1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
Mewara A, Khunger S, Sharma C, Krishnamoorthi S, Singh S, Yadav R, Khurana S, Sehgal R. A rapid multiplex loop-mediated isothermal amplification (mLAMP) assay for detection of Entamoeba histolytica and Giardia duodenalis. Lett Appl Microbiol 2023; 76:ovad114. [PMID: 37740570 DOI: 10.1093/lambio/ovad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/25/2023] [Accepted: 09/21/2023] [Indexed: 09/24/2023]
Abstract
We developed a rapid multiplex loop-mediated isothermal amplification (mLAMP) assay for two common intestinal parasites-Entamoeba histolytica and Giardia duodenalis, where early detection may be helpful. The mLAMP assay was optimized for the detection of DNA of E. histolytica (18S rRNA gene) and G. duodenalis (Elongation factor 1 alpha gene) from standard strains by using six specific primers FIP (forward inner primer), BIP (backward inner primer), F3 (forward outer primer), B3 (backward outer primer), loopF (forward loop primer), and loopB (backward loop primer) for each gene target. The amplification time was 16-26 min for E. histolytica and 10-15 min for G. duodenalis, and the parasites could be distinguished based on melting-curve analysis for specific annealing temperatures (Tm) of 84°C-86°C and 88°C-90°C for E. histolytica and G. duodenalis, respectively. The analytical sensitivity was one fg, and no cross-reactivity with other intestinal pathogens was observed. Thus, the mLAMP assay could detect and clearly distinguish E. histolytica and G. duodenalis with a rapid turnaround time and excellent analytical sensitivity and specificity.
Collapse
Affiliation(s)
- Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Sandhya Khunger
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
- Department of Microbiology (FAHS), Shree Guru Gobind Singh Tricentenary University, Budhera, Gurgaon 122505, India
| | - Chayan Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | | | - Shreya Singh
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Rakesh Yadav
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| |
Collapse
|
3
|
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]
|
4
|
Maher A, Atallah D, Hassan M, Hammad M, Galal M, Mohamed SE, Abdelkafy Y, Farid A. Role of anti-Giardia recombinant cyst wall protein IgG polyclonal antibodies in diagnosis and protection. AMB Express 2022; 12:147. [PMID: 36434306 PMCID: PMC9700546 DOI: 10.1186/s13568-022-01484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
Giardia duodenalis (G. duodenalis) is an infectious protozoan that has a global distribution especially in the hot climate. Around 200 million people are infected worldwide annually by Giardia, but infection is not always accompanied by symptoms, especially in endemic countries. Using traditional microscopy techniques in diagnosis, both in stool and water samples were less sensitive when compared to immunological methods; and the need for new diagnostic methods was necessary. Also, protection from infection is required in endemic areas. Therefore, the study aimed to produce anti- G. duodenalis IgG polyclonal antibodies (pAbs) by immunizing rabbit by G. duodenalis cyst recombinant protein. The produced antibodies were evaluated in the detection of G. duodenalis antigens in patients' stool and water samples from endemic areas across River Nile; where pAbs were used as a coating and a peroxidase conjugate antibody in sandwich ELISA. Moreover, pAbs were tested for the protection of mice from giardiasis. Sandwich ELISA using pAb has succeeded in the detection of G. duodenalis coproantigens in stool samples by a sensitivity of 97% and a specificity of 92.72%. Moreover, G. duodenalis cyst was detected in only seven water samples by ordinary microscopy; while sandwich ELISA revealed nineteen positive results. IgG pAb (1/200 µg/ml) protected mice from giardiasis; which was evident from the reduction in cysts and trophozoites numbers. We recommended the use of sandwich ELISA to monitor water quality, investigate environmental contamination and diagnosis in patients' stools. The pAbs can be prepared in large amount and used in field diagnosis and protection. This will help in the early diagnosis of G. duodenalis in water, which in turn can control outbreaks in rural areas.
Collapse
Affiliation(s)
- Ahmed Maher
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Donia Atallah
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Mahmoud Hassan
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Mariam Hammad
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Mohaned Galal
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Saif-Eldin Mohamed
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Yara Abdelkafy
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Alyaa Farid
- grid.7776.10000 0004 0639 9286Biotechnology/Biomolecular Chemistry Program, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Immunology Division, Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt ,grid.7776.10000 0004 0639 9286Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| |
Collapse
|
5
|
Gupta S, Allegretti JR. Mimics of Crohn's Disease. Gastroenterol Clin North Am 2022; 51:241-269. [PMID: 35595413 DOI: 10.1016/j.gtc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.
