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Zhang X, Li X, Yu Y, Zhang X, Wang X, Zhang N, Chen M, Gong P, Li J. Giardia lamblia
regulates the production of proinflammatory cytokines through activating the NOD2–Rip2–ROS signaling pathway in mouse macrophages. Immunol Cell Biol 2022; 100:440-452. [DOI: 10.1111/imcb.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Xu Zhang
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
| | - Xin Li
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
| | - Yanhui Yu
- The Second Hospital of Jilin University Changchun Jilin 130021 China
| | - Xichen Zhang
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
| | - Xiaocen Wang
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
| | - Nan Zhang
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
| | - Mengge Chen
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
| | - Pengtao Gong
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
| | - Jianhua Li
- Key Laboratory of Zoonosis Research Ministry of Education College of Veterinary Medicine Jilin University 5333 Xian Road Changchun Jilin 130062 China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Jangra M, Dutta U, Shah J, Thapa BR, Nada R, Gupta N, Sehgal R, Sharma V, Khurana S. Role of Polymerase Chain Reaction in Stool and Duodenal Biopsy for Diagnosis of Giardiasis in Patients with Persistent/Chronic Diarrhea. Dig Dis Sci 2020; 65:2345-2353. [PMID: 31955285 DOI: 10.1007/s10620-019-06042-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/31/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Giardia duodenalis is a common cause of chronic diarrhea especially in tropical countries. Diagnosis is based on microscopy (three stool samples) for trophozoites/cysts. Role of stool or duodenal biopsy PCR as a diagnostic method needs to be defined. We conducted a prospective study to determine the diagnostic characteristics of G. duodenalis stool and duodenal biopsy PCR in comparison to stool microscopy (reference standard). Later, we compared other techniques with stool PCR, considering it as new reference standard and characterized the type of Giardia assemblage. METHODS G. duodenalis stool nested PCR was first evaluated using 40 positive controls and 50 negative controls considering stool microscopy as reference standard. Patients with chronic diarrhea (n = 100) were evaluated by stool microscopy and nested PCR. In 30 patients in whom upper gastrointestinal endoscopy was performed, duodenal biopsy samples were obtained and evaluated by histopathology, imprint cytology, and nested PCR. The type of Giardia assemblage was detected by assemblage-specific PCR. RESULTS Stool nested PCR was found to have sensitivity and specificity of 100% and 94%, respectively, compared to stool microscopy. In patients with chronic diarrhea, 48% had evidence of Giardia infection. Stool microscopy detected 65%, stool PCR detected an additional 27%, and duodenal biopsy PCR detected an additional 8% of cases. The commonest assemblage found was assemblage B. Clinical and demographic characteristics were similar in patients harboring either assemblage A or B. CONCLUSION Stool PCR is more sensitive than stool microscopy. By utilizing stool microscopy, stool nested PCR, and duodenal biopsy PCR in sequential manner, diagnostic yield can be increased.
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Affiliation(s)
- Monika Jangra
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Usha Dutta
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jimil Shah
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B R Thapa
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritambhra Nada
- Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nalini Gupta
- Cytological and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Vishal Sharma
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India.
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Corleto VD, Di Marino VP, Galli G, Antonelli G, Coluccio C, Di Cerbo A, Uccini S, Annibale B. Improving basic skills in celiac-like disease diagnosis: a case report. BMC Gastroenterol 2018; 18:162. [PMID: 30390626 PMCID: PMC6215663 DOI: 10.1186/s12876-018-0894-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/23/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The diagnosis of Coeliac disease (CD) requires a combination of sign/symptoms, positivity of specific antibodies and duodenal histological evidence of villous atrophy. Duodenal villous atrophy, despite representing the CD landmark, is not specific since it is found in many gastrointestinal disorders. Giardiasis is one of the most common human intestinal protozoan infestations in industrialized countries whose histological duodenal mucosa damage could mimic that of CD. The present report shows how a wise clinical and laboratory assessment led us shortly to a correct diagnosis. CASE PRESENTATION A 42-year-old outpatient woman without previous significant gastrointestinal diseases, was referred with dyspeptic symptoms, fatigue and mild diarrhea from 4 months. Her first investigations including immunoglobulin A (IgA) anti-tissue transglutaminase antibodies (anti-tTG) and stool parasitological and cultural analysis were negative. An esophagogastroduodenoscopy (EGDS) showed no mucosal alteration. But histology demonstrated a Helicobacter Pylori (HP) pan-gastritis while duodenal mucosa showed villous atrophy consistent with a diagnosis of CD Marsh type 3b. While on gluten-free diet (GFD) the patient didn't experience any improvement of symptoms. Duodenal biopsies were then reviewed showing the presence of trophozoites of Giardia on the luminal surface of the duodenal wall and at the same time, a second stool examination revealed the presence of trophozoites and cysts of Giardia. Treated with metronidazole, 500 mg twice daily for 6 days the patient reduced diarrhea after few days. After about 2 months of GFD she was invited to discontinue it. At the same time stool examination was repeated with negative results. She subsequently performed eradication for Hp with triple therapy (Pylera®). Around 6 months later, the patient did not complain any gastrointestinal symptoms. Serological tests were normal and at a follow-up EGDS, duodenal mucosa had normal histology with normal finger-like villi and absence of Giardia trophozoites. CONCLUSION This case report shows how CD diagnosis can sometimes be manifold. Intestinal villous atrophy alone may not automatically establish a diagnosis of CD. In the present case the clinical scenario could be fully explained by giardiasis. Indeed, different diagnostic tools and a multi-step approaches have been used to determine the final correct diagnosis.
