prepared for glucose-6-phosphate dehydrogenase deficiency testing and primaquine treatment, which is difficult to procure and mainly unlicensed in Europe. There is an urgent need to explore the molecular epidemiology of P. vivax in Eritrean asylum-seekers, to investigate the area of acquisition of P. vivax along common transit routes and to determine whether there has been re-introduction of malaria in areas, such as Libya, where malaria is considered eliminated, but where capable vectors and Plasmodium co-circulate. Electronic supplementary material The online version of this article (10.1186/s12936-018-2586-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patricia Schlagenhauf
- WHO Collaborating Centre for Travel Medicine, Travel Clinic and Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, 8001, Zurich, Switzerland.
| | - Martin P Grobusch
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mogens Jensenius
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
| | - Egon Isenring
- WHO Collaborating Centre for Travel Medicine, Travel Clinic and Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, 8001, Zurich, Switzerland
| | - Jan Fehr
- WHO Collaborating Centre for Travel Medicine, Travel Clinic and Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, 8001, Zurich, Switzerland.,University Hospital, Department of Infectious Diseases, University of Zürich, Zurich, Switzerland
| | - Eli Schwartz
- The Center of Geographical Medicine-Dept. of Internal Medicine "C"-Sheba Medical Center Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elizabeth D Barnett
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Anne McCarthy
- Ottawa Hospital and Department of Medicine University of Ottawa, Ottawa, Canada
| | | | | | - Perry van Genderen
- Institute for Tropical Diseases, Harbour Hospital Rotterdam, Rotterdam, The Netherlands
| | - William Stauffer
- Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Philippe Gautret
- University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France
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Kießling N, Brintrup J, Zeynudin A, Abduselam N, Götz S, Mack M, Pritsch M, Wieser A, Kohne E, Berens-Riha N. Glucose-6-phosphate dehydrogenase activity measured by spectrophotometry and associated genetic variants from the Oromiya zone, Ethiopia. Malar J 2018; 17:358. [PMID: 30314477 PMCID: PMC6186078 DOI: 10.1186/s12936-018-2510-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The study aimed to gain first data on the prevalence of G6PD enzyme deficiency measured by spectrophotometry and associated genetic variants in Jimma and surroundings, Ethiopia. The area is a Plasmodium vivax endemic region, but 8-aminoquinolines such as primaquine are not recommended as G6PD testing is not available. METHODS Healthy volunteers were recruited at Jimma University, Ethiopia. Enzyme activity was tested by spectrophotometry at the University of Ulm, Germany. A G6PD RDT (Binax NOW® G6PD, Alere, USA) was additionally performed. The G6PD gene was analysed for polymorphisms in a sub-population. Tests for haemoglobinopathies and the presence of malaria parasites were conducted. RESULTS No severe or moderate (cut-off 60%) G6PD deficiency was found in 206 volunteers. Median male activity was 6.1 U/g Hb. Eleven participants (5.4%) showed activities between 70 and 80%. No haemoglobinopathy was detected. None of the subjects showed asymptomatic parasitaemia. One G6PD-A+ variant (A376G) and one new non-synonymous mutation (G445A) were found. CONCLUSIONS As the prevalence of G6PD deficiency seems low in this area, the use of 8-aminoquinolines should be encouraged. However, reliable G6PD testing methods have to be implemented and safe cut-off levels need to be defined.
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Affiliation(s)
- Nora Kießling
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Joaquin Brintrup
- Hemoglobin Laboratory, Department of Pediatrics, University Hospital Ulm, Eythstrasse 24, 89075, Ulm, Germany
| | - Ahmed Zeynudin
- Department of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Nuredin Abduselam
- Department of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Sylvia Götz
- Hemoglobin Laboratory, Department of Pediatrics, University Hospital Ulm, Eythstrasse 24, 89075, Ulm, Germany
| | - Margith Mack
- Hemoglobin Laboratory, Department of Pediatrics, University Hospital Ulm, Eythstrasse 24, 89075, Ulm, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany.,German Centre for Infection Research (DZIF) at LMU, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany.,Department of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia.,German Centre for Infection Research (DZIF) at LMU, Munich, Germany
| | - Elisabeth Kohne
- Hemoglobin Laboratory, Department of Pediatrics, University Hospital Ulm, Eythstrasse 24, 89075, Ulm, Germany
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany. .,German Centre for Infection Research (DZIF) at LMU, Munich, Germany.
