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Yerke Hansen P, Myers E, Rajalingam K, Labanowski M. A Rare Case of Hansen's Disease Complicated by G6PD Deficiency. Cureus 2023; 15:e42816. [PMID: 37664264 PMCID: PMC10471196 DOI: 10.7759/cureus.42816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
We present the case of a 37-year-old Haitian male who presented with a seven-month history of skin lesions on his face and extremities, weight loss, intermittent chills, difficulty in breathing, and bilateral paresthesias in his feet. The lesions were most prominent on the pinnae of the ears. Biopsy of the lesions revealed large, rounded granulomatous infiltrates and histiocytes. Acid fast (Ziehl-Neelsen technique) and Kinyoun stains were positive for numerous acid-fast mycobacteria within the histiocytes. A polymerase chain reaction (PCR) was positive for Mycobacterium leprae, which confirmed a diagnosis of lepromatous leprosy. Further analysis revealed positive purified protein derivatives (PPD) and QuantiFERON-TB™ test (QIAGEN, Hilden, Germany) with negative chest x-ray and sputum cultures. Labs also revealed vitamin D and G6PD (glucose-6-phosphate-dehydrogenasedeficiency. The patient was started on a combined therapy regimen of rifampin, moxifloxacin, and minocycline. In addition, he was started on vitamin D supplementation. After undergoing treatment for one year, there was notable regression of the patient's cutaneous lesions. Treatment is planned to continue for a total of 24 months. This case exemplifies the successful treatment of Hansen's disease in a patient with a G6PD deficiency. The patient's G6PD deficiency required avoidance of dapsone, which is typically used in the treatment of Hansen's disease. Furthermore, the patient's positive PPD and QuantiFERON-TB tests led to a delay in the treatment in order to rule out active tuberculosis. Left untreated, Hansen's disease has a high morbidity risk. Treatment regimens require careful consideration of coexisting comorbidities.
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Affiliation(s)
- Payton Yerke Hansen
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Elisha Myers
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Karan Rajalingam
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Mary Labanowski
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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2
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Ghorui AK, Patra PK. Dapsone induced hemolysis in a patient with Hansen's disease and G6PD deficiency: A preventable peril. Clin Case Rep 2022; 10:e05700. [PMID: 35498357 PMCID: PMC9043721 DOI: 10.1002/ccr3.5700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/09/2022] [Accepted: 03/20/2022] [Indexed: 11/27/2022] Open
Abstract
Although under‐reported, hemolytic anemia is common with dapsone‐containing regimen in leprosy. It is prudent to screen for underlying G6PD deficiency in boys before administering dapsone to prevent potentially life‐threatening episode of intravascular hemolysis in children with leprosy. Hansen's disease is a significant public health issue in many countries. Underlying G6PD deficiency should be ruled out before prescribing dapsone containing regimen in boys to prevent catastrophic intravascular hemolysis.
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Affiliation(s)
- Arnab Kumar Ghorui
- Department of Pediatrics All India Institute of Medical Sciences Patna India
| | - Pratap Kumar Patra
- Department of Pediatrics All India Institute of Medical Sciences Patna India
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3
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Wei H, Wang C, Huang W, He L, Liu Y, Huang H, Chen W, Zheng Y, Xu G, Lin L, Wei W, Chen W, Chen L, Wang J, Lin M. Simultaneous detection of G6PD mutations using SNPscan in a multiethnic minority area of Southwestern China. Front Genet 2022; 13:1000290. [PMID: 36704359 PMCID: PMC9871378 DOI: 10.3389/fgene.2022.1000290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives: Baise, a multiethnic inhabited area of southwestern China, is a historical malaria-endemic area with a high prevalence of G6PD deficiency. However, few studies of G6PD deficiency have been conducted in this region. Therefore, we performed a genetic analysis of G6PD deficiency in the Baise population from January 2020 to June 2021. Methods: A SNPscan assay was developed to simultaneously detect 33 common Chinese G6PD mutations. 30 G6PD-deficient samples were used for the method's validation. Then, a total of 709 suspected G6PD-deficient samples collated from the Baise population were evaluated for G6PD status, type of mutation and effect of mutations. Results: The SNPscan test had a sensitivity of 100% [95% confidence interval (CI): 94.87%-100%] and a specificity of 100% (95% CI: 87.66%-100%) for identifying G6PD mutations. A total of fifteen mutations were identified from 76.72% (544/709) of the samples. The most common mutation was discovered to be G6PD Kaiping (24.12%), followed by G6PD Canton (17.91%), and G6PD Gaohe (11.28%). We compared the G6PD mutation spectrum among Zhuang, Han and other Southeast Asian populations, and the Zhuang population's mutation distribution was quite similar to that in the Han population. Conclusion: This study provided a detailed G6PD mutation spectrum in Baise of southwestern China and will be valuable for the diagnosis and research of G6PD deficiency in this area. Furthermore, the SNPscan assay could be used to quickly diagnose these G6PD mutations accurately.
