Refractory Giardiasis in an Immunosuppressed Patient in Turkey

Demirel, Filiz; İnkaya, Ahmet Çağkan; Maçin, Salih; Akyön, Yakut; Ergüven, Sibel

doi:10.3855/jidc.9669

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…We consider the treatment successful because stool examination has remained negative to date. So far, only six refractory giardiasis cases in CVID patients have been published, and different curative treatments have been applied [ 20 , 22 , 26 , 30 , 31 , 33 ]. Currently, there is no standard therapy for refractory giardiasis, and multiple drugs have been tried [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Management Experience and Characteristics of Patients with Giardiasis and Common Variable Immunodeficiency

Díaz-Alberola

Gutiérrez‐Bautista

Espuch-Oliver

et al. 2022

JCM

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Common variable immunodeficiency (CVID) is an antibody immunodeficiency with a wide variety of clinical and immunological manifestations, and whose genetic cause is found in about 25% of diagnosed cases. Giardia lamblia is one of the main causes of gastrointestinal infections in CVID. 5-Nitroimidazoles are the most used first-line treatment, but nitroimidazole-refractory giardiasis is increasing. Nevertheless, only a few cases of refractory giardiasis in CVID have been reported. This study aimed to determine the incidence of Giardia infection in our CVID cohort, shows our management experience and describes patients’ phenotypic features. Clinical data collection, immunological, immunogenetics and microbiology assays were performed, and previous cases of giardiasis in CVID were reviewed. The incidence of symptomatic giardiasis was 12.9%. The main immunological features were undetectable or decreased IgA levels and reduced switched memory B cells. A probable PTEN pathogenic variant was detected in one. Three patients responded to metronidazole but suffered reinfections, and one was a refractory giardiasis eradicated with innovative quinacrine plus paromomycin combination. This work could contribute to the decision-making and therapeutic management of future patients with CVID and giardiasis, highlighting the importance of the early detection and treatment of infections in patients with CVID to ensure a good quality of life.

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Section: Discussionmentioning

confidence: 99%

Incidence, Management Experience and Characteristics of Patients with Giardiasis and Common Variable Immunodeficiency

Díaz-Alberola

Gutiérrez‐Bautista

Espuch-Oliver

et al. 2022

JCM

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“…have also emerged in recent years, mostly due to the introduction of molecular diagnostic methods [2,3]. Infections caused by Giardia intestinalis (G. intestinalis) are present in both immunosuppressed and immunocompetent patients [4].…”

Section: Introductonmentioning

confidence: 99%

Molecular screening for enteric parasites and subtyping of <i>Blastocystis</i> sp. in haemodialysis patients in Slovakia

Hatalová,

Babinská,

Gočálová

et al. 2024

Ann Agric Environ Med.

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Introduction and Objective. Intestinal parasitoses are important causes of morbidity and mortality, especially in immunocompromised individuals. In patients with chronic renal insufficiency (CRI), the accumulation of non-excreted metabolites leads to uraemia, which induces a state of immunodeficiency, increasing the incidence of infections. The aim of the study was molecular screening for enteric protozoa in patients with chronic renal insufficiency. Materials and Method. A total of 53 samples were collected in January 2023 from patients undergoing dialysis at Logman Ltd. Nephrodialysis Centre in Košice, Slovakia. Samples were examined by polymerase chain reaction (PCR) for the presence of Cryptosporidium parvum / Cryptosporidium hominis, Giardia intestinalis, Microsporidia spp., and Blastocystis sp. Results. From the 53 samples, the only pathogen identified by PCR was Blastocystis sp., in 13 patients (24.5 %). Sequence analyses confirmed that the most prevalent subtype (ST) among patients was ST 3 (n=9, 69.2%), followed by ST 1 (n=3, 23.1%) and ST 2 (n=1, 7.7%). Conclusions. Molecular methods for the detection of microscopic enteric parasites are not used as a first-line diagnostic method in Slovakia. In immunocompromised patients, diarrhoea can be caused not only by a chronic disease or therapy but can also be a result of an ongoing underdiagnosed infection. Early diagnosis leads to targeted therapy and subsequent partial improvement of the quality of life. This study also shows the first insights into Blastocystis sp. subtype distribution in humans in Slovakia.

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Treatment strategies for nitroimidazole-refractory giardiasis: a systematic review

Bourque

Neumayr

Libman

et al. 2021

Journal of Travel Medicine

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Rationale for review: Giardiasis is one of the most common human protozoal infections worldwide. First line therapy of giardiasis includes nitroimidazole antibiotics. However, treatment failure with nitroimidazoles is increasingly reported with up to 45% of patients not responding to initial treatment. There is no clear consensus on the approach to the management of nitroimidazole refractory giardiasis. This systematic review aims to summarize the literature on pharmacotherapy for nitroimidazole refractory giardiasis. Methods: We conducted a systematic review of the literature to determine the optimal management strategies for nitroimidazole refractory giardiasis. We searched Pubmed/MEDLINE, Embase, and Cochrane library using the following search terms ‘Giardia’ AND ‘treatment failure’ OR ‘refractory giardia’ OR ‘resistant giardia’ with date limits of January 1, 1970 to June 30, 2021. We included all reports on humans which described clinical outcomes of individuals with treatment refractory giardiasis, including case series and case reports. A descriptive synthesis of the data was conducted with pooling of data for interventions. Key Findings: Included in this review were 5 prospective studies, 3 retrospective studies, 7 case series and 9 case reports. Across these reports, a wide heterogeneity of treatment regimens was employed, including re-treatment with an alternative nitroimidazole, combination therapy with a nitroimidazole and another agent, and monotherapy with non-nitroimidazole regimens including quinacrine, paromomycin and nitazoxanide. Retreatment with a nitroimidazole was not an effective therapy for refractory giardiasis. However, treatment with a nitroimidazole in combination with albendazole had a cure rate of 66.9%. In the included studies, quinacrine monotherapy was administered to a total of 179 patients with a clinical cure rate of 88.8%. Overall, quinacrine was fairly well tolerated. Conclusions: Reports on the treatment of nitroimidazole refractory giardiasis demonstrate a heterogeneous approach to treatment. Of these, quinacrine appeared to be highly effective though more data on its safety is needed.

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Refractory Giardiasis in an Immunosuppressed Patient in Turkey

Cited by 3 publications

References 18 publications

Incidence, Management Experience and Characteristics of Patients with Giardiasis and Common Variable Immunodeficiency

Incidence, Management Experience and Characteristics of Patients with Giardiasis and Common Variable Immunodeficiency

Molecular screening for enteric parasites and subtyping of <i>Blastocystis</i> sp. in haemodialysis patients in Slovakia

Treatment strategies for nitroimidazole-refractory giardiasis: a systematic review

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