Collapse
Affiliation(s)
- Sanchit Gupta
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| |
Collapse
|
6
|
Abo-Zaid MA, Hamdi AA. Evaluation of Immune Response and Haematological Parameters in Infected Male Albino Rats by Giardiasis. Parasite Immunol 2022; 44:e12908. [PMID: 35104007 DOI: 10.1111/pim.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
The present work aimed to study the effects of G. lamblia infection on immunological, haematological studies and to evaluate immunoglobulins and some cytokines. Fifty male albino rats were divided into six groups. The control group including 20 rats and the infected group includes 30 rats. All the estimations were checked all over five checkpoints (CP) (7, 14, 21, 28, and 35 days post-infection). Serum levels of IgA, IgG, IgM and IgE. Cytokines INF-γ, TNF-alpha, IL-4, IL-10, and haematological parameters were determined. Cyst and trophozoite were counted. A considerable increase in the level of immunoglobulins and cytokines in all infected groups compared to the control group was documented. Furthermore, a significant decrease in red blood corpuscles, haemoglobin, and mean corpuscular haemoglobin concentration levels, whereas substantial increases in mean corpuscular volume, mean corpuscular haemoglobin and platelets were observed. Moreover, infected rats had a substantial rise in WBCs, lymphocytes, and eosinophil counts compared to the control group, whereas neutrophils and monocytes had a significant decrease. Number of trophozoites and cysts were significantly increased in infected groups before diminishing after day 28. The current results showed that Th1 and Th2 immune responses, which are characterized by the production of TNF-α, IFN-γ, IL-4 and IL-10, are important for protection against Giardia infections and also verified the balance between these cytokines and the timing of their production was crucial in G. lamblia immune response. Giardia lamblia, Immunity, Antibodies, cytokines, eosinophil.
Collapse
Affiliation(s)
- Mabrouk A Abo-Zaid
- Biology department faculty of science, Jazan University, Jazan, Saudi Arabia
| | - Aishah Ali Hamdi
- Biology department faculty of science, Jazan University, Jazan, Saudi Arabia
| |
Collapse
|
7
|
Kalas MA, Alduaij A, Alkhatib AA. Incidental Diagnosis of Duodenal Giardiasis. Cureus 2021; 13:e15499. [PMID: 34268030 PMCID: PMC8262110 DOI: 10.7759/cureus.15499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
Giardia lamblia is a protozoan that results in the commonly diagnosed giardiasis. Due to its prevalence and incidence worldwide, it is essential to recognize the different presentations of giardiasis, routes of transmission, modalities of diagnosis, treatments, and complications. Diagnostic modalities have evolved over the years and can be achieved reliably through noninvasive stool testing. Endoscopic duodenal aspirate and biopsies can also be used; however, they yield lower sensitivity and specificity rates and are therefore not used as a first-line modality for diagnosing giardiasis. Nonetheless, its use should be considered in cases with high suspicion and unremarkable stool testing. Herein, we discuss the case of a 27-year-old male with chronic weight loss and abdominal pain for six months diagnosed with G. lamblia through a duodenal biopsy.
Collapse
Affiliation(s)
- M Ammar Kalas
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Ahmed Alduaij
- Pathology and Laboratory Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, ARE
| | - Amer A Alkhatib
- Gastroenterology and Hepatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, ARE
| |
Collapse
|
8
|
La Hoz RM, Morris MI. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13618. [PMID: 31145496 DOI: 10.1111/ctr.13618] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 01/08/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a source of morbidity and mortality in solid-organ transplant recipients. Parasitic infections may be acquired from the donor allograft, from reactivation, or from de novo acquisition post-transplantation. Gastrointestinal multiplex assays have been developed; some of the panels include testing for Cryptosporidium, Cyclospora, Entamoeba histolytica, and Giardia, and the performance is comparable to conventional methods. A polymerase chain reaction test, not yet widely available, has also been developed to detect Strongyloides in stool samples. New recommendations have been developed to minimize the risk of Strongyloides donor-derived events. Deceased donors with epidemiological risk factors should be screened for Strongyloides and recipients treated if positive as soon as the results are available. New therapeutic agents and studies addressing the optimal treatment regimen for solid-organ transplant recipients are unmet needs.
Collapse
Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | | |
Collapse
|
9
|
Javed IN, Tajammal R, Ijaz SH, Ahmad N, Mahmood S. "Tear Drops in the Duodenum": Uncommon Cause of Iron Deficiency Anemia in Adults. Cureus 2019; 11:e5532. [PMID: 31687306 PMCID: PMC6819067 DOI: 10.7759/cureus.5532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 64-year-old man presented to the internal medicine resident clinic with fatigue and abdominal pain of six-month duration. He did not have diarrhea, hematemesis, melena, or hematochezia. Physical examination was unremarkable. Laboratory findings were consistent with iron deficiency anemia. Upper and lower gastrointestinal (GI) endoscopies revealed normal findings. Duodenal biopsy showed trophozoites (tear-drop-shaped) morphologically consistent with Giardia duodenalis. He was prescribed metronidazole and iron replacement therapy, with a resultant improvement in symptoms as well as lab values at the four-month follow-up visit.
