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Vicente B, Freitas AD, Freitas M, Midlej V. Systematic Review of Diagnostic Approaches for Human Giardiasis: Unveiling Optimal Strategies. Diagnostics (Basel) 2024; 14:364. [PMID: 38396402 PMCID: PMC10887752 DOI: 10.3390/diagnostics14040364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Giardiasis, caused by the protozoan Giardia intestinalis, affects around 400 million people worldwide, emphasizing the critical need for accurate diagnosis to enhance human health, especially in children. Prolonged giardiasis in childhood can lead to intellectual deficits and other complications. A variety of diagnostic tools, including microscopic, immunological, and molecular methods, are available for detecting G. intestinalis infection. Choosing the most suitable method can be challenging due to the abundance of options. This systematic review assesses the reliability and applicability of these diagnostic modalities. Utilizing the Dimensions and Wordart platforms for data analysis, we focus on relevant literature addressing diagnostic methods for human giardiasis. Microscopic techniques, particularly Ritchie's method, emerge as the primary choice, followed by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). PCR's limited use is attributed to its high cost and infrastructure challenges in developing nations. In conclusion, our analysis supports microscopic methods as the gold standard for giardiasis diagnosis. However, in cases where symptoms persist despite a negative diagnosis, employing more sensitive diagnostic approaches is advisable.
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Affiliation(s)
- Bruno Vicente
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, Brazil; (B.V.); (A.D.F.); (M.F.)
- Programa de Pós-Graduação em Biologia Celular e Molecular, Instituto Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Anna De Freitas
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, Brazil; (B.V.); (A.D.F.); (M.F.)
- Programa de Pós-Graduação em Biologia Parasitária, Instituto Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Marcus Freitas
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, Brazil; (B.V.); (A.D.F.); (M.F.)
| | - Victor Midlej
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, Brazil; (B.V.); (A.D.F.); (M.F.)
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Differenzialdiagnose: Diarrhoe als Symptom nach Tropenaufenthalt. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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3
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Decreased fecal calprotectin levels in Spondyloarthritis patients colonized by Blastocystis spp. Sci Rep 2022; 12:15840. [PMID: 36151228 PMCID: PMC9508226 DOI: 10.1038/s41598-022-18308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 08/09/2022] [Indexed: 11/08/2022] Open
Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases mainly characterized by inflammation in the spine and/or peripheral joints. Although a link between SpA-pathogenesis, intestinal inflammation and gut dysbiosis has been proposed, studies have been focused on bacteria-host interactions and very little has been reported regarding intestinal parasites. Here, intestinal parasitic infection of 51 SpA-patients were evaluated and compared to healthy control individuals. No significant differences in the frequency of any parasite between SpA-patients and control individuals were found. Significantly higher levels of fecal calprotectin (FCP) were found in the SpA-patients compared to the control individuals. However, FCP levels were the same when comparing SpA-patients and control individuals, both colonized by Blastocystis spp. On the other hand, when comparing Blastocystis spp. colonized and Blastocystis spp. free SpA-patients, FCP levels were significantly higher in those Blastocystis spp. free. Without ignoring the small sample size as a study limitation, the results showed that in the SpA-patients colonized by Blastocystis spp., the FCP levels were significantly lower than those in the Blastocystis spp. free group and comparable to those in the control group. These findings seem to suggest a relationship between Blastocystis spp. and intestinal inflammation in SpA-patients, but studies intended to explore that interaction specifically should be designed.
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Turner RA, Duke JN, Foran JRH. Giardia lamblia Reactive Arthritis Mimicking Acute Periprosthetic Knee Infection: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00040. [PMID: 34297707 DOI: 10.2106/jbjs.cc.21.00165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CASE A healthy 49-year-old man with a well-functioning total knee replacement developed a painful swollen knee. The erythrocyte sedimentation rate was 12 mm/hour, and C-reactive protein was 20.3 mg/L. Aspiration revealed 24,440 white blood cells and 5% neutrophils. His 2018 International Consensus Meeting (ICM) definition score of 5 met criteria for "possibly infected." He was diagnosed with reactive arthritis (ReA) secondary to Giardia lamblia, mimicking acute periprosthetic infection. He was successfully treated with a 10-week course of multiple oral antiparasitic medications. CONCLUSION Systemic parasitic infectious ReA can mimic acute infection in the presence of total knee arthroplasty. Careful application of the 2018 ICM criteria can be critical for workup and the treatment of suspected periprosthetic infection.
