Topic: If Treating Babs & Asian, African, Medit, Mid-Eastern...
CaliforniaLyme
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posted
get tested for G-6-PD!!! See if you have an G-6-PD deficiency because if you DO and take Babs meds you could have a BAD REACTION!!!!!!!!!!!! Doc SCh goes over this in his book on Babesiosis. *************************************************
1: Blood Rev. 1996 Mar;10(1):45-52. Links
G6PD: population genetics and clinical manifestations.
Beutler E. Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA.
The glucose-6-phosphate dehydrogenase (G6PD) gene is X-linked. There are numerous mutations that cause a deficiency of this enzyme in erythrocytes. G6PD deficiency can produce anemia, both when drugs are administered and under the stress induced by infection. Functionally severe variants cause hereditary non-spherocytic hemolytic anemia, i.e. anemia even in the absence of stress. Neonatal jaundice occurs in G6PD deficiency, but it is likely that it is largely due to impairment of liver function, rather than to hemolysis. It has been suggested that there are clinical manifestations of G6PD deficiency that are related to other tissues, but the existence of these is not well documented. Some mutations that produce G6PD deficiency in red cells exist at polymorphic frequencies. Individuals with such mutations seem to have enjoyed a selective advantage because of resistance to falciparum malaria. Different mutations, each characteristic of certain populations, are found, and have been characterized at the deoxyribonucleic acid (DNA) level. G6PD A-(202A376G) is the most common African mutation. G6PD Mediterranean(563T) is found in Southern Europe, the Middle East and in the Indian subcontinent. Several other mutations are common in Asia. Genetic variability of G6PD has played an important role in the understanding of a variety of developmental processes.
PMID: 8861278 SHORT REPORT G6PD gene mutations in India producing drug-induced haemolytic anaemia Sridevi Sukumar, Roshan Colah and Dipika MohantyInstitute of Immunohaematology, KEM Hospital Campus, Parel, Mumbai, India Correspondence: Dr Dipika Mohanty, Director, Institute of Immunohaematology, 13th Floor NMS Building, KEM Hospital Campus, Parel, Mumbai 400 012, India. E-mail: [email protected] Abstract Summary. We report 17 cases of glucose-6-phosphate dehydrogenase (G6PD) deficiency with drug-induced haemolytic anaemia. In most cases the drug involved was an antimalarial. However, we also found two cases in which other drugs could have been responsible for the haemolysis. The degree of severity of haemolysis differed in the individuals and most required multiple transfusions.
This article is cited by: CHUN DENG, CHUN-BAO GUO, YOU-HUA XU, BING DENG AND JIA-LIN YU. (2007) Three mutations analysis of glucose-6-phosphate dehydrogenase deficiency in neonates in South-west China. Pediatrics International 49:4, 463-467 Abstract Abstract and References Full Text Article Full Article PDF S. C. Sharma, S. Sharma, O. P. Gulati. (2003) Pycnogenol� prevents haemolytic injury in G6PD deficient human erythrocytes. Phytotherapy Research 17:6, 671 CrossRef (2002) Current Awareness: Pharmacoepidemiology and Drug Safety. Pharmacoepidemiology and Drug Safety 11:6, 529 CrossRef
-------------------- There is no wealth but life. -John Ruskin
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posted
Primaquine and Quinine are the only Babs meds that require this test. G6PD shouldn't be a problem for the normal meds of Mepron, Zith (or any Macrolide), Artemisinin, or Plaquenil.
Adverse Reactions and Contraindications of Antimalarial Drugs
Drug
Adverse Reactions
Contraindications
AtovaquoneSome Trade Names MEPRON Drug Information -proguanil
GI disturbances, headache, dizziness, pruritus
Hypersensitivity, pregnancy, breastfeeding, severe renal impairment (creatinine clearance 30 mL/min)
Chloroquine phosphate
Chloroquine HCl
HydroxychloroquineSome Trade Names PLAQUENIL Drug Information sulfate
GI disturbances, headaches, dizziness, blurred vision, rashes or pruritus, exacerbation of psoriasis, blood dyscrasias, alopecia, ECG changes, retinopathy, psychosis (rare)
Hypersensitivity, retinal or visual field changes
ClindamycinSome Trade Names CLEOCIN Drug Information
Bad dreams, neuropsychiatric symptoms, dizziness, vertigo, confusion, psychosis, seizures, sinus bradycardia, GI disturbances
Hypersensitivity, history of seizures or psychiatric disorders, drugs that may prolong cardiac conduction (eg, β-blockers, Ca channel blockers, quinine, quinidineSome Trade Names CARDIOQUIN QUINAGLUTE Drug Information , halofantrine) in patients with heart disease, occupations requiring fine coordination and spatial discrimination, pregnancy
Treatment of the acute attack: Chloroquine is the drug of choice against P. malariae, P. ovale, and chloroquine-sensitive P. falciparum and P. vivax. Chloroquine resistance is common among P. falciparum strains throughout endemic areas, with the exception of Central America west of the Panama Canal, Haiti, and the Dominican Republic. Chloroquine resistance is not always complete, but chloroquine should be used only for malaria acquired in areas where Plasmodium sp are known to be sensitive.
