Refractory giardiasis in Spanish travellers

Gutierrez, José Muñoz; Aldasoro, Edelweiss; Requena, Ana; Comin, Ana; Pinazo, María Jesús; Bardají, Azucena; Oliveira, Inês; Valls, María Eugenia; Gascón, Joaquim

doi:10.1016/j.tmaid.2012.10.004

Cited by 39 publications

(29 citation statements)

References 16 publications

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“…[56][57][58][59][60][61][62][63][64][65][66][67][68][69] Combinations of albendazole and a 5 nitroimidazole, or nitazoxanide with a second agent, are the usual next steps in the treatment ladder. Paromomycin and mepacrine have specific niches, as already discussed.…”

Section: Symptomatic Patientsmentioning

confidence: 99%

Giardiasis

Minetti

Chalmers

Beeching

et al. 2016

BMJ

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Section: Symptomatic Patientsmentioning

confidence: 99%

Giardiasis

Minetti

Chalmers

Beeching

et al. 2016

BMJ

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“…Metronidazole and tinidazole were ineffective in treating 22 % of giardiasis patients attending a travel clinic in Spain, and the efficacy of a second course of treatment was only 17 %. (Muñoz Gutiérrez et al 2013).…”

Section: G Intestinalismentioning

confidence: 99%

“…Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 day (Talari et al 2006). Despite low efficacy, paromomycin is preferred for treatment of pregnant women as it is poorly absorbed in the intestine (Mørch et al 2008;Muñoz Gutiérrez et al 2013). Quinacrine can achieve cure in patients with 5-NI-resistant giardiasis (Requena-Méndez et al 2014).…”

Section: G Intestinalismentioning

confidence: 99%

“…One study found no difference in drug susceptibility between field isolates of assemblages A and E. However, assemblage A laboratory strains were more susceptible to the benzimidazoles and less susceptible to 5-NI and furazolidone than assemblage B laboratory strain (Bénéré et al 2011). A study in Spain showed a relatively high rate of 5-NI refractory giardiasis among travelers visiting south and east of the Mediterranean basin and the Asian continent, suggesting that resistance is associated with infection by distinct genotypes (Muñoz Gutiérrez et al 2013). Genetic analysis of Giardia cysts isolated from patients with metronidazole refractory giardiasis detected after a waterborne outbreak revealed that the isolates had the same genotypes as glutamate dehydrogenase and β-giardin genes within assemblage B although sequence profiles from the isolates at the peak of the outbreak were more heterogenous.…”

Section: G Intestinalismentioning

confidence: 99%

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Understanding drug resistance in human intestinal protozoa

El-Taweel

2015

Parasitol Res

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Infections with intestinal protozoa continue to be a major health problem in many areas of the world. The widespread use of a limited number of therapeutic agents for their management and control raises concerns about development of drug resistance. Generally, the use of any antimicrobial agent should be accompanied by meticulous monitoring of its efficacy and measures to minimize resistance formation. Evidence for the occurrence of drug resistance in different intestinal protozoa comes from case studies and clinical trials, sometimes with a limited number of patients. Large-scale field-based assessment of drug resistance and drug sensitivity testing of clinical isolates are needed. Furthermore, the association of drug resistance with certain geographic isolates or genotypes deserves consideration. Drug resistance has been triggered in vitro and has been linked to modification of pyruvate:ferredoxin oxidoreductase, nitroreductases, antioxidant defense, or cytoskeletal system. Further mechanistic studies will have important implications in the development of second generation therapeutic agents.

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“…Muñoz Gutiérrez et al also reported a 22% failure rate of nitroimidazole treatment in Spanish travellers. They found that quinacrine treatment was more effective than albendazole and paromomycin therapy in eradicating G. duodenalis [16]. In our case, because of treatment failure with metronidazole and trimethoprimsulfamethoxazole, the patient received a second course of treatment with ornidazole.…”

Section: Discussionmentioning

confidence: 66%

Refractory Giardiasis in an Immunosuppressed Patient in Turkey

Demirel

İnkaya

Maçin

et al. 2018

J Infect Dev Ctries

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Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia duodenalis. In immunocompetent patients the infection is usually self-limited and no treatment may be needed. Immunodeficiency, however, is a predisposing factor for the development of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazoles and nitazoxanides presented. A 28-year-old male patient with hypogammaglobulinemia admitted to our hospital because of chronic diarrhoea. Microscopic examination of stool revealed a high number of Giardia trophozoites and cysts. Treatment with higher doses and a longer course of metronidazole, trimethoprim-sulfamethoxazole, ornidazole and albendazole failed. Administration of nitazoxanide, which has been reported to be effective against Giardia duodenalis refractory to nitroimidazoles, was commenced, but his symptoms persisted and stool samples demonstrated Giardia trophozoites and cysts again.

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Refractory giardiasis in Spanish travellers

Cited by 39 publications

References 16 publications

Giardiasis

Giardiasis

Understanding drug resistance in human intestinal protozoa

Refractory Giardiasis in an Immunosuppressed Patient in Turkey

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