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Nelwan EJ, Shakinah S, Pasaribu A. Association of G6PD status and haemolytic anaemia in patients receiving anti-malarial agents: a systematic review and meta-analysis. Malar J 2023; 22:77. [PMID: 36872344 PMCID: PMC9985861 DOI: 10.1186/s12936-023-04493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Some anti-malarial drugs often cause haemolytic anaemia in glucose-6-phosphate-dehydrogenase deficiency (G6PDd) patients. This study aims to analyse the association of G6PDd and anaemia in malaria patients receiving anti-malarial drugs. METHODS A literature search was performed in major database portals. All studies searched using keywords with Medical Subject Headings (MeSH) were included, without date or language restriction. Pooled mean difference of haemoglobin and risk ratio of anaemia were analysed using RevMan. RESULTS Sixteen studies comprising 3474 malaria patients that included 398 (11.5%) with G6PDd were found. Mean difference of haemoglobin in G6PDd/G6PD normal (G6PDn) patients was - 0.16 g/dL (95% CI - 0.48, 0.15; I2 5%, p = 0.39), regardless of the type of malaria and dose of drugs. In particular with primaquine (PQ), mean difference of haemoglobin in G6PDd/G6PDn patients with dose < 0.5 mg/kg/day was - 0.04 (95% CI - 0.35, 0.27; I2 0%, p = 0.69). The risk ratio of developing anaemia in G6PDd patients was 1.02 (95% CI 0.75, 1.38; I2 0%, p = 0.79). CONCLUSION Single or daily standard doses of PQ (0.25 mg/kg/day) and weekly PQ (0.75 mg/kg/week) did not increase the risk of anaemia in G6PDd patients.
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Affiliation(s)
- Erni J Nelwan
- Division of Tropical and Infectious Disease, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. .,Division of Tropical and Infectious Disease, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Sharifah Shakinah
- Division of Tropical and Infectious Disease, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Division of Tropical and Infectious Disease, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Adeline Pasaribu
- Division of Tropical and Infectious Disease, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Division of Tropical and Infectious Disease, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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de Oliveira HSS, da Silva ANLM, Andrade GB, Gaia KC, Costa GDLC, dos Santos ÂKCR, Guerreiro JF. Molecular genotyping of G6PD mutations and Duffy blood group in Afro-descendant communities from Brazilian Amazon. Genet Mol Biol 2018; 41:758-765. [PMID: 30508000 PMCID: PMC6415611 DOI: 10.1590/1678-4685-gmb-2017-0253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/15/2018] [Indexed: 11/30/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase deficiency (G6PDd) and Duffy-negative blood group are two red blood cells variants that confer protection against malaria. In this study, the distribution of the most common G6PD variants (G6PD*A-, GGPD*A and G6PD Mediterranean) and the major alleles of the Duffy blood group (FY*A, FY*B and FY*BES) were investigated in an Afro-descendant population from state of Pará, Brazilian Amazon. G6PD variants and Duffy blood group alleles were determined by TaqMan SNP genotyping assay. Overall, molecular genotyping revealed the presence of G6PD variants in 126 (24%) of the individuals studied (5% male and 19% female), and frequencies of the G6PD*A- and G6PD*A alleles were 0.061 and 0.104, respectively. Duffy blood group genotyping showed that 24.3% of people were Duffy-negative and 41.3% were heterozygous for FY*BES. The frequency of allele FY*BES was 41.0%. The results emphasize the need to monitor G6PD deficiency for the use of primaquine in the routine care of the Afro-descendant communities of the Trombetas, Erepecuru and Cumná rivers, evaluating the risks of hemolytic crisis in case of recurrence of malaria in the region. In addition, the possible greater protection against malaria conferred by these erythrocyte polymorphisms deserves to be better investigated and explored among these Afro-descendants.