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Affiliation(s)
- Huagui Wei
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Chunfang Wang
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Weiyi Huang
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Liqiao He
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yaqun Liu
- School of Biotechnology and Food Engineering, Hanshan Normal University, Chaozhou, China
| | - Huiying Huang
- School of Biotechnology and Food Engineering, Hanshan Normal University, Chaozhou, China
| | - Wencheng Chen
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yuzhong Zheng
- School of Biotechnology and Food Engineering, Hanshan Normal University, Chaozhou, China
| | - Guidan Xu
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Liyun Lin
- School of Biotechnology and Food Engineering, Hanshan Normal University, Chaozhou, China
| | - Wujun Wei
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Weizhong Chen
- Department of Medical Laboratory, Chaozhou People’s Hospital Affiliated to Shantou University Medical College, Chaozhou, China
| | - Liying Chen
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Junli Wang
- School of Laboratory Medicine, Youjiang Medical University for Nationalities, Baise, China
| | - Min Lin
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- School of Biotechnology and Food Engineering, Hanshan Normal University, Chaozhou, China
- School of Laboratory Medicine, Youjiang Medical University for Nationalities, Baise, China
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4
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G6PD Deficiency in Children: From Clinical Auditing to Optimizing Care. Indian J Pediatr 2021; 88:849-850. [PMID: 34152537 PMCID: PMC8215310 DOI: 10.1007/s12098-021-03841-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 11/06/2022]
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Agrawal M, Kirtania L, Jha A, Hishikar R. Students' knowledge and views on pharmacogenomic education in the medical curriculum. Indian J Pharmacol 2021; 53:19-24. [PMID: 33975995 PMCID: PMC8216119 DOI: 10.4103/ijp.ijp_495_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pharmacogenomics is a growing field of science that explores the genetic contributions in an individual's response to the drug, so as to choose the right drug in the right doses tailored to a patient's genetic makeup. Although pharmacogenomics information is incorporated in chapters discussing relevant drugs, it has not been materialized into clinical practice yet and still, it remains a challenge due to limited knowledge and accessibility of the pharmacogenomic tests to diagnose these polymorphisms. With this background, the objective of the study was to assess the knowledge and perception of pharmacogenomics among second-year MBBS students and to sensitize them regarding pharmacogenomics. MATERIALS AND METHODS A cross-sectional study was done in which 138 medical students responded to a preformed semi-structured assessment tool. It comprised two main components (1) knowledge and (2) relevance of pharmacogenomics in medical education and clinical practice. RESULTS Ninety-five percent students defined pharmacogenomics correctly, but only 54% were aware of genetic variations in drug targets, metabolizing enzymes, and transporters affecting drug therapy. Only 15% knew about the availability of pharmacogenomics tests in India. Eighty-four percent of students felt that incorporating pharmacogenomics education in the MBBS curriculum is a must for precision medicine. CONCLUSION Second-year MBBS students had good knowledge of pharmacogenomics, but knowledge about the application in clinical practice and interpretation of pharmacogenomics was limited. Therefore, we recommend (1) basic pharmacogenomic education at all levels of medical curricula, (2) development of case-based knowledge application modules, (3) regular continuing medical education to update about available screening tools/biomarkers, and (4) patient and public awareness programs so that they receive personalized/precision medicine with optimum efficacy and reduced side effects and health-care costs.
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Affiliation(s)
- Manju Agrawal
- Department of Pharmacology, Pt. J N M Medical College, Raipur, Chhattisgarh, India
| | - Lopamudra Kirtania
- Demonstrator, Department of Pharmacology, Maharaja Jitendra Narayan Medical College & Hospital, Coochbehar, West Bengal, India
| | - Anuja Jha
- Department of Pharmacology, Sri Aurobindo Institute of Medical Sciences Indore, Mathya Pradesh, India
| | - Rajesh Hishikar
- Department of Pharmacology, Pt. J N M Medical College, Raipur, Chhattisgarh, India
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Pandit N, Kalaria T, Lakhani JD, Jasani J. Assessment of protective relationship of G6PD and other lifestyle factors with Malaria: A case-control study of medical professionals from a teaching medical institute, Gujarat. J Family Med Prim Care 2020; 9:5638-5645. [PMID: 33532407 PMCID: PMC7842447 DOI: 10.4103/jfmpc.jfmpc_947_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/31/2020] [Accepted: 09/18/2020] [Indexed: 11/04/2022] Open
Abstract
Background There remains equivocal evidence in terms of glucose-6-phosphate dehydrogenase (G6PD) and malaria occurrence. A case-control study was performed to assess protective relationship of G6PD and other lifestyle factors with malaria. Methods One-hundred twenty six medical professionals were randomly selected from a tertiary care clinical institute. Along with demographic and lifestyle details, subjects were interviewed about their history of occurrence of malaria at all in previous 10 years. Their hematological, biochemical, and metabolic profile was assessed clinically as well as by investigations. The analysis was carried out with two groups: (1) those who were subjected with malaria at least once in past 10 years (Malaria Ever Group); (2) those who never encountered malaria (Malaria Never Group). Results Out of 126, 65 subjects were in Malaria Ever Group and 61were in Malaria Never Group. There was no difference in lifestyle measures, hematological, and biochemical parameters. Mean G6PD levels were found similar in both the groups. Of 61 subjects in "malaria-never" group, 1 had deficient (1.1 unit/gm of Hb), 9 had low normal (between 2.5 and 10 units/gm of Hb), 48 had normal (10.1-20.5 units/gm of Hb), and 3 had higher than normal (>20.5 units/gm of Hb) G6PD levels. In comparison, 65 participants from "malaria ever" group, none was deficient, 6 had low normal, 58 had normal, and none had higher than normal G6PD levels. HPLC-based hemoglobin analysis showed significant higher number of participants in "malaria-never" group having altered hemoglobin. 12 participants had increased hemoglobin A2 levels, of which 10 were in "Malaria Occurrence Never" group; of them 6 could be diagnosed having hemoglobinopathy of specified variety. 3 of these 10 participants of "malaria-never" group had low G6PD levels also. Conclusion Malaria Protection Hypothesis was not found to be true as per our findings, but there were subtle hints that G6PD protection with or without change in hemoglobin alteration maybe operable.
