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Journal articles on the topic 'Giardiasis'

Author: Grafiati

Published: 4 June 2021

Last updated: 7 September 2023

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1

Kimirilova, Olga Gennadievna, and G. A. Kharchenko. "DIAGNOSIS OF GIARDIOSIS IN CHILDREN: RESULTS OF A RETROSPECTIVE COHORT STUDY." Russian Clinical Laboratory Diagnostics 64, no. 6 (October 7, 2019): 376–79. http://dx.doi.org/10.18821/0869-2084-2019-64-6-376-379.

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Giardiasis in children remains an urgent problem, the importance of which is determined by the endemicity for many countries and regions, polymorphism of the clinic, which causes difficulties in clinical diagnosis of this pathology. The report presents the results of the diagnostic significance of methods of laboratory diagnostics giardiase: microscopy of native and stained with Lugol solution preparation fecal enzyme-linked immunoassay (ELISA) for the presence of antibodies of class IgM and IgG antibodies to the antigens of Giardia in the serum and antigen of G. Lamblia in feces, polymerase chain reaction (PCR) - detection of Giardia DNA in feces obtained during the examination of 160 patients with giardiasis children aged 3 to 14 years. The results of our study suggest that the most informative methods of diagnosis of giardiasis in children is coproscopy (specificity - 96.2%, sensitivity - 98.1%), PCR coprofiltrate. (specificity - 85%, sensitivity 82.5%), determination of antigen in feces by ELISA (specificity - 87,5%, sensitivity - 60%). With high specificity of the blood ELISA method (90%), the sensitivity of the method is only 27.5%. It should be recognized that the «gold standard» diagnosis of giardiasis remains microscopy of native and stained with a solution of Lugol preparation of feces with a three - time study at intervals of 2-3 days.

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2

Hill, David R. "GIARDIASIS." Infectious Disease Clinics of North America 7, no. 3 (September 1993): 503–26. http://dx.doi.org/10.1016/s0891-5520(20)30540-7.

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3

Seidel, J. "Giardiasis." Pediatrics in Review 14, no. 7 (July 1, 1993): 284–85. http://dx.doi.org/10.1542/pir.14-7-284.

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4

Desai, Angel N. "Giardiasis." JAMA 325, no. 13 (April 6, 2021): 1356. http://dx.doi.org/10.1001/jama.2020.10289.

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5

Burnett, Mark W. "Giardiasis." Journal of Special Operations Medicine 18, no. 1 (2018): 106. http://dx.doi.org/10.55460/x429-aks5.

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6

Harun, Haerani, Nurhayana Sennang, and Benny Rusli. "GIARDIASIS." Healthy Tadulako Journal (Jurnal Kesehatan Tadulako) 5, no. 3 (October 30, 2019): 4. http://dx.doi.org/10.22487/j25020749.2019.v5.i3.14047.

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Giardiasis merupakan salah satu penyakit gastrointestinal yang banyak menyerang di negara berkembang yang disebabkan oleh parasit Giardia lamblia. Penyakit ini umumnya menyerang orang orang yang berkemah dan minum air dari sungai yang terkontaminasi. Infeksi ini juga menyerang anak-anak yang rentan terhadap penularan parasit ini. Penelitian Simadibrata pada tahun 2004 menunjukkan prevalensi Giardiasis di Indonesia sebesar 3.62%, sedangkan dari anak-anak yang menderita diare di Malang 1.2% diantaranya disebabkan oleh Giardiasis. Artikel ini bertujuan memberi gambaran tentang penyakit Giardiasis mulai dari etiologi, pathogenesis hingga pengobatan. Selain itu dipaparkan pula beberapa pemeriksaan yang dapat dilakukan untuk mendeteksi giardiasis.

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7

Jones, Jerry E. "Giardiasis." Primary Care: Clinics in Office Practice 18, no. 1 (March 1991): 43–52. http://dx.doi.org/10.1016/s0095-4543(21)00915-5.

