Parasites, Hosts and Diseases

"primaquine"

Original Article

An Evaluation of a New Quantitative Point-of Care Diagnostic to Measure Glucose-6-phosphate Dehydrogenase Activity: Young Yil Bahk, Seong Kyu Ahn, Heung Jin Jeon, Byoung-Kuk Na, Sung-Keun Lee, Ho-Joon Shin; Korean J Parasitol 2022;60(4):281-288.
Published online August 24, 2022; DOI: https://doi.org/10.3347/kjp.2022.60.4.281

Abstract
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Malaria continues to be one of the most crucial infectious burdens in endemic areas worldwide, as well as for travelers visiting malaria transmission regions. It has been reported that 8-aminoquinolines are effective against the Plasmodium species, particularly primaquine, for anti-hypnozoite therapy in P. vivax malaria. However, primaquine causes acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Therefore, G6PD deficiency testing should precede hypnozoite elimination with 8-aminoquinoline. Several point-of-care devices have been developed to detect G6PD deficiency. The aim of the present study was to evaluate the performance of a novel, quantitative G6PD diagnostics based on a metagenomic blue fluorescent protein (mBFP). We comparatively evaluated the sensitivity and specificity of the G6PD diagnostic modality with standard methods using 120 human whole blood samples. The G6PD deficiency was spectrophotometrically confirmed. The performance of the G6PD quantitative test kit was compared with that of a licensed control medical device, the G6PD strip. The G6PD quantitative test kit had a sensitivity of 95% (95% confidence interval (CI): 89.3-100%) and a specificity of 100% (95% CI: 94.3-100%). This study shows that the novel diagnostic G6PD quantitative test kit could be a cost-effective and time-efficient, and universally mandated screening tool for G6PD deficiency.

Citations

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Performance of quantitative point-of-care tests to measure G6PD activity: An individual participant data meta-analysis
Arkasha Sadhewa, Ari Winasti Satyagraha, Mohammad Shafiul Alam, Wondimagegn Adissu, Anup Anvikar, Germana Bancone, Praveen K. Bharti, Vinod K. Bhutani, Santasabuj Das, Muzamil Mahdi Abdel Hamid, Mohammad Sharif Hossain, Nitika Nitika, Bernard A. Okech, Ly
PLOS Neglected Tropical Diseases.2025; 19(3): e0012864. CrossRef
Utilization of Glucose-6-Phosphate Dehydrogenase Test and the Prevalence of Enzyme Deficiency in Korea
Rihwa Choi, Wonseo Park, Gayoung Chun, Sang Gon Lee, Eun Hee Lee
Journal of Clinical Medicine.2023; 12(9): 3179. CrossRef

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Case Report

Four Times of Relapse of Plasmodium vivax Malaria Despite Primaquine Treatment in a Patient with Impaired Cytochrome P450 2D6 Function: Sungim Choi, Heun Choi, Seong Yeon Park, Yee Gyung Kwak, Je Eun Song, So Youn Shin, Ji Hyeon Baek, Hyun-IL Shin, Hong Sang Oh, Yong Chan Kim, Joon-Sup Yeom, Jin-Hee Han, Min Jae Kim; Korean J Parasitol 2022;60(1):39-43.
Published online February 23, 2022; DOI: https://doi.org/10.3347/kjp.2022.60.1.39

Plasmodium vivax exhibits dormant liver-stage parasites, called hypnozoites, which can cause relapse of malaria. The only drug currently used for eliminating hypnozoites is primaquine. The antimalarial properties of primaquine are dependent on the production of oxidized metabolites by the cytochrome P450 isoenzyme 2D6 (CYP2D6). Reduced primaquine metabolism may be related to P. vivax relapses. We describe a case of 4 episodes of recurrence of vivax malaria in a patient with decreased CYP2D6 function. The patient was 52-year-old male with body weight of 52 kg. He received total gastrectomy and splenectomy 7 months before the first episode and was under chemotherapy for the gastric cancer. The first episode occurred in March 2019 and each episode had intervals of 34, 41, and 97 days, respectively. At the first and second episodes, primaquine was administered as 15 mg for 14 days. The primaquine dose was increased with 30 mg for 14 days at the third and fourth episodes. Seven gene sequences of P. vivax were analyzed and revealed totally identical for all the 4 samples. The CYP2D6 genotype was analyzed and intermediate metabolizer phenotype with decreased function was identified.

