A 32-year-old man from Odisha returns from a forest area with fever for 5 days. Thick blood smear shows banana-shaped gametocytes. He is prescribed artesunate-based therapy. Two weeks later he develops haemoglobinuria and acute kidney injury. The drug MOST likely responsible is:
- A Artesunate causing artemisinin-induced haemolysis
- B Primaquine causing G6PD-deficiency-related haemolysis ✓
- C Mefloquine causing neuropsychiatric haemolysis
- D Atovaquone-proguanil causing mitochondrial toxicity
Explanation
Banana-shaped gametocytes are pathognomonic of Plasmodium falciparum. Primaquine is added to ACT (Artemisinin-based Combination Therapy) for falciparum malaria as a single low dose (0.25 mg/kg) to eliminate gametocytes and block transmission. In patients with G6PD deficiency — more common in tribal populations like Odisha — primaquine causes oxidative haemolysis leading to haemoglobinuria (blackwater fever) and acute kidney injury. Artesunate does not cause haemoglobinuria; mefloquine causes neuropsychiatric effects; atovaquone-proguanil is not the treatment used here.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.