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Low and heterogeneous prevalence of glucose-6-phosphate dehydrogenase deficiency in different settings in Ethiopia using phenotyping and genotyping approaches. Malar J 2018; 17:281. [PMID: 30071859 PMCID: PMC6071387 DOI: 10.1186/s12936-018-2437-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND 8-Aminoquinolines such as primaquine clear mature Plasmodium falciparum gametocytes that are responsible for transmission from human to mosquitoes and bring radical cure in Plasmodium vivax by clearing dormant liver stages. Deployment of primaquine is thus of relevance for malaria elimination efforts but challenged by the widespread prevalence of glucose-6-phosphate dehydrogenase deficiency (G6PDd) in endemic countries since primaquine in G6PDd individuals may lead to acute haemolysis. In this study, the prevalence of G6PDd was investigated in different settings in Ethiopia using phenotyping and genotyping approaches. METHODS Community and school based cross-sectional surveys were conducted from October to December 2016 in four administrative regions (Gambela, Benishangul Gumuz, Oromia, and Amhara) in Ethiopia. Finger prick blood samples were collected for G6PD enzyme activity using the CareStart™ G6PD screening test and genotyping of 36 selected single nucleotide polymorphisms (SNPs) located in the G6PD gene and its flanking regions. RESULTS Overall, the prevalence of phenotypic G6PDd was 1.4% (22/1609). For the first time in the Ethiopian population, the African variant (A-) was detected in 3.5% (7/199) of the limited set of genotyped samples, which were all phenotypically normal. Interestingly, all of these individuals had a variation at the rs2515904 locus. Strong geographical variation was observed for both phenotypic and genotypic G6PDd; three-quarters of the phenotypically G6PDd individuals were detected in Gambela. CONCLUSION A very low prevalence of G6PDd was detected in the present study populations. The presence of the A- variant alongside other G6PD mutants and the patchy distribution of G6PDd indicate that larger studies specifically designed to unravel the distribution of G6PDd at small geographical scale may be needed to tailor malaria elimination efforts in Ethiopia to the local context.
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Motshoge T, Ababio G, Aleksenko L, Souda S, Muthoga CW, Mutukwa N, Tawe L, Ramatlho P, Gabaitiri L, Chihanga S, Mosweunyane T, Hamda S, Moakofhi K, Ntebela D, Peloewetse E, Mazhani L, Pernica JM, Read J, Quaye IK, Paganotti GM. Prevalence of G6PD deficiency and associated haematological parameters in children from Botswana. INFECTION GENETICS AND EVOLUTION 2018; 63:73-78. [PMID: 29778768 DOI: 10.1016/j.meegid.2018.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/16/2022]
Abstract
Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is commonly seen in malaria endemic areas as it is known to confer a selective advantage against malaria. Recently, we reported a high proportion of asymptomatic reservoir of Plasmodium vivax in Botswana, that calls for intervention with primaquine to achieve radical cure of vivax malaria. Considering that individuals with this enzyme deficiency are at risk of haemolysis following primaquine treatment, assessment of the population for the relative frequency of G6PD deficiency is imperative. Samples from 3019 children from all the districts of Botswana were successfully genotyped for polymorphisms at positions 202 and 376 of the G6PD gene. Haematological parameters were also measured. The overall population allele frequency (based on the hemizygous male frequency) was 2.30% (95% CI, 1.77-2.83), while the overall frequency of G6PD-deficient genotypes A- (hemizygote and homozygote genotypes only) was 1.26% (95% CI, 0.86-1.66). G6PD deficiency is spread in Botswana according to the historical prevalence of malaria with a North-West to South-East decreasing gradient trend. There was no association between G6PD status and P. vivax infection. G6PD A- form was found to be associated with decreased RBC count and haemoglobin levels without a known cause or illness. In conclusion, we report for the first time the prevalence of G6PD deficiency in Botswana which is relevant for strategies in the malaria elimination campaign. Further work to examine the activities of the enzyme in the Botswana population at risk for malaria is warranted.