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8

Seidel, James. "Giardiasis." Pediatrics In Review 14, no. 7 (July 1, 1993): 284–85. http://dx.doi.org/10.1542/pir.14.7.284.

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Giardiasis is caused by infection with the protozoan parasite Giardia lamblia, also called Giardia intestinalis in Europe. Epidemiology Giardia infections are ubiquitous, and outbreaks occur in developed and underdeveloped nations throughout the world. Infection results from ingestion of cysts, usually contained in water or food, on hands, or on fomites contaminated with feces. The parasite is found in about 4% of stool specimens submitted to laboratories in the United States and is the most common parasite isolated. The exact prevalence of the infection in the United States is not known because it is not reportable in all states and may be difficult to isolate in the laboratory. Epidemic giardiasis in day care centers was first reported in 1977, with infection rates varying from 0 to 25%. Most children have symptoms. Chronic passage of cysts by some preschool children in day care facilities is found 5 to 6 months after the initial diagnosis, either because of continued transmission or chronic infection. Prevalence rates decline when children are toilet-trained. Sexual transmission may occur in heterosexual or homosexual contacts. Campers and hikers are at risk because of vertical transmission from animals, and waterborne outbreaks in national parks have been reported. In addition, many outbreaks have been attributed to municipal water supplies that have not been treated with flocculation or filtration.

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9

BENEKLİ, Mustafa, Bülent SİVRİ, Cenk SÖKMENSÜER, and Arzu SUNGUR. "Giardiasis." Turkish Journal of Medical Sciences 26, no. 2 (January 1, 1996): 217–18. http://dx.doi.org/10.55730/1300-0144.5257.

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10

Backer, Howard D. "Giardiasis." Physician and Sportsmedicine 28, no. 7 (July 2000): 46–57. http://dx.doi.org/10.3810/psm.2000.07.1079.

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11

Holtan, Neal R. "Giardiasis." Postgraduate Medicine 83, no. 5 (April 1988): 54–61. http://dx.doi.org/10.1080/00325481.1988.11700219.

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12

Wolfe, M. S. "Giardiasis." Clinical Microbiology Reviews 5, no. 1 (January 1992): 93–100. http://dx.doi.org/10.1128/cmr.5.1.93.

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Giardiasis is one of the most common pathogenic intestinal protozoal infections worldwide. Giardia lamblia is the most frequently identified etiologic agent in outbreaks associated with the ingestion of surface water, often due to ineffective filtration or pretreatment. In addition to humans, other sources of infection include beavers, perhaps muskrats, and possibly domestic animals. A low infecting dose (10 to 25 cysts) is reported to be sufficient to produce human infection. Clinical manifestations range from asymptomatic to a transient or persistent acute stage, with steatorrhea, intermittent diarrhea, and weight loss, or to a subacute or chronic stage that can mimic gallbladder or peptic ulcer disease. Diagnosis is usually based on repeated stool examinations but examination of duodenal fluid or biopsy material may also be necessary. Enzyme immunoassay or indirect immunofluorescence methods for direct detection of antigen or whole organisms in clinical specimens have also been developed. These tests are reported to be more sensitive than routine stool examination. Demonstration of serum immunoglobulin M and G antibodies may help differentiate recent from past infection or help detect recurrence in individuals who have been treated previously. Serum immunoglobulin A levels may be a useful indicator of exposure in waterborne outbreaks of diarrhea. Drugs available for treatment within the United States include metronidazole, quinacrine hydrochloride, and furazolidone.

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13

Wolfe, M. S. "Giardiasis." Clinical Microbiology Reviews 5, no. 1 (1992): 93–100. http://dx.doi.org/10.1128/cmr.5.1.93-100.1992.

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14

Loken, Sally. "Giardiasis." Nurse Practitioner 11, no. 12 (December 1986): 20???36. http://dx.doi.org/10.1097/00006205-198612000-00006.

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15

DUPONT, HERBERT L., and PEGGY S. SULLIVAN. "Giardiasis." Pediatric Infectious Disease Journal 5, Supplement (January 1986): 131–38. http://dx.doi.org/10.1097/00006454-198601001-00021.

