Four Times of Relapse of Plasmodium vivax Malaria Despite Primaquine Treatment in a Patient with Impaired Cytochrome P450 2D6 Function
Year: 2022
Type: article
Study design: Case Report
Abstract: 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.
Source: Korean Journal of Parasitology
Institutions: Dongguk University Ilsan Hospital, National Health Insurance Service Ilsan Hospital, Inje University Ilsan Paik Hospital, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University, Inha University, Inha University Hospital, Korea Disease Control and Prevention Agency, Armed Forces Capital Hospital, Yonsei University, Yongin Severance Hospital, Kangwon National University, Asan Medical Center, University of Ulsan
Language: English
Topic: Malaria Research and Control
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4214607289