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Affiliation(s)
- Haiala S. Silva de Oliveira
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | - Aylla N. Lima Martins da Silva
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | - Gabriela Barreto Andrade
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | - Karoline Coelho Gaia
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | - Greice de Lemos Cardoso Costa
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | | | - João Farias Guerreiro
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
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Carmo APBD, Borborema M, Ribeiro S, De-Oliveira ACX, Paumgartten FJR, Moreira DDL. A newly validated high-performance liquid chromatography method with diode array ultraviolet detection for analysis of the antimalarial drug primaquine in the blood plasma. Rev Soc Bras Med Trop 2017; 50:499-505. [PMID: 28954071 DOI: 10.1590/0037-8682-0023-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/10/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Primaquine (PQ) diphosphate is an 8-aminoquinoline antimalarial drug with unique therapeutic properties. It is the only drug that prevents relapses of Plasmodium vivax or Plasmodium ovale infections. In this study, a fast, sensitive, cost-effective, and robust method for the extraction and high-performance liquid chromatography with diode array ultraviolet detection (HPLC-DAD-UV ) analysis of PQ in the blood plasma was developed and validated. METHODS: After plasma protein precipitation, PQ was obtained by liquid-liquid extraction and analyzed by HPLC-DAD-UV with a modified-silica cyanopropyl column (250mm × 4.6mm i.d. × 5μm) as the stationary phase and a mixture of acetonitrile and 10mM ammonium acetate buffer (pH = 3.80) (45:55) as the mobile phase. The flow rate was 1.0mL·min-1, the oven temperature was 50OC, and absorbance was measured at 264nm. The method was validated for linearity, intra-day and inter-day precision, accuracy, recovery, and robustness. The detection (LOD) and quantification (LOQ) limits were 1.0 and 3.5ng·mL-1, respectively. The method was used to analyze the plasma of female DBA-2 mice treated with 20mg.kg-1 (oral) PQ diphosphate. RESULTS: By combining a simple, low-cost extraction procedure with a sensitive, precise, accurate, and robust method, it was possible to analyze PQ in small volumes of plasma. The new method presents lower LOD and LOQ limits and requires a shorter analysis time and smaller plasma volumes than those of previously reported HPLC methods with DAD-UV detection. CONCLUSIONS: The new validated method is suitable for kinetic studies of PQ in small rodents, including mouse models for the study of malaria.
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Affiliation(s)
- Ana Paula Barbosa do Carmo
- Laboratório de Toxicologia Ambiental, Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Manoella Borborema
- Laboratório de Toxicologia Ambiental, Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Stephan Ribeiro
- Laboratório de Toxicologia Ambiental, Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Ana Cecilia Xavier De-Oliveira
- Laboratório de Toxicologia Ambiental, Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Francisco Jose Roma Paumgartten
- Laboratório de Toxicologia Ambiental, Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Davyson de Lima Moreira
- Laboratório de Toxicologia Ambiental, Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.,Departamento de Produtos Naturais, Instituto de Tecnologia em Fármacos - Farmanguinhos, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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4
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Monteiro WM, Val FFA, Siqueira AM, Franca GP, Sampaio VS, Melo GC, Almeida ACG, Brito MAM, Peixoto HM, Fuller D, Bassat Q, Romero GAS, Maria Regina F O, Marcus Vinícius G L. G6PD deficiency in Latin America: systematic review on prevalence and variants. Mem Inst Oswaldo Cruz 2014; 109:553-68. [PMID: 25141282 PMCID: PMC4156449 DOI: 10.1590/0074-0276140123] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/02/2014] [Indexed: 01/14/2023] Open
Abstract
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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Affiliation(s)
- Wuelton M Monteiro
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Fernando FA Val
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - André M Siqueira
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Gabriel P Franca
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
| | - Vanderson S Sampaio
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Gisely C Melo
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Anne CG Almeida
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Marcelo AM Brito
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Henry M Peixoto
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
| | - Douglas Fuller
- Department of Geography and Regional Studies, University of Miami, Coral
Gables, FL, USA
| | - Quique Bassat
- Barcelona Centre for International Health Research, Hospital Clinic,
University of Barcelona, Barcelona, Spain
| | - Gustavo AS Romero
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias
em Saúde, Porto Alegre, RS, Brasil
| | - Oliveira Maria Regina F
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias
em Saúde, Porto Alegre, RS, Brasil
| | - Lacerda Marcus Vinícius G
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
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5
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Monteiro WM, Franca GP, Melo GC, Queiroz ALM, Brito M, Peixoto HM, Oliveira MRF, Romero GAS, Bassat Q, Lacerda MVG. Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes. Malar J 2014; 13:70. [PMID: 24568147 PMCID: PMC3938641 DOI: 10.1186/1475-2875-13-70] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/20/2014] [Indexed: 12/29/2022] Open
Abstract
Background Although 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. Methods A 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. Results The 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. Conclusion Haemolysis 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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Affiliation(s)
- Wuelton M Monteiro
- Fundação de Medicina Tropical Dr, Heitor Vieira Dourado (FMT-HVD), Av, Pedro Teixeira, 25, Dom Pedro, Manaus, AM 69040-000, Brazil.