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16

Fogle, B. "Giardiasis." Veterinary Record 134, no. 16 (April 16, 1994): 428. http://dx.doi.org/10.1136/vr.134.16.428-c.

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17

Babb, Richard R. "Giardiasis." Postgraduate Medicine 98, no. 2 (August 1995): 155–58. http://dx.doi.org/10.1080/00325481.1995.11946034.

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18

Heresi, Gloria P., James R. Murphy, and Thomas G. Cleary. "Giardiasis." Seminars in Pediatric Infectious Diseases 11, no. 3 (July 2000): 189–95. http://dx.doi.org/10.1053/pi.2000.6230.

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19

Farthing, Michael J. G. "GIARDIASIS." Gastroenterology Clinics of North America 25, no. 3 (September 1996): 493–515. http://dx.doi.org/10.1016/s0889-8553(05)70260-0.

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20

Lebwohl, Benjamin, Richard J. Deckelbaum, and Peter H. R. Green. "Giardiasis." Gastrointestinal Endoscopy 57, no. 7 (June 2003): 906–13. http://dx.doi.org/10.1016/s0016-5107(03)70028-5.

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21

Tessier, Julie L., and Gregory A. L. Davies. "Giardiasis." Primary Care Update for OB/GYNS 6, no. 1 (January 1999): 8–11. http://dx.doi.org/10.1016/s1068-607x(98)00175-9.

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22

Wright, S. G. "Giardiasis." Transactions of the Royal Society of Tropical Medicine and Hygiene 86, no. 5 (September 1992): 574. http://dx.doi.org/10.1016/0035-9203(92)90127-x.

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23

Kirkpatrick, Carle E. "Giardiasis." Veterinary Clinics of North America: Small Animal Practice 17, no. 6 (November 1987): 1377–87. http://dx.doi.org/10.1016/s0195-5616(87)50007-9.

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24

&NA;. "Giardiasis." Pediatric Infectious Disease Journal 32 (November 2013): J—1—J—7. http://dx.doi.org/10.1097/01.inf.0000437866.88454.a8.

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25

ZELASNEY, BONNIE S. "Giardiasis." Gastroenterology Nursing 14, no. 6 (June 1992): 313. http://dx.doi.org/10.1097/00001610-199206000-00009.

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26

Breek, TO, A. Knuistingh Neven, and JAH Eekhof. "Giardiasis." Huisarts en Wetenschap 48, no. 7 (July 2005): 548–50. http://dx.doi.org/10.1007/bf03084342.

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27

Schnell, Kerry, Sarah Collier, Gordana Derado, Jonathan Yoder, and Julia Warner Gargano. "Giardiasis in the United States – an epidemiologic and geospatial analysis of county-level drinking water and sanitation data, 1993–2010." Journal of Water and Health 14, no. 2 (November 12, 2015): 267–79. http://dx.doi.org/10.2166/wh.2015.283.

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Giardiasis is the most commonly reported intestinal parasitic infection in the United States. Outbreak investigations have implicated poorly maintained private wells, and hypothesized a role for wastewater systems in giardiasis transmission. Surveillance data consistently show geographic variability in reported giardiasis incidence. We explored county-level associations between giardiasis cases, household water and sanitation (1990 census), and US Census division. Using 368,847 reported giardiasis cases (1993–2010), we mapped county-level giardiasis incidence rates, private well reliance, and septic system reliance, and assessed spatiotemporal clustering of giardiasis. We used negative binomial regression to evaluate county-level associations between giardiasis rates, region, and well and septic reliance, adjusted for demographics. Adjusted giardiasis incidence rate ratios (aIRRs) were highest (aIRR 1.3; 95% confidence interval 1.2–1.5) in counties with higher private well reliance. There was no significant association between giardiasis and septic system reliance in adjusted models. Consistent with visual geographic distributions, the aIRR of giardiasis was highest in New England (aIRR 3.3; 95% CI 2.9–3.9; reference West South Central region). Our results suggest that, in the USA, private wells are relevant to giardiasis transmission; giardiasis risk factors might vary regionally; and up-to-date, location-specific national data on water sources and sanitation methods are needed.

