Efectividad del Oleozón® en el tratamiento de niños y adolescentes con giardiasis / Effectiveness of Oleozón® in the treatment of children and adolescents with giardiasis

Se realizó un ensayo clínico en fase IV para evaluar la efectividad del Oleozón® aplicado por vía oral en niños y adolescentes con giardiasis, atendidos en la interconsulta de Pediatría del Policlínico Universitario Julián Grimau García de Santiago de Cuba, desde enero hasta diciembre del 2015. El universo estuvo constituido por 116 pacientes (con igual número de casos y controles) en las edades de 1 a 18 años, infectados por Giardia lamblia, quienes presentaban dolor abdominal, vómito y anorexia como síntomas fundamentales. En la serie se obtuvo que el mayor número de los pacientes del grupo experimental, cuyo esquema terapéutico incluía el Oleozón®, resolvió el dolor abdominal y mejoró su estado general al disminuir el resto de los síntomas. Pudo concluirse que el Oleozón® resultó efectivo en el tratamiento contra la giardiasis, pues las muestras de heces fecales dieron negativo en todos los casos; además, no se produjeron reacciones adversas y su costo es bajo, lo que conlleva un impacto económico, social y medioambiental

A clinical assay in phase IV was carried out to evaluate the effectiveness of oral Oleozón® used in children and adolescents with giardiasis, assisted in the Pediatrics specialty consultation from Julián Grimau García University Polyclinic in Santiago de Cuba, from January to December, 2015. The universe was constituted by 116 patients (with the same number of cases and controls) and aged 1 to 18 years, infected by Giardia lamblia who presented abdominal pain, vomit and anorexy as fundamental symptoms. In the series it was obtained that the highest number in the patients of the experimental group whose therapeutic schedule included Oleozón® , solved the abdominal pain and it improved their general state when decreasing the rest of the symptoms. It could be concluded that the Oleozón® was effective in the treatment against giardiasis, because the samples of faeces were negative in all cases; besides, it produced no adverse reactions and its cost is low, what bears an economic, social and environmental impact

Effect of probiotics on giardiasis. Where are we?

ABSTRACT Giardiasis, an intestinal infection caused by Giardia lamblia, was recently included in the 'Neglected Diseases Initiative' by the World Health Organization. Symptomatic patients can develop mild diarrhea up to a severe malabsorption syndrome, and children may show significantly impaired cognitive and physical development. Currently, nitroimidazoles are the main class of antibiotic used to treat giardiasis. Despite the efficacy of these drugs, adverse effects and reported resistance have increased, encouraging studies to identify and develop therapeutic alternatives. In this context, probiotics may represent an attractive option. Probiotics are defined as live microorganisms that, when administered in suitable amounts, confer a health benefit to the host. The use of probiotics in the treatment of parasitosis has been suggested because of its beneficial effects, such as a reduced time of gastrointestinal symptoms and parasite load in animal models and humans. Probiotics have been studied as an alternative treatment for giardiasis. In this review, we evaluated probiotic effectiveness in the treatment and prevention of this disease. Based on the studies examined herein, we conclude that probiotics have a beneficial effect on the modulation of giardiasis.

Uso del Oleozon® en pacientes con giardiasis, impétigo contagioso y epidermofitosis de los pies / Use of Oleozon® in patients with giardiasis, contagious impetigo and epidermophytosis of feet

Se realizó una intervención terapéutica en 76 pacientes con giardiasis, impétigo contagioso y epidermofitosis de los pies, pertenecientes al consultorio No. 29 del Policlínico Docente "30 de Noviembre" de Santiago de Cuba, desde enero del 2013 hasta igual periodo del 2014, a fin de evaluar el uso del Oleozon® oral o tópico en el tratamiento de los afectados. En la casuística predominaron el sexo masculino (51,3 %), el grupo etario de 5-9 años (34,2 %) y los afectados con giardiasis (43,4 %). Se obtuvieron resultados favorables en 78,9 % de los pacientes, entre los cuales sobresalieron los que tenían giardiasis e impétigo.