Citations

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Ellagic Acid from Geranium thunbergii and Antimalarial Activity of Korean Medicinal Plants
Hojong Jun, Joon-Hee Han, Min Hong, Fadhila Fitriana, Jadidan Hada Syahada, Wang-Jong Lee, Ernest Mazigo, Johnsy Mary Louis, Van-Truong Nguyen, Seok Ho Cha, Wanjoo Chun, Won Sun Park, Se Jin Lee, Sunghun Na, Soo-Ung Lee, Eun-Taek Han, Tae-Hyung Kwon, Jin-
Molecules.2025; 30(2): 359. CrossRef
Characteristics of Plasmodium vivax apicomplexan amino acid transporter 8 (PvApiAT8) in the cationic amino acid transport
Wang-Jong Lee, Ernest Mazigo, Jin-Hee Han, Seok Ho Cha
Scientific Reports.2025;[Epub] CrossRef
Efficacy of Primaquine for the Radical Cure of Plasmodium vivax Malaria in Northeast Myanmar and the Impact of Cytochrome P450 2D6 Genotypes
Weilin Zeng, Huaie Liu, Pallavi Malla, Yan Zhao, Lynette Menezes, Yaming Cao, Chengqi Wang, Zhaoqing Yang, Liwang Cui
Clinical Infectious Diseases.2025; 81(2): 379. CrossRef
Evaluation of the antimalarial activity of SAM13-2HCl with morpholine amide (SKM13 derivative) against antimalarial drug-resistant Plasmodium falciparum and Plasmodium berghei infected ICR mice
Hyelee Hong, Kwonmo Moon, Thuy-Tien Thi Trinh, Tae-Hui Eom, Hyun Park, Hak Sung Kim, Seon-Ju Yeo
Parasites, Hosts and Diseases.2024; 62(1): 42. CrossRef
Identification of breeding habitats and kdr mutations in Anopheles spp. in South Korea
Hyelee Hong, Tae-Hui Eom, Thuy-Tien Thi Trinh, Bao Duong Tuan, Hyun Park, Seon-Ju Yeo
Malaria Journal.2023;[Epub] CrossRef
Capecitabine/oxaliplatin/primaquine

Reactions Weekly.2022; 1902(1): 124. CrossRef
Cost-Benefit Analysis of Tafenoquine for Radical Cure of Plasmodium vivax Malaria in Korea
Jiyeon Suh, Jung Ho Kim, Jong-Dae Kim, Changsoo Kim, Jun Yong Choi, Jeehyun Lee, Joon-Sup Yeom
Journal of Korean Medical Science.2022;[Epub] CrossRef
Cytochrome P450 2D6 (CYP2D6) and glucose-6-phosphate dehydrogenase (G6PD) genetic variations in Thai vivax malaria patients: Implications for 8-aminoquinoline radical cure
Kamonwan Chamchoy, Sirapapha Sudsumrit, Thanyapit Thita, Srivicha Krudsood, Rapatbhorn Patrapuvich, Usa Boonyuen, Paul O. Mireji
PLOS Neglected Tropical Diseases.2022; 16(12): e0010986. CrossRef

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Original Articles

A Profile of Glucose-6-Phosphate Dehydrogenase Variants and Deficiency of Multicultural Families in Korea: Young Yil Bahk, Seong Kyu Ahn, Jinyoung Lee, Jae Hyoung Im, Joon-Sup Yeom, Sookkyung Park, Jeongran Kwon, Hyesu Kan, Miyoung Kim, Woori Jang, Tong-Soo Kim; Korean J Parasitol 2021;59(5):447-455.
Published online October 22, 2021; DOI: https://doi.org/10.3347/kjp.2021.59.5.447

Abstract
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Vivax malaria incidence in Korea is now decreased and showing a low plateau. Nowadays, vivax malaria in Korea is expected to be successfully eliminated with anti-malaria chemotherapy, primaquine, and vector control. The glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with potential hemolytic anemia after primaquine administration. This inborn disorder has a pivotal polymorphism with genetic variants and is the most prevalent X-chromosome-linked disorder. The prevalence of G6PD deficiency was previously reported negligible in Korea. As the population of multicultural families pertaining marriage immigrants and their adolescents increases, it is necessary to check G6PD deficiency for them prior to primaquine treatment for vivax malaria. The prevalence of G6PD variants and G6PD deficiency in multicultural families was performed in 7 counties and 2 cities of Jeollanam-do (Province), Gyeonggi-do, and Gangwon-do. A total of 733 blood samples of multicultural family participants were subjected to test the phenotypic and genetic G6PD deficiency status using G6PD enzyme activity quantitation kit and PCR-based G6PD genotyping kit. The G6PD phenotypic deficiency was observed in 7.8% of male adolescent participants and 3.2% of materfamilias population. Based on the PCR-based genotyping, we observed total 35 participants carrying the mutated alleles. It is proposed that primaquine prescription should seriously be considered prior to malaria treatment.

