Glucose-6-phosphate dehydrogenase deficiency among malaria patients of Honduras: a descriptive study of archival blood samples

By Maimunat Alex-Adeomi Moderator | 10 Jan, 2017

Dear colleagues, following an earlier discussion on G6PD testing and the safe use of Primaquine in treating P. vivax and ovale malaria, see the attached article on a study done on G6PD deficiency in Honduras by Miguel Zuniga et al in the Malaria Journal 201514:308 DOI: 10.1186/s12936-015-0823-z.

Abstract

Background
The frequency of deficient variants of glucose-6-phosphate dehydrogenase (G6PDd) is particularly high in areas where malaria is endemic. The administration of anti relapse drugs, such as primaquine, has the potential to trigger an oxidative event in G6PD-deficient individuals. According to Honduras´ national scheme, malaria treatment requires the administration of chloroquine and primaquine for both Plasmodium vivax and Plasmodium falciparum infections. The present study aimed at investigating for the first time in Honduras the frequency of the two most common G6PDd variants.

Methods
This was a descriptive study utilizing 398 archival DNA samples of patients that had been diagnosed with malaria due to P. vivax, P. falciparum, or both. The most common allelic variants of G6PD: G6PD A+376G and G6PD A−376G/202A were assessed by two molecular methods (PCR–RFLP and a commercial kit).

Results
The overall frequency of G6PD deficient genotypes was 16.08%. The frequency of the “African” genotype A− (Class III) was 11.9% (4.1% A− hemizygous males; 1.5% homozygous A− females; and 6.3% heterozygous A− females). A high frequency of G6PDd alleles was observed in samples from malaria patients residing in endemic regions of Northern Honduras. One case of Santamaria mutation (376G/542T) was detected.

Conclusion:
Compared to other studies in the Americas, as well as to data from predictive models, the present study identified a higher-than expected frequency of genotype A− in Honduras. Considering that the national standard of malaria treatment in the country includes primaquine, further research is necessary to ascertain the risk of PQ-triggered haemolytic reactions in sectors of the population more likely to carry G6PD mutations. Additionally, consideration should be given to utilizing point of care technologies to detect this genetic disorder prior administration of 8-aminoquinoline drugs, either primaquine or any new drug available in the near future.

Replies

 

Pierre Bush, PhD Moderator Replied at 10:37 PM, 15 Jan 2017

Thank you Maimunat. The importance of testing for Glucose 6 phosphate dehydrogenase is very important before the administration of Primaquine which can induce very serious hemolytic events in individual whose RBCs are deficient in G6PD, which is the most prevalent enzymopathy worldwide (affecting ~ 400 million people).