Vivax malaria in pregnancy and lactation: a long way to health equity.
Adolescent
Aminoquinolines
/ therapeutic use
Anemia
/ drug therapy
Antimalarials
/ therapeutic use
Artemether, Lumefantrine Drug Combination
/ therapeutic use
Female
Fetal Growth Retardation
/ etiology
Glucosephosphate Dehydrogenase Deficiency
/ diagnosis
Health Equity
/ statistics & numerical data
Humans
Infant, Small for Gestational Age
Lactation Disorders
/ etiology
Malaria, Vivax
/ drug therapy
Pregnancy
Pregnancy Complications, Parasitic
/ drug therapy
Pregnancy Outcome
Primaquine
/ therapeutic use
Equity
G6PD deficiency
Plasmodium vivax
Primaquine
Radical cure
Journal
Malaria journal
ISSN: 1475-2875
Titre abrégé: Malar J
Pays: England
ID NLM: 101139802
Informations de publication
Date de publication:
22 Jan 2020
22 Jan 2020
Historique:
received:
17
12
2019
accepted:
13
01
2020
entrez:
24
1
2020
pubmed:
24
1
2020
medline:
8
9
2020
Statut:
epublish
Résumé
The Sustainable Development Goals (SDG) call for increased gender equity and reduction in malaria-related mortality and morbidity. Plasmodium vivax infections in pregnancy are associated with maternal anaemia and increased adverse perinatal outcomes. Providing radical cure for women with 8-aminoquinolines (e.g., primaquine) is hindered by gender-specific complexities. A symptomatic episode of vivax malaria at 18 weeks of gestation in a primigravid woman was associated with maternal anaemia, a recurrent asymptomatic P. vivax episode, severe intra-uterine growth restriction with no other identifiable cause and induction to reduce the risk of stillbirth. At 5 months postpartum a qualitative glucose-6-phosphate dehydrogenase (G6PD) point-of-care test was normal and radical cure with primaquine was prescribed to the mother. A 33% fractional decrease in haematocrit on day 7 of primaquine led to further testing which showed intermediate phenotypic G6PD activity; the G6PD genotype could not be identified. Her infant daughter was well throughout maternal treatment and found to be heterozygous for Mahidol variant. Adverse effects of vivax malaria in pregnancy, ineligibility of radical cure for pregnant and postpartum women, and difficulties in diagnosing intermediate levels of G6PD activity multiplied morbidity in this woman. Steps towards meeting the SDG include prevention of malaria in pregnancy, reducing unnecessary exclusion of women from radical cure, and accessible quantitative G6PD screening in P. vivax-endemic settings.
Sections du résumé
BACKGROUND
BACKGROUND
The Sustainable Development Goals (SDG) call for increased gender equity and reduction in malaria-related mortality and morbidity. Plasmodium vivax infections in pregnancy are associated with maternal anaemia and increased adverse perinatal outcomes. Providing radical cure for women with 8-aminoquinolines (e.g., primaquine) is hindered by gender-specific complexities.
CASE PRESENTATION
METHODS
A symptomatic episode of vivax malaria at 18 weeks of gestation in a primigravid woman was associated with maternal anaemia, a recurrent asymptomatic P. vivax episode, severe intra-uterine growth restriction with no other identifiable cause and induction to reduce the risk of stillbirth. At 5 months postpartum a qualitative glucose-6-phosphate dehydrogenase (G6PD) point-of-care test was normal and radical cure with primaquine was prescribed to the mother. A 33% fractional decrease in haematocrit on day 7 of primaquine led to further testing which showed intermediate phenotypic G6PD activity; the G6PD genotype could not be identified. Her infant daughter was well throughout maternal treatment and found to be heterozygous for Mahidol variant.
CONCLUSION
CONCLUSIONS
Adverse effects of vivax malaria in pregnancy, ineligibility of radical cure for pregnant and postpartum women, and difficulties in diagnosing intermediate levels of G6PD activity multiplied morbidity in this woman. Steps towards meeting the SDG include prevention of malaria in pregnancy, reducing unnecessary exclusion of women from radical cure, and accessible quantitative G6PD screening in P. vivax-endemic settings.
Identifiants
pubmed: 31969155
doi: 10.1186/s12936-020-3123-1
pii: 10.1186/s12936-020-3123-1
pmc: PMC6977346
doi:
Substances chimiques
Aminoquinolines
0
Antimalarials
0
Artemether, Lumefantrine Drug Combination
0
Primaquine
MVR3634GX1
8-aminoquinoline
U34EAV21TG
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
40Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
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