Nascimento Joabi Rocha, Brito-Sousa Jose Diego, Almeida Anne Cristine Gomes, Melo Marly M, Costa Monica Regina Farias, Barbosa Laila Rowena Albuquerque, Ramos Reinaldo Nery, Silva-Neto Alexandre Vilhena, Balieiro Patricia Carvalho da Silva, Figueiredo Erick Frota Gomes, Silva Emanuelle Lira, Baia-da-Silva Djane Clarys, Bassat Quique, Romero Gustavo, Melo Gisely Cardoso, Sampaio Vanderson Souza, Lacerda Marcus, Monteiro Wuelton
Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira 25 , Manaus, Amazonas CEP 69040-000, Brazil.
Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil.
Lancet Reg Health Am. 2022 May 26;12:100273. doi: 10.1016/j.lana.2022.100273. eCollection 2022 Aug.
Difficulties associated with the assessment of glucose-6-phosphate dehydrogenase deficiency (G6PDd), particularly in remote areas, hinders the safe use of 8-aminoquinolines such as primaquine (PQ) and tafenoquine against malaria due to the risk of haemolysis.
This cross-sectional study was conducted in 41 malaria-endemic municipalities of six states in the Brazilian Amazon, between 2014 and 2018. Male individuals were screened for G6PDd using the qualitative Fluorescent Spot Test using fingerpick-collected whole blood samples. Point and interval estimates of the G6PDd prevalence were calculated for each state. Deficient samples were genotyped for the most prevalent variants in the Amazon. Frequencies of malaria recurrences were estimated for G6PDd and non-G6PDd patients.
This is one of the largest surveys ever conducted in Latin America, covering the entire malaria endemic area in the Brazilian Amazon. These results indicate that an important proportion of the population is at risk of hemolysis if exposed to PQ and its congener drug tafenoquine. The adoption of G6PDd screening protocols is essential to ensure the safety of individuals treated with those drugs and should also be considered when implementing malaria elimination strategies.
A total of 14,847 individuals were included, of which 5.6% presented G6PDd. The state of Acre had the highest G6PDd prevalence (8.3%), followed by Amapá (5.8%), Pará (5.7%), Rondônia (5.4%), Roraima (4.2%) and Amazonas (4.0%). From 828 genotyped samples, African A (6.2%), African A (39.3%) and wild-type (non-African non-Mediterranean; 54.2%) variants were found. A greater proportion of malaria recurrences was found among G6PD deficient individuals [16.7% vs 4.1%, Risk ratio 3.52 (2.16-5.74) < 0.01].
Brazilian Ministry of Health; Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM).
葡萄糖-6-磷酸脱氢酶缺乏症（G6PDd）的评估存在困难，尤其是在偏远地区，这阻碍了诸如伯氨喹（PQ）和tafenoquine等8-氨基喹啉类药物因溶血风险而安全用于抗疟疾治疗。
这项横断面研究于2014年至2018年期间在巴西亚马逊地区六个州的41个疟疾流行市进行。使用定性荧光斑点试验，对男性个体采用手指采血采集的全血样本进行G6PDd筛查。计算每个州G6PDd患病率的点估计值和区间估计值。对缺乏样本进行基因分型，以确定亚马逊地区最常见的变异体。估计G6PDd患者和非G6PDd患者的疟疾复发频率。
这是拉丁美洲有史以来规模最大的调查之一，覆盖了巴西亚马逊地区的整个疟疾流行区。这些结果表明，如果接触PQ及其同类药物tafenoquine，相当一部分人群有溶血风险。采用G6PDd筛查方案对于确保接受这些药物治疗的个体的安全至关重要，在实施疟疾消除策略时也应予以考虑。
共纳入14847名个体，其中5.6%患有G6PDd。阿克里州的G6PDd患病率最高（8.3%），其次是阿马帕州（5.8%）、帕拉州（5.7%）、朗多尼亚州（5.4%）、罗赖马州（4.2%）和亚马逊州（4.0%）。在828份基因分型样本中，发现了非洲A（6.2%）、非洲A（39.3%）和野生型（非非洲非地中海型；54.2%）变异体。G6PD缺乏个体中疟疾复发的比例更高[16.7%对4.1%，风险比3.52（2.16 - 5.74）<0.01]。
巴西卫生部；亚马逊州研究资助基金会（FAPEAM）。
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