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Affiliation(s)
- Rachael A Turner
- University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas
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Allain T, Buret AG. Pathogenesis and post-infectious complications in giardiasis. ADVANCES IN PARASITOLOGY 2019; 107:173-199. [PMID: 32122529 DOI: 10.1016/bs.apar.2019.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Giardia is an important cause of diarrhoea, and results in post-infectious and extra-intestinal complications. This chapter presents a state-of-the art of our understanding of how this parasite may cause such abnormalities, which appear to develop at least in part in Assemblage-dependent manner. Findings from prospective longitudinal cohort studies indicate that Giardia is one of the four most prevalent enteropathogens in early life, and represents a risk factor for stunting at 2 years of age. This may occur independently of diarrheal disease, in strong support of the pathophysiological significance of the intestinal abnormalities induced by this parasite. These include epithelial malabsorption and maldigestion, increased transit, mucus depletion, and disruptions of the commensal microbiota. Giardia increases epithelial permeability and facilitates the invasion of gut bacteria. Loss of intestinal barrier function is at the core of the acute and post-infectious complications associated with this infection. Recent findings demonstrate that the majority of the pathophysiological responses triggered by this parasite can be recapitulated by the effects of its membrane-bound and secreted cysteine proteases.
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Affiliation(s)
- Thibault Allain
- University of Calgary, Host-Parasite Interactions Program, Inflammation Research Network, Department of Biological Sciences, Calgary, Canada
| | - André G Buret
- University of Calgary, Host-Parasite Interactions Program, Inflammation Research Network, Department of Biological Sciences, Calgary, Canada.
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Beer KD, Collier SA, Du F, Gargano JW. Response to Escobedo et al. Clin Infect Dis 2018; 67:481. [PMID: 29596601 PMCID: PMC6075678 DOI: 10.1093/cid/ciy125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karlyn D Beer
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah A Collier
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fan Du
- Human-Computer Interaction Lab, University of Maryland, College Park
| | - Julia W Gargano
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Reses HE, Gargano JW, Liang JL, Cronquist A, Smith K, Collier SA, Roy SL, Vanden Eng J, Bogard A, Lee B, Hlavsa MC, Rosenberg ES, Fullerton KE, Beach MJ, Yoder JS. Risk factors for sporadic Giardia infection in the USA: a case-control study in Colorado and Minnesota. Epidemiol Infect 2018; 146:1071-1078. [PMID: 29739483 PMCID: PMC9134275 DOI: 10.1017/s0950268818001073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/16/2018] [Accepted: 04/04/2018] [Indexed: 01/12/2023] Open
Abstract
Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9-39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0-20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5-7.0), male-male sexual behaviour (aOR = 45.7; 95% CI 5.8-362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01-2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2-5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1-3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1-0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.
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Affiliation(s)
- H. E. Reses
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. W. Gargano
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. L. Liang
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A. Cronquist
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - K. Smith
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - S. A. Collier
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S. L. Roy
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. Vanden Eng
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A. Bogard
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - B. Lee
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - M. C. Hlavsa
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - E. S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, SUNY, Rensselaer, New York, USA
| | - K. E. Fullerton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M. J. Beach
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. S. Yoder
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
Although Giardia, the aetiological agent of giardiasis, is one of the most prevalent intestinal parasitic infections world-wide, for industrialised countries, it is mainly appreciated as an imported disease with the minimal local transmission. However, the current evidence challenges this perception; Giardia has relevance beyond the high prevalence areas. This infection may be asymptomatic or cause gastrointestinal complains and long-term sequelae, including irritable bowel syndrome, chronic fatigue and impaired child growth and cognitive development. Its detection and diagnosis present a challenge to physicians who may not be familiar with this infection. To improve interventions to control this parasitosis, it is necessary to maintain a high index of suspicion and remain vigilant in finding cases at risk for infection. A better understanding of the characteristics of populations importing infections alongside improved methods to reliably classify infections as imported or acquired locally will help to ensure early and accurate diagnosis. The evidence shows that public health problems like giardiasis are global issues that need to be addressed collectively by both high and low prevalence countries.
