期刊
JOURNAL OF INFECTIOUS DISEASES
卷 215, 期 6, 页码 946-953出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jix066
关键词
Refractory giardiasis; Giardia; treatment; nitroimidazole; PCR; quinacrine; tpi gene; bp gene; genetic characterization
资金
- Ministerio de Sanidad y Consumo Project Formacion en Investigacion en Salud (FIS) Project [PI 09/1585 (IACS) + DGA - FSE B124]
- Agencia de Gestio d'Ajuts Universitaris i de Recerca (AGAUR) [2014SGR26]
- Red de Investigacion cooperativa en enfermedades tropicales (RICET) within the Spanish National plan of Recerca, Desenvolupament, Innovacio (R+D+I) - Instituto de Salud Carlos III (ISCIII)-(Fondo Europeo de Desarrollo Regional [FEDER]) [RD12/0018/0010]
Background. There is little evidence regarding the management of refractory giardiasis after treatment with nitroimidazoles. This study estimates the proportion of persistent giardiasis in 3 hospitals in Barcelona, describes associated risk factors and genotype, and evaluates the efficacy rate of quinacrine in those with persistent giardiasis. Methods. A clinical, prospective, observational study was conducted in patients with giardiasis treated with nitroimidazoles. Those with persistent giardiasis were provided quinacrine. Molecular characterization of Giardia isolates was performed by polymerase chain reaction amplification of a fragment of tpi and bg genes. Results. Seventy-seven patients were recruited and treated with nitroimidazoles, and in 14 of 71 (20%) of patients followed up, Giardia persisted. Refractory giardiasis was associated with malaise (P = .007) and anorexia (P = .02), with previous giardiasis (P = .03), and with previous antibiotic (P = .02) or antiparasitic(P = .04) use. Quinacrine had an effectiveness rate of 100% in refractory giardiasis (n = 13; 95% confidence interval = 75-100). Molecular characterization showed that 17 (25%) Giardia isolates belonged to assemblage A, and 31 (43%) belonged to assemblage B. In refractory giardiasis, assemblage A and B were found responsible in 4 and 6 cases, respectively. Conclusions. Almost 20% of patients presented persistent giardiasis, belonging to both assemblages A and B, after nitroimidazole. Short course of quinacrine was effective in treating refractory cases. Further controlled studies should evaluate its efficacy and safety.
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