1
|
Lo E, Zhong D, Raya B, Pestana K, Koepfli C, Lee MC, Yewhalaw D, Yan G. Prevalence and distribution of G6PD deficiency: implication for the use of primaquine in malaria treatment in Ethiopia. Malar J 2019; 18:340. [PMID: 31590661 PMCID: PMC6781416 DOI: 10.1186/s12936-019-2981-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/28/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND G6PD enzyme deficiency is a common enzymatic X-linked disorder. Deficiency of the G6PD enzyme can cause free radical-mediated oxidative damage to red blood cells, leading to premature haemolysis. Treatment of Plasmodium vivax malaria with primaquine poses a potential risk of mild to severe acute haemolytic anaemia in G6PD deficient people. In this study, the prevalence and distribution of G6PD mutations were investigated across broad areas of Ethiopia, and tested the association between G6PD genotype and phenotype with the goal to provide additional information relevant to the use of primaquine in malaria treatment. METHODS This study examined G6PD mutations in exons 3-11 for 344 febrile patient samples collected from seven sites across Ethiopia. In addition, the G6PD enzyme level of 400 febrile patient samples from Southwestern Ethiopia was determined by the CareStart™ biosensor. The association between G6PD phenotype and genotype was examined by Fisher exact test on a subset of 184 samples. RESULTS Mutations were observed at three positions of the G6PD gene. The most common G6PD mutation across all sites was A376G, which was detected in 21 of 344 (6.1%) febrile patients. Thirteen of them were homozygous and eight were heterozygous for this mutation. The G267+119C/T mutation was found in 4 (1.2%) individuals in South Ethiopia, but absent in other sites. The G1116A mutation was also found in 4 (1.2%) individuals from East and South Ethiopia. For the 400 samples in the south, 17 (4.25%) were shown to be G6PD-deficient. G6PD enzyme level was not significantly different by age or gender. Among a subset of 202 febrile patients who were diagnosed with malaria, 11 (5.45%) were G6PD-deficient. These 11 infected samples were diagnosed with Plasmodium vivax by microscopy. Parasitaemia was not significantly different between the G6PD-deficient and G6PD-normal infections. CONCLUSIONS The prevalence of G6PD deficiency is modest among febrile patients in Ethiopia. G6PD deficiency testing is thus recommended before administrating primaquine for radical cure of P. vivax infected patients. The present study did not indicate a significant association between G6PD gene mutations and enzyme levels.
Collapse
Affiliation(s)
- Eugenia Lo
- Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, 28223, USA.
| | - Daibin Zhong
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, 92697, USA
| | - Beka Raya
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Kareen Pestana
- Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, 28223, USA
| | - Cristian Koepfli
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Ming-Chieh Lee
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, 92697, USA
| | - Delenasaw Yewhalaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
| | - Guiyun Yan
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, 92697, USA.
| |
Collapse
|
2
|
Djigo OKM, Bollahi MA, Hasni Ebou M, Ould Ahmedou Salem MS, Tahar R, Bogreau H, Basco L, Ould Mohamed Salem Boukhary A. Assessment of glucose-6-phosphate dehydrogenase activity using CareStart G6PD rapid diagnostic test and associated genetic variants in Plasmodium vivax malaria endemic setting in Mauritania. PLoS One 2019; 14:e0220977. [PMID: 31525211 PMCID: PMC6746352 DOI: 10.1371/journal.pone.0220977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background Primaquine is recommended by the World Health Organization (WHO) for radical treatment of Plasmodium vivax malaria. This drug is known to provoke acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Due to lack of data on G6PD deficiency, the use of primaquine has been limited in Africa. In the present study, G6PD deficiency was investigated in blood donors of various ethnic groups living in Nouakchott, a P. vivax endemic area in Mauritania. Methodology/Principal findings Venous blood samples from 443 healthy blood donors recruited at the National Transfusion Center in Nouakchott were screened for G6PD activity using the CareStart G6PD deficiency rapid diagnostic test. G6PD allelic variants were investigated using DiaPlexC G6PD genotyping kit that detects African (A-) and Mediterranean (B-) variants. Overall, 50 of 443 (11.3%) individuals (49 [11.8%] men and 1 [3.7%] woman) were phenotypically deficient. Amongst men, Black Africans had the highest prevalence of G6PD deficiency (15 of 100 [15%]) and White Moors the lowest (10 of 168, [5.9%]). The most commonly observed G6PD allelic variants among 44 tested G6PD-deficient men were the African variant A- (202A/376G) in 14 (31.8%), the Mediterranean variant B- (563T) in 13 (29.5%), and the Betica-Selma A- (376G/968C) allelic variant in 6 (13.6%). The Santamaria A- variant (376G/542T) and A variant (376G) were observed in only one and two individuals, respectively. None of the expected variants was observed in 8 (18.2%) of the tested phenotypically G6PD-deficient men. Conclusion This is the first published data on G6PD deficiency in Mauritanians. The prevalence of phenotypic G6PD deficiency was relatively high (11.3%). It was mostly associated with either African or Mediterranean variants, in agreement with diverse Arab and Black African origins of the Mauritanian population.