A therapeutic intervention in 76 patients with giardiasis, contagious impetigo and epidermophytosis of feet, belonging to the doctor's office 29 of "30 de Noviembre" Teaching Polyclinic in Santiago de Cuba was carried out from January, 2013 to the same period of 2014, in order to evaluate the use of oral or topic Oleozon® in the treatment of those affected. Male sex (51.3%), the age group 5-9 years (34.2%) and those affected with giardiasis (43.4%) prevailed in the case material. Favorable results were obtained in 78.9% of the patients, among which there were those who had giardiasis and impetigo, with 31.6% each.

High occurrence of giardiasis in children living on a 'landless farm workers' settlement in Araras, São Paulo, Brazil / Alta ocorrência de giardíase em crianças do Assentamento Sem Terra, Araras, São Paulo, Brasil

Enteric parasitosis remains an important public health problem in many areas around the world including in Brazil, and it is frequently associated with poverty and lack of sanitation facilities. Research carried out over the course of a year revealed that 96.6% (28/29) of children randomly selected from a 'landless farm workers' settlement in Araras, São Paulo, aged 4 - 15 years, presented Giardia intestinalis cysts. After referral to the neighborhood Health Office, all the children received tinidazole, given as a single dose of 50 mg/kg and 12 months later, new fecal samples were collected and analyzed. Despite the low adherence to the study, a high percentage (64.3% - 9/14) of the children remained positive for the parasite. This study showed a high positivity of giardiasis in child residents of the settlement, even after treatment; adults were not sensitized to the study and did not collected and/or deliver children fecal samples. The precarious living conditions are consistent with a high susceptibility to parasitic diseases, suggesting that the treatment of the infected individuals without identifying and eradicating the means of contamination is simply a palliative measure.

Enteroparasitoses continuam a ser um importante problema de saúde pública em muitas áreas ao redor do mundo, bem como no Brasil, e está frequentemente associada com a pobreza e à falta de saneamento básico. Pesquisa realizada em um ano revelou que 96,6% (28/29) das crianças com idades entre quatro e 15 anos, recrutadas aleatoriamente no Assentamento Sem Terra em Araras, São Paulo, apresentaram cistos de Giardia intestinalis. Após o encaminhamento ao Posto de Saúde do bairro, todos receberam tinidazol, dose única de 50 mg/kg. Após 12 meses, novas amostras de fezes foram coletadas e analisadas. Apesar da baixa adesão ao estudo, um percentual elevado (64,3% - 9/14) de crianças permaneceu positivo para o protozoário. Este estudo mostrou alta positividade de giardíase nas crianças moradoras do assentamento, mesmo após o tratamento; indivíduos adultos não se mostraram sensibilizados com o estudo e não coletaram e/ou entregaram amostras fecais dos filhos; e o tratamento dos indivíduos infectados, sem identificação e erradicação das formas de contaminação, só funciona como medida paliativa.

Evaluación de diferentes regímenes terapéuticos empleados en el tratamiento de la giardiasis en niños / Evaluation of different therapeutic regimens used in the treatment of giardiasis in children

Se realizó un estudio experimental en los consultorios 15, 16, 17 y 18 correspondientes al área de salud del Policlínico Gaspar con el objetivo de evaluar la respuesta a diferentes regímenes terapéuticos en el período comprendido desde junio del 2007 al 2008. La muestra estuvo comprendida por 200 pacientes con edades comprendidas entre 0 y 14 años con complementarios de heces fecales directos o seriados positivos de giardiasis y sin tratamiento anterior. Los pacientes fueron distribuidos de forma aleatoria a cada uno de los grupos de tratamiento garantizando la homogeneidad de la muestra. Al finalizar el tratamiento se realizó la evaluación final en relación con los síntomas clínicos y los resultados de heces fecales. El grupo de edades comprendida entre 10 a 14 años y el sexo femenino predominaron en el universo de pacientes estudiados, el dolor abdominal y las diarreas fueron los síntomas más frecuentemente encontrados, estos desaparecieron en más de la mitad de los niños que fueron tratados con tinidazol y metronidazol. Los mejores resultados en el análisis de las heces fecales después de culminado el tratamiento correspondieron a los grupos tratados con estos dos medicamentos.