Citations

Citations to this article as recorded by

Glucose-6-phosphate dehydrogenase variants in Kachin, Myanmar
Zin Moon, Ja Moon Aung, Dorene VanBik, Hae Soo Yun, Sanghyun Lee, Sylvatrie-Danne Dinzouna-Boutamba, Zau Ring, Yeonchul Hong, Dong-Il Chung, Youn-Kyoung Goo
Parasites, Hosts and Diseases.2025; 63(4): 360. CrossRef
Georacial Epidemiological Estimates of Glucose-6-Phosphate Dehydrogenase Deficiency among Newborns in the United States
Ramesh Vidavalur, Vinod K. Bhutani
American Journal of Perinatology.2024; 41(S 01): e1841. CrossRef
Suboptimal Doses of Antimalarials Relative to Increasing Body Weight and the Risk of Plasmodium vivax Recurrence in the Republic of Korea Armed Forces, 2012–2021
Young Hoon Hwang, Doran Yoon, Suryeong Go, Joon-Sup Yeom, Hong Sang Oh
Journal of Korean Medical Science.2024;[Epub] CrossRef
Utilization of Glucose-6-Phosphate Dehydrogenase Test and the Prevalence of Enzyme Deficiency in Korea
Rihwa Choi, Wonseo Park, Gayoung Chun, Sang Gon Lee, Eun Hee Lee
Journal of Clinical Medicine.2023; 12(9): 3179. CrossRef
An Evaluation of a New Quantitative Point-of Care Diagnostic to Measure Glucose-6-phosphate Dehydrogenase Activity
Young Yil Bahk, Seong Kyu Ahn, Heung Jin Jeon, Byoung-Kuk Na, Sung-Keun Lee, Ho-Joon Shin
The Korean Journal of Parasitology.2022; 60(4): 281. CrossRef

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121 Download
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Therapeutic Assessment of Primaquine for Radical Cure of Plasmodium vivax Malaria at Primary and Tertiary Care Centres in Southwestern India: Rishikesh Kumar, Vasudeva Guddattu, Kavitha Saravu; Korean J Parasitol 2016;54(6):733-742.
Published online December 31, 2016; DOI: https://doi.org/10.3347/kjp.2016.54.6.733

Abstract
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Acquaintance is scanty on primaquine (PQ) efficacy and Plasmodium vivax recurrence in Udupi district, Karnataka, India. We assessed the efficacy of 14 days PQ regimen (0.25 mg/kg/day) to prevent P. vivax recurrence. Microscopically, aparasitemic adults (≥18 years) after acute vivax malaria on day 28 were re-enrolled into 15 months’ long follow-up study. A peripheral blood smear examination was performed with participants at every 1-2 month interval. A nested PCR test was performed to confirm the mono-infection with P. vivax. Of 114 participants, 28 (24.6%) recurred subsequently. The median (IQR) duration of the first recurrence was 3.1 (2.2-5.8) months which ranged from 1.2 to 15.1 months, including initial 28 days. Participants with history of vivax malaria had significantly higher risk of recurrence, with hazard ratio (HR) (95% CI) of 2.62 (1.24-5.54) (P=0.012). Severity of disease (11.4%, 13/114) was not associated (P=1.00) with recurrence. Of 28 recurrence cases, the nPCR proved that P. vivax mono-infection recurrence rate was at least 72.7% (16/22) at first recurrence. In Udupi district, PQ dose of 0.25 mg/kg/day over 14 days seems inadequate to prevent recurrence in substantial proportion of vivax malaria. Patients with a history of vivax malaria are at high risk of recurrences.

