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Molecular characterization of Giardia duodenalis in Yemen

Alyousefi NA, Mahdy MA, Xiao L, Mahmud R, Lim YA

Exp Parasitol, 2013 Jun;134(2):141-7.
PMID: 23523861 DOI: 10.1016/j.exppara.2013.03.001

Giardia duodenalis is an important intestinal protozoan in Yemen with infection rates ranging from 18% to 27%. To date, there has been no genotyping study to provide a better understanding of the transmission dynamic. This study was conducted to genotype and subtype G. duodenalis in Yemen. Stool samples were collected from 503 Yemeni outpatients between 1 and 80 years old, including 219 males and 284 females. Giardia cysts were detected via microscopy after the formal-ether concentration. Genotyping of Giardia was carried out using PCR and sequence analysis of the 16s rRNA and b-giardin genes. Of the 89 microscopy-positive Giardia samples, 65 were successfully sequenced, of which 66% (43 of 65) were identified as G. duodenalis assemblage A and 34% (22 of 65) as assemblage B. Further subtyping analysis based on b-giardin gene identified the presence of subtypes A2 and A3, which belong to the anthroponotic sub-assemblage AII. Data of the study suggest that anthroponotic transmission played a potential role in the transmission of giardiasis in the community. However, further genotyping and subtyping studies of specimens from humans and animals living in the same households are needed for a more definitive understanding of giardiasis transmission in Yemen.

Matched MeSH terms: Giardia lamblia/classification*; Giardia lamblia/genetics*; Giardia lamblia/isolation & purification
Parasitological survey of schoolchildren from a highaltitude community from Tucumán Province, Argentina: Remarkable low detection of soil-transmitted helminths in comparison with coastal communities

Dib JR, Fernández-Zenoff MV, Oquilla J, Rudelli M, Lazarte S, González SN

Trop Biomed, 2015 Dec 01;32(4):800-804.
PMID: 33557474

The prevalence of intestinal parasitic infections among schoolchildren in Colalao del Valle, a high-altitude community in Tucumán province, Argentina, was investigated. The data revealed a high prevalence of parasitism (79.7%) with no significant differences in distribution by sex or age. Protozoa infections were the most common with Blastocystis hominis being the most prevalent (62.5%), followed by Giardia lamblia (29.7%), Endolimax nana (15.6%), Entamoeba coli (12.5%) and Iodamoeba bütschlii (3.1%). Interestingly, there was an absence of soil-transmitted helminths among the studied population which could be related to climate (variable temperatures, moderate rainfall) and soil type (clay).

Matched MeSH terms: Giardia lamblia
Serum IgE levels in Malaysian infants and children with gastrointestinal disease

Yadav, M., Iyngkaran, N.

Malaysian Journal of Child Health, 1991;3(1):7-10.
MyJurnal

The total serum IgE levels in infants and children was quantitated by the radioimmunoassay technique. The serum levels increased from about 300 IUlml in the 2-3 month old infants to about 8000 1U/m1 in the 10-year-old children who were probably infected with intestinal helminths. The total serum IgE levels in infants with cow's milk protein-sensitive entero-pathy were similar in level to those in normal infants. Infants and children with acute gastroenteritis, giardia infection and malnutrition had elevated levels of serum IgE levels. The high serum I gE levels noted in Malaysian children are probably indicative of the pattern in the tropics. (Copied from article).

Matched MeSH terms: Giardia
Fulltext Inadequate water treatment quality as assessed by protozoa removal in Sarawak, Malaysia

Ting Lo N, Abul Bashar Sarker M, Ai Lian Lim Y, Harun-Or-Rashid M, Sakamoto J

Nagoya J Med Sci, 2018 May;80(2):165-174.
PMID: 29915434 DOI: 10.18999/nagjms.80.2.165