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Affiliation(s)
- Vito Domenico Corleto
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
- grid.7841.aDigestive Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Vincenza Patrizia Di Marino
- grid.7841.aPaedriatic Allergology, Allergology Unit, “Policlinico Umberto I” University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Gloria Galli
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Giulio Antonelli
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Chiara Coluccio
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Arcangelo Di Cerbo
- grid.7841.aPathology Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Stefania Uccini
- grid.7841.aPathology Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Bruno Annibale
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
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Pipiková J, Papajová I, Majláthová V, Šoltys J, Bystrianska J, Schusterová I, Vargová V. First report on Giardia duodenalis assemblage F in Slovakian children living in poor environmental conditions. J Microbiol Immunol Infect 2018; 53:148-156. [PMID: 29907537 DOI: 10.1016/j.jmii.2018.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/16/2018] [Accepted: 04/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Giardiasis is one of the most common gastrointestinal infections of humans and animals attributable to complex of eight morphologically identical genetic assemblages, further divided into sub-assemblages. Disease is common for a wide range of hosts and genetic characterization is needed for better understanding of multifaceted epidemiology for this protozoan parasite. The aim of this study was to identify genetic heterogeneity in assemblages and sub-assemblages of Giardiaduodenalis circulating among the children population living in deprived socioeconomic conditions. METHODS A total of 333 stool samples from children in eastern Slovakia were collected during the period of 2015-2016 and analysed by molecular methods. Molecular characterization of G. duodenalis was performed by sequence analysis of triose phosphate isomerase gene (tpi) and glutamate dehydrogenase gene (gdh). RESULTS G. duodenalis DNA was detected in 21 samples (6.3%), out of which 14 isolates (66.7%) belonged to assemblage B, 4 isolates (19.0%) to sub-assemblage AII and 3 isolates (14.3%) corresponded to assemblage F. As regards the determination of sub-assemblages of assemblage B, 4 isolates were characterized as sub-assemblage BIII and 6 isolates as sub-assemblage BIV. CONCLUSION This study is the first finding of cat specific assemblage F in man not only in Slovakia, but also in Europe. The absence of molecular data about G. duodenalis in companion animals in Slovakia establishes a strong need for further investigation for potential sources of giardiasis and understanding the epidemiology will help to improve the preventive strategies in eradication of infection in this population.
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Affiliation(s)
- Jana Pipiková
- Institute of Parasitology, Slovak Academy of Sciences, Košice, Slovak Republic
| | - Ingrid Papajová
- Institute of Parasitology, Slovak Academy of Sciences, Košice, Slovak Republic.