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9
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Beer KD, Collier SA, Du F, Gargano JW. Giardiasis Diagnosis and Treatment Practices Among Commercially Insured Persons in the United States. Clin Infect Dis 2018; 64:1244-1250. [PMID: 28207070 DOI: 10.1093/cid/cix138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background Giardiasis, the most common enteric parasitic infection in the United States, causes an estimated 1.2 million episodes of illness annually. Published clinical recommendations include readily available Giardia-specific diagnostic testing and antiparasitic drugs. We investigated sequences of giardiasis diagnostic and treatment events using MarketScan, a large health insurance claims database. Methods We created a longitudinal cohort of 2995 persons diagnosed with giardiasis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 007.1) from 2006 to 2010, and analyzed claims occurring 90 days before to 90 days after initial diagnosis. We evaluated differences in number and sequence of visits, diagnostic tests, and prescriptions by age group (children 1-17 years, adults 18-64 years) using χ2 tests and data visualization software. Results Among 2995 patients (212433 claims), 18% had a Giardia-specific test followed by or concurrent with an effective antiparasitic drug, without ineffective antibiotics. Almost two-thirds of patients had an antiparasitic and 27% had an antibiotic during the study window. Compared with children, adults more often had ≥3 visits before diagnosis (19% vs 15%; P = .02). Adults were also less likely to have a Giardia-specific diagnostic test (48% vs 58%; P < .001) and more likely to have an antibiotic prescription (28% vs 25%; P = .04). When Giardia-specific tests and antiparasitic and antibiotic prescriptions were examined, pediatric clinical event sequences most frequently began with a Giardia-specific test, whereas adult sequences most frequently began with an antiparasitic prescription. Conclusions Giardiasis care infrequently follows all aspects of clinical recommendations. Multiple differences between pediatric and adult care, despite age-agnostic recommendations, suggest opportunities for provider education or tailored guidance.
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Affiliation(s)
- Karlyn D Beer
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A Collier
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fan Du
- Human-Computer Interaction Lab, University of Maryland, College Park, USA
| | - Julia W Gargano
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Adams DA, Thomas KR, Jajosky RA, Foster L, Baroi G, Sharp P, Onweh DH, Schley AW, Anderson WJ. Summary of Notifiable Infectious Diseases and Conditions - United States, 2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 64:1-143. [PMID: 28796757 DOI: 10.15585/mmwr.mm6453a1] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Summary of Notifiable Infectious Diseases and Conditions - United States, 2015 (hereafter referred to as the summary) contains the official statistics, in tabular and graphical form, for the reported occurrence of nationally notifiable infectious diseases and conditions in the United States for 2015. Unless otherwise noted, data are final totals for 2015 reported as of June 30, 2016. These statistics are collected and compiled from reports sent by U.S. state and territories, New York City, and District of Columbia health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). This summary is available at https://www.cdc.gov/MMWR/MMWR_nd/index.html. This site also includes summary publications from previous years.
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Affiliation(s)
- Deborah A Adams
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Kimberly R Thomas
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Ruth Ann Jajosky
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Loretta Foster
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Gitangali Baroi
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Pearl Sharp
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Diana H Onweh
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Alan W Schley
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Willie J Anderson
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
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Abstract
BACKGROUND Infection with Giardia lamblia is a common cause of diarrheal disease in the developing and industrialized world. AIMS We aimed to assess the prevalence of giardiasis in the United States (US) among patients with duodenal biopsies, investigating demographic and clinical factors associated with this condition. METHODS We conducted a cross-sectional study of patients with duodenal biopsies submitted to a national pathology laboratory between January 2, 2008, and December 31, 2015. The prevalence of giardiasis was calculated and categorized by the following patient sociodemographic and clinical data: age, sex, ethnicity, endoscopy indication, season, year, urban-rural setting, region, and presence of H. pylori and atrophic gastritis. RESULTS Among all patients (n = 432,813), the mean age was 52.2 years. The prevalence of giardiasis was 0.11%. Patients with giardiasis were more likely to be male (57.8 vs. 34.1%, p < 0.0001). Among patients who had a gastric biopsy (n = 363,788), those with giardiasis were more likely to be colonized with H. pylori (25.7 vs. 9.4%, p < 0.0001). There was no statistically significant association with age, endoscopy indication, urban-rural setting, ethnicity, season, or the presence of atrophic gastritis. On multivariate analysis, male sex, Southern region, and the presence of H. pylori were independently associated with giardiasis. CONCLUSIONS To our knowledge, this is the largest study to date to assess predictors of giardiasis in the US. We found that male sex, being colonized with H. pylori, and residing in the Southern US are independently associated with giardiasis infection.