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Affiliation(s)
- Niraj Pandit
- Prof and Head, Department of Community Medicine, SBKS Medical Institute and Research Centre and Dhiraj Hospital, Sumandeep Deemed University, Piparia, (Dist :Vadodara) Gujarat, India
| | - Tejaskumar Kalaria
- Ex. Assistant Professor in Biochemistry, SBKS Medical Institute and Research Centre and Dhiraj Hospital, Sumandeep Deemed University, Piparia, (Dist :Vadodara) Gujarat, India
| | - Jitendra D Lakhani
- Professor of Medicine and Academic Director, SBKS Medical Institute and Research Centre and Dhiraj Hospital, Sumandeep Deemed University, Piparia, (Dist :Vadodara) Gujarat, India
| | - Jasmin Jasani
- Professor of Pathology and Incharge Central Laboratory, SBKS Medical Institute and Research Centre and Dhiraj Hospital, Sumandeep Deemed University, Piparia, (Dist :Vadodara) Gujarat, India
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Fine Mapping of Glucose 6 Phosphate Dehydrogenase (G6PD) Deficiency in a Rural Malaria Area of South West Odisha Using the Clinical, Hematological and Molecular Approach. Mediterr J Hematol Infect Dis 2020; 12:e2020015. [PMID: 32180910 PMCID: PMC7059741 DOI: 10.4084/mjhid.2020.015] [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: 10/18/2019] [Accepted: 02/10/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of the study was to enumerate the clinical, hematological, and molecular spectrum of G6PD deficiency in malaria endemic regions of south west Odisha. Methods Diagnosis of G6PD deficiency was made by using the Di-chloroindophenol Dye test in two south west districts (Kalahandi and Rayagada) of Odisha State. Demographic and clinical history was taken from each individual using a pre-structured questionnaire. Molecular characterization of G6PD deficiency was done using PCR-RFLP and Sanger sequencing. Results A total of 1981 individuals were screened; among them, 59 (2.97%) individuals were G6PD deficient. The analysis revealed that G6PD deficiency was more among males (4.0%) as compared to females (2.3%). Prevalence of G6PD deficiency was significantly higher among tribal populations (4.8%) as compared to non-tribal populations (2.4%) (p=0.012, OR=2.014, 95%CI=1.206–3.365). Twenty four individuals with G6PD deficiency had mild to moderate anemia, whereas 26 G6PD deficient individuals had a history of malaria infection. Among them, 3 (11.5%) required blood transfusion during treatment. Molecular analysis revealed G6PD Orissa as the most common (88%) mutation in the studied cohort. G6PD Kaiping (n=3), G6PD Coimbra (n=2) and G6PD Union (n=1) were also noted in this cohort. Conclusion The cumulative prevalence of G6PD deficiency in the present study is below the estimated national prevalence. G6PD deficiency was higher among tribes as compared to non-tribes. Clinical significance for G6PD deficiency was noted only in malaria infected individuals. Rare G6PD Kaiping and G6PD Union variants were also present.
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8
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Anvikar AR, van Eijk AM, Shah A, Upadhyay KJ, Sullivan SA, Patel AJ, Joshi JM, Tyagi S, Singh R, Carlton JM, Gupta H, Wassmer SC. Clinical and epidemiological characterization of severe Plasmodium vivax malaria in Gujarat, India. Virulence 2020; 11:730-738. [PMID: 32490754 PMCID: PMC7549892 DOI: 10.1080/21505594.2020.1773107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
The mounting evidence supporting the capacity of Plasmodium vivax to cause severe disease has prompted the need for a better characterization of the resulting clinical complications. India is making progress with reducing malaria, but epidemics of severe vivax malaria in Gujarat, one of the main contributors to the vivax malaria burden in the country, have been reported recently and may be the result of a decrease in transmission and immune development. Over a period of one year, we enrolled severe malaria patients admitted at the Civil Hospital in Ahmedabad, the largest city in Gujarat, to investigate the morbidity of severe vivax malaria compared to severe falciparum malaria. Patients were submitted to standard thorough clinical and laboratory investigations and only PCR-confirmed infections were selected for the present study. Severevivax malaria (30 patients) was more frequent than severe falciparum malaria (8 patients) in our setting, and it predominantly affected adults (median age 32 years, interquartile range 22.5 years). This suggests a potential age shift in anti-malarial immunity, likely to result from the recent decrease in transmission across India. The clinical presentation of severe vivax patients was in line with previous reports, with jaundice as the most common complication. Our findings further support the need for epidemiological studies combining clinical characterization of severe vivax malaria and serological evaluation of exposure markers to monitor the impact of elimination programmes.