| | - Viktória Majláthová
- Institute of Parasitology, Slovak Academy of Sciences, Košice, Slovak Republic; Institute of Biology and Ecology, Pavol Jozef Šafárik University, Faculty of Natural Sciences, Košice, Slovak Republic
| | - Jindřich Šoltys
- Institute of Parasitology, Slovak Academy of Sciences, Košice, Slovak Republic
| | - Júlia Bystrianska
- Institute of Parasitology, Slovak Academy of Sciences, Košice, Slovak Republic
| | - Ingrid Schusterová
- Department of Pediatrics and Adolescent Medicine, Pavol Jozef Šafárik University, Faculty of Medicine, Košice, Slovak Republic
| | - Veronika Vargová
- Department of Pediatrics and Adolescent Medicine, Pavol Jozef Šafárik University, Faculty of Medicine, Košice, Slovak Republic
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Lass A, Szostakowska B, Korzeniewski K, Karanis P. Detection of Giardia intestinalis in water samples collected from natural water reservoirs and wells in northern and north-eastern Poland using LAMP, real-time PCR and nested PCR. J Water Health 2017; 15:775-787. [PMID: 29040080 DOI: 10.2166/wh.2017.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Giardia intestinalis is a protozoan parasite, transmitted to humans and animals by the faecal-oral route, mainly through contaminated water and food. Knowledge about the distribution of this parasite in surface water in Poland is fragmentary and incomplete. Accordingly, 36 environmental water samples taken from surface water reservoirs and wells were collected in Pomerania and Warmia-Masuria provinces, Poland. The 50 L samples were filtered and subsequently analysed with three molecular detection methods: loop-mediated isothermal amplification (LAMP), real-time polymerase chain reaction (real-time PCR) and nested PCR. Of the samples examined, Giardia DNA was found in 15 (42%) samples with the use of LAMP; in 12 (33%) of these samples, Giardia DNA from this parasite was also detected using real-time PCR; and in 9 (25%) using nested PCR. Sequencing of selected positive samples confirmed that the PCR products were fragments of the Giardia intestinalis small subunit rRNA gene. Genotyping using multiplex real-time PCR indicated the presence of assemblages A and B, with the latter predominating. The results indicate that surface water in Poland, as well as water taken from surface wells, may be a source of Giardia strains which are potentially pathogenic for humans. It was also demonstrated that LAMP assay is more sensitive than the other two molecular assays.
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Affiliation(s)
- Anna Lass
- Department of Tropical Parasitology, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, 9b Powstania Styczniowego Str., Gdynia 81-519, Poland; State Key Laboratory of Plateau Ecology and Agriculture, Center for Biomedicine and Infectious Disease, Qinghai Academy of Animal Sciences and Veterinary Medicine, Medical School of Qinghai University Xining, 1#Wei'er Road, Qinghai Biological Scientific Estate Garden, Xining 810016, P. R. China E-mail:
| | - Beata Szostakowska
- Department of Tropical Parasitology, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, 9b Powstania Styczniowego Str., Gdynia 81-519, Poland
| | - Krzysztof Korzeniewski
- Epidemiology and Tropical Medicine Department in Gdynia, Military Institute of Medicine in Warsaw, Grudzinskiego St. 4, Gdynia 81-103, Poland
| | - Panagiotis Karanis
- State Key Laboratory of Plateau Ecology and Agriculture, Center for Biomedicine and Infectious Disease, Qinghai Academy of Animal Sciences and Veterinary Medicine, Medical School of Qinghai University Xining, 1#Wei'er Road, Qinghai Biological Scientific Estate Garden, Xining 810016, P. R. China E-mail:
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Lass A, Karanis P, Korzeniewski K. First detection and genotyping of Giardia intestinalis in stool samples collected from children in Ghazni Province, eastern Afghanistan and evaluation of the PCR assay in formalin-fixed specimens. Parasitol Res 2017; 116:2255-2264. [PMID: 28612148 PMCID: PMC5529491 DOI: 10.1007/s00436-017-5529-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
It is estimated that faecal-orally transmitted diseases are common in Afghanistan, as a consequence of poor hygienic standards of life and widespread contamination of water and food with both human and animal faeces. However, there is little information in the literature concerning infections caused by intestinal parasites in the Afghan population. In this study, we report the occurrence of Giardia intestinalis assemblages (A and B) in formalin-fixed stool samples collected from 245 Afghan schoolchildren living in Ghazni Province in eastern Afghanistan. Detection of the parasite’s DNA and genotyping was performed using real-time PCR, specific to the β-giardin gene of G. intestinalis. Positive results were recorded in 52 (21.2%) samples. Genotyping was successful in 39 faecal samples and showed the predominance of assemblage B of G. intestinalis in this population (15 assemblage A and 24 assemblage B). Co-infection with both genotypes A and B was detected in four samples. Additionally, we evaluated the effect of 10% buffered formalin fixative on the detection of G. intestinalis DNA using real-time PCR and nested PCR characterised by different lengths of PCR products (74 and 479 bp, respectively). The human faeces containing the Giardia cysts were tested for 16 weeks. Amplification of G. intestinalis DNA with real-time PCR was possible up to 6 weeks of preservation of stool sample in formalin, compared to only 2 weeks with nested PCR. This suggests that real-time PCR is a more suitable tool in cases where stool samples have to be kept in formalin for longer periods of time.