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28

Roshidi, Norhamizah, Nur Hassanah Mohd Hassan, Asma Abdul Hadi, and Norsyahida Arifin. "Current state of infection and prevalence of giardiasis in Malaysia: a review of 20 years of research." PeerJ 9 (November 11, 2021): e12483. http://dx.doi.org/10.7717/peerj.12483.

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Background Giardiasis is a neglected parasitic zoonotic disease caused by Giardia duodenalis that is often overlooked despite the damage inflicted upon humans and domestic/wild animals. Lack of surveillance studies, low sensitivity of diagnostic tools, and resistance to giardiasis treatment add to the challenge in managing giardiasis, leaving a gap that continues to render giardiasis a silent threat to public health worldwide. This situation is not much different in Malaysia, where giardiasis remains a public health problem, especially in the indigenous communities. Realizing the existence of gaps in the literature and information on giardiasis in Malaysia, this review aims to revisit and update the situation of giardiasis in Malaysia based on articles published in 20 years from 2000 to 2020, providing estimates on the incidence of giardiasis in humans, animals, and the environment, which may inform efforts to prevent and control the impact of giardiasis in the country. Methodology We searched PubMed, Science Direct, and Scopus using MeSH terms and text keywords “Giardia duodenalis OR Giardia intestinalis OR Giardia lamblia OR intestinal protozoa AND Malaysia”. Information was collected from all giardiasis reports published between 2000 and 2020. Results Giardiasis in Malaysia is more prevalent among the poorest segments of the population, namely the indigenous communities and people living in densely populated areas such as slums and prisons, due to low standard of personal hygiene, unsafe water resources, and improper sanitation. While the prevalence data is hugely dependent on microscopic fecal examination in epidemiological studies of giardiasis, current studies mostly focused on species identification and genotype distribution by multilocus genotyping. Thus far, the outbreak of giardiasis has not been reported in the country, but the disease was found to be significantly associated with stunting, wasting, and malnutrition among children of the indigenous communities. Surveillance studies also discovered the simultaneous presence of Giardia in the animal-environments, including wild animals, ruminants, and treated and untreated water. The data collected here will be a useful addition to the literature body on giardiasis in Malaysia, which can be exploited in efforts to prevent and control the impact of giardiasis in the country. Conclusions The last 10 years have shown that the overall mean rate of giardiasis in Malaysia is quite encouraging at 13.7%. While this figure appears to be declining, there has been a slight increase in the prevalence of underweight, stunting, and wasting among rural children in 2019. The fact that giardiasis is linked to long-term childhood developmental problems, indicates that addressing and providing better disease control against giardiasis should be a priority in supporting the national agenda to achieve Malaysia Global Nutrition Targets by 2025.

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29

Setness, Peter A., and Donna Hoel. "Avoiding giardiasis." Postgraduate Medicine 109, no. 6 (June 2001): 129–30. http://dx.doi.org/10.3810/pgm.2001.06.966.

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30

Amin, Navin M., Glen C. Griffin, Neal R. Holtan, and James K. Patrick. "Avoiding Giardiasis." Postgraduate Medicine 83, no. 5 (April 1988): 340. http://dx.doi.org/10.1080/00325481.1988.11700247.

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31

Doglioni, C., M. De Boni, R. Cielo, L. Laurino, P. Pelosio, P. Braidotti, and G. Viale. "Gastric giardiasis." Journal of Clinical Pathology 45, no. 11 (November 1, 1992): 964–67. http://dx.doi.org/10.1136/jcp.45.11.964.

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32

Oberhuber, Georg, Manfred Stolte, Birgit Bethke, Maximiliane Ritter, and Harro Eidt. "Gastric giardiasis." European Journal of Gastroenterology & Hepatology 5, no. 5 (May 1993): 357–60. http://dx.doi.org/10.1097/00042737-199305000-00010.