Uncomplicated chloroquine-resistant P. falciparum can be treated with atovaquoneSome Trade Names MEPRON Drug Information -proguanil or quinine plus doxycyclineSome Trade Names PERIOSTAT VIBRAMYCIN Drug Information . If the patient is pregnant, quinine plus clindamycinSome Trade Names CLEOCIN Drug Information can be used. Mefloquine at treatment doses is an option, but adverse effects are common. IV quinidineSome Trade Names CARDIOQUIN QUINAGLUTE Drug Information or quinine dihydrochloride is used in patients unable to take oral drugs. These drugs should be used with hemodynamic and ECG monitoring; the infusion is slowed or tlus doxycyclineSome Trade Names PERIOSTAT VIBRAMYCIN Drug Information or with mefloquine.
Curative therapy for hypnozoites: To prevent relapses of P. vivax or P. ovale malaria, the hypnozoite stage must be eliminated from the liver with primaquine. Primaquine may be given simultaneously with chloroquine or afterward. Some P. vivax strains are less sensitive and require repeated treatment with higher doses. Primaquine therapy is not necessary for P. falciparum or P. malariae, because these Plasmodium sp do not have a persistent hepatic phase.
Prevention
Prophylactic antimalarial drugs and insect repellants reduce but do not eliminate risk of malaria. No vaccine is currently available.
Prophylaxis against mosquitoes includes using permethrin- or pyrethrum-containing residual insecticide sprays on clothing or in homes and outbuildings, placing screens on doors and windows, using mosquito netting (preferably impregnated with permethrin or pyrethrum) around beds, using mosquito repellents such as DEET, and wearing protective clothing, especially between dusk and dawn, when Anopheles mosquitoes are active.
Chemoprophylaxis: Regimens and dosing vary by geographic location and patient characteristics (see Table 3: Extraintestinal Protozoa: Prevention of MalariaTables). If exposure to P. vivax or P. ovale was intense or prolonged or the traveler was splenectomized, a 14-day prophylactic course of primaquine phosphate on return helps reduce the risk of recurrence. The major adverse effect is hemolysis in people with G6PD deficiency.
Malaria during pregnancy poses a serious threat to both the mother and fetus. If travel to an endemic area is unavoidable, chemoprophylaxis with at least chloroquine should be given. The safety of mefloquine during pregnancy has not been documented, but limited experience suggests that it may be used when the benefits are judged to outweigh the risks. DoxycyclineSome Trade Names PERIOSTAT VIBRAMYCIN Drug Information , atovaquoneSome Trade Names MEPRON Drug Information -proguanil, and primaquine should not be used during pregnancy.
Last full review/revision November 2005
Content last modified November 2005
Posts: 945 | From U.S | Registered: Oct 2004
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posted
This is kind of scary. We are of Indian descent and my wife just started Mepron. She seems to be fatigued with chest tightness and heavy legs.
What constitutes a bad reaction versus a normal Herx? What are the signs we should look for? Is it for sure only the Quinine drugs that can cause this?
Where can she get tested for G-6-PD?
Posts: 655 | From USA | Registered: Sep 2007
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CaliforniaLyme
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Doc James Sch covers it in his Babs book- you should be able to get the test through your regular doctor- just test for the deficiency of that enzyme- G6PD!!!
This deficiency is also activated negatively by certain other medications including sulfa drugs-
I have heard of this before- the writer Alice Walkers daughter Rebecca mentions in one of her books that she has this deficiency- 10% of African AMericans do= that's a lot!! and varying rates in other populations- you will be- like I AM- allergic to sulfa drugs- and also to fava beans!! It is very intersting to me because I DID have hemolytic anemia when I took Babs meds- I wonder if I have this deficiency myself because I AM allergic to sulfa which could have been through this kind of allergic reaction!!
Is your wife allergic to fava beans or sulfa meds? Those would be red flags for this!!
I am going to get tested- It is a simple blood draw & they test it- any lab can do it- no specialty lab needed!!