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Affiliation(s)
- Anna Lass
- Department of Tropical Parasitology, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, 9b Powstania Styczniowego Str, 81-519, Gdynia, Poland.
| | - Panagiotis Karanis
- State Key Laboratory of Plateau Ecology and Agriculture, Center for Biomedicine and Infectious Disease, Qinghai Academy of Animal Sciences and Veterinary Medicine, Qinghai University, Xining, 1#Wei'er Road, Qinghai Biological Scientific Estate Garden, Xining, 810016, People's Republic of China
| | - Krzysztof Korzeniewski
- Epidemiology and Tropical Medicine Department in Gdynia, Military Institute of Medicine in Warsaw, Grudzinskiego St. 4, 81-103, Gdynia, Poland
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Zylberberg HM, Green PH, Turner KO, Genta RM, Lebwohl B. Prevalence and Predictors of Giardia in the United States. Dig Dis Sci 2017; 62:432-40. [PMID: 28070825 DOI: 10.1007/s10620-016-4447-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/30/2016] [Indexed: 12/19/2022]
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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Marcial-Quino J, Gómez-Manzo S, Fierro F, Vanoye-Carlo A, Rufino-González Y, Sierra-Palacios E, Castillo-Villanueva A, Castillo-Rodríguez RA, Rodríguez-Bustamante E, Arreguin-Espinosa R, Reyes-Vivas H. Stem-Loop RT-qPCR as an Efficient Tool for the Detection and Quantification of Small RNAs in Giardia lamblia. Genes (Basel) 2016; 7:E131. [PMID: 27999395 DOI: 10.3390/genes7120131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/26/2016] [Accepted: 11/26/2016] [Indexed: 11/16/2022] Open
Abstract
Stem-loop quantitative reverse transcription PCR (RT-qPCR) is a molecular technique used for identification and quantification of individual small RNAs in cells. In this work, we used a Universal ProbeLibrary (UPL)-based design to detect-in a rapid, sensitive, specific, and reproducible way-the small nucleolar RNA (snoRNA) GlsR17 and its derived miRNA (miR2) of Giardia lamblia using a stem-loop RT-qPCR approach. Both small RNAs could be isolated from both total RNA and small RNA samples. Identification of the two small RNAs was carried out by sequencing the PCR-amplified small RNA products upon ligation into the pJET1.2/blunt vector. GlsR17 is constitutively expressed during the 72 h cultures of trophozoites, while the mature miR2 is present in 2-fold higher abundance during the first 48 h than at 72 h. Because it has been suggested that miRNAs in G. lamblia have an important role in the regulation of gene expression, the use of the stem-loop RT-qPCR method could be valuable for the study of miRNAs of G. lamblia. This methodology will be a powerful tool for studying gene regulation in G. lamblia, and will help to better understand the features and functions of these regulatory molecules and how they work within the RNA interference (RNAi) pathway in G. lamblia.
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Donowitz JR, Alam M, Kabir M, Ma JZ, Nazib F, Platts-Mills JA, Bartelt LA, Haque R, Petri WA. A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea. Clin Infect Dis 2016; 63:792-7. [PMID: 27313261 PMCID: PMC4996141 DOI: 10.1093/cid/ciw391] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/07/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Growth stunting in children under 2 years of age in low-income countries is common. Giardia is a ubiquitous pathogen in this age group but studies investigating Giardia's effect on both growth and diarrhea have produced conflicting results. METHODS We conducted a prospective longitudinal birth cohort study in Dhaka, Bangladesh, with monthly Giardia and continuous diarrheal surveillance. RESULTS 629 children were enrolled within the first 72 hours of life, and 445 completed 2 years of the study. 12% of children were stunted at birth with 57% stunted by 2 years. 7% of children had a Giardia positive surveillance stool in the first 6 months of life, whereas 74% had a positive stool by 2 years. The median time to first Giardia positive surveillance stool was 17 months. Presence of Giardia in a monthly surveillance stool within the first 6 months of life decreased length-for-age Z score at 2 years by 0.4 (95% confidence interval, -.80 to -.001; P value .05) whereas total number of Giardia positive months over the 2-year period of observation did not. Neither variable was associated with weight-for-age Z score at 2 years. In our model to examine predictors of diarrhea only exclusive breastfeeding was significantly associated with decreased diarrhea (P value <.001). Concomitant giardiasis was neither a risk factor nor protective. CONCLUSIONS Early life Giardia was a risk factor for stunting at age 2 but not poor weight gain. Presence of Giardia neither increased nor decreased odds of acute all cause diarrhea.
