Abstract
Primaquine and other 8-amnoquinoline based anti-malarials can cause haemolysis in subjects with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Correct diagnosis of G6PD status in patients is crucial for safe treatment of both relapsing stages of Plasmodium vivax and transmitting forms of Plasmodium falciparum. Lack of suitable point-of-care tests has hampered a much needed wide use of primaquine for malaria elimination. In this study we have assessed the performances of two qualitative tests, the fluorescent spot test (FST) and the G6PD CareStart test (CST), against the gold standard quantitative spectrophotometric assay in a population of 1000 random adult healthy volunteers living in Yangon, Myanmar. The prevalence of G6PD deficiency in the Bamar, Karen and in the whole sample set was 6.6% (10.1% in males), 9.2% (21.0% in males) and 6.8% (11.1% in males) respectively. The FST and CST showed comparable performances with sensitivity over 95% and specificity over 90%, however for cases with severe G6PD activity the FTS had improved performance. If used with a conservative interpretation of the signal, the CareStart test has the potential to be used in the field and, by allowing a wider use of primaquine, to help malaria elimination.
Highlights
Glucose-6-Phosphate Dehydrogenase (G6PD) is the enzyme responsible for maintaining redox equilibrium in red blood cells (RBC)
Mutations on the gene result in a decrease of the enzyme stability and activity which translates in increased risk of haemolysis under oxidative challenge at the cell level
Samples were transported refrigerated to the Department of Medical Research (DMR) Biochemistry laboratory and analyzed for complete blood count and G6PD phenotypes within 6 hours
Summary
Glucose-6-Phosphate Dehydrogenase (G6PD) is the enzyme responsible for maintaining redox equilibrium in red blood cells (RBC). Mutations on the gene result in a decrease of the enzyme stability and activity which translates in increased risk of haemolysis under oxidative challenge at the cell level. The G6PD gene is on the X-chromosome such that males are either G6PD deficient or normal both in terms of genotype and phenotype whereas females with two alleles can PLOS ONE | DOI:10.1371/journal.pone.0152304. Validation of G6PD Point-of-Care Tests in Myanmar in study design, data collection and analysis, decision to publish, or preparation of the manuscript The G6PD gene is on the X-chromosome such that males are either G6PD deficient or normal both in terms of genotype and phenotype whereas females with two alleles can PLOS ONE | DOI:10.1371/journal.pone.0152304 April 1, 2016
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