Providing safe drinking-water to human civilization is indispensable; it is one of the most cost-effective means of reducing the disease burden of diarrhea. Unfortunately, water supply quality monitoring from public water treatment plants (WTPs) is often neglected or taken for granted. To determine the produced water quality, WTPs in Sarawak, Malaysia were assessed for their protozoa removal ability. A self-administered questionnaire based on the regulations in the Drinking-water Standards for New Zealand (DWSNZ) was developed. Optional 10-liter raw water samples were collected from willing WTPs for the detection of protozoan cysts. Routine physical and microbial testing of WTP parameters were also requested for raw water quality overview. Two of the nine assessed WTPs achieved three log credits in the treatment component, one of which belonged to Peninsular Malaysia. No log credits were obtained in the other tested components for any samples. Most of the WTPs employed "Coagulation, Sedimentation, and Filtration" using rapid gravity filters without enhancement (P < 0.05). Giardia cysts were detected in raw water sources used for treatment, and the geographical location was identified as an influencing factor for raw water quality. There is an urgent requirement for active collaboration and holistic approaches to review existing water management policies and interventions. WTPs in Sarawak did not achieve the log credits required to safeguard the microbial quality of the water supplied; however, only Giardia cysts were detected in 10-liter raw water samples despite routine microbial parameter monitoring showing disturbing contamination levels.

Matched MeSH terms: Giardia
Fulltext Efficacy of albendazole in the treatment of Trichuris trichuria and Giardia intestinalis infection in rural Malay communities

Penggabean M, Norhayati, Oothuman P, Fatmah MS

Med J Malaysia, 1998 Dec;53(4):408-12.
PMID: 10971985

A community study was carried out to evaluate the efficacy of a 3-day course of 400 mg albendazole daily in the treatment of Trichuris trichiura and Giardia intestinalis infection. This treatment regimen was effective in the treatment of Trichuris trichiura and Giardia intestinalis infection with cure rates of 91.5% and 96.6% respectively. Uses of a 3-day course of 400 mg albendazole daily should be considered in mass or targeted soil-transmitted helminths chemotherapy particularly in areas where the prevalence of Trichuris trichiura is high and polyparasitism is common.

Matched MeSH terms: Giardia lamblia*
Risk factors for endemic giardiasis: highlighting the possible association of contaminated water and food

Mohammed Mahdy AK, Lim YA, Surin J, Wan KL, Al-Mekhlafi MS

Trans R Soc Trop Med Hyg, 2008 May;102(5):465-70.
PMID: 18377940 DOI: 10.1016/j.trstmh.2008.02.004

This study was conducted to reassess the risk factors for giardiasis in communities of the Orang Asli (indigenous people) in Pahang, Malaysia. Stool samples were collected from 321 individuals (2-76 years old; 160 males, 161 females). Data were collected via laboratory analysis of faecal samples and a pre-tested standard questionnaire. River water samples were tested for Giardia cysts and Cryptosporidium oocysts. The overall prevalence of G. intestinalis infection was 23.7%. Children < or =12 years old had the highest infection rate and have been identified as a high risk group (odds ratio (OR)=6.2, 95% CI 1.5-27.0, P<0.005). The risk of getting giardiasis also appeared to be significantly associated with drinking piped water (OR=5.1, 95% CI 0.06-0.7, P<0.005) and eating raw vegetables (OR=2.4, 95% CI 0.2-0.6, P<0.005). In conclusion, sociodemographic factors have always been associated with the high prevalence of Giardia infections in Malaysia. However, the present study also highlights the need to look into the possibility of other risks such as water and food transmission routes. In future, it is necessary that these two aspects be considered in control strategies.

Matched MeSH terms: Giardia lamblia/isolation & purification
Prevalence of Giardia lamblia with or without diarrhea in South East, South East Asia and the Far East

Dib HH, Lu SQ, Wen SF

Parasitol Res, 2008 Jul;103(2):239-51.
PMID: 18425689 DOI: 10.1007/s00436-008-0968-6

This article is a review of the latest information on the prevalence of G. lamblia in South Asia, South East Asia and Far East, characterizing the current endemic situation within these regions. Around 33 published papers from 2002-2007 were collected on G. lamblia. The included countries were Nepal, Bangladesh, India, Cambodia, Vietnam, Malaysia, Philippines, Indonesia, Thailand, Republic of Korea, and China. Only five published papers were discarded because data was extracted before 2002-2007 or they are not included within our regions, emphasizing more on G. lamblia in animals, or performed at extensive molecular level. The prevalence of G. lamblia varied markedly between studies illustrating higher levels in the urban than in the rural areas, more among poor communities, slightly higher in males than in females with age range of 2-5-year-old children, and among university students, old-aged people, HIV-positive patients, and gastric carcinoma patients. Though G. lamblia is not a life-threatening parasite, nevertheless, it is still considered as the most common water-borne diarrhea-causing disease. It is important to understand the etiology, frequency, and consequences of acute diarrhea in children. Routine surveillance such as bi-annual follow-up treatments, treating G. duodenalis cysts and other protozoa oocysts detected in ground water sources, and continuous health education are the most preventive measures.