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33

Karabiber, Nihal, and Firdevs Aktaş. "Foodborne giardiasis." Lancet 337, no. 8737 (February 1991): 376–77. http://dx.doi.org/10.1016/0140-6736(91)91022-m.

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34

PAINTER, J. E., S. A. COLLIER, and J. W. GARGANO. "Association between Giardia and arthritis or joint pain in a large health insurance cohort: could it be reactive arthritis?" Epidemiology and Infection 145, no. 3 (September 19, 2016): 471–77. http://dx.doi.org/10.1017/s0950268816002120.

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SUMMARYThis study aimed to assess the association between giardiasis and subsequent development of arthritis or joint pain using a retrospective cohort of individuals from a large administrative claims database in the United States. Using 2006–2010 data from MarketScan Commercial Claims and Encounters, we conducted a retrospective cohort study in people with an ICD-9-CM code for giardiasis (n = 3301) and persons without giardiasis (n = 14 612) individually matched on age, sex, and enrolment length. We used conditional logistic regression to model the association between giardiasis and arthritis or joint pain documented in the 6 months following initial giardiasis diagnosis or index date for matched controls. After adjusting for healthcare utilization rate, giardiasis was associated with a 51% increase in claims for arthritis or joint pain (odds ratio 1·51, 95% confidence interval 1·26–1·80). In age- and sex-stratified adjusted analyses, the association remained significant across all subgroups (age 0–19 years, age 20–64 years, males, and females). Findings from this study lend epidemiological support for the association between giardiasis and subsequent development of arthritis. Reactive arthritis might occur more frequently than has been reported in the literature. Further research is necessary to determine the mechanisms by which giardiasis could lead to arthritis.

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35

Nengsih, Dwi Septia, Sigit Ari Saputro, and Khuliyah Candraning Diyanah. "PREVALENSI GIARDIASIS DAN KONDISI HYGIENE PERORANGAN PADA MURID PAUD DI KB-TK AL AMIN PACIRAN LAMONGAN." JURNAL EKOLOGI KESEHATAN 19, no. 2 (September 23, 2020): 94–100. http://dx.doi.org/10.22435/jek.v19i2.2893.

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ABSTRACT Small intestine infection caused by Giardia lamblia (giardiasis) occurs mostly in children living in developing country with poor sanitation. This study aims to determine the risk of giardiasis and personal hygiene conditions in pre-school students at KB-TK Al Amin Paciran Lamongan aged 2-6 years. Number of samples were 61 students, the dependent variable was the incidence of giardiasis, and independent variable was personal hygiene including nail hygiene, hand washing habit, footwear habit, and defecating habits. The result showed that 5 out of 61 students (8,2%) were infected with Giardia lamblia. All children (100%) with giardiasis had poor nail hygiene, footwear habit, and defecating habit. As many as 80% of students with giardiasis have poor handwashing habits. Students with poor footwear habit (OR=43,71; 95% CI 3,98-2046,9); open defecation habits (OR=13,33; 95% CI 1,40-628,05); poor nail hygiene (OR=12,31; 95% CI 1,29-580,49); poor hand washing habits (OR=5,73; 95% CI 0,5-290,96) had a greater risk of developing giardiasis. Supervision and healthy behavior are highly recommended, including using footwear when playing on the ground, defecating in the latrine, maintaining nail hygiene, and washing hands with soap before eating or after defecating. Keywords: Prevalence, giardiasis, personal hygiene, pre-school students ABSTRAK Infeksi usus halus disebabkan oleh Giardia lamblia (giardiasis) banyak terjadi pada anak-anak yang tinggal di negara berkembang dengan tingkat sanitasi buruk. Penelitian ini bertujuan untuk mengetahui risiko terjadinya giardiasis dan kondisi hygiene perorangan pada murid PAUD di KB-TK Al Amin Paciran Lamongan usia 2-6 tahun. Jumlah sampel adalah 61 murid, variabel dependen adalah kejadian giardiasis, dan variabel independen adalah hygiene perorangan meliputi kebersihan kuku, kebiasaan mencuci tangan, kebiasaan menggunakan alas kaki, dan kebiasaan buang air besar (BAB). Hasil penelitian menunjukkan bahwa 5 dari 61 murid (8,2%) terinfeksi Giardia lamblia. Seluruh murid (100%) dengan giardiasis mempunyai kebersihan kuku, kebiasaan menggunakan alas kaki dan kebiasaan BAB yang kurang baik. Sebanyak 80% murid dengan giardiasis mempunyai kebiasaan mencuci tangan yang kurang baik. Murid dengan kebiasaan menggunakan alas kaki kurang baik (OR=43,71; 95% CI 3,98–2046,9); kebiasaan BAB sembarangan (OR=13,33; 95% CI 1,40–628,05); kebersihan kuku kurang baik (OR=12,31; 95% CI 1,29-580,49); kebiasaan mencuci tangan yang kurang baik (OR=5,73; 95% CI 0,5–290,96) mempunyai risiko lebih besar terkena giardiasis. Pengawasan dan berperilaku hidup sehat sangat dianjurkan antara lain menggunakan alas kaki ketika bermain di tanah, membiasakan BAB di jamban, menjaga kebersihan kuku, dan mencuci tangan dengan sabun sebelum makan atau setelah buang air besar. Kata kunci: Prevalensi, giardiasis, hygiene perorangan, murid PAUD