Collapse
Affiliation(s)
- Isma N Javed
- Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Rutaba Tajammal
- Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Sardar H Ijaz
- Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Nazir Ahmad
- Internal Medicine, Saint Anthony Hospital, Oklahoma City, USA
| | | |
Collapse
|
10
|
Immune response markers in sera of children infected with Giardia duodenalis AI and AII subassemblages. Immunobiology 2019; 224:595-603. [PMID: 30962033 DOI: 10.1016/j.imbio.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/29/2022]
Abstract
In this study, we evaluated serum markers of immune responses in children infected with G. duodenalis and compared them with the characterized parasite isolates. The reactivity indexes (RI) of IgG (1.503 ± 0.819) and IgA (2.308 ± 1.935) antibodies were significantly higher (P < 0.001) in infected children than in non-infected children. There were also statistically significantly higher serum levels (P < 0.05) of IFN-γ (393.10 ± 983.90 pg/mL) as well as serum (30.03 ± 10.92 μmol/L) and saliva nitric oxid derivatives (NOx) (192.4 ± 151.2 μmol/L) in children infected with G. duodenalis compared to the group of non-parasitized children (127.4 ± 274.30 pg/mL; 25.82 ± 7.74 μmol/L and 122.5 ± 105.90 μmol/L, respectively). Regarding the characterized genetic variants of G. duodenalis and the immune response profiles, no differences were observed in terms of antibody reactivity or levels of serum cytokine and NOx among children infected with AI or AII subassemblages. The elevated levels of IFN-γ and NOx indicate that G. duodenalis intestinal infection in humans induces a cellular immune response detectable at the systemic level. Moreover, no significant differences in the antibody reactivity profile or the cytokine and NOx production in the sera of children infected with AI or AII G. duodenalis variants were observed, suggesting that subtypes of the parasite do not influence the immune response profile.
Collapse
|
11
|
|
12
|
Current Treatment Options for Giardiasis and Cryptosporidiosis. CURRENT TROPICAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40475-016-0082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
13
|
Bartelt LA, Sartor RB. Advances in understanding Giardia: determinants and mechanisms of chronic sequelae. F1000PRIME REPORTS 2015; 7:62. [PMID: 26097735 PMCID: PMC4447054 DOI: 10.12703/p7-62] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Giardia lamblia is a flagellated protozoan that is the most common cause of intestinal parasitic infection in children living in resource-limited settings. The pathogenicity of Giardia has been debated since the parasite was first identified, and clinical outcomes vary across studies. Among recent perplexing findings are diametrically opposed associations between Giardia and acute versus persistent diarrhea and a poorly understood potential for long-term sequelae, including impaired child growth and cognitive development. The mechanisms driving these protean clinical outcomes remain elusive, but recent advances suggest that variability in Giardia strains, host nutritional status, the composition of microbiota, co-infecting enteropathogens, host genetically determined mucosal immune responses, and immune modulation by Giardia are all relevant factors influencing disease manifestations after Giardia infection.
Collapse
Affiliation(s)
- Luther A. Bartelt
- Division of Infectious Diseases and International Health, University of VirginiaBox 801340, Charlottesville, VA 22908USA
| | - R. Balfour Sartor
- Division of Gastroenterology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel HillCampus Box 7032, Chapel Hill, NC 27599-7032USA
| |
Collapse
|
14
|
Abstract
The coccidians Cryptosporidium spp, Cyclospora cayetanensis, and Cystoisospora belli and the flagellate Giardia duodenalis are pathogenic protozoa associated with gastrointestinal manifestations. Diagnosis relies heavily on microscopy, and although ova-and-parasite examinations can detect Giardia and Cystoisospora, Cryptosporidium and Cyclospora often require specific diagnostic requests. Approved non-microscopy methods are available for Giardia and Cryptosporidium, although negative results are frequently followed by microscopic assays. Polymerase chain reaction-based methods are not frequently used for diagnosis of Giardia and Cryptosporidium and have been used primarily for epidemiologic or outbreak investigations of Giardia and Cryptosporidium.
Collapse
Affiliation(s)
- Vitaliano A Cama
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, MS D-65, Atlanta, GA 30341, USA.
| | - Blaine A Mathison
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, MS D-64, Atlanta, GA 30341, USA
| |
Collapse
|