Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

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 (L...

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Published in:	Malaria journal Vol. 13; no. 1; p. 70
Main Authors:	Monteiro, Wuelton M, Franca, Gabriel P, Melo, Gisely C, Queiroz, Amanda L M, Brito, Marcelo, Peixoto, Henry M, Oliveira, Maria Regina F, Romero, Gustavo A S, Bassat, Quique, Lacerda, Marcus V G
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 25-02-2014 BioMed Central
Subjects:	Anemia Care and treatment Caribbean Region - epidemiology Complications and side effects Dehydrogenases Disease Eradication Drug dosages Glucose Glucosephosphate Dehydrogenase Deficiency - epidemiology Hemolysis Humans Latin America - epidemiology Malaria Malaria, Vivax - drug therapy Malaria, Vivax - epidemiology Malaria, Vivax - pathology Medical research Population Primaquine Primaquine - adverse effects Primaquine - therapeutic use Technological change Caribbean Region Latin America Colombia ASW, Caribbean Sea
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1475-2875 1475-2875
DOI:	10.1186/1475-2875-13-70