Requena-Méndez Ana, Goñi Pilar, Rubio Encarnación, Pou Diana, Fumadó Victoria, Lóbez Silvia, Aldasoro Edelweiss, Cabezos Juan, Valls Maria Eugenia, Treviño Begoña, Martínez Montseny Antonio Federico, Clavel Antonio, Gascon Joaquim, Muñoz José
Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Barcelona , Spain.
Department of Microbiology, Preventive Medicine and Public Health, Faculty of Medicine, University of Zaragoza, Spain.
J Infect Dis. 2017 Mar 15;215(6):946-953. doi: 10.1093/infdis/jix066.
There is little evidence regarding the management of refractory giardiasis after treatment with nitroimidazoles. This study estimates the proportion of persistent giardiasis in 3 hospitals in Barcelona, describes associated risk factors and genotype, and evaluates the efficacy rate of quinacrine in those with persistent giardiasis.
A clinical, prospective, observational study was conducted in patients with giardiasis treated with nitroimidazoles. Those with persistent giardiasis were provided quinacrine. Molecular characterization of Giardia isolates was performed by polymerase chain reaction amplification of a fragment of tpi and bg genes.
Seventy-seven patients were recruited and treated with nitroimidazoles, and in 14 of 71 (20%) of patients followed up, Giardia persisted. Refractory giardiasis was associated with malaise (P = .007) and anorexia (P = .02), with previous giardiasis (P = .03), and with previous antibiotic (P = .02) or antiparasitic(P = .04) use. Quinacrine had an effectiveness rate of 100% in refractory giardiasis (n = 13; 95% confidence interval = 75-100). Molecular characterization showed that 17 (25%) Giardia isolates belonged to assemblage A, and 31 (43%) belonged to assemblage B. In refractory giardiasis, assemblage A and B were found responsible in 4 and 6 cases, respectively.
Almost 20% of patients presented persistent giardiasis, belonging to both assemblages A and B, after nitroimidazole. Short course of quinacrine was effective in treating refractory cases. Further controlled studies should evaluate its efficacy and safety.
关于硝基咪唑类药物治疗后难治性贾第虫病的管理，证据较少。本研究估计了巴塞罗那3家医院持续性贾第虫病的比例，描述了相关危险因素和基因型，并评估了奎纳克林对持续性贾第虫病患者的疗效。
对接受硝基咪唑类药物治疗的贾第虫病患者进行了一项临床、前瞻性观察研究。为持续性贾第虫病患者提供奎纳克林。通过聚合酶链反应扩增tpi和bg基因片段对贾第虫分离株进行分子特征分析。
招募了77例患者并给予硝基咪唑类药物治疗，在71例接受随访的患者中，有14例（20%）贾第虫持续存在。难治性贾第虫病与不适（P = 0.007）、厌食（P = .02）、既往有贾第虫病（P = 0.03）以及既往使用抗生素（P = 0.02）或抗寄生虫药（P = 0.04）有关。奎纳克林治疗难治性贾第虫病的有效率为100%（n = 13；95%置信区间 = 75 - 100）。分子特征分析表明，17株（25%）贾第虫分离株属于A群，31株（43%）属于B群。在难治性贾第虫病中，A群和B群分别导致4例和6例感染。
硝基咪唑类药物治疗后，近20%的患者出现持续性贾第虫病，A群和B群均有。短期使用奎纳克林治疗难治性病例有效。进一步的对照研究应评估其疗效和安全性。