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Affiliation(s)
- Anupkumar R. Anvikar
- Indian Council of Medical Research (ICMR), National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research (ICMR), National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, India
| | - Anna Maria van Eijk
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Asha Shah
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Kamlesh J. Upadhyay
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Steven A. Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Ankita J. Patel
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Jaykumar M. Joshi
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Suchi Tyagi
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Ranvir Singh
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Jane M. Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Himanshu Gupta
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Samuel C. Wassmer
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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9
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Faraji-Goodarzi M, Taee N, Bajelan A, Safdari M. Leukocytosis in patients with favism and association with blood transfusion. J Clin Lab Anal 2019; 33:e22906. [PMID: 31074073 PMCID: PMC6642307 DOI: 10.1002/jcla.22906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Leukocytosis is a condition marked by abnormal increase in leukocyte count due to an inflammatory response as a defense against most of the infections, or bone tumors; including leukemia. The aim of this study is to analyze the effect of blood transfusion in leukocytosis patients with favism as compared to patients treated with antibiotics or combination of both. Methods A total of 97 patients with favism who were referred to the University hospital in 2016‐2017 were studied. Key findings These patients experienced acute hemolysis following beans meal. These patients were either treated with blood transfusion, antibiotics or combination of both. Conclusions This study shows that blood transfusion is an effective therapeutic option for the treatment of leukocytosis. Antibiotics are not deemed necessary for the treatment and blood transfusion alone, can decrease leukocytes to the normal level.
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Affiliation(s)
- Mojgan Faraji-Goodarzi
- Faculty of Medicine, Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nadereh Taee
- Faculty of Medicine, Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Amir Bajelan
- Student of Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Safdari
- Student of Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Tripathi P, Agarwal S, Muthuswamy S. Prevalence and Genetic Characterization of Glucose-6-Phosphate Dehydrogenase Deficiency in Anemic Subjects from Uttar Pradesh, India. J Pediatr Genet 2019; 8:47-53. [PMID: 31061745 DOI: 10.1055/s-0039-1677729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is caused by one or more mutations in the G6PD gene on chromosome X. It affects approximately 400 million people worldwide. The purpose of this study was to detect the prevalence of G6PD deficiency and G6PD gene mutations in the hospital-based settings in patients referred for suspected G6PD deficiency. A qualitative fluorescent spot test and dichlorophenol-indolphenol (DCIP) test were performed. G6PD-deficient, positive samples were further processed for mutation analysis by Sanger sequencing. Out of 1,069 cases, 95 (8.8%) were detected as G6PD deficient (by DCIP test) and were sent for molecular analysis. The G6PD Mediterranean mutation (563C > T) is the most common variant among G6PD-deficient individuals followed by the Coimbra (592C→T) and Orissa (131C→G) variants. We concluded that all symptomatic patients (anemic or jaundiced) should be investigated for G6PD deficiency. Our findings will inform our population screening approach and help provide better management for G6PD-deficient patients.
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Affiliation(s)
- Poonam Tripathi
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sarita Agarwal
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Srinivasan Muthuswamy
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Islam MT, Sarker SK, Talukder S, Bhuyan GS, Rahat A, Islam NN, Mahmud H, Hossain MA, Muraduzzaman AKM, Rahman J, Qadri SK, Shahidullah M, Mannan MA, Tahura S, Hussain M, Saha N, Akhter S, Nahar N, Begum F, Shirin T, Akhteruzzaman S, Qadri SS, Qadri F, Mannoor K. High resolution melting curve analysis enables rapid and reliable detection of G6PD variants in heterozygous females. BMC Genet 2018; 19:58. [PMID: 30097005 PMCID: PMC6086071 DOI: 10.1186/s12863-018-0664-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/31/2018] [Indexed: 12/23/2022] Open
Abstract
Background Like glucose-6-phosphate dehydrogenase (G6PD) deficient hemizygous males and homozygous females, heterozygous females could also manifest hemolytic crisis, neonatal hyperbilirubinemia or kernicterus upon exposure to oxidative stress induced by certain foods such as fava beans, drugs or infections. Although hemizygous males and homozygous females are easily detected by conventional G6PD enzyme assay method, the heterozygous state could be missed by the conventional methods as the mosaic population of both normal and deficient RBCs circulates in the blood. Thus the present study aimed to apply high resolution melting (HRM) curve analysis approach to see whether HRM could be used as a supplemental approach to increase the chance of detection of G6PD heterozygosity. Results Sixty-three clinically suspected females were evaluated for G6PD status using both enzyme assay and HRM analysis. Four out of sixty-three participants came out as G6PD deficient by the enzyme assay method, whereas HRM approach could identify nine participants with G6PD variants, one homozygous and eight heterozygous. Although only three out of eight heterozygous samples had G6PD enzyme deficiency, the HRM-based heterozygous G6PD variants detection for the rest of the samples with normal G6PD enzyme activities could have significance because their newborns might fall victim to serious consequences under certain oxidative stress. Conclusions In addition to the G6PD enzyme assay, HRM curve analysis could be useful as a supplemental approach for detection of G6PD heterozygosity.
