G6PD Deficiency has been said to provide resistance against malaria infection. This concept was first examined after scientists noticed a similarity between areas of the world where G6PD Deficiency is prevalent and malaria infested areas. It has even been suggested that the G6PDD gene mutation is nature’s way of providing the body with resistance against the parasite. This hypothesis is understandable since the discovery of G6PDD as a genetic disorder was partially fueled by the reaction of G6PDD patients to antimalarials such as primaquine and quinine. Unfortunately, there is no conclusive clinical evidence that G6PDD patients are protected against malaria infection.
How Malaria Works
Malaria is transmitted to humans by infected mosquitoes where it incubates in the liver. This can sometimes take years. The malaria parasites are then released into the blood stream where they infect red blood cells. The parasites then grow and replicate in the red blood cell for 10 to 14 days until the RBC bursts. When this happens, several poisons are released into the blood stream which causes the high fever, chills and sweats.
Effects of G6PDD
Malaria parasites cannot thrive in immature red blood cells. Because hemolysis affects mature red blood cells more readily there are fewer of them to host malaria parasites. When an infected RBC dies before the parasite is ready, the malaria parasite dies as well and it does not have the chance to produce the poisons. Because of this the typical symptoms do not usually manifest themselves in G6PD Deficient patients. Atypical symptoms could make malaria more difficult to diagnose and account for the belief that it is less prevalent in G6PD Deficient patients. Malaria can still sequester in the liver however. The dangerous part is that a person can die or become very ill from hemolysis and G6PDD patients cannot take antimalarials. All of the antimalarials listed by the CDC are contraindicated except Doxycycline, which cannot be taken by pregnant women or children under the age of eight. People must limit their sun exposure while on the drug as well.
When visiting malaria-endemic areas, take the following precautions described in the CDC link below:
Use natural repellents and insecticides on outside of clothing and avoid contact with skin as much as possible. Use light applications and allow clothing to dry before use. Avoid deet, petrochemicals and chemicals derived from petrochemicals. Use of aerosols is not recommended.
It would be best to try repellents in small amounts before visiting malaria-endemic areas to make sure hemolysis does not occur from their use.
A letter from Dr. Ogundu
G6pdd conferring immunity against malaria is a myth, not just any myth but a dangerous one. Most may remember I posted the fact that I almost met my maker in March 2011 when I came down with Malaria during my visits to sub-Saharan Africa. So we do get them. Ask those in military. They have the statistics.
This is what happens to us:
Plasmodium species, of which Falciparium is most ubiquitous, vector is mosquito and only replicates inside matured erythrocytes, ie rbcs. This is where the confusion started. As we know, we with g6pdd are blessed with fragile rbcs. Therefore, as our matured rbcs get inoculated with this parasite they do what they do best, hemolyze and in doing this destroys the parasite with self since the parasite can’t live in blood stream outside the rbc. The problem is our body fights better by doing what most of the drugs are intended to do but if prolonged and severe an attack, our hemolysis is more threatening. This may explain why malaria is dubbed the “world’s most dangerous infectious disease”, at a globally 3.3 billion at risk mosquito-borne disease, it claims over a million lives annually but, read this, over half are noted where g6pdd is endemic. The good news is the lack of g6pd allows early destruction of our rbcs so that a bad infestation wont take hold as we immediately build up on uninfestible reticulocytes. This is our saving grace. However, the other side of the coin, with that early sequestration we are anemic, bilirubin start building up and if you have not paid attention to your health and followed Dale’s health catechism, you are already behind the 8 ball. Borderline or any state of anemia is not where you want to be if attacked by malaria.
Also, one of the problems is finding a non-homicidal drug for people with g6pdd. Most of the old ones are no-no. Some say take in smaller doses. Take it from this guinea pig, don’t try it on your own.
Presently, there are newer drugs. Part of the testing is using our blood for testing. We are the ideal canaries in this coal mine.
1. Malarone is a combo drug best against P. falciparium, acts at liver stage and blood level. Our problem is atovaquone may be judiciously taken but the other part of the combo, proguanil causes hematuria in some people. To me this says stay away if you tend to hemolyze.
2. Tafenoquine is a long acting 8-amino quinoline with half life in weeks not hours. Stay far away from this drug. It is one that they actually stated: Do not give in presence of g6pdd.
3. Larium and Fansidar cause oxidant-induced hemolytic anemia with methemeglobinemia. Stay away from these.
4. Clindamycin (Dalacin) although causes blood dyscracia, liver damage and colitis may work but need high dose that exposes one to colitis.
5. Doxycycline under Vibramycin, Vibra tabs, Doryxy
Can cause blood dyscrias, rarely esophageal ulcers. Commonly Candida overgrowth in women and sensitivity to sunlight.
6. Azithromycin (G.I upsets)
7. Halofantrine is quinine and mefloquine in fancy name and suit. Stay far away!
8. Pyronaridine is the new drug from China and for your health it is same as chloroquine.
9. Artemisin is a derivative of Qmghaosu. It is said to be safe for us with g6pdd BUT, until they explain about the controversial brain tumors in those poor rodents and the neurotoxicity I won’t be any where near it.
Having said all these, my take home is do your research. For me, I take precaution against malaria because when we do come down with it, it’s not pretty. I use my home made spray, prevention therapy of doxycycline 100mg daily and, if I come down with it I go for Azithhromycin. Although some infectious disease experts will opt for doubling same doxycycline 100mg twice a day for 7days. Women if you do, get monistat or eat plain cultured yogurt to ward off the yeast that will come. Of course, I always have my net to sleep in and bright PJ’s.
Lastly, there is a new baby added for prevention, the Zero-Vector Durable Lining (DL) by DART. It is a combo of insecticidal nets plus indoor residual spraying(IRS) that lasts 3 years. The nets are said to be safe. And made from woven thick polyethylene panels that are treated with Deltametrin (a WHO recommended insecticide said to be safe). Unfortunately, no one could give me a printable answer regarding Deltametrin’s safety in g6pdd so I did my own digging. These are what are available, “neurotoxic in humans, found in breast milk, highly toxic to aquatic life(fish). No mention of g6pdd effect. Didn’t expect one and they didn’t disappoint. WHO does not see g6pdd as a problem. I agree with them it is not in an ideal environment but, none of in our over chemicalized environment would call it ideal.
Please continue to take precautions against ALL infections. We do poorly with all of them. The best prevention is one I never was exposed to. Stay healthy and remember statistics is number game, when you are that one, percentages don’t matter.
G6PDD does not kill. IGNORANCE does.