Matched MeSH terms: Giardia lamblia/isolation & purification*
A comparative study of four methods for detecting Giardia lamblia in children with diarrheal disease and malabsorption

Kamath KR, Murugasu R

Gastroenterology, 1974 Jan;66(1):16-21.
PMID: 4809494
Matched MeSH terms: Giardia/isolation & purification*; Giardiasis/diagnosis*
Fulltext Molecular epidemiology of giardiasis among Orang Asli in Malaysia: application of the triosephosphate isomerase gene

Anuar TS, Azreen SN, Salleh FM, Moktar N

BMC Infect Dis, 2014 Feb 12;14:78.
PMID: 24520940 DOI: 10.1186/1471-2334-14-78

BACKGROUND: Giardia duodenalis is a flagellate parasite which has been considered the most common protozoa infecting human worldwide. Molecular characterization of G. duodenalis isolates have revealed the existence of eight groups (Assemblage A to H) which differ in their host distribution. Assemblages A and B are found in humans and in many other mammals.
METHODS: This cross-sectional study was conducted to identify assemblage's related risk factors of G. duodenalis among Orang Asli in Malaysia. Stool samples were collected from 611 individuals aged between 2 and 74 years old of whom 266 were males and 345 were females. Socioeconomic data were collected through a pre-tested questionnaire. All stool samples were processed with formalin-ether sedimentation and Wheatley's trichrome staining techniques for the primary identification of G. duodenalis. Molecular identification was carried out by the amplification of a triosephosphate isomerase gene using nested-PCR assay.
RESULTS: Sixty-two samples (10.2%) were identified as assemblage A and 36 (5.9%) were assemblage B. Risk analysis based on the detected assemblages using univariate and logistic regression analyses identified subjects who have close contact with household pets i.e. dogs and cats (OR = 2.60; 95% CI = 1.42, 4.78; P = 0.002) was found to be significant predictor for assemblage A. On the other hand, there were three significant risk factors caused by assemblage B: (i) children ≤15 years old (OR = 2.33; 95% CI = 1.11, 4.87; P = 0.025), (ii) consuming raw vegetables (OR = 2.82; 95% CI = 1.27, 6.26; P = 0.011) and (iii) the presence of other family members infected with giardiasis (OR = 6.31; 95% CI = 2.99, 13.31; P

Matched MeSH terms: Giardia lamblia*
Parasitic infections in Malaysia: changing and challenges

Nissapatorn V, Lim YA, Jamaiah I, Agnes LS, Amyliana K, Wen CC, et al.

