Complicated forms of vivax malaria due to the use of primaquine in patients with G6PD deficiency. Case report.

Background Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis, with clinical repercussions, such as renal insufficiency and severe anemia in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. Surveys carried out in areas of Brazil, Colombia and Cuba showed high prevalence rates (> 10%) of G6PDd. Case Report Boy, 12 years old, student, from the community of Juí, Santo Antonio do Içá, Amazonas State. The patient was transported to the Amazon Medical Medicine Foundation Dr. Heitor Vieira Dourado (FMTAMHVD), with daily febrile illness, anaemia, inappetence, asthenia and coluria. His mother reported that two months ago the lowest received diagnosis and treatment of vivax malaria. Two weeks prior to the patient's transfer, the patient developed clinical worsening with abdominal pain, nausea, vomiting and need for hospitalization and indication of blood transfusion. The mother reported: school delay, denied previous malaria, dengue, or hospital admissions. Born of normal childbirth. She denied similar cases in the family. Physical Examination: Regular General, hypoactive, hypoxic, dehydrated Abdomen: painful: Hypochondrium D. Laboratory tests: Leukocytes: 19,750 (8B/86% S/ 4% Lymphocytes)/Haemoglobine: 5.6g/dL, HT: 17%; Urea: 148; Creatinine 3.0mg/dL; Potassium: 1,4 Amylase162; Stool sample: Ascaris lumbricoides/Trichuris trichiura. Urine test: haematuria/Granular Cylinders/Proteinuria. Blood smear: negative/Quantitative dosage of G6PD (normal), Genotyping of G6PD: positive for African variant. Studies have shown that G6PD deficiency is associated with an increased risk of blood transfusions and death due to QP-induced hemolysis in patients with malaria. The case presented shows the delay in the diagnosis of G6PD deficiency in remote areas, a high cost in the SUS treatment of a case that could be resolved without the need to remove the patient, and without family emotional involvement due to the detachment of three family members, as observed in this report. Researchers call attention to the need for rapid test implantation for the diagnosis of G6PD deficiency as a way to avoid the complications triggered by this condition, reduction in the cost of treatment and control of the disease. So why not optimize the care of these individuals when contemplating the rapid test for G6PD deficiency, at a time when there is a reduction in the number of malaria cases in Brazil? Probably this measure would also impact the control of vivax malaria in the country.