Just thought I should raise the alert on what to watch out for- the symptoms are exactly like Babesiosis herxing- but worse-!!! because it causes what Babs does- hemolytic anemia. Those populations listed are the highest risk but it exists in all populations in smaller numbers- high in African & Asian peoples because it is genetically related to malaria exposure supposedly-!! Best wishes all, Sarah
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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Thanks Calif. I guess I'll have her ask for a G6PD test next time she sees her PCP. Was planning on going anyways to ask for a CD57 test.
We've never eaten Fava beans - does Lima count? She's never taken Sulfa drugs that I know of.
I don't think that my wife ever had Malaria, but her mom might. Her mom grew up in rural India, where it's not uncommon to have Malaria at some point.
Posts: 655 | From USA | Registered: Sep 2007
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AliG
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This is a really interesting find, Sarah!
I noticed that it said the deficiency can cause hemolytic anemia "under the stress induced by infection".
I wonder if maybe some people actually have this when they have Babs symptoms with Lyme but test negative for Babs.
This is terrible.
Yanivnaced,
I think I might call the LLMD's office & ask if you need to worry about the possibility of a G-6-PD deficiency with the medication your wife is on.
That way if the Dr wasn't already aware of this, he'll look it up. If he is & you have nothing to worry about, he can put your mind at ease.
I would still think it would be a good thing to be tested for since the stress of infection can also cause hemolytic anemia.
Did your wife test positive for Babs?
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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CaliforniaLyme
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Here, I looked this up in the appendices- the test is called:
If you have LabCorp the test number is 001917 and requires two tubes of whole blood (ew!!)
I actually think I have this- and it is intersting to me because although Norweigian & Scottish & Irish by blood, I lived in India for years of my life and have a history of recurrent malaria. Why do I tihnk I have it???
Even though the populations I listed are particularly suspect for this deficiency- African pops especially at 10% even!!!- all peoples can have it.
When I was 19 years old I was given a sulfa drug for the first time and I was hospitalzed for a week and almost died because it caused a reaction where my red blood cells burst. That is what this does. Exactly. AND when I was on Babs meds I DID GET hemolytic anemia!!!!!!!!!!!!!
BOTH of those things are what WOULD happen if you were or are G-6-PD deficient.
So I am going to get tested myself. QUININE in any form is bad for people with this- AND although certain drugs have been found to set if off ANY malaria drug can do it if you are bad enough. There is a variation of response, some people with this respond a little badly, some respond a LOT badly!!!!!!!!!!!!!!!!!!!!!!!!!!!!
You would NOT respond badly to Mepron but just to quinine type drugs BUT some people with this have been shown to be hypersensitive to other Babs meds as well-
Anyway, it is interesting!!!!!! Best wishes to all, Sarah p.s. I love India, Hyderabad is where I lived when I was little and I am a Hyderabadi at heart- I don't speak Hindi or Urdu anymore but they were two of my first 3 languages- now I just speak one- (although I Do remember simple things like aak do teen char ponch-!*))!*!!!!!!!
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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CaliforniaLyme
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Sukumar S, Mukherjee MB, Colah RB, Mohanty D. Institute of Immunohaematology (ICMR), KEM Hospital Campus, Parel, Mumbai - 400 012, India.
G6PD deficiency has been reported from India more than 30 years ago and about 13 variants have been characterized biochemically.
Here, we report the results of an epidemiological study investigating G6PD deficiency and the mutations among 14 heterogenous populations of India.
Of the 3166 males tested, 332 (10.5%) were found to be G6PD-deficient and the prevalence rate varied from 5.7% to 27.9% in the different population groups.
Molecular characterization revealed that G6PD Mediterranean was the commonest (60.4%) deficient variant followed by G6PD Kerala-Kalyan and G6PD Orissa.
G6PD Mediterranean had a more widespread distribution as compared to G6PD Kerala-Kalyan and G6PD Orissa and was associated with both 1311 C and 1311 T polymorhism.
G6PD Mediterranean was found to have significantly lower red cell enzyme activity and more severe clinical manifestations than the other two.
G6PD Chatham with undetected red cell enzyme activity and G6PD Insuli with normal G6PD activity were very rare in the Indian population.
The absence of a large number of mutations causing G6PD deficiency points to the fact that the genetic diversity of these populations is considerably lowered than expected.
PMID: 15315792
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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CaliforniaLyme
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The importance of this too is that G6PD deficiency can BE CONFUSED WITH BABESIOSIS IT IS CLINICALLY IDENTICAL IN TERMS OF SYMPTOMS AND IS INHERITED.