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Affiliation(s)
- Jeffrey R Donowitz
- Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University
| | - Masud Alam
- Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Mamun Kabir
- Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Jennie Z Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville
| | - Forida Nazib
- Department of Medicine and Vaccine Testing Center, The University of Vermont College of Medicine, Burlington
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Luther A Bartelt
- Division of Infectious Diseases, University of North Carolina-Chapel Hill
| | - Rashidul Haque
- Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
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Marcial-Quino J, Fierro F, De la Mora-De la Mora I, Enríquez-Flores S, Gómez-Manzo S, Vanoye-Carlo A, Garcia-Torres I, Sierra-Palacios E, Reyes-Vivas H. Validation of housekeeping genes as an internal control for gene expression studies in Giardia lamblia using quantitative real-time PCR. Gene 2016; 581:21-30. [PMID: 26778241 DOI: 10.1016/j.gene.2016.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 02/06/2023]
Abstract
The analysis of transcript levels of specific genes is important for understanding transcriptional regulation and for the characterization of gene function. Real-time quantitative reverse transcriptase PCR (RT-qPCR) has become a powerful tool to quantify gene expression. The objective of this study was to identify reliable housekeeping genes in Giardia lamblia. Twelve genes were selected for this purpose, and their expression was analyzed in the wild type WB strain and in two strains with resistance to nitazoxanide (NTZ) and metronidazole (MTZ), respectively. RefFinder software analysis showed that the expression of the genes is different in the three strains. The integrated data from the four analyses showed that the NADH oxidase (NADH) and aldolase (ALD) genes were the most steadily expressed genes, whereas the glyceraldehyde-3-phosphate dehydrogenase gene was the most unstable. Additionally, the relative expression of seven genes were quantified in the NTZ- and MTZ-resistant strains by RT-qPCR, using the aldolase gene as the internal control, and the results showed a consistent differential pattern of expression in both strains. The housekeeping genes found in this work will facilitate the analysis of mRNA expression levels of other genes of interest in G. lamblia.
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Tortora R, Capone P, Imperatore N, De Stefano G, Gerbino N, Leo M, Caporaso N, Rispo A. Predictive value of "Marsh 1" type histology in subjects with suspected cealic disease. Scand J Gastroenterol 2014; 49:801-6. [PMID: 24958090 DOI: 10.3109/00365521.2014.919019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The diagnosis of celiac disease (CD) is based on histology in combination with anti-tissue transglutaminase (a-tTG) and anti-endomysial antibodies (EMAs). The increase of intraepithelial lymphocytes defines the Marsh 1 histology that appears not to be specific for CD. AIM To explore the positive predictive value (PPV) and clinical relevance of Marsh 1 histology in suspected CD. METHODS We carried out an observational prospective study including all consecutive subjects with a Marsh 1 histology. All patients were tested for a-tTG and EMAs. Diagnosis of potential CD was defined in the presence of Marsh 1 with positive a-tTG and EMAs. Patients were investigated for symptoms, CD familial aggregation, other diseases, and current medication. RESULTS Sixty-three patients with Marsh 1 were included. Diagnosis of potential CD was made in 23 subjects (36%), so that Marsh 1 histology showed a PPV of 36%. With regard to familial aggregation, patients with potential CD showed a higher frequency of familiarity for CD (60.8% vs. 15.0%; p < 0.01). No significant difference was detected between CD and non-CD in terms of intestinal and extra-intestinal symptoms. We also documented the presence of conditions other than CD in the remaining population: 7 patients (17.5%) with immuno-mediated diseases while 5 patients (12.5%) showed Helicobacter pylori (HP) infection. About medication, 3 patients (7.5%) were on non-steroidal anti-inflammatory drugs, while another 4 (10%) patients were being treated with other drugs. CONCLUSION The Marsh 1 type histology is not specific for CD and it can also be associated with immuno-mediated disorders, HP infection, and drugs.