An experimental study was conducted in 15, 16, 17 and 18 clinics for the health area of Gaspar Polyclinic in order to evaluate the response to different treatment regimens from June 2007 to 2008. The sample consisted of 200 patients aged between 0 and 14 years with fecal specimens or positive serial of giardiasis and without prior treatment. Patients were randomly assigned to each of the treatment groups by ensuring the homogeneity sample. After treatment the final evaluation was conducted in relation to clinical symptoms and fecal specimens’ results. The age group between 10 and 14 years and female predominance in the studied group of patients, abdominal pain and diarrhea were the most frequently found symptoms; they disappeared in more than half of children who were treated with tinidazole and metronidazole. The best results in the analysis of feces after the treatment completion corresponded to the groups treated with these two drugs.

A randomized, controlled, open-label trial evaluating the efficacy and safety of chloroquine in the treatment of giardiasis in children / Estudio de etiqueta abierta, randomizado y controlado, para evaluar la eficacia y seguridad de la cloroquina en el tratamiento de la giardiasis en niños

BACKGROUND: Giardia duodenalis is among the commonest protozoan parasites in the intestinal tract of humans and may cause significant morbidity worldwide. Although there are several antigiardial agents, treatment failures have been commonly reported. OBJECTIVE: To compare the efficacy and safety of chloroquine (CQ) versus metronidazole (MTZ) in the treatment of children with confirmed G duodenalis mono-infection. METHODS: A randomized, controlled, open-label trial was carried out at the Cuban Institute of Gastroenterology. One hundred and twenty-two children were randomly assigned to receive either CQ (10 mg/Kg bodyweight twice a day for five days) or MTZ [15 mg/Kg bodyweight divided in three daily does for five days]. All children were asked to provide three faecal samples on days 3, 5 and 7 after treatment completion. Children were considered to be cured, if no Giardia trophozoites or cysts were found in any of the three post-treatment faecal specimens evaluated by direct wet mounts and/or after Ritchie concentration techniques. RESULTS: The frequency of cure was a little higher for CQ than for MTZ but the difference was not statistically significant. Headache was more common in patients treated with CQ as was bitter taste. Yellowish colouration of the urine was more frequent in the MTZ treated group. CONCLUSION: Chloroquine, for five days, is as efficacious as the recommended treatment with MTZ in children infected with G duodenalis.

ANTECEDENTES: La giardia lamblia (giardia duodenalis) se halla entre los parásitos protozoos más comunes del tracto intestinal de los seres humanos, y puede causar una morbilidad significativa a nivel mundial. Aunque existen varios agentes antigiardiales, se han reportado fracasos en el tratamiento OBJETIVO: Comparar la eficacia y seguridad de la cloroquina (CQ) con el metronidazol (MTZ) en el tratamiento de los niños con mono-infección de G duodenalis. MÉTODOS: En el Instituto Cubano de Gastroenterología, se llevó a cabo un estudio de etiqueta abierta, randomizado y controlado. Ciento veintidós niños fueron aleatoriamente designados para recibir bien CQ (10 mg/Kg peso corporal dos veces por día durante cinco días) o MTZ (15 mg/Kg peso corporal dividido en tres dosis diarias por un período de cinco días). A todos los niños se les tomaron tres pruebas fecales los días 3, 5 y 7 después de terminado el tratamiento. Los niños se daban por curados, si no había presencia de tropozoítos o quistes de giardia en ninguno de los tres especimenes fecales post-tratamiento, evaluados directamente con portaobjetos húmedos y/o después de técnicas de concentración de Ritchie. RESULTADO: La frecuencia de la cura fue un poco más alta para CQ que para MTZ, pero la diferencia no fue estadísticamente significativa. El dolor de cabeza fue más común en pacientes tratados con CQ que el sabor amargo. La coloración amarillenta de la orina fue más frecuente en el grupo tratado con MTZ. CONCLUSIÓN: La cloroquina, administrada durante cinco días, es tan eficaz como el tratamiento recomendado con MTZ en niños infectados con giardias lamblias.

