Abstract
Accurate diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency is required to avoid the risk of acute hemolysis associated with 8-aminoquinoline treatment. The performance of the BinaxNOW G6PD test compared with the quantitative spectrophotometric analysis of G6PD activity was assessed in 356 Plasmodium vivax-infected subjects in Brazil, Peru, Thailand, and India. In the quantitative assay, the median G6PD activity was 8.81 U/g hemoglobin (range = 0.05–20.19), with 11 (3%) subjects identified as deficient. Sensitivity of the BinaxNOW G6PD to detect deficient subjects was 54.5% (6 of 11), and specificity was 100% (345 of 345). Room temperatures inadvertently falling outside the range required to perform the rapid test (18–25°C) together with subtlety of color change and insufficient training could partially explain the low sensitivity found. Ensuring safe use of 8-aminoquinolines depends on additional development of simple, highly sensitive G6PD deficiency diagnostic tests suitable for routine use in malaria-endemic areas.
Highlights
The public health importance of Plasmodium vivax malaria is more widely recognized as renewed targets for malaria elimination are defined.[1]
The 8-aminoquinoline primaquine is the only drug recommended by the World Health Organization (WHO) to treat P. vivax hypnozoites, but it is contraindicated in subjects with severe glucose-6-phosphate dehydrogenase (G6PD) deficiency
401 subjects were screened with the reference test, and from these subjects, 357 subjects were tested with the BinaxNOW G6PD
Summary
The public health importance of Plasmodium vivax malaria is more widely recognized as renewed targets for malaria elimination are defined.[1] The capability of P. vivax to relapse from a liver stage known as the hypnozoite weeks or months after an initial infection poses a challenge for the estimation of its transmission burden and control efforts. Mild G6PD-deficient subjects are recommended a dose of 0.75 mg base/kg one time per week for 8 weeks instead of the standard dose of 0.25–0.5 mg base/kg one time per day for 14 days.[2] in a clinical setting, these differential dosages can only be implemented if G6PD deficiency status is known. The facts that the geographical distribution of malaria and G6PD deficiency is shown to overlap and that Plasmodium-infected subjects, might be exposed to high doses of 8-aminoquinolines highlight the need to assess the status of G6DP in the population to ensure the safe use of these drugs.[4,5]
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