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Affiliation(s)
- Thato Motshoge
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana; Department of Biological Sciences, University of Botswana, Private Bag 00704, Gaborone, Botswana
| | - Grace Ababio
- Department of Medical Biochemistry, University of Ghana, P.O. Box 143, Korle-Bu, Accra, Ghana
| | - Larysa Aleksenko
- Department of Pathology, University of Namibia, Private Bag 13301, Windhoek, Namibia; Department of Obstetrics and Gynaecology, Lund University, Kvinnokliniken, SUS, 221 85 Lund, Sweden
| | - Sajini Souda
- Department of Pathology, University of Botswana, Private Bag UB 713, Gaborone, Botswana
| | | | - Naledi Mutukwa
- Department of Pathology, University of Botswana, Private Bag UB 713, Gaborone, Botswana
| | - Leabaneng Tawe
- Department of Medical Laboratory Sciences, University of Botswana, Private Bag 00712, Gaborone, Botswana; Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), Private Bag BO 320, Gaborone, Botswana
| | - Pleasure Ramatlho
- Department of Biological Sciences, University of Botswana, Private Bag 00704, Gaborone, Botswana
| | - Lesego Gabaitiri
- Department of Statistics, University of Botswana, Private Bag 00705, Gaborone, Botswana
| | - Simon Chihanga
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana
| | | | - Shimeles Hamda
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana; Department of Family Medicine and Public Health, University of Botswana, Private Bag 0022, Gaborone, Botswana
| | - Kentse Moakofhi
- World Health Organisation, Botswana country office, P.O. Box 1355, Gaborone, Botswana
| | - Davies Ntebela
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana
| | - Elias Peloewetse
- Department of Biological Sciences, University of Botswana, Private Bag 00704, Gaborone, Botswana
| | - Loeto Mazhani
- Department of Pediatrics and Adolescent Health, University of Botswana, Private Bag 00713, Gaborone, Botswana
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, 1280 Main Street West, Room 3A, Hamilton, Ontario L8S 4K1, Canada
| | - John Read
- Department of Biomedical Sciences, University of Botswana, Private Bag 00713, Gaborone, Botswana
| | - Isaac Kweku Quaye
- Department of Biochemistry and Microbiology, University of Namibia, Private Bag 13301, Windhoek, Namibia
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, P.O. Box AC 157, ACH, Gaborone, Botswana; Department of Biomedical Sciences, University of Botswana, Private Bag 00713, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard Building 421, Philadelphia, PA 19104, USA.
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Bancone G, Gornsawun G, Chu CS, Porn P, Pal S, Bansil P, Domingo GJ, Nosten F. Validation of the quantitative point-of-care CareStart biosensor for assessment of G6PD activity in venous blood. PLoS One 2018; 13:e0196716. [PMID: 29738562 PMCID: PMC5940185 DOI: 10.1371/journal.pone.0196716] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy in the human population affecting an estimated 8% of the world population, especially those living in areas of past and present malaria endemicity. Decreased G6PD enzymatic activity is associated with drug-induced hemolysis and increased risk of severe neonatal hyperbilirubinemia leading to brain damage. The G6PD gene is on the X chromosome therefore mutations cause enzymatic deficiency in hemizygote males and homozygote females while the majority of heterozygous females have an intermediate activity (between 30-80% of normal) with a large distribution into the range of deficiency and normality. Current G6PD qualitative tests are unable to diagnose G6PD intermediate activities which could hinder wide use of 8-aminoquinolines for Plasmodium vivax elimination. The aim of the study was to assess the diagnostic performances of the new Carestart G6PD quantitative biosensor. METHODS A total of 150 samples of venous blood with G6PD deficient, intermediate and normal phenotypes were collected among healthy volunteers living along the north-western Thailand-Myanmar border. Samples were analyzed by complete blood count, by gold standard spectrophotometric assay using Trinity kits and by the latest model of Carestart G6PD biosensor which analyzes both G6PD and hemoglobin. RESULTS Bland-Altman comparison of the CareStart normalized G6PD values to that of the gold standard assay showed a strong bias in values resulting in poor area under-the-curve values for both 30% and 80% thresholds. Performing a receiver operator curve identified threshold values for the CareStart product equivalent to the 30% and 80% gold standard values with good sensitivity and specificity values, 100% and 92% (for 30% G6PD activity) and 92% and 94% (for 80% activity) respectively. CONCLUSION The Carestart G6PD biosensor represents a significant improvement for quantitative diagnosis of G6PD deficiency over previous versions. Further improvements and validation studies are required to assess its utility for informing radical cure decisions in malaria endemic settings.