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Affiliation(s)
- Md Tarikul Islam
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Suprovath Kumar Sarker
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.,Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | - Shezote Talukder
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Golam Sarower Bhuyan
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Asifuzzaman Rahat
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Nafisa Nawal Islam
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Hasan Mahmud
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Amir Hossain
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - A K M Muraduzzaman
- Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Jakia Rahman
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Syeda Kashfi Qadri
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mohammod Shahidullah
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mohammad Abdul Mannan
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Sarabon Tahura
- Department of Paediatric hematology and oncology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Manzoor Hussain
- Department of Paediatric Medicine and Cardiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Narayan Saha
- Department of Paediatric Neurology, National Institute of Neurosciences & Hospital, Dhaka, Bangladesh
| | - Shahida Akhter
- Department of Paediatrics, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Dhaka, Bangladesh
| | - Nazmun Nahar
- Department of Paediatrics, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Dhaka, Bangladesh
| | - Firoza Begum
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Tahmina Shirin
- Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Sharif Akhteruzzaman
- Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | - Syed Saleheen Qadri
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Firdausi Qadri
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.,Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kaiissar Mannoor
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh. .,Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
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Recht J, Ashley EA, White NJ. Use of primaquine and glucose-6-phosphate dehydrogenase deficiency testing: Divergent policies and practices in malaria endemic countries. PLoS Negl Trop Dis 2018; 12:e0006230. [PMID: 29672516 PMCID: PMC5908060 DOI: 10.1371/journal.pntd.0006230] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primaquine is the only available antimalarial drug that kills dormant liver stages of Plasmodium vivax and Plasmodium ovale malarias and therefore prevents their relapse (‘radical cure’). It is also the only generally available antimalarial that rapidly sterilises mature P. falciparum gametocytes. Radical cure requires extended courses of primaquine (usually 14 days; total dose 3.5–7 mg/kg), whereas transmissibility reduction in falciparum malaria requires a single dose (formerly 0.75 mg/kg, now a single low dose [SLD] of 0.25 mg/kg is recommended). The main adverse effect of primaquine is dose-dependent haemolysis in glucose 6-phosphate dehydrogenase (G6PD) deficiency, the most common human enzymopathy. X-linked mutations conferring varying degrees of G6PD deficiency are prevalent throughout malaria-endemic regions. Phenotypic screening tests usually detect <30% of normal G6PD activity, identifying nearly all male hemizygotes and female homozygotes and some heterozygotes. Unfortunately, G6PD deficiency screening is usually unavailable at point of care, and, as a consequence, radical cure is greatly underused. Both haemolytic risk (determined by the prevalence and severity of G6PD deficiency polymorphisms) and relapse rates vary, so there has been considerable uncertainty in both policies and practices related to G6PD deficiency testing and use of primaquine for radical cure. Review of available information on the prevalence and severity of G6PD variants together with countries’ policies for the use of primaquine and G6PD deficiency testing confirms a wide range of practices. There remains lack of consensus on the requirement for G6PD deficiency testing before prescribing primaquine radical cure regimens. Despite substantially lower haemolytic risks, implementation of SLD primaquine as a P. falciparum gametocytocide also varies. In Africa, a few countries have recently adopted SLD primaquine, yet many with areas of low seasonal transmission do not use primaquine as an antimalarial at all. Most countries that recommended the higher 0.75 mg/kg single primaquine dose for falciparum malaria (e.g., most countries in the Americas) have not changed their recommendation. Some vivax malaria–endemic countries where G6PD deficiency testing is generally unavailable have adopted the once-weekly radical cure regimen (0.75 mg/kg/week for 8 weeks), known to be safer in less severe G6PD deficiency variants. There is substantial room for improvement in radical cure policies and practices.
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Affiliation(s)
- Judith Recht
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elizabeth A. Ashley
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- 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 Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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13
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Wadi I, Pillai CR, Anvikar AR, Sinha A, Nath M, Valecha N. Methylene blue induced morphological deformations in Plasmodium falciparum gametocytes: implications for transmission-blocking. Malar J 2018; 17:11. [PMID: 29310655 PMCID: PMC5759873 DOI: 10.1186/s12936-017-2153-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/23/2017] [Indexed: 12/24/2022] Open
Abstract
Background Malaria remains a global health problem despite availability of effective tools. For malaria elimination, drugs targeting sexual stages of Plasmodium falciparum need to be incorporated in treatment regimen along with schizonticidal drugs to interrupt transmission. Primaquine is recommended as a transmission blocking drug for its effect on mature gametocytes but is not extensively utilized because of associated safety concerns among glucose-6-phosphate dehydrogenase (G6PD) deficient patients. In present work, methylene blue, which is proposed as an alternative to primaquine is investigated for its gametocytocidal activity amongst Indian field isolates. An effort has been made to establish Indian field isolates of P. falciparum as in vitro model for gametocytocidal drugs screening. Methods Plasmodium falciparum isolates were adapted to in vitro culture and induced to gametocyte production by hypoxanthine and culture was enriched for gametocyte stages using N-acetyl-glucosamine. Gametocytes were incubated with methylene blue for 48 h and stage specific gametocytocidal activity was evaluated by microscopic examination. Results Plasmodium falciparum field isolates RKL-9 and JDP-8 were able to reproducibly produce gametocytes in high yield and were used to screen gametocytocidal drugs. Methylene blue was found to target gametocytes in a concentration dependent manner by either completely eliminating gametocytes or rendering them morphologically deformed with mean IC50 (early stages) as 424.1 nM and mean IC50 (late stages) as 106.4 nM. These morphologically altered gametocytes appeared highly degenerated having shrinkage, distortions and membrane deformations. Conclusions Field isolates that produce gametocytes in high yield in vitro can be identified and used to screen gametocytocidal drugs. These isolates should be used for validation of gametocytocidal hits obtained previously by using lab adapted reference strains. Methylene blue was found to target gametocytes produced from Indian field isolates and is proposed to be used as a gametocytocidal adjunct with artemisinin-based combination therapy. Further exploration of methylene blue in clinical studies amongst Indian population, including G6PD deficient patients, is recommended.