Citations

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Automated reporting of primaquine dose efficacy, tolerability and safety for Plasmodium vivax malaria using a systematic review and individual patient data meta-analysis
Peta Edler, Megha Rajasekhar, David J. Price, Ishag Adam, Ghulam Rahim Awab, Bridget E. Barber, Larissa W. Brasil, Nathália N. Chamma-Siqueira, Cindy S. Chu, Liwang Cui, André Daher, Margarete do Socorro M. Gomes, Lilia Gonzalez-Ceron, Matthew J. Grigg, H
Malaria Journal.2025;[Epub] CrossRef
Plasmodium vivax elimination from India may need therapeutic efficacy studies - Informed shift to Artemisinin-based treatment
Meghavi Kathpalia, Loick P. Kojom Foko, Pragya Rawat, Rini Chaturvedi, Manju Rahi, Amit Sharma
IJID Regions.2025; : 100822. CrossRef
Effectiveness of an Unsupervised Primaquine Regimen for Preventing Plasmodium vivax Malaria Relapses in Northeast Myanmar: A Single-Arm Nonrandomized Observational Study
Pallavi Malla, Zenglei Wang, Awtum Brashear, Zhaoqing Yang, Eugenia Lo, Kevin Baird, Chengqi Wang, Liwang Cui
The Journal of Infectious Diseases.2024; 229(5): 1557. CrossRef
Burden and clinical characteristics of recurrent Plasmodium vivax infections, and impact of primaquine for radical cure: a systematic scoping review in India
Loick Pradel Kojom Foko, Vineeta Singh
Frontiers in Malaria.2024;[Epub] CrossRef
Safety and efficacy of primaquine in patients with Plasmodium vivax malaria from South Asia: a systematic review and individual patient data meta-analysis
Reena Verma, Robert J Commons, Apoorv Gupta, Manju Rahi, Nitika, Praveen K Bharti, Kamala Thriemer, Megha Rajasekhar, Sauman Singh-Phulgenda, Bipin Adhikari, Mohammad Shafiul Alam, Prakash Ghimire, Wasif A Khan, Rishikesh Kumar, Toby Leslie, Benedikt Ley
BMJ Global Health.2023; 8(12): e012675. CrossRef
Recurrence in Plasmodium vivax malaria: a prospective cohort study with long follow-up from a coastal region in South-West India
Divya Gandrala, Nitin Gupta, Alekhya Lavu, Vishnu Teja Nallapati, Vasudeva Guddattu, Kavitha Saravu
F1000Research.2022; 11: 279. CrossRef
Recurrence in Plasmodium vivax malaria: a prospective cohort study with long follow-up from a coastal region in South-West India
Divya Gandrala, Nitin Gupta, Alekhya Lavu, Vishnu Teja Nallapati, Vasudeva Guddattu, Kavitha Saravu
F1000Research.2022; 11: 279. CrossRef
Population Pharmacokinetics of Primaquine in the Korean Population
Woo-Yul Lee, Dong-Woo Chae, Choon-Ok Kim, Sang-Eun Lee, Yee-Gyung Kwak, Joon-Sup Yeom, Kyung-Soo Park
Pharmaceutics.2021; 13(5): 652. CrossRef
Efficacy of Primaquine in Preventing Short- and Long-Latency Plasmodium vivax Relapses in Nepal
Komal Raj Rijal, Bipin Adhikari, Prakash Ghimire, Megha Raj Banjara, Garib Das Thakur, Borimas Hanboonkunupakarn, Mallika Imwong, Kesinee Chotivanich, Nicholas P J Day, Nicholas J White, Sasithon Pukrittayakamee
The Journal of Infectious Diseases.2019; 220(3): 448. CrossRef
A pilot randomized controlled trial to compare the effectiveness of two 14-day primaquine regimens for the radical cure of vivax malaria in South India
Kavitha Saravu, Chaitanya Tellapragada, Shrivathsa Kulavalli, Wilbin Xavier, Shashikiran Umakanth, Gouthami Brahmarouphu, Navyasree Kola Srinivas, Jagadish Puralae Channabasavaiah, Anzil Bava, Abdul Vahab Saadi, Vasudev Guddattu, Kapaettu Satyamoorthy, Kr
Malaria Journal.2018;[Epub] CrossRef

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Case Report

A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole: Sang Min Lee, Yong Kyun Cho, Yon Mi Sung, Dong Hae Chung, Sung Hwan Jeong, Jeong-Woong Park, Sang Pyo Lee; Korean J Parasitol 2015;53(3):321-327.
Published online June 30, 2015; DOI: https://doi.org/10.3347/kjp.2015.53.3.321