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6
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Howes RE, Battle KE, Satyagraha AW, Baird JK, Hay SI. G6PD deficiency: global distribution, genetic variants and primaquine therapy. ADVANCES IN PARASITOLOGY 2013; 81:133-201. [PMID: 23384623 DOI: 10.1016/b978-0-12-407826-0.00004-7] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) is a potentially pathogenic inherited enzyme abnormality and, similar to other human red blood cell polymorphisms, is particularly prevalent in historically malaria endemic countries. The spatial extent of Plasmodium vivax malaria overlaps widely with that of G6PD deficiency; unfortunately the only drug licensed for the radical cure and relapse prevention of P. vivax, primaquine, can trigger severe haemolytic anaemia in G6PD deficient individuals. This chapter reviews the past and current data on this unique pharmacogenetic association, which is becoming increasingly important as several nations now consider strategies to eliminate malaria transmission rather than control its clinical burden. G6PD deficiency is a highly variable disorder, in terms of spatial heterogeneity in prevalence and molecular variants, as well as its interactions with P. vivax and primaquine. Consideration of factors including aspects of basic physiology, diagnosis, and clinical triggers of primaquine-induced haemolysis is required to assess the risks and benefits of applying primaquine in various geographic and demographic settings. Given that haemolytically toxic antirelapse drugs will likely be the only therapeutic options for the coming decade, it is clear that we need to understand in depth G6PD deficiency and primaquine-induced haemolysis to determine safe and effective therapeutic strategies to overcome this hurdle and achieve malaria elimination.
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de Carvalho GB, de Carvalho GB. Duffy Blood Group System and the malaria adaptation process in humans. Rev Bras Hematol Hemoter 2013; 33:55-64. [PMID: 23284245 PMCID: PMC3521437 DOI: 10.5581/1516-8484.20110016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 02/04/2011] [Indexed: 11/27/2022] Open
Abstract
Malaria is an acute infectious disease caused by the protozoa of the genus
Plasmodium. The antigens of the Duffy Blood Group System, in addition to
incompatibilities in transfusions and hemolytic disease of the newborn, are of great
interest in medicine due to their association with the invasion of red blood cells by
the parasite Plasmodium vivax. For invasions to occur an interaction between the
parasites and antigens of the Duffy Blood Group System is necessary. In Caucasians
six antigens are produced by the Duffy locus (Fya, Fyb, F3, F4, F5 and F6). It has
been observed that Fy(a-b-) individuals are resistant to Plasmodium knowlesi and P.
vivax infection, because the invasion requires at least one of these antigens. The P.
vivax Duffy Binding Protein (PvDBP) is functionally important in the invasion process
of these parasites in Duffy / DARC positive humans. The proteins or fractions may be
considered, therefore, an important and potential inoculum to be used in immunization
against malaria.
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Lacerda MVG, Mourão MPG, Alexandre MAA, Siqueira AM, Magalhães BML, Martinez-Espinosa FE, Filho FSS, Brasil P, Ventura AMRS, Tada MS, Couto VSCD, Silva AR, Silva RSU, Alecrim MGC. Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature. Malar J 2012; 11:12. [PMID: 22230294 PMCID: PMC3268102 DOI: 10.1186/1475-2875-11-12] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 01/09/2012] [Indexed: 12/12/2022] Open
Abstract
The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out.
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Affiliation(s)
- Marcus V G Lacerda
- Fundação de Medicina Tropical Dr, Heitor Vieira Dourado, Av, Pedro Teixeira, 25, 69040-000, Manaus Amazonas, Brazil.
