The Use of Quinacrine in Nitroimidazole-resistant Giardia Duodenalis: An Old Drug for an Emerging Problem
| Autor: | Maria Eugenia Valls, Ana Requena-Méndez, Antonio Clavel, Victoria Fumadó, Diana Pou, Encarnación Rubio, Edelweiss Aldasoro, Silvia Lóbez, Jose Muñoz, Begoña Treviño, Joaquim Gascon, Antonio Federico Martínez Montseny, Pilar Goñi, Juan Cabezos |
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| Rok vydání: | 2017 |
| Předmět: |
Giardiasis
0301 basic medicine medicine.medical_specialty medicine.drug_class 030106 microbiology 030231 tropical medicine Antibiotics Mepacrine Anorexia medicine.disease_cause Gastroenterology bp gene 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Refractory Internal medicine treatment Genotype Genetics medicine Immunology and Allergy Giardia lamblia Refractory giardiasis Nitroimidazole biology business.industry Giardiosi nitroimidazole Giardia biology.organism_classification Infectious Diseases chemistry genetic characterization PCR tpi gene medicine.symptom business quinacrine Genètica medicine.drug |
| Zdroj: | Dipòsit Digital de la UB Universidad de Barcelona JOURNAL OF INFECTIOUS DISEASES r-FSJD: Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu Fundació Sant Joan de Déu Recercat. Dipósit de la Recerca de Catalunya instname Zaguán. Repositorio Digital de la Universidad de Zaragoza r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu |
| ISSN: | 1537-6613 0022-1899 |
| DOI: | 10.1093/infdis/jix066 |
| Popis: | Background: 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. Methods: 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. Results: 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. Conclusions: 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. |
| Databáze: | OpenAIRE |
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