Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among malaria patients in Upper Myanmar

Abstract

Background: Glucose-6-phosphate dehydrogenase (G6PD; EC 1.1.1.49) deficiency is one of the most common X-linked recessive hereditary disorders in the world. Primaquine (PQ) has been used for radical cure of P. vivax to prevent relapse. Recently, it is also used to reduce P. falciparum gametocyte carriage to block transmission. However, PQ metabolites oxidize hemoglobin and generate excessive reactive oxygen species which can trigger acute hemolytic anemia in malaria patients with inherited G6PD deficiency.

Methods: A total of 252 blood samples collected from malaria patients in Myanmar were used in this study. G6PD variant was analysed by a multiplex allele specific PCR kit, DiaPlexC™ G6PD Genotyping Kit [Asian type]. The accuracy of the multiplex allele specific PCR was confirmed by sequencing analysis.

Results: Prevalence and distribution of G6PD variants in 252 malaria patients in Myanmar were analysed. Six different types of G6PD allelic variants were identified in 50 (7 females and 43 males) malaria patients. The predominant variant was Mahidol (68%, 34/50), of which 91.2% (31/34) and 8.8% (3/34) were males and females, respectively. Other G6PD variants including Kaiping (18%, 9/50), Viangchan (6%, 3/50), Mediterranean (4%, 2/50), Union (2%, 1/50) and Canton (2%, 1/50) were also observed.

Conclusions: Results of this study suggest that more concern for proper and safe use of PQ as a radical cure of malaria in Myanmar is needed by combining G6PD deficiency test before PQ prescription. Establishment of a follow-up system to monitor potential PQ toxicity in malaria patients who are given PQ is also required.

Keywords: G6PD deficiency; Glucose-6-phosphate dehydrogenase (G6PD); Malaria; Myanmar; Primaquine.

Fig. 1

G6PD multiplex allele specific PCR. G6PD variants in 252 Myanmar malaria patients were analyzed by multiplex allele specific PCR. Six different types of G6PD variants were identified in 50 malaria patients (19.8%): Mahidol (487 G > A, 337 bp), Mediterranean (563 C > T, 262 bp), Viangchan (871 G > A, 501 bp), Union (1360 C > T, 803 bp), Canton (1376 G > T, 681 bp) and Kaiping (1388 G > A, 557 bp). Representative PCR results for G6PD variants are presented. Each PCR reaction was confirmed by an internal control (wild type G6PD control, 1234 bp) following the manufacturer’s instruction. The results presented in this figure were obtained in male malaria patients except for Canton

Fig. 2

Schematic diagram of G6PD variants in Myanmar malaria patients. The 50 G6PD variants identified by multiplex allele specific PCR were confirmed by sequencing analysis