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Affiliation(s)
- Germana Bancone
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gornpan Gornsawun
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Cindy S. Chu
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pen Porn
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Sampa Pal
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Pooja Bansil
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Gonzalo J. Domingo
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Hamid MMA, Thriemer K, Elobied ME, Mahgoub NS, Boshara SA, Elsafi HMH, Gumaa SA, Hamid T, Abdelbagi H, Basheir HM, Marfurt J, Chen I, Gosling R, Price RN, Ley B. Low risk of recurrence following artesunate-Sulphadoxine-pyrimethamine plus primaquine for uncomplicated Plasmodium falciparum and Plasmodium vivax infections in the Republic of the Sudan. Malar J 2018; 17:117. [PMID: 29548285 PMCID: PMC5857106 DOI: 10.1186/s12936-018-2266-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/08/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND First-line schizontocidal treatment for uncomplicated malaria in the Republic of the Sudan is artesunate (total dose 12 mg/kg) plus Sulphadoxine/pyrimethamine (25/1.25 mg/kg) (AS/SP). Patients with Plasmodium vivax are also treated with 14 days primaquine (total dose 3.5 mg/kg) (PQ). The aim of this study was to assess the efficacy of the national policy. METHODS Patients above 1 year, with microscopy-confirmed, Plasmodium falciparum and/or P. vivax malaria were treated with AS/SP. Patients with P. falciparum were randomized to no primaquine (Pf-noPQ) or a single 0.25 mg/kg dose of PQ (Pf-PQ1). Patients with P. vivax received 14 days unsupervised 3.5 mg/kg PQ (Pv-PQ14) on day 2 or at the end of follow up (Pv-noPQ). Primary endpoint was the risk of recurrent parasitaemia at day 42. G6PD activity was measured by spectrophotometry and the Accessbio Biosensor™. RESULTS 231 patients with P. falciparum (74.8%), 77 (24.9%) with P. vivax and 1 (0.3%) patient with mixed infection were enrolled. The PCR corrected cumulative risk of recurrent parasitaemia on day 42 was 3.8% (95% CI 1.2-11.2%) in the Pf-noPQ arm compared to 0.9% (95% CI 0.1-6.0%) in the Pf-PQ1 arm; (HR = 0.25 [95% CI 0.03-2.38], p = 0.189). The corresponding risks of recurrence were 13.4% (95% CI 5.2-31.9%) in the Pv-noPQ arm and 5.3% (95% CI 1.3-19.4%) in the Pv-PQ14 arm (HR 0.36 [95% CI 0.1-2.0], p = 0.212). Two (0.9%) patients had G6PD enzyme activity below 10%, 19 (8.9%) patients below 60% of the adjusted male median. Correlation between spectrophotometry and Biosensor™ was low (rs = 0.330, p < 0.001). CONCLUSION AS/SP remains effective for the treatment of P. falciparum and P. vivax. The addition of PQ reduced the risk of recurrent P. falciparum and P. vivax by day 42, although this did not reach statistical significance. The version of the Biosensor™ assessed is not suitable for routine use. Trial registration https://clinicaltrials.gov/ct2/show/NCT02592408.
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Affiliation(s)
- Muzamil Mahdi Abdel Hamid
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Kamala Thriemer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia
| | - Maha E. Elobied
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Nouh S. Mahgoub
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Salah A. Boshara
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Hassan M. H. Elsafi
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Suhaib A. Gumaa
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Tassneem Hamid
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Hanadi Abdelbagi
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Hamid M. Basheir
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Jutta Marfurt
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia
| | - Ingrid Chen
- 0000 0001 2297 6811grid.266102.1Global Health Group, University of California San Francisco, San Francisco, CA USA
| | - Roly Gosling
- 0000 0001 2297 6811grid.266102.1Global Health Group, University of California San Francisco, San Francisco, CA USA
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benedikt Ley
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia
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Chu CS, Bancone G, Nosten F, White NJ, Luzzatto L. Primaquine-induced haemolysis in females heterozygous for G6PD deficiency. Malar J 2018; 17:101. [PMID: 29499733 PMCID: PMC5833093 DOI: 10.1186/s12936-018-2248-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/24/2018] [Indexed: 01/15/2023] Open
Abstract
Oxidative agents can cause acute haemolytic anaemia in persons with G6PD deficiency. Understanding the relationship between G6PD genotype and the phenotypic expression of the enzyme deficiency is necessary so that severe haemolysis can be avoided. The patterns of oxidative haemolysis have been well described in G6PD deficient hemizygous males and homozygous females; and haemolysis in the proportionally more numerous heterozygous females has been documented mainly following consumption of fava beans and more recently dapsone. It has long been known that 8-aminoquinolines, notably primaquine and tafenoquine, cause acute haemolysis in G6PD deficiency. To support wider use of primaquine in Plasmodium vivax elimination, more data are needed on the haemolytic consequences of 8-aminoquinolines in G6PD heterozygous females. Two recent studies (in 2017) have provided precisely such data; and the need has emerged for the development of point of care quantitative testing of G6PD activity. Another priority is exploring alternative 8-aminoquinoline dosing regimens that are practical and improve safety in G6PD deficient individuals.