Collapse
Affiliation(s)
- Oum kelthoum Mamadou Djigo
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
| | | | - Moina Hasni Ebou
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
| | - Mohamed Salem Ould Ahmedou Salem
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
| | - Rachida Tahar
- UMR 216 MERIT, IRD, Faculté de Pharmacie, Univ. Paris Descartes, Paris, France
| | - Hervé Bogreau
- Unité de Parasitologie et d’Entomologie, Institut de Recherche Biomédicale des Armées, IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- Centre National de Référence du Paludisme, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Leonardo Basco
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Ali Ould Mohamed Salem Boukhary
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- * E-mail:
| |
Collapse
|
3
|
Avalos S, Mejia RE, Banegas E, Salinas C, Gutierrez L, Fajardo M, Galo S, Pinto A, Mejia A, Fontecha G. G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients. Malar J 2018; 17:415. [PMID: 30409136 PMCID: PMC6225638 DOI: 10.1186/s12936-018-2564-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/01/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The incidence of malaria in the Americas has decreased markedly in recent years. Honduras and the other countries of Mesoamerica and the island of Hispaniola have set the goal of eliminating native malaria by the year 2020. To achieve this goal, Honduras has recently approved national regulations to expand the possibilities of a shortened double dose primaquine (PQ) treatment for vivax malaria. Considering this new shortened anti-malarial treatment, the high frequency of G6PDd genotypes in Honduras, and the lack of routinely assessment of the G6PD deficiency status, this study aimed at investigating the potential association between the intake of PQ and haemolysis in malaria-infected G6PDd subjects. METHODS This was a prospective cohort and open-label study. Participants with malaria were recruited. Plasmodium vivax infection was treated with 0.25 mg/kg of PQ daily for 14 days. Safety and signs of haemolysis were evaluated by clinical criteria and laboratory values before and during the 3rd and 7th day of PQ treatment. G6PD status was assessed by a rapid test (CareStart™) and two molecular approaches. RESULTS Overall 55 participants were enrolled. The frequency of G6PD deficient genotypes was 7/55 (12.7%), where 5/7 (71.4%) were hemizygous A- males and 2/7 (28.6%) heterozygous A- females. Haemoglobin concentrations were compared between G6PD wild type (B) and G6PDd A- subjects, showing a significant difference between the means of both groups in the 3rd and 7th days. Furthermore, a statistically significant difference was evident in the change in haemoglobin concentration between the 3rd day and the 1st day for both genotypes, but there was no statistical difference for the change in haemoglobin concentration between the 7th day and the 1st day. Besides these changes in the haemoglobin concentrations, none of the patients showed signs or symptoms associated with severe haemolysis, and none needed to be admitted to a hospital for further medical attention. CONCLUSIONS The findings support that the intake of PQ during 14 days of treatment against vivax malaria is safe in patients with a class III variant of G6PDd. In view of the new national regulations in the shortened treatment of vivax malaria for 7 days, it is advisable to be alert of potential cases of severe haemolysis that could occur among G6PD deficient hemizygous males with a class II mutation such as the Santamaria variant, previously reported in the country.
Collapse
Affiliation(s)
- Sara Avalos
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Rosa E Mejia
- Pan American Health Organization, Tegucigalpa, Honduras
| | - Engels Banegas
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Cesar Salinas
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Lester Gutierrez
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Marcela Fajardo
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Suzeth Galo
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Alejandra Pinto
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Angel Mejia
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Gustavo Fontecha
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras.
| |
Collapse
|