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Affiliation(s)
- Ishan Wadi
- Indian Council of Medical Research-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India. .,Department of Chemistry, University of Delhi, Delhi, 110007, India.
| | - C Radhakrishna Pillai
- Indian Council of Medical Research-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
| | - Anupkumar R Anvikar
- Indian Council of Medical Research-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
| | - Abhinav Sinha
- Indian Council of Medical Research-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
| | - Mahendra Nath
- Department of Chemistry, University of Delhi, Delhi, 110007, India
| | - Neena Valecha
- Indian Council of Medical Research-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
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14
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Ghimire P, Singh N, Ortega L, Rijal KR, Adhikari B, Thakur GD, Marasini B. Glucose-6-phosphate dehydrogenase deficiency in people living in malaria endemic districts of Nepal. Malar J 2017; 16:214. [PMID: 28535765 PMCID: PMC5442674 DOI: 10.1186/s12936-017-1864-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 05/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) is a rate limiting enzyme of the pentose phosphate pathway and is closely associated with the haemolytic disorders among patients receiving anti-malarial drugs, such as primaquine. G6PD deficiency (G6PDd) is an impending factor for radical treatment of malaria which affects the clearance of gametocytes from the blood and subsequent delay in the achievement of malaria elimination. The main objective of this study was to assess the prevalence of G6PD deficiency in six malaria endemic districts in Southern Nepal. Methods A cross-sectional population based prevalence survey was conducted in six malaria endemic districts of Nepal, during April–Dec 2013. A total of 1341 blood samples were tested for G6PDd using two different rapid diagnostic test kits (Binax-Now® and Care Start™). Equal proportions of participants from each district (n ≥ 200) were enrolled considering ethnic and demographic representation of the population groups. Results Out of total 1341 blood specimens collected from six districts, the overall prevalence of G6PDd was 97/1341; 7.23% on Binax Now and 81/1341; 6.0% on Care Start test. Higher prevalence was observed in male than females [Binax Now: male 10.2%; 53/521 versus female 5.4%; 44/820 (p = 0.003) and Care Start: male 8.4%; 44/521 versus female 4.5%; 37/820 (p = 0.003)]. G6PDd was higher in ethnic groups Rajbanshi (11.7%; 19/162) and Tharu (5.6%; 56/1005) (p = 0.006), major inhabitant of the endemic districts. Higher prevalence of G6PDd was found in Jhapa (22/224; 9.8%) and Morang districts (18/225; 8%) (p = 0.031). In a multivariate analysis, male were found at more risk for G6PDd than females, on Binax test (aOR = 1.97; CI 1.28–3.03; p = 0.002) and Care Start test (aOR = 1.86; CI 1.16–2.97; p = 0.009). Conclusions The higher prevalence of G6PDd in certain ethnic group, gender and geographical region clearly demonstrates clustering of the cases and ascertained the risk groups within the population. This is the first study in Nepal which identified the vulnerable population groups for G6PDd in malaria endemic districts. The finding of this study warrants the need for G6PDd testing in vulnerable population groups in endemic districts, and also facilitates use of primaquine in mass supporting timely progress for malaria elimination.
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Affiliation(s)
- Prakash Ghimire
- World Health Organization, Country Office Nepal, UN House, Pulchowk, Lalitpur, Nepal.
| | - Nihal Singh
- World Health Organization, Country Office Nepal, UN House, Pulchowk, Lalitpur, Nepal
| | - Leonard Ortega
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | | | | | - Baburam Marasini
- Epidemiology & Disease Control Division, Ministry of Health, Kathmandu, Nepal
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15
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Roshankhah S, Rostami-Far Z, Shaveisi-Zadeh F, Movafagh A, Bakhtiari M, Shaveisi-Zadeh J. Glucose-6-phosphate dehydrogenase deficiency does not increase the susceptibility of sperm to oxidative stress induced by H 2O 2. Clin Exp Reprod Med 2016; 43:193-198. [PMID: 28090457 PMCID: PMC5234281 DOI: 10.5653/cerm.2016.43.4.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/09/2016] [Accepted: 08/20/2016] [Indexed: 11/06/2022] Open
Abstract
Objective Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect. G6PD plays a key role in the pentose phosphate pathway, which is a major source of nicotinamide adenine dinucleotide phosphate (NADPH). NADPH provides the reducing equivalents for oxidation-reduction reductions involved in protecting against the toxicity of reactive oxygen species such as H2O2. We hypothesized that G6PD deficiency may reduce the amount of NADPH in sperms, thereby inhibiting the detoxification of H2O2, which could potentially affect their motility and viability, resulting in an increased susceptibility to infertility. Methods Semen samples were obtained from four males with G6PD deficiency and eight healthy males as a control. In both groups, motile sperms were isolated from the seminal fluid and incubated with 0, 10, 20, 40, 60, 80, and 120 µM concentrations of H2O2. After 1 hour incubation at 37℃, sperms were evaluated for motility and viability. Results Incubation of sperms with 10 and 20 µM H2O2 led to very little decrease in motility and viability, but motility decreased notably in both groups in 40, 60, and 80 µM H2O2, and viability decreased in both groups in 40, 60, 80, and 120 µM H2O2. However, no statistically significant differences were found between the G6PD-deficient group and controls. Conclusion G6PD deficiency does not increase the susceptibility of sperm to oxidative stress induced by H2O2, and the reducing equivalents necessary for protection against H2O2 are most likely produced by other pathways. Therefore, G6PD deficiency cannot be considered as major risk factor for male infertility.
