Severe Giardiasis in the United States

Lengerich, Eugene J.; Addiss, David G.; Juranek, Dennis D.

doi:10.1093/clinids/18.5.760

Cited by 73 publications

(51 citation statements)

References 11 publications

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“…Despite the recognition of G. lamblia clinical illness for the last 40 years, the nearly 5,000 people hospitalized with giardiasis annually in the United States (149), and the millions infected worldwide, there have been few reviews of therapy for this infection and no definitive treatment protocols have been published (58,113,150,165,261). In addition, only a handful of agents have been used in therapy, and the agents which are available may have adverse effects or be contraindicated in certain clinical situations.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Giardiasis

2001

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Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine

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Section: Introductionmentioning

confidence: 99%

Treatment of Giardiasis

2001

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“…The microaerophilic flagellate parasitic protozoon Giardia intestinalis is the most commonly diagnosed cause of waterborne diarrhoea in the USA and a major problem worldwide (Lengerich et al, 1994). Not only are the transmissible cysts viable in cold water for several months (Bingham et al, 1979) but animals such as voles, muskrats and birds act as reservoirs for humanpathogenic strains (Davies & Hibler, 1979).…”

Section: Introductionmentioning

confidence: 99%

The microaerophilic flagellate Giardia intestinalis: Allium sativum (garlic) is an effective antigiardial

et al. 2000

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Whole garlic (Allium sativum L.) extract and some of its components were assayed for antigiardial activity. Whole garlic extract gave an IC 50 at 24 h of 03 mg ml N1 . Most of the components assayed were inhibitory to the organism, especially allyl alcohol and allyl mercaptan, with IC 50 values of 7 µg ml N1 and 37 µg ml N1 respectively. Studies with calcofluor white indicated that whole garlic and allyl alcohol collapse the transmembrane electrochemical membrane potential (∆ψ) of the organism, as indicated by uptake of the fluorochrome. Electron microscopy allowed the morphological changes that occur with garlic inhibition to be recorded. Both the surface topography and internal architecture of the organism changed during incubation with the biocides. Both whole garlic and allyl alcohol resulted in fragmentation of the disc and an overexpression of disc microribbons, internalization of flagella, vacuole formation and an increase in distended vesicles. Allyl mercaptan, however, only gave an increase in distended vesicles, suggesting that this biocide has a different mode of action.

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“…Recent findings indicate that the pathogenic effects of Giardia may be further compounded by degradation of local mucins by the parasite [56], which may in turn contribute to the translocation of commensal bacteria through the epithelium [45, 56, 57, 58•]. An isolated report indicates that giardiasis may be associated with increased mucus secretion, but the biological significance of this observation has yet to be determined [27]. Recent findings indicate that G. duodenalis may cause mucin depletion in goblet cells of the small intestine, as well as in the colon [56].…”

Section: Introductionmentioning

confidence: 99%

Giardia duodenalis: New Research Developments in Pathophysiology, Pathogenesis, and Virulence Factors

et al. 2015

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Giardia duodenalis is a very common, ubiquitous, intestinal protozoan parasite infecting animals and humans. Of the eight distinct genetic assemblages known to date, assemblages A and B are infectious to humans. Giardia is the most commonly recognized cause of traveller's diarrhea. Giardiasis impairs weight gain and is responsible for a variety of extraintestinal and post-infectious complications, including postinfectious irritable bowel syndrome, chronic fatigue, failure to thrive, and cognitive impairment. Giardiasis occurs in the absence of invasion of the intestinal tissues by the trophozoites and in the absence of any overt inflammatory cell infiltration, with the exception of a modest increase in intraepithelial lymphocytes and mast cells. In endemic parts of the World where the infection is often concurrent with bacterial enteritis causing inflammation-driven diarrheal disease, giardiasis appears to be protective against diarrhea. Recent observations have demonstrated that this effect may be due to a direct immuno-modulating effect of the parasite via its cathepsin B cysteine protease which cleaves pro-inflammatory CXCL8. No known toxin has yet been directly implicated in the pathophysiology of giardiasis. Diarrhea in giardiasis is mostly malabsorptive in nature, rather than hypersecretory. Findings from ongoing research indicate that the post-infectious effects of giardiasis may be due to microbiota dysbiosis induced by the parasite during the acute phase of infection.

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Severe Giardiasis in the United States

Cited by 73 publications

References 11 publications

Treatment of Giardiasis

Treatment of Giardiasis

The microaerophilic flagellate Giardia intestinalis: Allium sativum (garlic) is an effective antigiardial

Giardia duodenalis: New Research Developments in Pathophysiology, Pathogenesis, and Virulence Factors

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