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36

Hakim, Gözde Derviş, Şafak Kızıltaş, Hilmi Çiftçi, Şafak Göktaş, and İlyas Tuncer. "The Prevalence of Giardia Intestinalis in Dyspeptic and Diabetic Patients." ISRN Gastroenterology 2011 (July 27, 2011): 1–4. http://dx.doi.org/10.5402/2011/580793.

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Background and Aims. We aimed to investigate the prevalence of Giardiasis in patients with dyspepsia and patients with diabetes mellitus. Methods. 400 patients and 100 healthy persons were included in this clinical prospective study. The number of patients in each group was equal, 200 dyspeptic and 200 diabetic, respectively. The antigen of G. lntestinalis was determined in the stool specimens by ELISA method. Results. The frequency of Giardiasis was 7% in dyspeptic and 15% in diabetic patients. There was no positive results in any of the healthy persons. There was a significant difference in prevalence rate of Giardiasis between patients with dyspepsia and diabetes mellitus (P<0.05). Conclusions. These results revealed that the prevalence of Giardiasis in dyspepsia and with diabetes mellitus was high in our country. This is the first study investigating the prevalence of Giardiasis in diabetic patients. To investigate Giardiasis in diabetic patients, who have dyspepsia or not, may be a good approach for public health.

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37

Leung, Alexander K. C., Amy A. M. Leung, Alex H. C. Wong, Consolato M. Sergi, and Joseph K. M. Kam. "Giardiasis: An Overview." Recent Patents on Inflammation & Allergy Drug Discovery 13, no. 2 (December 4, 2019): 134–43. http://dx.doi.org/10.2174/1872213x13666190618124901.