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Affiliation(s)
- Raffaella Tortora
- Department of Clinical Medicine and Surgery - University of Naples "Federico II", Gastroenterology , Naples , Italy
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Abstract
There are inconsistent findings concerning the role of Giardia lamblia in pediatric diarrhea. A prospective cohort study of the incidence of acute diarrhea among Israeli Arab preschool children offered the opportunity to examine the association between G. lamblia infection (at baseline) and subsequent diarrhea. Following baseline screening by light microscopy for the presence of Giardia in their stools, a cohort was assembled of 142 children who were followed between October 2003 and August 2004 for the incidence of diarrhea. Surveillance was performed through maternal interviews. At baseline, 21 children tested Giardia-positive. During the prospective surveillance, acute diarrhea occurred less often among Giardia-positive children (9.5%) than among children who were not infected with Giardia (26.5%). G. lamblia infection was associated with lower risk of acute diarrhea; adjusted odds ratio of 0.18 (95% confidence interval 0.04-0.93) (p = 0.041). This prospective study provides additional evidence that Giardia may lower the risk of subsequent acute diarrhea among preschool children.
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Affiliation(s)
- Khitam Muhsen
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
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Neiva VDA, Ribeiro MNS, Nascimento FR, Cartágenes MDSS, Coutinho-Moraes DF, Amaral FMD. Plant species used in giardiasis treatment: ethnopharmacology and in vitro evaluation of anti-Giardia activity. Revista Brasileira de Farmacognosia 2014. [DOI: 10.1016/j.bjp.2014.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Plutzer J, Törökné A, Szénási Z, Kucsera I, Farkas K, Karanis P. Detection and genotype analysis of Giardia duodenalis from asymptomatic Hungarian inhabitants and comparative findings in three distinct locations. Acta Microbiol Immunol Hung 2014; 61:19-26. [PMID: 24631751 DOI: 10.1556/amicr.61.2014.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The transmission route of giardiasis not yet understood and why some infected individuals remain asymptomatic while others become quite ill. The drinking water quality is supposedly responsible for the prevalence of asymptomatic Giardia duodenalis infections in different areas, therefore asymptomatic giardiasis has been investigated in three water supply areas of Hungary: three hundred stool samples from inhabitants of Budapest, Füzér and Mátrafüred were examined by immunological and molecular methods for the presence of G. duodenalis infections. Individuals were asked to fill out a validated questionnaire at the time of stool collection and the interview covered demographic data, family life, education and travel history.In Budapest and in Mátrafüred in one stool sample G. duodenalis Assemblage A, whereas in Füzér once G. duodenalis Assemblage A, once Assemblage B and twice mixed infection were detected. We found higher prevalence rate of 4% of G. duodenalis infections of asymptomatic people in the village Füzér, where the removal of the Giardia cysts of the drinking water treatment plant was not effective. This study throws a light the need to look into the possibility of other risks of Giardia infections such as water transmission routes. To our knowledge, this is the first study evaluating the prevalence of G. duodenalis infections in asymptomatic persons in Hungary.
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Affiliation(s)
- Judit Plutzer
- 1 National Institute of Environmental Health Department of Water Hygiene Albert Flórián u. 2-6 H-1097 Budapest Hungary
| | - Andrea Törökné
- 1 National Institute of Environmental Health Department of Water Hygiene Albert Flórián u. 2-6 H-1097 Budapest Hungary
| | - Zsuzsanna Szénási
- 2 National Center for Epidemiology Department of Parasitology Albert Flórián u. 2-6 H-1097 Budapest Hungary
| | - István Kucsera
- 2 National Center for Epidemiology Department of Parasitology Albert Flórián u. 2-6 H-1097 Budapest Hungary
| | - Kata Farkas
- 1 National Institute of Environmental Health Department of Water Hygiene Albert Flórián u. 2-6 H-1097 Budapest Hungary
| | - Panagiotis Karanis
- 3 University of Cologne Medical and Molecular Parasitology, Center of Anatomy, Institute II, Medical School Kerpener Str. 62 D-50937 Cologne Germany
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Abstract
CONTEXT The finding of increased intraepithelial lymphocytes with normal villous architecture (Marsh I lesion) is seen in up to 3% of duodenal biopsies. The differential diagnosis includes a wide range of possibilities, including celiac disease, bacterial overgrowth, nonsteroidal antiinflammatory drug damage, reaction to Helicobacter pylori infection, tropical sprue, and chronic inflammatory bowel disease. OBJECTIVES To highlight the histologic features of the Marsh I lesion, review the diseases and conditions associated with that finding, and to provide pathologists with a rationale and a template for how to identify and report such cases. DATA SOURCES A review of the literature regarding the histologic features and clinical associations of Marsh I lesions. CONCLUSIONS Marsh I lesions are a nonspecific finding associated with a number of disease conditions. Historically, between 9% and 40% of cases have been shown to represent celiac disease. Current data do not suggest histologic features to differentiate between diseases associated with this histologic change.