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Affiliation(s)
- Shiva Roshankhah
- Department of Anatomical Sciences and Biology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Rostami-Far
- Molecular Pathology Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farhad Shaveisi-Zadeh
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Bakhtiari
- Department of Anatomical Sciences and Biology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jila Shaveisi-Zadeh
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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16
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Sarker SK, Islam MT, Eckhoff G, Hossain MA, Qadri SK, Muraduzzaman AKM, Bhuyan GS, Shahidullah M, Mannan MA, Tahura S, Hussain M, Akhter S, Nahar N, Shirin T, Qadri F, Mannoor K. Molecular Analysis of Glucose-6-Phosphate Dehydrogenase Gene Mutations in Bangladeshi Individuals. PLoS One 2016; 11:e0166977. [PMID: 27880809 PMCID: PMC5120827 DOI: 10.1371/journal.pone.0166977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/06/2016] [Indexed: 11/25/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common X-linked human enzyme defect of red blood cells (RBCs). Individuals with this gene defect appear normal until exposed to oxidative stress which induces hemolysis. Consumption of certain foods such as fava beans, legumes; infection with bacteria or virus; and use of certain drugs such as primaquine, sulfa drugs etc. may result in lysis of RBCs in G6PD deficient individuals. The genetic defect that causes G6PD deficiency has been identified mostly as single base missense mutations. One hundred and sixty G6PD gene mutations, which lead to amino acid substitutions, have been described worldwide. The purpose of this study was to detect G6PD gene mutations in hospital-based settings in the local population of Dhaka city, Bangladesh. Qualitative fluorescent spot test and quantitative enzyme activity measurement using RANDOX G6PDH kit were performed for analysis of blood specimens and detection of G6PD-deficient participants. For G6PD-deficient samples, PCR was done with six sets of primers specific for G6PD gene. Automated Sanger sequencing of the PCR products was performed to identify the mutations in the gene. Based on fluorescence spot test and quantitative enzyme assay followed by G6PD gene sequencing, 12 specimens (11 males and one female) among 121 clinically suspected patient-specimens were found to be deficient, suggesting a frequency of 9.9% G6PD deficiency. Sequencing of the G6PD-deficient samples revealed c.C131G substitution (exon-3: Ala44Gly) in six samples, c.G487A substitution (exon-6:Gly163Ser) in five samples and c.G949A substitution (exon-9: Glu317Lys) of coding sequence in one sample. These mutations either affect NADP binding or disrupt protein structure. From the study it appears that Ala44Gly and Gly163Ser are the most common G6PD mutations in Dhaka, Bangladesh. This is the first study of G6PD mutations in Bangladesh.
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Affiliation(s)
- Suprovath Kumar Sarker
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Md Tarikul Islam
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Grace Eckhoff
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Amir Hossain
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Syeda Kashfi Qadri
- Department of Paediatric Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - A. K. M. Muraduzzaman
- Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Golam Sarower Bhuyan
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
| | - Mohammod Shahidullah
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mohammad Abdul Mannan
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Sarabon Tahura
- Department of Paediatric Medicine, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Manzoor Hussain
- Department of Paediatric Medicine, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Shahida Akhter
- Department of Paediatrics, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Dhaka, Bangladesh
| | - Nazmun Nahar
- Department of Paediatrics, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Dhaka, Bangladesh
| | - Tahmina Shirin
- Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Firdausi Qadri
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
- Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Kaiissar Mannoor
- Laboratory of Genetics and Genomics, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh
- * E-mail:
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17
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Wangchuk S, Drukpa T, Penjor K, Peldon T, Dorjey Y, Dorji K, Chhetri V, Trimarsanto H, To S, Murphy A, von Seidlein L, Price RN, Thriemer K, Auburn S. Where chloroquine still works: the genetic make-up and susceptibility of Plasmodium vivax to chloroquine plus primaquine in Bhutan. Malar J 2016; 15:277. [PMID: 27176722 PMCID: PMC4866075 DOI: 10.1186/s12936-016-1320-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/30/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Bhutan has made substantial progress in reducing malaria incidence. The national guidelines recommend chloroquine (CQ) and primaquine (PQ) for radical cure of uncomplicated Plasmodium vivax, but the local efficacy has not been assessed. The impact of cases imported from India on the genetic make-up of the local vivax populations is currently unknown. METHODS Patients over 4 years of age with uncomplicated P. vivax mono-infection were enrolled into a clinical efficacy study and molecular survey. Study participants received a standard dose of CQ (25 mg/kg over 3 days) followed by weekly review until day 28. On day 28 a 14-day regimen of PQ (0.25 mg/kg/day) was commenced under direct observation. After day 42, patients were followed up monthly for a year. The primary and secondary endpoints were risk of treatment failure at day 28 and at 1 year. Parasite genotyping was undertaken at nine tandem repeat markers, and standard population genetic metrics were applied to examine population diversity and structure in infections thought to be acquired inside or outside of Bhutan. RESULTS A total of 24 patients were enrolled in the clinical study between April 2013 and October 2015. Eight patients (33.3 %) were lost to follow-up in the first 6 months and another eight patients lost between 6 and 12 months. No (0/24) treatment failures occurred by day 28 and no (0/8) parasitaemia was detected following PQ treatment. Some 95.8 % (23/24) of patients were aparasitaemic by day 2. There were no haemolytic or serious events. Genotyping was undertaken on parasites from 12 autochthonous cases and 16 suspected imported cases. Diversity was high (H E 0.87 and 0.90) in both populations. There was no notable differentiation between the autochthonous and imported populations. CONCLUSIONS CQ and PQ remains effective for radical cure of P. vivax in Bhutan. The genetic analyses indicate that imported infections are sustaining the local vivax population, with concomitant risk of introducing drug-resistant strains.