Utilidad de 2 métodos coproparasitológicos y su empleo en un ensayo terapéutico antigiardiásico

Se realizó un estudio a 456 niños con edades de 1 a 5 años, pertenecientes a 4 guarderías infantiles del municipio San Miguel del Padrón, en el mes de noviembre de 1998; para evaluar el diagnóstico de Giardia lamblia y otros protozoos intestinales, utilizando comparativamente los métodos de diagnóstico coproparasitológicos de examen directo y la técnica de concentración de Ritchie o formol-éter. Además, se desarrolló un ensayo terapéutico, utilizando tinidazol y albendazol, para el tratamiento de la infección por G. lamblia. La técnica de concentración de Ritchie fue más efectiva que el examen microscópico directo para el diagnóstico de Giardia lamblia, Entamoeba histolytica/ Entamoeba dispar y Cyclospora cayetanensis y se demostró la mayor sensibilidad del examen seriado sobre el análisis de una sola muestra (p< 0,01). Por otra parte, el tinidazol demostró mayor eficacia que el albendazol para el tratamiento de la infección por G. lamblia, con un mayor porcentaje de curación (72 % vs. 34,6 %) (p< 0,01).

A study of 456 children aged 1-5 from 4 day care centers of San Miguel del Padrón municipality was conducted in November, 1998, to evaluate the diagnosis of Giardia lamblia and other intestinal protozoa by using comparatively the coproparasitological diagnostic methods of direct examination and Ritchie's concentration technique or formol-ether. Besides, a therapeutical trial was developed with tinidazole and albendazole for treating the infection caused by G. lamblia. Ritchie's concentration technique was more effective than the microscopic direct examination for diagnosing Giardia lamblia, Entamoeba histolytical/Entamoeba dispar and Cyclospora cayetanensis. It was demonstratyed that the serial examination was more sensitive than the analysis of just one sample (p< 0.01). On the other hand, tinidazole proved to be more efficient than albendazole to treat the infection produced by G. lamblia, with a greater cure percentage (72 % vs. 334.6 %), (p < 0.01).

Intestinal giardiasis. Mini-review / Giardiasis intestinal. Mini-Revisión

Giardia intestinalis is a common parasite in our country and the rest of the world and is responsible for several clinical disturbances that include dysentery type diarrheas, recurrent abdominal pain, duodenitis, jejunitis, cholecystitis and in some cases toxemias and convulsions. In this paper we review recent concepts of intestinal giardiasis, considering the basic aspects of the biology and physiology of Giardia intestinalis, its morphology and its relationship the parasite pathogenicity. We detail the physiopathological mechanisms responsible for the different clinic manifestations of giardiasis, the specific laboratory and endoscopic methods of diagnosis and the most recent advances in the treatment and prophylaxis of this disease.

Efficacy of praziquantel against Giardia lamblia in rats: parasitological, pathological and therapeutic study

Four-five weeks old rats were included in this study and divided into two experimental groups received single or split doses of praziquantel [PZQ] as well as two control groups, one infected untreated and the other normal healthy rats. The effect of infection on rat growth as well as the jejunal and duodenal architecture was histopathologically studied after H and E staining. The jejunal ultrastructure was examined by SEM and TEM. The effect of PZQ was evaluated using the same techniques. It was observed that infected as well as infected treated animals had less weight than the healthy controls. The intensity of infection decreased gradually after treatment. The cure rate was 100% after split dose and 80% after a single dose. Altered villus height and cryptic depth were the characteristic changes in the architecture of the duodenum and jejunum, more pronounced in the latter. The split dose of PZQ revealed a more improvement of the histopathological findings than the single dose. By SEM, circular imprints representing defects in the villi were observed in the jejunum. By TEM deformation of microvillar architecture was observed together with organellar changes in the RER and the mitochondria after PZQ treatment

