Deficiency malaria

Glucose- 6-phosphate dehydrogenase Low or absent enzyme activity in about 10% of African populations. Hemolysis following intake of a number of drugs which have electrophilic reactive metabolites, but also, carriers of this enzyme deficiency have a partial protection from malaria. 

When advising potential travelers on prophylaxis for malaria, be aware of the incidence of chloroquine-resistant P. falciparum malaria and the countries where it is prevalent. In patients who have P. vivax or P. ovale malaria (note that some patients can have P. falciparum and one of these species), following the treatment of the acute phase of malaria and screening for glucose-6-phosphate dehydrogenase deficiency, patients should receive a regimen of primaquine for 14 days to ensure eradication of the hypnozoite stage of P. vivax or P. ovale. For detailed recommendations for prevention of malaria go to www.cdc.gov/travel/. 

G2. Ganczakowski, M., Town, M., Bowden, D. K Vulliamy, T. J., Kaneko, A., Clegg, J. B., Weatherall, D. J., and Luzzatto, L Multiple glucose 6-phosphate dehydrogenase-deficient variants correlate with malaria endemicity in the Vanuatu archipelago (southwestern Pacific). Am. J. Hum. Genet. 56,294-301 (1995). 

Iron-deficiency anaemia results from a discrepancy between iron availability and the amount required for production of red blood cells. The causes of acquired iron deficiency in so-called underdeveloped and developed countries must be differentiated. In underdeveloped countries, the main causes of iron deficiency are (a) the poor availability of iron in the diet due to low haem and high fibre and phytate content (D Souza et ah, 1987), and (b) chronic blood loss due to hookworm, schistosomiasis and malaria (Stoltzfus et ah, 1997 Olsen et ah, 1998 Dreyfuss et ah, 2000). Inflammation and vitamin A deficiency often interfere with the above causes of iron deficiency, causing a mixed type of anaemia. In underdeveloped countries diet improvement, iron fortification of natural foods and eradication of parasites will have a much higher impact than will refinement of diagnostic procedures and therapy of iron-deficiency anaemia. 

The endemic presence of malaria in subequatorial Africa, where up to 25% of males are G6PD-deficient, is associated with G6PD deficiency because the malaria protozoan is less viable in RBCs with increased oxidative stress. 

I Contraindications Hypersensitivity to pyrimethamine, megaloblastic anemia due to folate deficiency, monotherapy for freafmenf of acufe malaria. 

Deficiency of the first enzyme of the pentose phosphate pathway, glucose 6-phosphate dehydrogenase, is widespread.11 Its geographical distribution suggests that, like the sickle-cell trait, it confers some resistance to malaria. A partial deficiency of 6-phosphogluconolactonase (Eq. 17-12, step b) has also been detected within a family and may have contributed to the observed hemolytic anemia.1... 

Min-Oo, G., Fortin, A., Tam, M.F., Nantel, A., Stevenson, M.M. and Cros, P. (2003) Pyruvate kinase deficiency in mice protects against malaria. Nature Genetics 35, 357-362. 

Jalloh A, Tantular IS, Pusarawati S, et al. Rapid epidemiologic assessment of glucose-6-phosphate dehydrogenase deficiency in malaria-endemic areas in Southeast Asia using a novel diagnostic kit. Trap Med Int Health. 2004 9 615-623. 

The interest in oxines has now moved from antimicrobial therapy to nuclear medicine and the chemotherapy of malaria. A few other applications have also been found 5,7-diiodo-oxinate enhances gastrointestinal uptake of zinc, an element whose deficiency may cause acrodermatis enteropathica1905 several halogenated oxines - 5-chloro-7-iodooxine (Entero-Vioform), 5,7-diiodooxine (Diodoquin) - have been used in the treatment of amoebic dysentry but this is now a discontinued therapy. 5-Methyloxine has proved an effective therapy in the treatment of cholera in humans191,1925. 

Not very long after the discovery of the deficiency of isoniazid acetylation, it turned out that the frequency of this phenotypic fault also differed much between the world s populations (47). Today, the reason for this particular interethnic variability is still unknown an influence of geographical latitude and climate is suspected. Such scientific uncertainty is common in this field of research, and it contrasts with the clear-cut findings relating malaria resistance and G-6-PD deficiency (see below). 

However, the mechanism of the malaria protection is complex (64). It probably involves a sufficient survival time of particularly the malaria-infected heterozygous infant girls to allow them to develop immunological defences against malaria. This could mean that after puberty, their better state of health might render them more fertile than their less protected sisters. Since the occurrence of G-6-PD deficiency, of sickle cell anemia,... 

Piguet PF, Da-Laperrousaz C, Vesin C et al. (2000) Delayed mortality and attenuated thrombocytopenia associated with severe malaria in urokinase- and urokinase receptor-deficient mice. Infect Immun 68 3822-3829... 

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