Mørch K, Hanevik K, Robertson L J, Strand E A, Langeland N
National Centre for Tropical Medicine and Imported Infectious Diseases, Haukeland University Hospital, 5021 Bergen, Norway.
J Infect. 2008 Apr;56(4):268-73. doi: 10.1016/j.jinf.2008.01.013. Epub 2008 Mar 7.
To evaluate the efficacy of a treatment ladder in metronidazole-refractory giardiasis, and to compare genetic characteristics of the parasites.
A clinical observational study was carried out in 38 adult patients with metronidazole-refractory giardiasis, during an outbreak in Norway with more than 1200 cases. All patients were treated with albendazole in combination with metronidazole. Those who failed were treated with paromomycin. Those who failed on paromomycin were treated with quinacrine in combination with metronidazole. Giardia isolates from 17 patients were characterised by PCR and sequencing at two separate genes.
Metronidazole in combination with albendazole was effective in 30 (79%) out of 38 patients. Paromomycin was effective in three out of six patients. Quinacrine in combination with metronidazole was effective in 3 patients. Molecular characterisation of the Giardia isolates revealed that these parasites were identical at two different gene segments, while sequence profiles from isolates at the peak of the outbreak were more heterogenous.
Albendazole and quinacrine both in combination with metronidazole were effective in treating metronidazole-refractory giardiasis in this cohort. Paromomycin was less effective. Particular Giardia sub-genotypes may have been associated with the treatment-refractory giardiasis in these patients, although other undefined factors are probably also of importance.
评估治疗阶梯方案在甲硝唑难治性贾第虫病中的疗效，并比较寄生虫的基因特征。
在挪威一次超过1200例病例的疫情暴发期间，对38例甲硝唑难治性贾第虫病成年患者进行了一项临床观察性研究。所有患者均接受阿苯达唑联合甲硝唑治疗。治疗失败的患者接受巴龙霉素治疗。巴龙霉素治疗失败的患者接受喹吖因联合甲硝唑治疗。对17例患者的贾第虫分离株进行了两个不同基因的PCR和测序鉴定。
38例患者中，30例（79%）接受甲硝唑联合阿苯达唑治疗有效。6例患者中有3例接受巴龙霉素治疗有效。3例患者接受喹吖因联合甲硝唑治疗有效。贾第虫分离株的分子特征显示，这些寄生虫在两个不同基因片段上是相同的，而疫情高峰期分离株的序列图谱更具异质性。
在该队列中，阿苯达唑和喹吖因联合甲硝唑均对治疗甲硝唑难治性贾第虫病有效。巴龙霉素效果较差。特定的贾第虫亚基因型可能与这些患者的难治性贾第虫病有关，尽管其他未明确的因素可能也很重要。
