Fundação de Medicina Tropical Dr, Heitor Vieira Dourado (FMT-HVD), Av, Pedro Teixeira, 25, Dom Pedro, Manaus, AM 69040-000, Brazil.
Malar J. 2014 Feb 25;13:70. doi: 10.1186/1475-2875-13-70.
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.
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.
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.
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.
尽管 G6PDd 个体在其一生中通常无症状，但这种遗传状况的临床负担包括一系列血液学状况，包括急性溶血性贫血（AHA）、新生儿黄疸（NNJ）和慢性非球形细胞性贫血（CNSA）。在拉丁美洲（LA），对 G6PDd 的巨大知识差距与对 G6PDd 携带的临床表现负担的理解甚少有关。这项工作的目的是通过系统评价研究 LA 和加勒比地区 G6PDd 的临床意义。
于 2013 年 8 月进行了已发表文献的系统搜索。还搜索了手稿的参考文献，并确定了其他参考文献。仅包括原始研究。只要有任何临床信息，所有研究设计都包括在内。如果研究报告了居住在 LA 或加勒比国家的人群或居住在该大陆以外国家的这些国家移民的临床信息，则符合纳入标准。
Medline 搜索产生了 487 篇论文，LILACS 搜索确定了 140 篇论文。应用纳入标准后，检索到 100 篇有任何关于 LA 中 G6PDd 的临床信息的原始论文。此外，在阅读这些论文的参考文献后，还纳入了 16 篇文章。这些 116 篇文章报道了来自 18 个 LA 和加勒比国家的数据。从 LA 国家报告的主要临床表现是与 AHA 相关的那些，即药物诱导的溶血性贫血。关于 LA 中药物诱导溶血性贫血的大多数已发表的工作都提到了在用伯氨喹（PQ）治疗间日疟原虫疟疾患者时发生的溶血性危机。蚕豆病、感染诱导的溶血性贫血、NNJ 和 CNSA 在该大陆似乎只起次要的公共卫生作用。
PQ 使用者中的溶血似乎是 LA 中 G6PDd 的主要临床表现，并导致该大陆间日疟感染的发病率增加，尽管报告的病例数较少，这可能与并发症报告不足有关。这些结果支持在疟疾现场条件下诊断和管理 G6PDd 的更好策略的必要性。此外，LA 的疟疾控制计划不应在其国家指南中忽视这种情况。