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Background: Giardiasis is an important cause of waterborne and foodborne diarrhea, daycare center outbreaks, and traveler's diarrhea. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of giardiasis. Methods: A PubMed search was completed in Clinical Queries using the key terms “giardiasis”, "Giardia lamblia", "Giardia duodenalis" and "Giardia intestinalis". The search strategy included metaanalyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. Patents were searched using the key term “giardiasis” from www.freepatentsonline.com. Results: Giardiasis is caused by the protozoan parasite Giardia lamblia. The parasite is transmitted by the fecal-oral route, frequently through ingestion of contaminated water and food or person-to person transmission. Risk factors for infection include children in day-care settings, child-care workers, institutionalized individuals, travelers in endemic areas, ingestion of contaminated or recreational water, immunodeficiency, cystic fibrosis, and oral-anal sex. Approximately 50 to 75% of infected children are asymptomatic. Other children present acute or chronic diarrhea. Direct fluorescent antibody tests that detect intact organisms, enzyme immunoassays that detect soluble antigens, and multiplex real-time polymerase chain reaction assays that detect specific genes of the parasite in stool samples have improved sensitivity and specificity compared with microscopic examination of stool specimens for the detection of Giardia trophozoites or cysts. Drugs used in the treatment of symptomatic giardiasis are reviewed in this study. Moreover, recent patents related to the management of giardiasis are also discussed. Conclusion: Metronidazole, tinidazole, and nitazoxanide are drugs of choice. Resistance to common antigiardial drugs has increased in recent years, therefore, the search for new molecular targets for antigiardial drugs is urgently needed. In general, treatment of asymptomatic carriers is not recommended. Purification of water supply is an important preventive measure.

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38

Stevens, D. M., and H. M. Adam. "Giardiasis and Cryptosporidiosis." Pediatrics in Review 25, no. 7 (July 1, 2004): 260–61. http://dx.doi.org/10.1542/pir.25-7-260.

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39

Kalyoussef, S., D. Goldman, and H. M. Adam. "Giardiasis and Cryptosporidiosis." Pediatrics in Review 31, no. 2 (February 1, 2010): 81–82. http://dx.doi.org/10.1542/pir.31-2-81.

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40

Kalyoussef, Sabah, and David Goldman. "Giardiasis and Cryptosporidiosis." Pediatrics In Review 31, no. 2 (February 1, 2010): 81–82. http://dx.doi.org/10.1542/pir.31.2.81.

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41

Stevens, David M. "Giardiasis and Cryptosporidiosis." Pediatrics In Review 25, no. 7 (July 1, 2004): 260–61. http://dx.doi.org/10.1542/pir.25.7.260.

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42

Genta, Robert M. "Giardia and Giardiasis." American Journal of Tropical Medicine and Hygiene 34, no. 1 (January 1, 1985): 204. http://dx.doi.org/10.4269/ajtmh.1985.34.1.tm0340010204a.

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43

&NA;. "Diagnosis of Giardiasis." Journal of Pediatric Gastroenterology and Nutrition 9, no. 1 (July 1989): 134. http://dx.doi.org/10.1097/00005176-198907000-00030.

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&NA;. "Diagnosis of Giardiasis." Journal of Pediatric Gastroenterology and Nutrition 9, no. 1 (July 1989): 134. http://dx.doi.org/10.1097/00005176-198909010-00030.

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45

Gardner, Timothy B., and David R. Hill. "Treatment of Giardiasis." Clinical Microbiology Reviews 14, no. 1 (January 1, 2001): 114–28. http://dx.doi.org/10.1128/cmr.14.1.114-128.2001.

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SUMMARY Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine.

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46

Wright, Stephen. "Amoebiasis and giardiasis." Medicine 33, no. 8 (August 2005): 47–50. http://dx.doi.org/10.1383/medc.2005.33.8.47.

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47

Wright, Stephen. "Amoebiasis and Giardiasis." Medicine 29, no. 5 (May 2001): 29–33. http://dx.doi.org/10.1383/medc.29.5.29.28138.

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48

Nakano, Itsuro, Toshihiko Miyahara, Tetsuhide Ito, Yoshikatsu Migita, and Hajime Nawata. "Giardiasis in pancreas." Lancet 345, no. 8948 (February 1995): 524–25. http://dx.doi.org/10.1016/s0140-6736(95)90623-1.

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49

Cook, G. C. "Amoebiasis and Giardiasis." Drug Investigation 8, S1 (December 1994): 1–18. http://dx.doi.org/10.1007/bf03260000.

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50

Farthing, M. J. G. "Pathogenesis of giardiasis." Transactions of the Royal Society of Tropical Medicine and Hygiene 87 (December 1993): 17–21. http://dx.doi.org/10.1016/0035-9203(93)90531-t.

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