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Affiliation(s)
- Cindy S Chu
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Germana Bancone
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - François Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucio Luzzatto
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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Thielemans L, Gornsawun G, Hanboonkunupakarn B, Paw MK, Porn P, Moo PK, Van Overmeire B, Proux S, Nosten F, McGready R, Carrara VI, Bancone G. Diagnostic performances of the fluorescent spot test for G6PD deficiency in newborns along the Thailand-Myanmar border: A cohort study. Wellcome Open Res 2018; 3:1. [PMID: 29552643 PMCID: PMC5829521 DOI: 10.12688/wellcomeopenres.13373.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 01/19/2023] Open
Abstract
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited enzymatic disorder associated with severe neonatal hyperbilirubinemia and acute haemolysis after exposure to certain drugs or infections. The disorder can be diagnosed phenotypically with a fluorescent spot test (FST), which is a simple test that requires training and basic laboratory equipment. This study aimed to assess the diagnostic performances of the FST used on umbilical cord blood by locally-trained staff and to compare test results of the neonates at birth with the results after one month of age. Methods: We conducted a cohort study on newborns at the Shoklo Malaria Research Unit, along the Thai-Myanmar border between January 2015 and May 2016. The FST was performed at birth on the umbilical cord blood by locally-trained staff and quality controlled by specialised technicians at the central laboratory. The FST was repeated after one month of age. Genotyping for common local G6PD mutations was carried out for all discrepant results. Results: FST was performed on 1521 umbilical cord blood samples. Quality control and genotyping revealed 10 misdiagnoses. After quality control, 10.7% of the males (84/786) and 1.2% of the females (9/735) were phenotypically G6PD deficient at birth. The FST repeated at one month of age or later diagnosed 8 additional G6PD deficient infants who were phenotypically normal at birth. Conclusions: This study shows the short-comings of the G6PD FST in neonatal routine screening and highlights the importance of training and quality control. A more conservative interpretation of the FST in male newborns could increase the diagnostic performances. Quantitative point-of-care tests might show higher sensitivity and specificity for diagnosis of G6PD deficiency on umbilical cord blood and should be investigated.
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Affiliation(s)
- Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Gornpan Gornsawun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Pen Porn
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Paw Khu Moo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Bart Van Overmeire
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Baird JK. Tafenoquine for travelers' malaria: evidence, rationale and recommendations. J Travel Med 2018; 25:5150129. [PMID: 30380095 PMCID: PMC6243017 DOI: 10.1093/jtm/tay110] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023]
Abstract
Background Endemic malaria occurring across much of the globe threatens millions of exposed travelers. While unknown numbers of them suffer acute attacks while traveling, each year thousands return from travel and become stricken in the weeks and months following exposure. This represents perhaps the most serious, prevalent and complex problem faced by providers of travel medicine services. Since before World War II, travel medicine practice has relied on synthetic suppressive blood schizontocidal drugs to prevent malaria during exposure, and has applied primaquine for presumptive anti-relapse therapy (post-travel or post-diagnosis of Plasmodium vivax) since 1952. In 2018, the US Food and Drug Administration approved the uses of a new hepatic schizontocidal and hypnozoitocidal 8-aminoquinoline called tafenoquine for the respective prevention of all malarias and for the treatment of those that relapse (P. vivax and Plasmodium ovale). Methods The evidence and rationale for tafenoquine for the prevention and treatment of malaria was gathered by means of a standard search of the medical literature along with the package inserts for the tafenoquine products Arakoda™ and Krintafel™ for the prevention of all malarias and the treatment of relapsing malarias, respectively. Results The development of tafenoquine-an endeavor of 40 years-at last brings two powerful advantages to travel medicine practice against the malaria threat: (i) a weekly regimen of causal prophylaxis; and (ii) a single-dose radical cure for patients infected by vivax or ovale malarias. Conclusions Although broad clinical experience remains to be gathered, tafenoquine appears to promise more practical and effective prevention and treatment of malaria. Tafenoquine thus applied includes important biological and clinical complexities explained in this review, with particular regard to the problem of hemolytic toxicity in G6PD-deficient patients.
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Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta 10430, Indonesia; and Nuffield Department of Medicine, the Centre for Tropical Medicine and Global Health, University of Oxford, UK
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