Performance of microscopy and ELISA for diagnosing Giardia duodenalis infection in different pediatric groups

Silva, Renata K.N.R.; Pacheco, Flávia Thamiris Figueiredo; Martins, Adson Santos; Menezes, Joelma Figueiredo; Costa-Ribeiro, Hugo; Ribeiro, Tereza Cristina Medrado; Mattos, Ângela Peixoto de; Oliveira, Ricardo Riccio; Soares, Neci Matos; Teixeira, Márcia Cristina Aquino

doi:10.1016/j.parint.2016.08.012

Cited by 25 publications

(20 citation statements)

References 54 publications

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“…Microscopy-based diagnostic modalities, whether on fresh samples or stained slides are still the most commonly-used methods for the diagnosis of infection with G. duodenalis , especially in resource-limited settings (McHardy et al, 2014; Silva et al, 2016). However, several lines of experimental evidence have suggested that microscopy-based diagnostic methods are labor-intensive and show limited sensitivity compared with highly sensitive and specific methods such as the stool-based PCR assays (Koehler et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Stool antigen immunodetection for diagnosis of Giardia duodenalis infection in human subjects with HIV and cancer

Nooshadokht

Kalantari-Khandani

Sharifi

et al. 2017

Journal of Microbiological Methods

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Human infection with the protozoan parasite Giardia duodenalis is one the most common parasitic diseases worldwide. Higher incidence rates of giardiasis have been reported from human subjects with multiple debilitating chronic conditions, including hypogammaglobulinemia and common variable immunodeficiency (CVID). In the current study, stool specimens were collected from 199 individuals diagnosed with HIV or cancer and immunocompetent subjects. The sensitivity of microscopy-based detection on fresh stool preparations, trichrome staining and stool antigen immunodetection for the diagnosis of G. duodenalis were 36%, 45.5% and 100%, respectively when compared with a highly sensitive stool-based PCR method as the gold standard. Further multilocus molecular analyses using glutamate dehydrogenase (gdh) and triose phosphate isomerase (tpi) demonstrated that the AI genotype of G. duodenalis was the most prevalent, followed by the AII genotype and mixed (AI+B) infections. We concluded that stool antigen immunodetection-based immunoassays and stool-based PCR amplification had comparable sensitivity and specificity for the diagnosis of G. duodenalis infections in these populations. Stool antigen detection-based diagnostic modalities are rapid and accurate and may offer alternatives to conventional microscopy and PCR-based diagnostic methods for the diagnosis of G. duodenalis in human subjects living with HIV or cancer.

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Section: Introductionmentioning

confidence: 99%

Stool antigen immunodetection for diagnosis of Giardia duodenalis infection in human subjects with HIV and cancer

Nooshadokht

Kalantari-Khandani

Sharifi

et al. 2017

Journal of Microbiological Methods

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“…[ 6 ] While extensive data are available in children, [ 7 ] people with human immunodeficiency virus [ 8 ] and solid organ transplant (renal transplant, [ 9 , 10 ] kidney or liver transplant, [ 11 ] heart transplant, [ 12 , 13 ] intestinal transplant, [ 14 ] pancreas-kidney transplantation), [ 15 ] rarely has giardiasis been reported post allo-HSCT in detail. According to our literature review of relevant studies, it can occur either in autologous HSCT [ 16 ] or allo-HSCT, [ 1 , 18 ] children [ 16 , 18 ] or adults, [ 17 ] peri-transplantation period [ 19 ] or post-transplantation, [ 19 , 20 ] asymptomatic [ 20 ] or symptomatic. [ 16 , 17 , 19 ]…”

Section: Discussionmentioning

confidence: 99%

Giardia lamblia mimicking acute graft versus host disease after allogeneic hematopoietic stem cell transplantation