Southeast Asian J Trop Med Public Health, 2005;36 Suppl 4:50-9.
PMID: 16438180

A total of 1,885 blood and stool samples of four main protozoan parasitic infections were retrospectively reviewed from January, 2000 to April, 2004. Eleven of the 1,350 stool samples were shown positive for Cryptosporidium and Giardia infections; one of the 5 cases was clinically diagnosed as gastrointestinal cryptosporidiosis, while 6 cases were giardiasis. In patients with giardiasis, children were among the high-risk groups, making up 66.7% of these patients. The common presenting signs and symptoms were: diarrhea (83.3%), loss of appetite (83.3%), lethargy (83.3%), fever (66.7%), nausea/vomiting (50.0%), abdominal pain (16.7%), dehydration (16.7%) and rigor and chills (16.7%). Metronidazole was the drug of choice and was given to all symptomatic patients (83.3%). For the blood samples, 28 of the 92 peripheral smears for Plasmodium spp infection were diagnosed as malaria. The age range was from 4 to 57, with a median of 32.5 years. The sex ratio (M:F) was 3.6:1, while the age group of 30-44 years was the most commonly affected in both sexes. The majority of patients were foreigners (60.7%) and non-professional (39%). Plasmodium vivax (71%) infection was the most common pathogen found in these patients, along with a history of traveling to an endemic area of malaria (31%). The predominant presenting signs and symptoms were: fever (27%), rigor and chills (24%), nausea/vomiting (15%) and headache (8%). Chloroquine and primaquine was the most common anti-malarial regimen used (78.6%) in these patients. The seroprevalence of toxoplasmosis in different groups was 258/443 (58%): seropositive for IgG 143 (32.3%); IgM 67 (15%); and IgG + IgM 48 (10.8%). The age range was from 1 to 85, with a mean of 34 (+/- SD 16.6) years. The predominant age group was 21 to 40 years (126; 28.4%). The sex ratio (M:F) was 1.2:1. Subjects were predominantly male (142; 32%) and the Malay (117; 26.4%). Of these, 32 cases were clinically diagnosed with ocular toxoplasmosis. The range of age was from 10 to 56 years with a mean of 30.5 (+/- SD 12.05) years. The sex ratio (M:F) was 1:1.7. The majority were in the age group of 21 to 40 years, female (20; 62.5%), and Malay (17; 53%). They were also single (16; 50%), unemployed (12; 37%), and resided outside Kuala Lumpur (21; 65.6%). The more common clinical presentations were blurring of vision (25; 78%), floaters (10; 31%) and pain in the eye (7; 22%). We found that funduscopic examination (100%) and seropositivity for anti-Toxoplasma antibodies (93.7%) were the main reasons for investigation. Choroidoretinitis was the most common clinical diagnosis (69%), while clindamycin was the most frequently used antimicrobial in all cases. Among HIV-infected patients, 10 cases were diagnosed as AIDS-related toxoplasmic encephalitis (TE) (9 were active and 1 had relapse TE). In addition, 1 case was confirmed as congenital toxoplasmosis.

Matched MeSH terms: Giardia lamblia/isolation & purification*
Intestinal parasitic infections frequency in referred patients to a large teaching hospital, Khuzestan, Southwest, Iran, 2017

Feiz Haddad MH, Maraghi S, Ali SA, Feiz Haddad R, Nasser Zadeh R

Trop Biomed, 2018 Dec 01;35(4):915-925.
PMID: 33601841

Intestinal parasitic infections (IPIs) are among the most important infectious diseases in Iran. A cross sectional study was designed to determine frequency of intestinal parasites among referrals to a large teaching hospital in Khuzestan, Southwest of Iran, 2017. A total number of 5613 stool samples were examined through direct smear and formalin-ether concentration methods to detect possible parasitic infections. Samples consisted of 2643 (47.09%) male and 2970 (52.91%) female. A total of 1468 (26.15%) samples were positive (13.11% male and 13.4% female) and 4145 (73.85%) were negative. The results also showed that 255 of samples had more than one type of parasite (mix infections). Counting single and mix parasite infections, the total number of positive cases reached to 1723. Helminthes parasites were present in 12 (0.7%) cases, while intestinal protozoan parasites were in 1711 (99.3%) cases. Almost equally, pathogenic and nonpathogenic parasites infected 860 (49.91%) and 863 (50.09%) of patients, respectively. The frequency for helminthes was determined at 0.52% with Hymenolepis nana and Enterobius vermicularis however, Giardia lamblia in 38.54% and Entamoeba histolytica/dispar at 10.68% were concluded as protozoa elements. The IPIs frequency was recorded in female and male patients at 49.16% and 50.14%, respectively. According to the current results the infection rate of intestinal parasites has been significantly reduced especially for helminths infections in this region possibly due to public attention to health issues such as; increased awareness of people, improvement of sanitation, seasonal variations, health education and personal hygiene.

Matched MeSH terms: Giardia lamblia
Diagnostics of intestinal parasites by light microscopy among the population of children between the ages of 4-12 in eastern Turkey