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Association between Giardia and arthritis or joint pain in a large health insurance cohort: could it be reactive arthritis? Epidemiol Infect 2016; 145:471-477. [PMID: 27640995 DOI: 10.1017/s0950268816002120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study aimed to assess the association between giardiasis and subsequent development of arthritis or joint pain using a retrospective cohort of individuals from a large administrative claims database in the United States. Using 2006-2010 data from MarketScan Commercial Claims and Encounters, we conducted a retrospective cohort study in people with an ICD-9-CM code for giardiasis (n = 3301) and persons without giardiasis (n = 14 612) individually matched on age, sex, and enrolment length. We used conditional logistic regression to model the association between giardiasis and arthritis or joint pain documented in the 6 months following initial giardiasis diagnosis or index date for matched controls. After adjusting for healthcare utilization rate, giardiasis was associated with a 51% increase in claims for arthritis or joint pain (odds ratio 1·51, 95% confidence interval 1·26-1·80). In age- and sex-stratified adjusted analyses, the association remained significant across all subgroups (age 0-19 years, age 20-64 years, males, and females). Findings from this study lend epidemiological support for the association between giardiasis and subsequent development of arthritis. Reactive arthritis might occur more frequently than has been reported in the literature. Further research is necessary to determine the mechanisms by which giardiasis could lead to arthritis.
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Escobedo AA, Almirall P, Cimerman S, Rodríguez-Morales AJ. Sequelae of giardiasis: an emerging public health concern. Int J Infect Dis 2016; 49:202-3. [DOI: 10.1016/j.ijid.2016.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/03/2015] [Accepted: 06/07/2016] [Indexed: 11/26/2022] Open
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Robertson LJ, Tysnes KR, Hanevik K, Langeland N, Mørch K, Hausken T, Nygård K. Hund som Giardia-kilde i Bergen i 2004 – barking up the wrong tree? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1718-20. [DOI: 10.4045/tidsskr.15.0883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Inman RD. Reactive arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc 2014; 80:689-706. [PMID: 25070906 DOI: 10.1016/j.gie.2014.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- M Aamir Ali
- Department of Gastroenterology, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Escobedo AA, Almirall P, Ávila I, Salazar Y, Alfonso M. Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital. Pathog Glob Health 2014; 108:271-8. [PMID: 25253040 PMCID: PMC4216749 DOI: 10.1179/2047773214y.0000000152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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.
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Escobedo AA, Hanevik K, Almirall P, Cimerman S, Alfonso M. Management of chronic Giardia infection. Expert Rev Anti Infect Ther 2014; 12:1143-57. [PMID: 25059638 DOI: 10.1586/14787210.2014.942283] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Angel A Escobedo
- Academic Paediatric Hospital "Pedro Borrás", Calle F No. 616 esquina 27, Plaza, La Habana, CP 10400, Cuba
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Giardia duodenalis: Number and Fluorescence Reduction Caused by the Advanced Oxidation Process (H2O2/UV). INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:525719. [PMID: 27379301 PMCID: PMC4897353 DOI: 10.1155/2014/525719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
Abstract
This study evaluated the effect of peroxidation assisted by ultraviolet radiation (H2O2/UV), which is an advanced oxidation process (AOP), on Giardia duodenalis cysts. The cysts were inoculated in synthetic and surface water using a concentration of 12 g H2O2 L−1 and a UV dose (λ = 254 nm) of 5,480 mJcm−2. The aqueous solutions were concentrated using membrane filtration, and the organisms were observed using a direct immunofluorescence assay (IFA). The AOP was effective in reducing the number of G. duodenalis cysts in synthetic and surface water and was most effective in reducing the fluorescence of the cyst walls that were present in the surface water. The AOP showed a higher deleterious potential for G. duodenalis cysts than either peroxidation (H2O2) or photolysis (UV) processes alone.
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Morris D, Inman RD. Reactive arthritis: developments and challenges in diagnosis and treatment. Curr Rheumatol Rep 2013; 14:390-4. [PMID: 22821199 DOI: 10.1007/s11926-012-0280-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Reactive arthritis (ReA) has traditionally been described as a nonseptic arthritis occurring in the joint following an extra-articular bacterial infection. This concept became clinically associated with antecedent infections of either the gastrointestinal or genitourinary tract. Yet this operational definition of ReA has led to diagnostic uncertainty in different clinical settings. There are several scenarios in which the ReA has been complex. One is in the SAPHO syndrome, which shares many features with ReA. Another is the development of arthritis after infection with atypical organisms such as Clostridium difficile and Giardia lamblia. Treatment of ReA remains an area of ongoing investigation. There has been a randomized controlled trial of combination antibiotics in Chlamydia-induced ReA, which reported a positive result. There are several uncontrolled reports of anti-TNF agents being used successfully in refractory ReA. These studies in treatment modalities require validation on larger samples but do provide some encouraging preliminary findings from which to develop new therapeutic approaches.
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Affiliation(s)
- Davina Morris
- Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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