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dc.contributor.authorMartin-Ramirez, Alexandra 
dc.contributor.authorLombardia González, Carlos
dc.contributor.authorSoler Maniega, Tamara
dc.contributor.authorGutierrez Liarte, Ángela
dc.contributor.authorDomingo García, Diego
dc.contributor.authorLanza-Suarez, Marta 
dc.contributor.authorBernal Fernández, María Josefa 
dc.contributor.authorRubio Muñoz, Jose Miguel
dc.identifier.citationMalar J. 2020 Jul 17;19(1):259es_ES
dc.description.abstractPlasmodium 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. 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. 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 considered in any study of dosage and duration of primaquine treatment.es_ES
dc.description.sponsorshipThis work was funded by project PI17CIII/00035, from the Instituto de Salud Carlos III (Ministry of Science and Innovation).es_ES
dc.publisherBioMed Central (BMC) es_ES
dc.relation.isversionofPublisher's versiones_ES
dc.subject.meshMalaria es_ES
dc.subject.meshPlasmodium vivax es_ES
dc.subject.meshPrimaquine es_ES
dc.titleSeveral Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function.es_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.contributor.funderInstituto de Salud Carlos III 
dc.identifier.journalMalaria journales_ES
dc.repisalud.centroISCIII::Centro Nacional de Microbiologíaes_ES

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