1887

Abstract

Giardiasis is an infection of the small intestine caused by the protozoan parasite and one of the most common parasitic intestinal diseases in humans worldwide. It mainly manifests as a self-limited illness in the case of immunocompetent patients and usually does not require treatment. However, immunodeficiency is a risk factor for the onset of severe infection. In this report, a case of recurrent giardiasis refractory to nitroimidazole therapy is presented. A 7-year-old male patient with steroid-resistant nephrotic syndrome came to our hospital because of chronic diarrhoea. The patient was on long-term immunosuppressive therapy. Microscopic examination of stool showed a significant number of trophozoites and cysts of . Treatment with metronidazole for longer duration than recommended has failed to clear the parasite in the present case.

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/content/journal/acmi/10.1099/acmi.0.000476.v3
2023-04-25
2024-04-30
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References

  1. Yadav P, Tak V, Mirdha BR, Makharia GK. Refractory giardiasis: a molecular appraisal from a tertiary care centre in India. Indian J Med Microbiol 2014; 32:378–382 [View Article]
    [Google Scholar]
  2. Nash TE, Ohl CA, Thomas E, Subramanian G, Keiser P et al. Treatment of patients with refractory giardiasis. Clin Infect Dis 2001; 33:22–28 [View Article] [PubMed]
    [Google Scholar]
  3. Lopez-Velez R, Batlle C, Jiménez C, Navarro M, Norman F et al. Short course combination therapy for giardiasis after nitroimidazole failure. Am J Trop Med Hyg 2010; 83:171–173 [View Article] [PubMed]
    [Google Scholar]
  4. World Health Organization The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. World Health Organization; 2005 https://apps.who.int/iris/handle/10665/43209
  5. Upcroft P. Drug resistance in Giardia: clinical versus laboratory isolates. Drug Resist Updat 1998; 1:166–168 [View Article] [PubMed]
    [Google Scholar]
  6. Iza JA, Iza SN, Olivera MJ. Giardiasis: report of a case refractory to treatment. Infez Med 2019; 27:336–339
    [Google Scholar]
  7. Carter ER, Nabarro LE, Hedley L, Chiodini PL. Nitroimidazole-refractory giardiasis: a growing problem requiring rational solutions. Clin Microbiol Infect 2018; 24:37–42 [View Article]
    [Google Scholar]
  8. Faubert G. Immune response to Giardia duodenalis . Clin Microbiol Rev 2000; 13:35–54 [View Article]
    [Google Scholar]
  9. Singer SM, Nash TE. T-cell-dependent control of acute Giardia lamblia infections in mice. Infect Immun 2000; 68:170–175 [View Article]
    [Google Scholar]
  10. Waldmann TA, Durm M, Broder S, Blackman M, Blaese RM et al. Role of suppressor T cells in pathogenesis of common variable hypogammaglobulinaemia. Lancet 1974; 2:609–613 [View Article]
    [Google Scholar]
  11. Cunningham-Rundles C. Clinical and immunologic analyses of 103 patients with common variable immunodeficiency. J Clin Immunol 1989; 9:22–33 [View Article]
    [Google Scholar]
  12. Di Renzo M, Zhou Z, George I, Becker K, Cunningham-Rundles C. Enhanced apoptosis of T cells in common variable immunodeficiency (CVID): role of defective CD28 co-stimulation. Clin Exp Immunol 2000; 120:503–511 [View Article] [PubMed]
    [Google Scholar]
  13. Nabarro LEB, Lever RA, Armstrong M, Chiodini PL. Increased incidence of nitroimidazole-refractory giardiasis at the Hospital for Tropical Diseases, London: 2008-2013. Clin Microbiol Infect 2015; 21:791–796 [View Article]
    [Google Scholar]
  14. Bourque DL, Neumayr A, Libman M, Chen LH. Treatment strategies for nitroimidazole-refractory giardiasis: a systematic review. J Travel Med 2022; 29:taab120 [View Article]
    [Google Scholar]
  15. Boone JH, Wilkins TD, Nash TE, Brandon JE, Macias EA et al. TechLab and alexon Giardia enzyme-linked immunosorbent assay kits detect cyst wall protein 1. J Clin Microbiol 1999; 37:611–614 [View Article] [PubMed]
    [Google Scholar]
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