Babat SO, Sirekbasan S, Macin S, Kariptas E, Polat E

Trop Biomed, 2018 Dec 01;35(4):1087-1091.
PMID: 33601855

Intestinal parasitic infections are among important health problems in developing countries. In societies living in low socioeconomic conditions, it has been neglected and mostly affects children. It is important to determine the prevalence and type of intestinal parasites in order to determine the intervention strategies for these infections. Therefore, the aim of this study is to evaluate intestinal parasite prevalence and IgE levels and the factors associated with the region in which the children population live, in Sirnak province, in the eastern of Turkey. A total of 357 symptomatic children aged 4 to 12 years, who were admitted to the Paediatric Polyclinic of Sirnak State Hospital, were examined prospectively. The collected stool samples were examined with direct wet-mount and concentration method under light microscope. In addition, total serum IgE levels were compared among 223 children with parasitic disease and 134 children without parasitic disease. One or more intestinal parasites were detected in 223 out of the 357 children participating in the study. The ratio of single, double, and triple parasitic infections in children was 32.5 %, 22.4 % and 7.6 %, respectively. The most common parasites determined in the study were Taenia spp. (39.9%), Enterobius vermicularis (38.6%) and Giardia intestinalis. (30 %). The difference between IgE levels determined in both groups was not regarded to be statistically significant. This study indicated that that intestinal polyparism is very common in children living in the province of Sirnak, which is located in the east of Turkey, neighbouring Iraq and Syria in the South. For this reason, sustainable control measures are urgently needed to improve personal hygiene and sanitation, to provide a healthy infrastructure and to improve the quality of existing water resources.

Matched MeSH terms: Giardia lamblia
Fulltext Food and water-borne protozoal diseases (FWBPD)

Baha Latif

Medical Health Reviews, 2009;2009(2):27-46.
MyJurnal

This review places emphasis on the food and water borne protozoal diseases like, cryptosporidiosis, giardiasis, cyclosporiasis, and toxoplasmosis which are endemic in many parts of the world. The article addresses cryptosporidiosis, giardiasis, cyclosporiasis, and toxoplasmosis. Cryptosporidium and Giardia are widespread in the environment and major outbreaks have occurred as a result of contaminated drinking water. Cyclospora has significance in the preparation and consumption of fresh food that have not received heat treatment. Toxoplasma gondii, transmission occur through contaminated water, unpasteurised milk and also the consumption of raw meat, which has been regarded as a major route of transmission to humans .These parasitic protozoa do not multiply in foods, but they may survive in or on moist foods for months especially in cool and damp environment. Their ecology makes control of these parasites difficult. Transmission, clinical manifestations, outbreaks, public health surveillance and control measures that are used for those diseases will be reviewed in this article.

Matched MeSH terms: Giardia; Giardiasis
Fulltext Giardiasis amongst the orang asli school children at pos Titom, Pahang, Malaysia

Mohamed Kamel Abd. Ghani, Anisah Hj. Musa

Jurnal Sains Kesihatan Malaysia, 2018;16(101):89-93.
MyJurnal

Giardia intestinalis is among the protozoa that is commonly found in the human fecal samples throughout the world. The prevalence of infection is higher among people living in developing countries than developed countries. One hundred and eleven Orang Asli children at Pos Titom, Pahang participated in this study. The prevalence study was conducted in accordance to gender, age groups and the diagnostic techniques employed. Fecal samples were collected and examined for the presence of G. intestinalis using three diagnostic techniques ie; the direct fecal smear, formalin-ether concentration and the trichrome staining technique. The overall prevalence of G. intestinalis infection among Orang Asli children at Pos Titom was 23.42%. The infection was higher among females (25%) as compared to males (21.57%) eventhough it was not statistically significant (p > 0.05). In terms of age groups, no positive case was observed among preschoolers whose age were below seven-years while the school aged children (7 to 12-years old) showed 24.53% infection. The trichrome staining technique was the most sensitive with a detection rate of 22.52% followed by the formalin-ether concentration technique with a detection of 19.82% whilst the direct smear technique only detected 12.61% of cases. The prevalence of giardiasis amongst the Orang Asli children at Pos Titom, Pahang was still high despite various efforts made and improvements in basic infrastructural facilities undertaken for their community. The health care status and personal hygiene of Orang Asli children remains poor and needs to be further improved.

Matched MeSH terms: Giardia lamblia
Effect of nitazoxanide on diarrhea: A systematic review and network meta-analysis of randomized controlled trials

Hashan MR, Elhusseiny KM, Huu-Hoai L, Tieu TM, Low SK, Minh LHN, et al.

