Efficacy of Nitazoxanide, Nitazoxanide-Garlic Combination and Tinidazole in Treatment of Giardia duodenalis and Blastocystis hominis: Coproscopic Assessment

Background

Giardia duodenalis and Blastocystis hominis are among the most common intestinal protozoa worldwide. Treatment of infection by metronidazole (MTZ) has some limitations. The objective of this study was to detect the prevalence of Blastocystis and giardiasis among school-age children from December 2021 till March 2022 from Motoubes, Kafrelsheikh, Egypt, and determine the efficacy of nitazoxanide (NTZ), NTZ plus garlic and tinidazole (TIN) on Blastocystis and giardiasis infection.

Methods

Stool samples were collected from 390 children and microscopically examined using formalin-ethyl acetate concentration and culturing on Jones' medium for B. hominis. Those who tested positive for giardiasis (120 children, 30.7%) (Group I) or Blastocystis (180 children, 46.1%) (Group II) were equally divided into four subgroups. The first subgroup received NTZ orally, every 12 hours for three successive days. The second subgroup received NTZ in the same dose as the first subgroup plus dry garlic powder every 12 hours for three successive days. The third subgroup received TIN as a single oral dose, and a fourth control subgroup. Successful cure was considered if no Blastocystis or giardiasis stages were found in post-treatment faecal specimens.

Results

Cure rate was significantly higher in TIN treated groups (75.5% and 96.6%) than NTZ (57.7% and 40%) or NTZ plus garlic treated groups (55.5% and 43%) in both Blastocystis and giardiasis, respectively (P<0.05).

Conclusion

TIN, once, is more efficacious than NTZ or NTZ plus garlic in the treatment of Blastocystis and giardiasis in children.

P entatrichomonas hominis and other intestinal parasites in school-aged children: coproscopic survey

Pentatrichomonas hominis (P. hominis) is a large intestinal flagellated protozoan infecting humans. Little is known about the epidemiology of P.hominis in Egypt, its association with gastrointestinal symptoms and the co-infection with other parasites. Demographic and clinical data were collected from 180 school-aged children. Parasitological examination of fecal samples was done using direct wet mount, formalin ethyl-acetate, Kato-Katz and cultivation on Jones' medium to detect P. hominis and associated parasitic infection. The diagnosis of P. hominis was confirmed using Giemsa stain and scanning electron microscopy. The prevalence of P. hominis was 13.8% (25 out of 180 children). The prevalence of parasitic co-infection was significantly higher in P. hominis infected (84%, 21 participants) than in non-infected children (56%, 87 participants). The presence of abdominal pain and diarrhea in P. hominis infected children was higher than in non-infected children (84% and 32% vs. 76% and 18%), respectively. The difference was not statistically significant. This is the first report of P. hominis in Egypt. The significant association between P. hominis and other intestinal parasites need more investigations. Further studies are needed to understand the epidemiology and pathogenicity of P. hominis.