AND INFECTION- like with LYME_ can SET it OFF.
So you could potentially have SERONEGATIVE BABS clinically but could really be having active G6PD symptoms!!!
Holy. I am seronegative Babs!! Holy! I REALLY want to get tested-
there are different variations of it- some people will hvae mild cases- liek African Americans although higher statistically to have it are STILL often treated with quinine type drugs because their hemolysis is usually transitory and manageable (read in article re G6PD and PCP pneumonia tx with is with same Babs drugs)
but there are types of it which are very severe and so you can guarantee a severe reaction.
better to find out!! get tested!!!
Best wishes, Sarah
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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Symptoms of G6PD Deficiency A child with G6PD deficiency who is exposed to a medication or infection that triggers the destruction of RBCs may have no symptoms at all. In more serious cases, a child may exhibit symptoms of anemia (also known as a hemolytic crisis), including:
paleness (in darker-skinned children paleness is sometimes best seen in the mouth, especially on the lips or tongue) extreme tiredness rapid heartbeat rapid breathing or shortness of breath jaundice, or yellowing of the skin and eyes, particularly in newborns an enlarged spleen dark, tea-colored urine
Posts: 655 | From USA | Registered: Sep 2007
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CaliforniaLyme
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Thank you for posting Y*)!!!! Yup, I am going to get tested too-
1: Mil Med. 2006 Sep;171(9):905-7.Links
Prevalence of glucose-6-phosphate dehydrogenase deficiency in U.S. Army personnel.
Chinevere TD, Murray CK, Grant E Jr, Johnson GA, Duelm F, Hospenthal DR. Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
The U.S. Army recently mandated that soldiers undergo glucose-6-phosphate dehydrogenase (G6PD) testing before deployment to malarious regions.
We retrospectively characterize the presence and degree of G6PD deficiency in U.S. military personnel by sex, self-reported ethnicity, and World Health Organization deficiency classification through test results obtained October 1, 2004 through January 17, 2005.
Data were available for 63,302 (54,874 males and 8,428 females) subjects; 2.5% of males and 1.6% of females were deficient, with most having only moderate enzyme deficiency.
African American males (12.2%) and females (4.1%), along with Asian males (4.3%), had the highest rates of G6PD deficiency.
Most males were found to have class III variants while most females were class IV variants.
The most severely deficient were Asian males (class II).
These results suggest that universal screening for G6PD deficiency is clinically warranted, and particularly essential for those male service members who self-report ethnicity as African American, Asian, or Hispanic.
PMID: 17036616
1: Science. 1964 Sep 4;145:1056-7. Links
ERYTHROCYTE GLUCOSE-6-PHOSPHATE DEHYDROGENASE IN CAUCASIANS: NEW INHERITED VARIANT.
SHOWS TB Jr, TASHIAN RE, BREWER GJ, DERN RJ.
A new inherited variant of glucose-6-phosphate dehydrogenase having both a lowered enzyme activity and an altered electrophoretic mobility was discovered in two unrelated American families, one of Irish and the other of German ancestry.
Family studies of the trait indicate that it is due to a sexlinked gene.
PMID: 14172618
1: J Med Genet. 1980 Jun;17(3):191-3.Links
G6PD (Dublin): chronic non-spherocytic haemolytic anaemia resulting from glucose-6-phosphate dehydrogenase deficiency in an Irish kindred.
McCann SR, Smithwick AM, Temperley IJ, Tipton K.
A new variant of G6PD associated with chronic non-spherocytic haemolytic anaemia (CNSHA) in an Irish male is described.
This variant is unique in that it has a normal electrophoretic mobility, Michaelis constant for G6P and NADP, and a normal pH optimum, together with a marked increase in utilisation of the substrate 2 deoxy glucose-6-phosphate. It is also relatively heat stable when compared with the normal (B) variant.
These characteristics distinguish this variant from previously reported variants associated with CNSHA and we have called it G6PD Dublin.
PMID: 7401130
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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groovy2
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Hi All
Soon I am going to start taking primaduine and chloroquine-- I asked my LLMD about the G6pd test--
She told me that because I had taken Bactrum DS and had no problem with it that I do not have to take the test-
Take care--Jay--
Posts: 2999 | From Austin tx USA | Registered: Oct 2004
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CaliforniaLyme
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That is TRUE Jay- and that is why I want to get etsted- anyone with a sulfa allergy should htink about it-
I took a sulfa drug when I was 19 and almost died- and that would happen if I took Bactrim-!!! Too bad- it is a great drug for Lyme!!!
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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