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Affiliation(s)
- Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Tobgyel Drukpa
- Vector Borne Disease Control Programme in Gelephu, Communicable Disease Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Kinley Penjor
- Sarpang District Hospital, Ministry of Health, Sarpang District, Bhutan
| | - Tashi Peldon
- Gelephu Regional Referral Hospital, Ministry of Health, Gelephu, Bhutan
| | - Yeshey Dorjey
- Yebilaptsa Hospital, Ministry of Health, Zhemgang District, Bhutan
| | - Kunzang Dorji
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Vishal Chhetri
- Gelephu Regional Referral Hospital, Ministry of Health, Gelephu, Bhutan
| | - Hidayat Trimarsanto
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat, 10430, Indonesia.,The Ministry of Research and Technology (RISTEK), Jakarta, Indonesia.,Agency for Assessment and Application of Technology, Jl. MH Thamrin 8, Jakarta, 10340, Indonesia
| | - Sheren To
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia
| | - Amanda Murphy
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.,Faculty of Medicine and Biomedical Sciences, School of Population Health, The University of Queensland, Brisbane, Australia
| | - Lorenz von Seidlein
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford Old Road Campus, Oxford, UK
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford Old Road Campus, Oxford, UK
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.
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18
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Rostami-Far Z, Ghadiri K, Rostami-Far M, Shaveisi-Zadeh F, Amiri A, Rahimian Zarif B. Glucose-6-phosphate dehydrogenase deficiency (G6PD) as a risk factor of male neonatal sepsis. J Med Life 2016; 9:34-38. [PMID: 27974910 PMCID: PMC5152609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction.Neonatal sepsis is a disease process, which represents the systemic response of bacteria entering the bloodstream during the first 28 days of life. The prevalence of sepsis is higher in male infants than in females, but the exact cause is unknown. Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme in the pentose phosphate pathway, which leads to the production of NADPH. NADPH is required for the respiratory burst reaction in white blood cells (WBCs) to destroy microorganisms. The purpose of this study was to evaluate the prevalence of G6PD deficiency in neonates with sepsis. Materials and methods.This study was performed on 76 neonates with sepsis and 1214 normal neonates from February 2012 to November 2014 in the west of Iran. The G6PD deficiency status was determined by fluorescent spot test. WBCs number and neutrophils percentages were measured and compared in patients with and without G6PD deficiency. Results.The prevalence of the G6PD deficiency in neonates with sepsis was significantly higher compared to the control group (p=0.03). WBCs number and neutrophils percentages in G6PD deficient patients compared with patients without G6PD deficiency were decreased, but were not statistically significant (p=0.77 and p=0.86 respectively). Conclusions.G6PD deficiency is a risk factor of neonatal sepsis and also a justification for more male involvement in this disease. Therefore, newborn screening for this disorder is recommended.
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Affiliation(s)
- Z Rostami-Far
- Department of Biology, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
| | - K Ghadiri
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - M Rostami-Far
- Department of Environmental Health Engineering, School of Public Health, Kermanshah University of Medical Sciences, Iran
| | - F Shaveisi-Zadeh
- Molecular Pathology Research Center, Imam Reza Hospital, Kermanshah, University of Medical Sciences, Kermanshah, Iran
| | - A Amiri
- Molecular Pathology Research Center, Imam Reza Hospital, Kermanshah, University of Medical Sciences, Kermanshah, Iran
| | - B Rahimian Zarif
- Department of Biology, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
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19
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Singh N. Understanding poor man's diseases in contemporary perspective. Indian J Med Res 2015; 141:501-4. [PMID: 26139764 PMCID: PMC4510745 DOI: 10.4103/0971-5916.159487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Neeru Singh
- National Institute for Research in Tribal Health (ICMR), Jabalpur 482 003, Madhya Pradesh, India & Coordinator, ICMR THRF, India
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