Maydel Alfonso

Treatment of intestinal protozoan infections in children

Intestinal protozoan infections are a worldwide problem in both industrialised and unindustrialised countries; in the latter they may be the cause of significant morbidity and mortality. Children, in particular, are more likely to experience considerable morbidity. Most intestinal protozoan infections can cause acute or chronic diarrhoea in healthy individuals and may result in intractable, life-threatening illness in patients with immunosuppressive diseases such as AIDS. Adequate identification and treatment of these infections may provide significant benefit for individual patients and public health. This article presents an update on the pharmacotherapy currently available for amoebiasis, giardiasis and other intestinal protozoan infections.

A bibliometric study of international scientific productivity in giardiasis covering the period 1971–2010

INTRODUCTION Despite years of relative neglect, interest in Giardia infection seems to be recently growing, perhaps in part due to its inclusion into the World Health Organizations Neglected Diseases Initiative since 2004. The purpose of this study was to provide an overview of Giardia and giardiasis research over time, as represented by the quantity of published papers. METHODOLOGY Data for this study were collected from the electronic PubMed/Medline database of National Library of Medicines (NLM), due to it is easily accessibility and wide use. It was accessed online between April and December 2011. Data for the period 1971-2010 were obtained and information was downloaded using the EndNote program developed by Thomson Reuters. RESULTS During the study period, a total of 6,964 references (articles, reviews, editorials, letter to the editor, etc.) covering different aspects of Giardia and giardiasis were located in the PubMed database after applying the search strategy reported above. Most papers were original articles and published in English. CONCLUSIONS In this first effort to explore the development and research productivity on giardiasis over time (no previously published bibliometric studies on giardiasis exist), two interesting characteristics of the Giardia and giardiasis literature were discovered: the concentration of papers over journals disseminating the research results, and that research in this field is growing and will likely continue to grow in the coming years.

Sexual transmission of giardiasis: A neglected route of spread?

Sexually transmitted infections (STIs) are often discussed in the context of syphilis, gonorrhea, herpes, chlamydiasis and AIDS. However, since the past 30 years of the last century, epidemiology and natural history studies have led to improved understanding of giardiasis as a STI, as a result of oral-anal sexual contact. Studies suggest that Giardia is an increasingly recognized infection that may be underdiagnosed under the STI context. Health care providers should maintain a high index of suspicion for Giardia, obtain suitable diagnostic tests to identify and screen those at high risk for this infection, institute appropriate therapy, counsel patients regarding treatment compliance, follow-up, encourage partner notification and teach strategies for preventing the transmission of this disease, including the discussion of the risk of enteric infections after oral-anal sexual contact. We summarize some data concerning the research and clinical literature on Giardia infection as a STI and identify the specific recommendations for control of giardiasis as STI that available evidence indicates can reduce its transmission.

Management of chronic Giardia infection

Advances in our understanding of chronic giardiasis (CG) may improve our care of patients in this stage of the disease. This review proposes a new concept of CG and highlights the recent advances in our understanding and management of this condition. According to this review, management requires, initially, an accurate diagnosis, which may exclude several conditions that can mimic CG. Optimal treatment requires a tailored approach which includes the recognition of the known modifiable causes of this health condition, assessment of symptoms and potential complications, their treatment utilizing, if necessary, a multidisciplinary team, and an ongoing monitoring for the effect of therapy – weighing the efficacy of individual drugs – all of these together may lead to a successful treatment of CG.

Mebendazole Compared with Secnidazole in the Treatment of Adult Giardiasis: A Randomised, No-Inferiority, Open Clinical Trial

To compare the efficacy and safety of mebendazole and secnidazole in the treatment of giardiasis in adult patients, a single-centre, parallel group, open-label, randomized non-inferiority trial was carried out. One-hundred and 26 participants who had symptomatic Giardia mono-infection took part in the study. Direct wet mount and/or Ritchie concentration techniques and physical examinations were conducted at the time of enrolment and at the follow-up visit. The primary outcome measure was parasitological cure, performed at 3, 5, 10 days post-treatment. Negative faecal specimens for Giardia were ensured by the same parasitological techniques. At follow up (day 10) the parasitological cure rate for the per protocol populations was 88.7% (55/62) for MBZ and 91.8% (56/61) for SNZ. For the intention to treat populations the cure rate at the end of treatment was 85.9% (55/64) for MBZ and 90.3% (56/62) for SNZ. Both analyzes showed there was not significant statistical difference between MBZ and SNZ treatment efficacy. Both drugs were well tolerated, only mild, transient and self-limited side effects were reported and did not require discontinuation of treatment. A 3-day course of mebendazole seems to be as efficacious and safe for treatment of giardiasis as a single dose of secnidazole in adults.

Variaciones en las manifestaciones clínicas de la giardiosis en pacientes pediátricos hospitalizados, según grupos de edades

INTRODUCTION It has been suggested that the clinical features of giardiasis might vary in patients of different age groups. OBJECTIVE To compare clinical presentation of giardiasis in children less than 5 years of age and older children. METHODS A retrospective study of patients hospitalized with giardiasis during 2007 was performed. The clinical features of the two age groups were compared. Additionally, length of stay was analyzed. RESULTS In total, 170 patients were included. In children ≥ 5 years of age, abdominal pain and urticaria were significantly more frequent (OR=9.46; 95%CI: 4.35-20.52,P5=0.000+ and OR=11.0; 95%CI: 1.205-101.11, P=0.023, respectively). Diarrhoea was more frequently found in children younger than 5 years (OR=6.45; IC 95%: 3. 12-13.37, P=0.000+). The frequencies of other symptoms were similar. Length of stay was significantly higher in children under 5 years of age. DISCUSSION AND CONCLUSIONS Clinical presentations differed in some aspects among the examined age group of our paediatric patients. Our finding might be of importance for an early recognition of giardiasis, which is essential for an accurate diagnosis and a prompt treatment.

Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital

Abstract Giardiasis is one of the commonest intestinal parasitic infections in Cuba. In order to determine care-seeking behaviour and diagnostic processes in paediatric in-patients with giardiasis, structured questionnaires were administered by interview mothers of children with giardiasis during January to December 2010. During the study period, 97 children were diagnosed with giardiasis, of whom 86 (88·6%) caregivers were interviewed. The median number of days from symptoms onset to the first presentation in a health unit was 2 days (range: 0–15 days). The pattern of care-seeking behaviour was variable; 41 (47·7%) of children initially visited the emergency unit in a paediatric hospital. Sixty-six children had, at least, one further contact for help before diagnosis of giardiasis was made (range: 1–5 contacts) and of the 128 contact visits, 94 (73·4%) were also targeted more to hospitals. There was a median time of 6 days between the first presentation to a health unit until diagnosis, which was mainly made by microscopic examination of duodenal aspiration. Among factors investigated in mothers, only knowing other person with giardiasis had significant association with their ability to suspect giardiasis [odds ratio (OR): 29·8, 95% confidence interval (CI): 3·71–239·4, P = 0·001]. Requesting a faecal specimen or ordering duodenal aspiration for microscopic examination during the first visit appeared associated with correct diagnosis (OR: 3·84, 95% CI: 1·57–9·40, P = 0·003). Efforts should be made to increase doctors’ awareness of- and diagnostic skills for childhood giardiasis. At the same time, it is necessary to improve caregivers’ awareness about giardiasis.