Acta Trop, 2020 Oct;210:105603.
PMID: 32598920 DOI: 10.1016/j.actatropica.2020.105603

We aimed to systematically review evidence pertaining to the safety and efficacy of nitazoxanide in treating infectious diarrhea. On September 21, 2017, we identified relevant studies using 12 databases. The estimates of the included studies were pooled as a risk ratio (RR). We conducted a network and pairwise random-effects meta-analysis for both direct and indirect comparisons of different organisms that are known to cause diarrhea. The primary and secondary analysis outcomes were clinical response until cessation of illness, parasitological response and adverse events. We included 18 studies in our analysis. In cryptosporidiosis, the overall estimate favored nitazoxanide in its clinical response in comparison with placebo RR 1.46 [95% CI 1.22-1.74; P-value <0.0001]. Network meta-analysis among patients with Giardia intestinalis showed an increase in the probability of diarrheal cessation and parasitological responses in comparison with placebo, RR 1.69 [95% CI 1.08-2.64, P-score 0.27] and RR 2.91 [95% CI 1.72-4.91, P-score 0.55] respectively. In Clostridium difficile infection, the network meta-analysis revealed a non-significantly superior clinical response effect of nitazoxanide to metronidazole 31 days after treatment RR 1.21 [95% CI 0.87-1.69, P-score 0.26]. In Entamoeba histolytica, the overall estimate significantly favored nitazoxanide in parasitological response with placebo RR 1.80 [95% CI 1.35-2.40, P-value < 0.001]. We highlighted the effectiveness of nitazoxanide in the cessation of diarrhea caused by Cryptosporidium, Giardia intestinalis and Entamoeba histolytica infection. We also found significant superiority of NTZ to metronidazole in improving the clinical response to G. intestinalis, thus it may be a suitable candidate for treating infection-induced diarrhea. To prove the superiority of NTZ during a C. difficile infection may warrant a larger-scale clinical trial since its superiority was deemed insignificant. We recommend nitazoxanide as an appropriate option for treating infectious diarrhea.

Matched MeSH terms: Giardia lamblia
Fulltext Important zoonotic intestinal protozoan parasites in Asia

Mak JW

Trop Biomed, 2004 Dec;21(2):39-50.
PMID: 16493397

Intestinal protozoa are increasingly being studied because of their association with acute and chronic diarrhoea in immunocompromised as well as immunocompetent patients. Various community outbreaks due to contamination of water or food with these protozoa have further highlighted their importance in public health. Among these important pathogens are Giardia duodenalis, Entamoeba histolytica, Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli, and microsporidia. Except for the cyst-forming G. duodenalis and E. histolytica, the others are intracellular and form spores which are passed out with the faeces. These organisms are also found in various animals and birds and zoonotic transmission is thought to occur. These infections are distributed worldwide, with a higher prevalence in developing compared to developed countries. However, the relative importance of zoonotic infections especially in developing countries has not been studied in detail. The prevalence rates are generally higher in immunodeficient compared to immunocompetent patients. Higher prevalence rates are also seen in rural compared to urban communities. Most studies on prevalence have been carried out in developed countries where the laboratory and other health infrastructure are more accessible than those in developing countries. This relative inadequacy of laboratory diagnosis can affect accurate estimates of the prevalence of these infections in developing countries. However, reports of these infections in travellers and workers returning from developing countries can provide some indication of the extent of these problems. Most studies on prevalence of amoebiasis in developing countries were based on morphological identification of the parasite in faecal smears. As the pathogenic E. histolytica is morphologically indistinguishable from that of non-pathogenic E. dispar, estimates of amoebiasis may not be accurate. The epidemiology of human microsporidia infections is not completely understood. Two species, Enterocytozoon bieneusi and Encephalitozoon intestinalis, are associated with gastrointestinal disease in humans and it is believed that human to human as well as animal to human infections occur. However, the importance of zoonotic infections has not been fully characterised. G. duodenalis cysts, microsporidia and Cryptosporidium oocysts have been detected in various ground water resources, but their role in community outbreaks and maintenance of the infection has not been fully characterised. The taxonomic classification and pathogenic potential of B. hominis are still controversial. While considered by many as yeast, fungi or protozoon, recent sequence analysis of the complete SSUrRNA gene has placed it within an informal group, the stramenopiles. This review covers recent published data on these zoonotic infections and examines their public health importance in Asian countries.

Matched MeSH terms: Giardia lamblia

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