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Affiliation(s)
- Suntrea T G Hammer
- Department of Pathology, University of Michigan Health System, Ann Arbor, 48109, USA.
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Xiao G, Qiu Z, Qi J, Chen JA, Liu F, Liu W, Luo J, Shu W. Occurrence and potential health risk of Cryptosporidium and Giardia in the Three Gorges Reservoir, China. Water Res 2013; 47:2431-45. [PMID: 23478072 DOI: 10.1016/j.watres.2013.02.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 05/20/2023]
Abstract
The Three Gorges Reservoir (TGR) is the biggest lake in the world and a major water source in China. There is no information about occurrence and impact of Cryptosporidium and Giardia on the aquatic ecosystem. 61 surface water samples from 23 monitoring sites and 5 treated effluent samples were collected and analyzed. Cryptosporidium oocysts and Giardia cysts were found, respectively, in 86.4% and 65.2% of a total of 66 water samples, with high concentrations in treated effluent. The mean percent recovery was 29.14% for oocysts and 34.86% for cysts. A seasonal pattern was observed, with positive samples for Cryptosporidium more frequent in flood period and positive samples for Giardia more frequent in impounding period. Counts of enterococci, fecal coliforms and total coliforms, and turbidity were significantly associated with Cryptosporidium concentration in backwater (water in a main river which is backed up by the Three Gorges Dam) areas of tributaries but not Giardia. High associations were also found between oocyst and cyst in backwater areas of tributaries and cities. The risks of infection and illness due to water consumption in four different exposure routes were estimated. The results showed that swimming in the TGR has the highest infection risk with 1.39 × 10(-3) per time (95% confidence interval (CI): 0.05-600.3 × 10(-5)) for Cryptosporidium and 2.08 × 10(-4) per time (95% CI: 0.05-878.87 × 10(-6)) for Giardia, while directly drinking unboiled tap water treated with the conventional process has the highest morbidity with 524.98 per 100,000 population per year (95% CI: 10.35-2040.26) for Cryptosporidium and 5.89 per 100,000 population per year (95% CI: 0.08-22.67) for Giardia. This study provides new useful information for drinking water plants, health care workers and managers to improve the safety of tap water and deduce the risk of surface water contamination in China.
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Affiliation(s)
- Guosheng Xiao
- Department of Environmental Hygiene, School of Military Preventive Medicine, Third Military Medical University, 400038 Chongqing, China
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Muhsen K, Levine MM. A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries. Clin Infect Dis 2012; 55 Suppl 4:S271-93. [PMID: 23169940 PMCID: PMC3502312 DOI: 10.1093/cid/cis762] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38-.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50-6.76; P < .001), positively linking Giardia with that syndrome. The well-powered Global Enteric Multicenter Study (GEMS) is prospectively addressing the association between G. lamblia infection and diarrhea in children in developing countries.
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Affiliation(s)
- Khitam Muhsen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Pickering H, Wu M, Bradley M, Bridle H. Analysis of Giardia lamblia interactions with polymer surfaces using a microarray approach. Environ Sci Technol 2012; 46:2179-2186. [PMID: 22303893 DOI: 10.1021/es203637e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The interaction of the waterborne protozoan parasite, Giardia lamblia, with polymeric materials was investigated by microarray screening of 652 polymers. Polymers were identified which either bound G. lamblia cysts or prevented their binding. Correlation of material properties such as wettability and surface roughness with cyst attachment revealed no influence of these factors upon Giardia adhesion. However, the study of polymer composition allowed the correlation of binding and generation of polymer structure function relationships; glycol and aromatic functionalities appeared to prevent adhesion, whereas secondary amine groups promoted adhesion, in agreement with previous literature. A significant reduction in attachment was observed following both cyst treatments with proteinase K and performing experiments at extremes of pH (2 and 12). It is suggested that proteinase K removes the proteins needed for specific surface interactions, whereas extremes of pH influence either protonation of the polymer or the surface charge of the cysts. The mechanism by which the protozoa attach to polymeric surfaces is proposed to be through ion-pair interactions. Improved understanding of G. lamblia surface interactions could assist in predicting transport and fate behavior in the environment and contribute to better design of water treatment processes, while the polymers identified in this work could find use in sensor applications and membrane filtration.