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Ramos Júnior WM, Sardinha JF, Costa MR, Santana MS, Alecrim MG, Lacerda MV. Clinical aspects of hemolysis in patients with P. vivax malaria treated with primaquine, in the Brazilian Amazon. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70084-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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10
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Katsuragawa TH, Cunha RPDA, Souza DCAD, Gil LHS, Cruz RB, Silva ADAE, Tada MS, Silva LHPD. Malária e aspectos hematológicos em moradores da área de influência dos futuros reservatórios das hidrelétricas de Santo Antônio e Jirau, Rondônia, Brasil. CAD SAUDE PUBLICA 2009; 25:1486-92. [DOI: 10.1590/s0102-311x2009000700006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 02/10/2008] [Indexed: 11/22/2022] Open
Abstract
Em Rondônia, prevê-se a construção de mais duas usinas hidrelétricas (UHE) no rio Madeira, a montante da cidade de Porto Velho, Rondônia, Brasil (de Santo Antônio e Jirau). O objetivo deste trabalho foi analisar a prevalência da malária antes do início da implantação das obras civis e fazer considerações sobre os impactos da doença com o ingresso de milhares de trabalhadores e agregados atraídos pelas oportunidades de emprego e comércio. Os resultados obtidos mostram que a malária se faz presente em toda região, em variados graus de prevalência. Além disso, a existência de potenciais portadores assintomáticos de malária entre a população nativa pode ter relevância epidemiológica e deve ser considerada nos programas de controle da malária, vinda tanto das autoridades públicas quanto das empresas responsáveis pela instalação das UHE, visando o diagnóstico e tratamento precoce, controle vetorial, abastecimento de água e aplicação de infra-estrutura nos centros urbanos.
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Affiliation(s)
- Tony Hiroshi Katsuragawa
- Instituto de Pesquisa em Patologias Tropicais, Brasil; Centro de Pesquisa em Medicina Tropical, Brasil
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Glucose-6-phosphate dehydrogenase deficiency in an endemic area for malaria in Manaus: a cross-sectional survey in the Brazilian Amazon. PLoS One 2009; 4:e5259. [PMID: 19370159 PMCID: PMC2667256 DOI: 10.1371/journal.pone.0005259] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 03/12/2009] [Indexed: 11/28/2022] Open
Abstract
Background There is a paucity of information regarding glucose-6-phosphate dehydrogenase (G6PD) deficiency in endemic areas for malaria in Latin America. Methodology/Principal Findings This study determined the prevalence of the G6PD deficiency in 200 male non-consanguineous individuals residing in the Ismail Aziz Community, on the outskirts of Manaus (Brazilian Amazon). Six individuals (3%) were deficient using the qualitative Brewer's test. Gel electrophoresis showed that five of these patients were G6PD A−. The deficiency was not associated with the ethnic origin (P = 0.571). In a multivariate logistic regression analysis, G6PD deficiency protected against three or more episodes of malaria (P = 0.049), independently of the age, and was associated with a history of jaundice (P = 0.020) and need of blood transfusion (P = 0.045) during previous treatment for malarial infection, independently of the age and the previous malarial exposure. Conclusions/Significance The frequency of G6PD deficiency was similar to other studies performed in Brazil and the finding of a predominant G6PD A− variant will help the clinical management of patients with drug-induced haemolysis. The history of jaundice and blood transfusion during previous malarial infection may trigger the screening of patients for G6PD deficiency. The apparent protection against multiple malarial infections in an area primarily endemic for Plasmodium vivax needs further investigation.
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12
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Freitas LF, Chaves GC, Wannmacher L, Osorio-de-Castro CGS. [Uncomplicated Plasmodium vivax and P. falciparum malaria in Brazil: evidence on single and combined drug treatments recommended by official guidelines]. CAD SAUDE PUBLICA 2007; 23:2285-94. [PMID: 17891290 DOI: 10.1590/s0102-311x2007001000004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 03/22/2007] [Indexed: 11/22/2022] Open
Abstract
Malaria is the most important endemic parasitic disease in the world. Conditions are favorable for transmission of the disease in 60% of Brazil's territory. Over 500,000 cases per year are recorded in the country. However, the geographic distribution is uneven, which may explain differences in the efficacy and effectiveness of antimalarial drugs. We conducted an extensive literature review of antimalarial treatment in Brazil from 1980 to 2005 in order to identify evidence that might have been available for the 2001 Edition of the Malaria Treatment Manual, the official Ministry of Health guidelines. Only a few studies, of low methodological quality, were identified by the search. None of the studies would have been capable of generating evidence-based guidelines according to the current classification of levels of pharmacological and clinical evidence. Studies published after 2001 drew on more evidence and are expected to provide the basis for the next edition of the manual, due in 2007. References in the 2001 Edition were outdated, possibly perceived as traditional references in the field, but lacking in specificity for region, population, and/or type of malaria.
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