Yan

Shi

et al. 2020

Medicine

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Rationale: As the major complications post allogeneic hematopoietic stem cell transplantation (allo-HSCT), gastrointestinal disorders were most commonly ascribed to acute graft-versus-host disease (aGVHD) and opportunistic infections. Though Giardia lamblia ( G lamblia ) is the most common waterborne parasite of intestinal infection worldwide, seldom has it been reported in a patient with acute severe aplastic anemia after allo-HSCT. Patient concerns: A 23-year-old male with severe aplastic anemia developed diarrhea, abdominal cramps, bloating, nausea, vomiting, fever, weight loss, and fatigue after allo-HSCT. Diagnosis: Stool examinations for ova and parasites showed Giardia trophozoites and cysts. Interventions: Methylprednisolone was stopped and the patient was intravenously treated with a 7-day course of metronidazole (500 mg, tid.). Simultaneously, cyclosporine (5 mg/kg) was continually utilized for suspicious gut GVHD. Outcomes: The Giardia lamblia in stool turned negative and his symptoms were resolved after the 7-day course. Lessons: Incorporating non-invasive monitoring of stool examination for ova and parasites in the follow-up algorithm for post-HSCT patients can expedite clinical decision-making in the differential diagnoses for aGVHD even in the non-endemic area. Metronidazole therapy can be well-tolerated in HSCT patients with giardiasis.

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“…G. duodenalis infection is more common in the infant population than in adults, with especially high frequencies detected in daycare centers and schools [27]. The frequency of G. duodenalis in children from Salvador, Brazil, was reported to range from 13% to 18.4% [11,28]. Although we observed a lower frequency of G. duodenalis infection in our study, it was the most common pathogenic parasite found, with no differences observed between children in daycare centers and those attending the clinical laboratory.…”

Section: Discussionmentioning

confidence: 99%

“…However, microscopic identification has limited sensitivity due to the intermittent elimination of G. duodenalis cysts in feces and requires trained technicians for accurate diagnosis [ 4 , 5 ]. Coproantigen tests based on ELISA or immunochromatography were also developed for detecting parasite proteins in feces and are considered more sensitive than microscopy-based methods [ 8 – 11 ]. In addition, the detection of antibodies against G. duodenalis in sera by ELISA or immunofluorescence can also be useful for diagnosis and seroepidemiological studies in large communities [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Specific IgG and IgA Antibody Reactivities in Sera of Children by Enzyme-Linked Immunoassay and Comparison With Giardia duodenalis Diagnosis in Feces

et al. 2020

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Background: Giardia duodenalis is conventionally diagnosed in fecal samples using parasitological methods. However, sensitivity is poor when only a single sample is analyzed, due to intermittent excretion of cysts in feces. Alternatively, the serum antibodies to G. duodenalis can be used for parasite diagnosis and epidemiological studies to determine previous exposure. We compared the rate of G. duodenalis infection between serum anti-Giardia IgG and IgA antibodies and fecal examination in Brazilian children. Methods: Fecal and serum samples were tested from 287 children at a clinical laboratory and from 187 children at daycare centers. Fecal samples were processed using conventional parasitological methods and coproantigen detection for Giardia diagnosis. Serum samples were tested using an in-house ELISA for detection of anti-Giardia IgG and IgA. Results: G. duodenalis was found in 8.2% (N = 39) of the 474 children analyzed. The sensitivity and specificity of ELISA were 80.0% and 90.0% for IgG and 80.0% and 83.3% for IgA, respectively. The total positivity rate of anti-Giardia IgG and IgA in the sera was 13.9% (N = 66) and 23.6% (N = 112). The agreement between the positivity of specific antibodies and the detection of G. duodenalis in feces was moderate for ELISA-IgG, kappa index (95% CI) = 0.543 (0.422-0.664), and mild for ELISA-IgA, kappa index (95% CI) = 0.283 (0.162-0.404). Among the children infected with other enteroparasites, 11.6% (N = 10) and 24.4% (N = 21) showed reactivity to anti-Giardia IgG and to IgA, respectively. This cross-reactivity was more frequent in samples from children infected with Endolimax nana and Entamoeba coli. Conclusions: The higher frequency of specific antibody reactivity compared with G. duodenalis diagnosis in feces could reflect continuous exposure of children to G. duodenalis infection, resulting in long-lasting immunological memory and/or cross-reactivity with other intestinal amoebas.

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Performance of microscopy and ELISA for diagnosing Giardia duodenalis infection in different pediatric groups

Cited by 25 publications

References 54 publications

Stool antigen immunodetection for diagnosis of Giardia duodenalis infection in human subjects with HIV and cancer

Stool antigen immunodetection for diagnosis of Giardia duodenalis infection in human subjects with HIV and cancer

Giardia lamblia mimicking acute graft versus host disease after allogeneic hematopoietic stem cell transplantation

Specific IgG and IgA Antibody Reactivities in Sera of Children by Enzyme-Linked Immunoassay and Comparison With Giardia duodenalis Diagnosis in Feces

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