Metemoglobinemia em pacientes com malária por Plasmodium vivax em uso oral de primaquina

Ferreira, Michelli Erica Souza; Gomes, Margarete do Socorro Mendonça; Vieira, José Luiz Fernandes

doi:10.1590/s0037-86822011000100026

Cited by 9 publications

(6 citation statements)

References 12 publications

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“…In G6PDd patients, a significantly higher occurrence of MetHb was observed following oral therapy with PQ when compared to non-G6PDd individuals (Santana et al 2007, Ferreira et al 2011). In Nicaragua, however, administration of 10-20 mg of PQ base daily over 14 days to 321 Miskito Indians with chronic malaria did not lead to any case of secondary adverse events (Thaeler Jr et al 1953).…”

Section: Resultsmentioning

confidence: 88%

G6PD deficiency in Latin America: systematic review on prevalence and variants

Monteiro

Val

Siqueira

et al. 2014

Mem. Inst. Oswaldo Cruz

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Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. The aim of this work was to study the G6PDd prevalence and variants in Latin America (LA) and the Caribbean region. A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Low prevalence rates of G6PDd were documented in Argentina, Bolivia, Mexico, Peru and Uruguay, but studies from Curaçao, Ecuador, Jamaica, Saint Lucia, Suriname and Trinidad, as well as some surveys carried out in areas of Brazil, Colombia and Cuba, have shown a high prevalence (> 10%) of G6PDd. The G6PD A-202A mutation was the variant most broadly distributed across LA and was identified in 81.1% of the deficient individuals surveyed. G6PDd is a frequent phenomenon in LA, although certain Amerindian populations may not be affected, suggesting that PQ could be safely used in these specific populations. Population-wide use of PQ as part of malaria elimination strategies in LA cannot be supported unless a rapid, accurate and field-deployable G6PDd diagnostic test is made available.

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Section: Resultsmentioning

confidence: 88%

G6PD deficiency in Latin America: systematic review on prevalence and variants

Monteiro

Val

Siqueira

et al. 2014

Mem. Inst. Oswaldo Cruz

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“…A significant increase in methaemoglobinaemia was observed following oral therapy with PQ in patients with P. vivax presenting G6PDd [115,116]. Additionally, in Colombia, an association between haemolysis and physical exercise was observed in individuals with reduced G6PD activity [117].…”

Section: Resultsmentioning

confidence: 99%

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

Monteiro

Franca

Queiroz

et al. 2014

Malar J

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BackgroundAlthough G6PDd individuals are generally asymptomatic throughout their life, the clinical burden of this genetic condition includes a range of haematological conditions, including acute haemolytic anaemia (AHA), neonatal jaundice (NNJ) and chronic non-sphaerocytic anaemia (CNSA). In Latin America (LA), the huge knowledge gap regarding G6PDd is related to the scarce understanding of the burden of clinical manifestation underlying G6PDd carriage. The aim of this work was to study the clinical significance of G6PDd in LA and the Caribbean region through a systematic review.MethodsA systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Only original research was included. All study designs were included, as long as any clinical information was present. Studies were eligible for inclusion if they reported clinical information from populations living in LA or Caribbean countries or about migrants from these countries living in countries outside this continent.ResultsThe Medline search generated 487 papers, and the LILACS search identified 140 papers. After applying the inclusion criteria, 100 original papers with any clinical information on G6PDd in LA were retrieved. Additionally, 16 articles were included after reading the references from these papers. These 116 articles reported data from 18 LA and Caribbean countries. The major clinical manifestations reported from LA countries were those related to AHA, namely drug-induced haemolysis. Most of the published works regarding drug-induced haemolysis in LA referred to haemolytic crises in P. vivax malaria patients during the course of the treatment with primaquine (PQ). Favism, infection-induced haemolysis, NNJ and CNSA appear to play only a minor public health role in this continent.ConclusionHaemolysis in patients using PQ seems to be the major clinical manifestation of G6PDd in LA and contributes to the morbidity of P. vivax infection in this continent, although the low number of reported cases, which could be linked to under-reporting of complications. These results support the need for better strategies to diagnose and manage G6PDd in malaria field conditions. Additionally, Malaria Control Programmes in LA should not overlook this condition in their national guidelines.

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“…Santana et al [50] showed that in a group of patients developing methaemoglobinaemia following primaquine therapy, 51% were G6PD deficient (G6PD deficiency in those without methaemoglobinaemia was 8.7%). However, Ferreira et al failed to demonstrate a similar association [51]. …”

Section: Methodsmentioning

confidence: 99%

Primaquine in vivax malaria: an update and review on management issues

Fernando

Rodrigo

Rajapakse

2011

Malar J

135

123

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Primaquine was officially licensed as an anti-malarial drug by the FDA in 1952. It has remained the only FDA licensed drug capable of clearing the intra-hepatic schizonts and hypnozoites of Plasmodium vivax. This update and review focuses on five major aspects of primaquine use in treatment of vivax malaria, namely: a) evidence of efficacy of primaquine for its current indications; b) potential hazards of its widespread use, c) critical analysis of reported resistance against primaquine containing regimens; d) evidence for combining primaquine with artemisinins in areas of chloroquine resistance; and e) the potential for replacement of primaquine with newer drugs.

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Metemoglobinemia em pacientes com malária por Plasmodium vivax em uso oral de primaquina

Abstract: A statistically significant increase in methemoglobinemia was observed following oral therapy with primaquine, with no clinical manifestations, and independent of sex and the qualitative expression of glucose-6-phosphate dehydrogenase.

Cited by 9 publications

References 12 publications

G6PD deficiency in Latin America: systematic review on prevalence and variants

G6PD deficiency in Latin America: systematic review on prevalence and variants

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

Primaquine in vivax malaria: an update and review on management issues

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