Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens: a workshop report

Malaria Journal

Review

Dennis Shanks¹  Qin Cheng¹  Kevin Baird²  Ari Winasti-Satyahraha²  Justin Green³  Sarah Auburn⁴  Lorenz von Seidlein⁴  Ric Price⁵  Didier Ménard⁶  Gonzalo Domingo⁷  James McCarthy⁸  Fe Espino⁹  Germana Bancone^1,10  Catherine Moyes^1,11  Rosalind Howes^1,11  Shunmay Yeung^1,12  Lasse S Vestergaard^1,13 

[1] Australian Army Malaria Institute, Enoggera, Australia;Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia;GlaxoSmithKline, Stockley Park, Uxbridge, UK;Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia;Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia;Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Institut Pasteur of Cambodia, Phnom Penh, Cambodia;PATH, Seattle, SE, USA;Queensland Institute of Medical Research, University of Queensland, 300 Herston Road, 4006, Herston, Brisbane, Queensland, Australia;Research Institute for Tropical Medicine, Manila, Philippines;Shoklo Malaria Research Unit, Mae Sot, Thailand;Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford, Oxford, UK;The Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand;WHO/WPRO, Manila, Philippines;

关键词: Malaria;    Vivax;    Falciparum;    8-aminoquinolines;    Primaquine;    Tafenoquine;    G6PD;    Deficiency;    Diagnostic tests;   

DOI  :  10.1186/1475-2875-12-112

 received in 2013-02-07, accepted in 2013-03-14,  发布年份 2013

来源: Springer

【 摘 要 】

The diagnosis and management of glucose-6-phosphate dehydrogenase (G6PD) deficiency is a crucial aspect in the current phases of malaria control and elimination, which will require the wider use of 8-aminoquinolines for both reducing Plasmodium falciparum transmission and achieving the radical cure of Plasmodium vivax. 8-aminoquinolines, such as primaquine, can induce severe haemolysis in G6PD-deficient individuals, potentially creating significant morbidity and undermining confidence in 8-aminoquinoline prescription. On the other hand, erring on the side of safety and excluding large numbers of people with unconfirmed G6PD deficiency from treatment with 8-aminoquinolines will diminish the impact of these drugs. Estimating the remaining G6PD enzyme activity is the most direct, accessible, and reliable assessment of the phenotype and remains the gold standard for the diagnosis of patients who could be harmed by the administration of primaquine. Genotyping seems an unambiguous technique, but its use is limited by cost and the large range of recognized G6PD genotypes. A number of enzyme activity assays diagnose G6PD deficiency, but they require a cold chain, specialized equipment, and laboratory skills. These assays are impractical for care delivery where most patients with malaria live. Improvements to the diagnosis of G6PD deficiency are required for the broader and safer use of 8-aminoquinolines to kill hypnozoites, while lower doses of primaquine may be safely used to kill gametocytes without testing. The discussions and conclusions of a workshop conducted in Incheon, Korea in May 2012 to review key knowledge gaps in G6PD deficiency are reported here.

【 授权许可】

CC BY   
© von Seidlein et al.; licensee BioMed Central Ltd. 2013