Adhikari Bipin, Tripura Rupam, Dysoley Lek, Peto Thomas J, Callery James J, Heng Chhoeun, Vanda Thy, Simvieng Ou, Cassidy-Seyoum Sarah, Thriemer Kamala, Dondorp Arjen M, Ley Benedikt, Seidlein Lorenz von
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
Pathogens. 2023 Mar 1;12(3):400. doi: 10.3390/pathogens12030400.
Vivax malaria can relapse after an initial infection due to dormant liver stages of the parasite. Radical cure can prevent relapses but requires the measurement of glucose-6-phosphate dehydrogenase enzyme (G6PD) activity to identify G6PD-deficient patients at risk of drug-induced haemolysis. In the absence of reliable G6PD testing, vivax patients are denied radical curative treatment in many places, including rural Cambodia. A novel Biosensor, 'G6PD Standard' (SD Biosensor, Republic of Korea; Biosensor), can measure G6PD activity at the point of care. The objectives of this study were to compare the G6PD activity readings using Biosensors by village malaria workers (VMWs) and hospital-based laboratory technicians (LTs), and to compare the G6PD deficiency categorization recommended by the Biosensor manufacturer with categories derived from a locally estimated adjusted male median (AMM) in Kravanh district, Cambodia. Participants were enrolled between 2021 and 2022 in western Cambodia. Each of the 28 VMWs and 5 LTs received a Biosensor and standardized training on its use. The G6PD activities of febrile patients identified in the community were measured by VMWs; in a subset, a second reading was done by LTs. All participants were tested for malaria by rapid diagnostic test (RDT). The adjusted male median (AMM) was calculated from all RDT-negative participants and defined as 100% G6PD activity. VMWs measured activities in 1344 participants. Of that total, 1327 (98.7%) readings were included in the analysis, and 68 of these had a positive RDT result. We calculated 100% activity as 6.4 U/gHb (interquartile range: 4.5 to 7.8); 9.9% (124/1259) of RDT-negative participants had G6PD activities below 30%, 15.2% (191/1259) had activities between 30% and 70%, and 75.0% (944/1259) had activities greater than 70%. Repeat measurements among 114 participants showed a significant correlation of G6PD readings (r = 0.784, < 0.001) between VMWs and LTs. Based on the manufacturer's recommendations, 285 participants (21.5%) had less than 30% activity; however, based on the AMM, 132 participants (10.0%) had less than 30% activity. The G6PD measurements by VMWs and LTs were similar. With the provisions of training, supervision, and monitoring, VMWs could play an important role in the management of vivax malaria, which is critical for the rapid elimination of malaria regionally. Definitions of deficiency based on the manufacturer's recommendations and the population-specific AMM differed significantly, which may warrant revision of these recommendations.
由于疟原虫的休眠肝期，间日疟在初次感染后可能会复发。根治性治疗可以预防复发，但需要检测葡萄糖-6-磷酸脱氢酶（G6PD）的活性，以识别有药物诱导溶血风险的G6PD缺乏患者。在缺乏可靠的G6PD检测的情况下，包括柬埔寨农村地区在内的许多地方，间日疟患者无法接受根治性治疗。一种新型生物传感器“G6PD标准”（韩国SD生物传感器公司；生物传感器）可以在护理点测量G6PD活性。本研究的目的是比较乡村疟疾防治人员（VMW）和医院实验室技术人员（LT）使用生物传感器测得的G6PD活性读数，并比较生物传感器制造商推荐的G6PD缺乏分类与柬埔寨克拉万区根据当地估计的调整后男性中位数（AMM）得出的分类。2021年至2022年期间，在柬埔寨西部招募了参与者。28名VMW和5名LT每人都收到了一个生物传感器，并接受了关于其使用的标准化培训。社区中确诊的发热患者的G6PD活性由VMW测量；在一个子集中，LT进行了第二次读数。所有参与者都通过快速诊断检测（RDT）进行疟疾检测。根据所有RDT阴性参与者计算出调整后男性中位数（AMM），并将其定义为100%的G6PD活性。VMW测量了1344名参与者的活性。其中，1327份（98.7%）读数纳入分析，其中68份RDT结果为阳性。我们将100%活性计算为6.4 U/gHb（四分位间距：4.5至7.8）；9.9%（124/1259）的RDT阴性参与者G6PD活性低于30%，15.2%（191/1259）的活性在30%至70%之间，75.0%（944/1259）的活性大于70%。114名参与者的重复测量显示，VMW和LT之间的G6PD读数存在显著相关性（r = 0.784，<0.001）。根据制造商的建议，285名参与者（21.5%）活性低于30%；然而，根据AMM，132名参与者（10.0%）活性低于30%。VMW和LT的G6PD测量结果相似。通过提供培训、监督和监测，VMW可以在间日疟的管理中发挥重要作用，这对于在区域内快速消除疟疾至关重要。基于制造商建议和特定人群AMM的缺乏定义存在显著差异，这可能需要修订这些建议。