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Affiliation(s)
- Harry Pickering
- Institute for Infrastructure and Environment, School of Engineering, University of Edinburgh , Edinburgh, EH9 3JL, United Kingdom
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Plutzer J, Ongerth J, Karanis P. Giardia taxonomy, phylogeny and epidemiology: Facts and open questions. Int J Hyg Environ Health 2010; 213:321-33. [DOI: 10.1016/j.ijheh.2010.06.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/25/2010] [Accepted: 06/02/2010] [Indexed: 11/18/2022]
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Silva RR, da Silva CAM, de Jesus Pereira CA, de Carvalho Nicolato RL, Negrão-corrêa D, Lamounier JA, Carneiro M. Association between nutritional status, environmental and socio-economic factors and Giardia lamblia infections among children aged 6–71 months in Brazil. Trans R Soc Trop Med Hyg 2009; 103:512-9. [DOI: 10.1016/j.trstmh.2008.10.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 10/16/2008] [Accepted: 10/16/2008] [Indexed: 11/18/2022] Open
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Zuckerman MJ, Peters J, Fleming RV, Boman D, Calleros JE, Adler DG. Cholangiopathy associated with giardiasis in a patient with human immunodeficiency virus infection. J Clin Gastroenterol 2008; 42:328-9. [PMID: 18223486 DOI: 10.1097/01.mcg.0000248016.23762.ca] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Aijaz B, Beckman TJ. 25-year-old man with abdominal pain, nausea, and fatigue. Mayo Clin Proc 2007; 82:359-62. [PMID: 17352372 DOI: 10.4065/82.3.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bilal Aijaz
- Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Abstract
The United States Food and Drug Administration has approved the parasiticidal agent nitazoxanide for treatment of diarrhea caused by Giardia lamblia/intestinalis or Cryptosporidium parvum. This novel agent has a broad spectrum of activity against many other gastrointestinal pathogens, including bacteria, roundworms, flatworms, and flukes. Nitazoxanide is used in many areas of the world, especially in Central and South America, as a broad-spectrum parasiticidal agent in adults and children. Nitazoxanide appears to be well tolerated, has a relatively low incidence of adverse effect, and displays no significant known drug-to-drug interactions. Recently, preliminary reports indicate that nitazoxanide may be an effective treatment for Clostridium difficile-associated diarrhea as well. Future work will likely solidify and further expand the role of nitazoxanide in the treatment of a wide range of intestinal pathogens.
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Affiliation(s)
- David A Bobak
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Case Medical Center, 1110 Euclid Avenue, Cleveland, OH 44106, USA.
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Abstract
Treatment of parasitic infections in children presents many challenges for the clinician. Although parasitic infections are ubiquitous on a worldwide basis, with an estimated 1 billion persons infected with intestinal helminthes alone, physicians in the United States and other developed countries are often unfamiliar with the management of these diseases. Children are traveling internationally in larger numbers than ever before, however, and emigration from developing countries to the United States and other Western countries is increasing, so clinicians in these countries are confronted more frequently with parasitic diseases from the tropics. This article describes current approaches to antiparasitic therapy. Drugs used in the treatment of more than one type of parasite are presented once in detail, with reference to the detailed description in subsequent sections.
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Affiliation(s)
- Troy D Moon
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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Abstract
The diagnosis of coeliac disease depends on the finding of characteristic, though not specific changes, of intraepithelial lymphocytosis, crypt hyperplasia and various degrees of villous height reduction identified in duodenal biopsies of individuals ingesting a gluten containing diet, together with symptomatic and histologic improvement on gluten withdrawal. Serologic testing has become the main mode of determining who will undergo biopsy. The IgA endomysial antibody and IgA tissue transglutaminase antibody have approximately 90% sensitivity and specificity, though there are reports of lower sensitivity and specificity in the clinical practice setting. This is due to lower titers of these antibodies in the presence of lesser degrees of mucosal damage. The widespread availability of serologic tests for coeliac disease allows the diagnosis to be considered by any physician. Gastroenterologists will be required to interpret the results of serologic tests and perform duodenal biopsies when indicated. Pathologists likewise need to be better acquainted with the more subtle changes of cell mediated immunity within the mucosa that are suggestive of underlying gluten sensitivity.
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Affiliation(s)
- Peter H R Green
- Department of Medicine, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, New York 10032, USA.
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