1. Origins and implications of neglect of G6PD deficiency and primaquine toxicity in Plasmodium vivax malaria
- Author
-
J. Kevin Baird
- Subjects
Anti-relapse therapy ,medicine.medical_specialty ,History ,Primaquine ,media_common.quotation_subject ,030231 tropical medicine ,Plasmodium vivax ,Microbiology ,Neglect ,03 medical and health sciences ,Antimalarials ,0302 clinical medicine ,Pharmacotherapy ,Recurrence ,G6PD deficiency ,parasitic diseases ,medicine ,Malaria, Vivax ,Humans ,030212 general & internal medicine ,Adverse effect ,Intensive care medicine ,media_common ,Withholding Treatment ,biology ,business.industry ,Public Health, Environmental and Occupational Health ,Special Issue Article ,Anemia ,General Medicine ,biology.organism_classification ,medicine.disease ,3. Good health ,Primary Prevention ,Infectious Diseases ,Glucosephosphate Dehydrogenase Deficiency ,Liver ,Immunology ,Parasitology ,Chemical and Drug Induced Liver Injury ,business ,Malaria ,medicine.drug - Abstract
Most of the tens of millions of clinical attacks caused by Plasmodium vivax each year likely originate from dormant liver forms called hypnozoites. We do not systematically attack that reservoir because the only drug available, primaquine, is poorly suited to doing so. Primaquine was licenced for anti-relapse therapy in 1952 and became available despite threatening patients having an inborn deficiency of glucose-6-phosphate dehydrogenase (G6PD) with acute haemolytic anaemia. The standard method for screening G6PD deficiency, the fluorescent spot test, has proved impractical where most malaria patients live. The blind administration of daily primaquine is dangerous, but so too are the relapses invited by withholding treatment. Absent G6PD screening, providers must choose between risking harm by the parasite or its treatment. How did this dilemma escape redress in science, clinical medicine and public health? This review offers critical historic reflection on the neglect of this serious problem in the chemotherapy of P. vivax.
- Published
- 2015