Giardiasis co-existing with pregnancy: a distressing and threatening condition

To treat or not to treat Giardia lamblia infection during pregnancy is a debatable issue since, at occasions, it may be advisable to withhold antiparasitic therapy till after delivery. There is no justification for a prescription simply because Giardia lamblia was detected on routine stool microscopy. There is convincing evidence that Giardiasis fits into the category of infectious diseases, which become more severe in pregnancy. The increased nutritional requirements, lowered immunological status and decreased gastric acidity may predispose the already existing Giardial infection to symptomatic Giardiasis which may cause intestinal mucosal injury resulting in disruption of the digestive and absorptive capacity of gut. Three cases of pregnancy associated Giardiasis, in a suburban setting in Punjab [Pakistan], are being reported. The severity of the disease in these patients, impending damage to their foetuses- and public health significance necessitated immediate intervention in the form of specific anti-giardial therapy. The choice of the drug was based on the clinical evaluation and obstetric status. The first patient [23 weeks gestation] was given Intravenous Metronidazole and the third one [30 weeks gestation] oral Secnidazole. Paromomycin [very poorly absorbed from gastrointestinal tract] was selected for the second case [11 weeks gestation]. Regular clinical, parasitological and ultrasonic follow ups of the cases, till term, were carried out. They had uneventful deliveries with normal healthy looking babies. Screening for Giardia lamblia in the family contacts of these patients revealed 11[8 children, 3 adults] parasitologically proven cases [linked to the index cases]. They were successfully treated. It was justifiably concluded that treating the pregnant ladies with acute symptomatic Giardiasis and search for index cases in their family contacts [and their management] were very well rewarding

Efficacy of albendazole in giardiasis

Albendazole and metronidazole were compared in 68 patients diagnosed positive for giardiasis. Albendazole 1200 mg, one dose was given to 24 patients, albendazole 400 mg twice a day for 3 days was given to 23 patients, and metronidazole 400 mg 3 times a day for 5 days to 21 patients. Response to therapy was monitored by clinical examination and analysis of fresh faecal samples on days 0, 3, 7 and 10. Response to the single dose of albendazole was 55%, to the divided dose of albendazole 70%, and to metronidazole 84%. The results show that albendazole, originally recommended for helminthic infection, can also be used in patients with mixed protozoal infection or for infections resistant to metronidazole

Eficácia e tolerabilidade do secnidazol suspensão versus tinidazol suspensão no tratamento da giardíase em crianças / Efficacy and tolerability of secnizadol and tinizadol both in the suspension form in the treatment of giardiasis in children

Objetivo: Comparar a eficácia e tolerabilidade do secnidazol(SEC) e tinidazol(TIN) no tratamento da giardíase em crianças. Métodos: Em estudo multicêntrico, aberto, randomizado, 321 crianças de 2 a 14 anos de idade, dos sexos feminino e masculino e portadores de giardíase, receberam secnidazol suspensäo, 30mg/kg(N=160) ou tinidazol suspensäo, 50mg/kg(N=161), ambos em dose única. Todas as crianças apresentavam exame protoparasitológico positivo par Giardia lambia antes do tratamento e foram reavaliadas laboratorialmente (métodos Faust e Kato-Katz) 7, 14 e 21 dias após a administraçäo das drogas. Resultados: Cura parasitológica foi obtida em 95 porcento dos pacientes do grupo SEC e 97 porcento dos pacientes do grupo TIN, näo apresentando diferença estatística significativa (p=0,430). Eventos adversos, possível ou provavelmente relacionados ao medicamento em estudo, ocorreram em 7 porcento dos pacientes do grupo SEC versus 16 porcento do grupo TIN, uma diferença estatisticamente significativa (p=0,009). Os eventos individuais "gosto amargo" (1,9 porcento SEC vs 7,5 porcento TIN, p=0,018) e "vômito" (0,6 porcento SEC versus 4,3 porcento TIN, p=0,032) também tiveram uma incidência significativamente diferente nos dois grupos. Conclusöes: Secnidazol e tinidazol foram igualmente eficazes no tratamento da giardíase, mas o secnidazol apresentou melhor perfil de tolerabilidade nesta faixa etária