Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function
Abstract Background Plasmodium vivax malaria is characterized by the presence of dormant liver-stage parasites, called hypnozoites, which can cause malaria relapses after an initial attack. Primaquine, which targets liver hypnozoites, must be used in combination with a schizonticidal agent to get th...
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ftdoajarticles:oai:doaj.org/article:17759ba5dac54973b30ab68c4112c01c 2023-05-15T15:18:12+02:00 Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function Alexandra Martin Ramírez Carlos Lombardia González Tamara Soler Maniega Ángela Gutierrez Liarte Diego Domingo García Marta Lanza Suárez María Josefa Bernal Fernández José Miguel Rubio 2020-07-01T00:00:00Z https://doi.org/10.1186/s12936-020-03326-1 https://doaj.org/article/17759ba5dac54973b30ab68c4112c01c EN eng BMC http://link.springer.com/article/10.1186/s12936-020-03326-1 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-020-03326-1 1475-2875 https://doaj.org/article/17759ba5dac54973b30ab68c4112c01c Malaria Journal, Vol 19, Iss 1, Pp 1-7 (2020) Plasmodium vivax Malaria Relapse CYP2D6 Primaquine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2020 ftdoajarticles https://doi.org/10.1186/s12936-020-03326-1 2022-12-31T04:17:16Z Abstract Background Plasmodium vivax malaria is characterized by the presence of dormant liver-stage parasites, called hypnozoites, which can cause malaria relapses after an initial attack. Primaquine, which targets liver hypnozoites, must be used in combination with a schizonticidal agent to get the radical cure. However, relapses can sometimes occur in spite of correct treatment, due to different factors such as a diminished metabolization of primaquine. Case presentation In January 2019, a 21 years old woman with residence in Madrid, returning from a trip to Venezuela with clinical symptoms compatible with malaria infection, was diagnosed with vivax malaria. Chloroquine for 3 days plus primaquine for 14 days was the elected treatment. Two months later and after a second trip to Venezuela, the patient presented a second P. vivax infection, which was treated as the previous one. A third P. vivax malaria episode was diagnosed 2 months later, after returning from a trip to Morocco, receiving chloroquine for 3 days but increasing to 28 days the primaquine regimen, and with no more relapses after 6 months of follow up. The genotyping of P. vivax in the three malaria episodes revealed that the same strain was present in the different relapses. Upon confirmation of correct adherence to the treatment, non-description of resistance in the infection area and the highly unlikely re-infection on subsequent trips or stays in Spain, a possible metabolic failure was considered. CYP2D6 encodes the human cytochrome P450 isoenzyme 2D6 (CYP2D6), responsible for primaquine activation. The patient was found to have a CYP2D6*4/*1 genotype, which turns out in an intermediate metabolizer phenotype, which has been related to P. vivax relapses. Conclusions The impairment in CYP2D6 enzyme could be the most likely cause of P. vivax relapses in this patient. This highlights the importance of considering the analysis of CYP2D6 gene polymorphisms in cases of P. vivax relapses after a correct treatment and, especially, it should be ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 19 1 |
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ftdoajarticles |
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English |
topic |
Plasmodium vivax Malaria Relapse CYP2D6 Primaquine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
spellingShingle |
Plasmodium vivax Malaria Relapse CYP2D6 Primaquine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Alexandra Martin Ramírez Carlos Lombardia González Tamara Soler Maniega Ángela Gutierrez Liarte Diego Domingo García Marta Lanza Suárez María Josefa Bernal Fernández José Miguel Rubio Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function |
topic_facet |
Plasmodium vivax Malaria Relapse CYP2D6 Primaquine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background Plasmodium vivax malaria is characterized by the presence of dormant liver-stage parasites, called hypnozoites, which can cause malaria relapses after an initial attack. Primaquine, which targets liver hypnozoites, must be used in combination with a schizonticidal agent to get the radical cure. However, relapses can sometimes occur in spite of correct treatment, due to different factors such as a diminished metabolization of primaquine. Case presentation In January 2019, a 21 years old woman with residence in Madrid, returning from a trip to Venezuela with clinical symptoms compatible with malaria infection, was diagnosed with vivax malaria. Chloroquine for 3 days plus primaquine for 14 days was the elected treatment. Two months later and after a second trip to Venezuela, the patient presented a second P. vivax infection, which was treated as the previous one. A third P. vivax malaria episode was diagnosed 2 months later, after returning from a trip to Morocco, receiving chloroquine for 3 days but increasing to 28 days the primaquine regimen, and with no more relapses after 6 months of follow up. The genotyping of P. vivax in the three malaria episodes revealed that the same strain was present in the different relapses. Upon confirmation of correct adherence to the treatment, non-description of resistance in the infection area and the highly unlikely re-infection on subsequent trips or stays in Spain, a possible metabolic failure was considered. CYP2D6 encodes the human cytochrome P450 isoenzyme 2D6 (CYP2D6), responsible for primaquine activation. The patient was found to have a CYP2D6*4/*1 genotype, which turns out in an intermediate metabolizer phenotype, which has been related to P. vivax relapses. Conclusions The impairment in CYP2D6 enzyme could be the most likely cause of P. vivax relapses in this patient. This highlights the importance of considering the analysis of CYP2D6 gene polymorphisms in cases of P. vivax relapses after a correct treatment and, especially, it should be ... |
format |
Article in Journal/Newspaper |
author |
Alexandra Martin Ramírez Carlos Lombardia González Tamara Soler Maniega Ángela Gutierrez Liarte Diego Domingo García Marta Lanza Suárez María Josefa Bernal Fernández José Miguel Rubio |
author_facet |
Alexandra Martin Ramírez Carlos Lombardia González Tamara Soler Maniega Ángela Gutierrez Liarte Diego Domingo García Marta Lanza Suárez María Josefa Bernal Fernández José Miguel Rubio |
author_sort |
Alexandra Martin Ramírez |
title |
Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function |
title_short |
Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function |
title_full |
Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function |
title_fullStr |
Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function |
title_full_unstemmed |
Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function |
title_sort |
several plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome p450 2d6 function |
publisher |
BMC |
publishDate |
2020 |
url |
https://doi.org/10.1186/s12936-020-03326-1 https://doaj.org/article/17759ba5dac54973b30ab68c4112c01c |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 19, Iss 1, Pp 1-7 (2020) |
op_relation |
http://link.springer.com/article/10.1186/s12936-020-03326-1 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-020-03326-1 1475-2875 https://doaj.org/article/17759ba5dac54973b30ab68c4112c01c |
op_doi |
https://doi.org/10.1186/s12936-020-03326-1 |
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Malaria Journal |
container_volume |
19 |
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1 |
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1766348425254666240 |