Clinical aspects of hemolysis in patients with P. vivax malaria treated with primaquine, in the Brazilian Amazon

Júnior, Wilson Marques; Sardinha, José F.J.; Costa, Mônica R.F.; Santana, Marli Stela; Alecrim, Maria G.C.; Lacerda, Marcus Vinícius Guimarães

doi:10.1590/s1413-86702010000400017

Cited by 26 publications

(17 citation statements)

References 10 publications

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“…In Panama, a mutation analysis revealed that a Mediterranean variant was behind the development of kernicterus after exposure to naphthalene in a male patient (de Gurrola et al 2008). In Manaus, Brazil, G6PDd was associated with a considerably higher risk of malaria-related transfusions, suggesting that G6PDd may contribute to a considerable proportion of malaria-related complications in an area with an unexpectedly high prevalence of the Mediterranean variant (Ramos-Júnior et al 2010, Lacerda et al 2012a, Santana et al 2013). …”

Section: Resultsmentioning

confidence: 99%

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: 99%

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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“…It is the only drug proven to be effective, and licensed to eliminate, the hypnozoites of Plasmodium vivax and Plasmodium ovale . Though primaquine is effective, unique and irreplaceable, it is also associated with serious hazards and side effects, such as its ability to precipitate haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals [3]. This prohibits its use in key groups, such as pregnant women [4].…”

Section: Introductionmentioning

confidence: 99%

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

Fernando

Rodrigo

Rajapakse

2011

Malar J

137

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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“…Although there was strong evidence of the deficient status being protective to malaria infection, individuals with reduced G6PD activity reported a higher incidence of jaundice and blood transfusion when presenting malaria, probably due to primaquine-induced hemolysis. Primaquine has been prescribed in Brazil for decades without prior assessment of G6PD status, posing a potential risk to the small proportion of G6PD-deficient individuals receiving this drug, demonstrated by series of hospitalized patients and fatal cases 42,47,48. A large population survey of G6PD deficiency in the Amazon region is ongoing and should provide valuable information that will help to guide safer policies.…”

Section: Plasmodium Vivax Epidemiologymentioning

confidence: 99%

“…Though oral chloroquine is usually safe, it has been demonstrated that pruritus can occur in around 20% of patients being treated for P. vivax infection,54 with risk of noncompletion of treatment. Adverse events associated with primaquine use, especially hemolysis, are of greater concern55 as they can lead to severe complications 48. An autopsy series of P. vivax patients found severe primaquine-induced hemolysis and associated complications as the main cause of death in two individuals 42.…”

Section: Malaria Control Interventionsmentioning

confidence: 99%

Plasmodium vivax Landscape in Brazil: Scenario and Challenges

Siqueira¹,

Mesones-Lapouble²,

Marchesini³

et al. 2016

Am J Trop Med Hyg

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Brazil is the largest country of Latin America, with a considerable portion of its territoritory within the malaria-endemic Amazon region in the North. Furthermore, a considerable portion of its territory is located within the Amazon region in the north. As a result, Brazil has reported half of the total malaria cases in the Americas in the last four decades. Recent progress in malaria control has been accompanied by an increasing proportion of Plasmodium vivax, underscoring a need for a better understanding of management and control of this species and associated challenges. Among these challenges, the contribution of vivax malaria relapses, earlier production of gametocytes (compared with Plasmodium falciparum), inexistent methods to diagnose hypnozoite carriers, and decreasing efficacy of available antimalarials need to be addressed. Innovative tools, strategies, and technologies are needed to achieve further progress toward sustainable malaria elimination. Further difficulties also arise from dealing with the inherent socioeconomic and environmental particularities of the Amazon region and its dynamic changes.

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Clinical aspects of hemolysis in patients with P. vivax malaria treated with primaquine, in the Brazilian Amazon

Cited by 26 publications

References 10 publications

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

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

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

Plasmodium vivax Landscape in Brazil: Scenario and Challenges

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