Abstract
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A 50-year-old male visited the outpatient clinic and complained of fever, poor oral intake, and weight loss. A chest X-ray demonstrated streaky and fibrotic lesions in both lungs, and chest CT revealed multifocal peribronchial patchy ground-glass opacities with septated cystic lesions in both lungs. Cell counts in the bronchoalveolar lavage fluid revealed lymphocyte-dominant leukocytosis, and further analysis of lymphocyte subsets showed a predominance of cytotoxic T cells and few T helper cells. Video-assisted wedge resection of the left upper lobe was performed, and the histologic examination was indicative of a Pneumocystis jirovecii infection. Trimethoprim-sulfamethoxazole (TMP-SMX) was orally administered for 3 weeks; however, the patient complained of cough, and the pneumonia was aggravated in the follow-up chest X-ray and chest CT. Molecular studies demonstrated mutations at codons 55 and 57 of the dihydropteroate synthase (DHPS) gene, which is associated with the resistance to TMP-SMX. Clindamycin-primaquine was subsequently administered for 3 weeks replacing the TMP-SMX. A follow-up chest X-ray showed that the pneumonia was resolving, and the cough was also alleviated. A positive result of HIV immunoassay and elevated titer of HCV RNA indicated HIV infection as an underlying condition. This case highlights the importance of careful monitoring of patients with P. jirovecii pneumonia (PCP) during the course of treatment, and the molecular study of DHPS mutations. Additionally, altering the anti-PCP drug utilized as treatment must be considered when infection with drug-resistant P. jirovecii is suspected. To the best of our knowledge, this is the first case of TMP-SMX-resistant PCP described in Korea.

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Brief Communications

Appropriate Time for Primaquine Treatment to Reduce Plasmodium falciparum Transmission in Hypoendemic Areas: Polrat Wilairatana, Srivicha Krudsood, Noppadon Tangpukdee; Korean J Parasitol 2010;48(2):179-182.
Published online June 17, 2010; DOI: https://doi.org/10.3347/kjp.2010.48.2.179

Abstract
PDF

Artemesinin-combination therapies (ACT) for falciparum malaria reduce gametocyte carriage, and therefore reduce transmission. Artemisinin derivatives will act against only young gametocytes whereas primaquine acts on mature gametocytes which are present usually in the circulation at the time when the patient presents for treatment. Both artemisinin derivatives and primaquine have short half-lives, less than 1 hr and 7 hr, respectively. Therefore, asexual parasites or young gametocytes remain after completed ACT. A single dose of primaquine (0.50-0.75 mg base/kg) at the end of ACT can kill only mature gametocytes but cannot kill young gametocytes (if present). Remaining asexual forms after completion of ACT course, e.g., artesunate-mefloquine for 3 days, may develop to mature gametocytes 7-15 days later. Thus, an additional dose of primaquine (0.50-0.75 mg base/kg) given 2 weeks after ACT completion may be beneficial for killing remaining mature gametocytes and contribute to more interruption of Plasmodium falciparum transmission than giving only 1 single dose of primaquine just after completing ACT.

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Primaquine Administration after Falciparum Malaria Treatment in Malaria Hypoendemic Areas with High Incidence of Falciparum and Vivax Mixed Infection: Pros and Cons: Polrat Wilairatana, Noppadon Tangpukdee, Shigeyuki Kano, Srivicha Krudsood; Korean J Parasitol 2010;48(2):175-177.
Published online June 17, 2010; DOI: https://doi.org/10.3347/kjp.2010.48.2.175

Abstract
PDF

Mixed infections of Plasmodium falciparum and Plasmodium vivax is high (~30%) in some malaria hypoendemic areas where the patients present with P. falciparum malaria diagnosed by microscopy. Conventional treatment of P. falciparum with concurrent chloroquine and 14 days of primaquine for all falciparum malaria patients may be useful in areas where mixed falciparum and vivax infections are high and common and also with mild or moderate G6PD deficiency in the population even with or without subpatent vivax mixed infection. It will be possibly cost-effective to reduce subsequent vivax illness if the patients have mixed vivax infection. Further study to prove this hypothesis may be warranted.

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Impact of enhanced malaria control on the competition between Plasmodium falciparum and Plasmodium vivax in India
Olivia Prosper, Maia Martcheva
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