Hospitalization of Cuban children for giardiasis: a retrospective study in a paediatric hospital in Havana.

The medical records of the 185 children who, in 2007, were admitted to the Academic Paediatric Hospital 'Centro Habana', in the Cuban capital of Havana, because of giardiasis were analysed retrospectively. A standardized form was used to collect data on the socio-demographic characteristics, clinical features, laboratory diagnosis, treatment and length of stay of each child. Information on the 15 children who had incomplete medical records was excluded from the data analysis. Of the remaining 170 children, 85 (50·0%) were aged 1-4 years, 97 (57·1%) were male, and 106 (62·4%), 92 (54·1%) and 69 (40·6%) had presented with diarrhoea, vomiting, and/or abdominal pain, respectively. Most (91·2%) of the cases had been diagnosed by the microscopical examination of a duodenal aspirate, and the drugs that had been most used frequently were quinacrine and tinidazole, which had been given to 72 (42·4%) and 62 (36·5%) of the cases, respectively. The mean length of hospital stay was 4·9 days. Such information on the clinical characteristics of giardiasis among children living in an endemic area may be valuable to paediatricians and public-health officials who wish to screen for the disease.

Prevalence of intestinal parasitic infections in patients with acquired immunodeficiency syndrome in Brazil.

OBJECTIVES: To evaluate the prevalence of intestinal parasitic infections and to investigate the possible associations of clinical status and laboratory findings with the different parasites found in stool samples. METHODS: Each patient was provided with one standard fecal collection vial containing 10% formalin for detecting ova, larvae, and cysts. To detect Cryptosporidium parvum and Isospora belli, the acid-fast Kinyoun stain and fluorescent auramine-rhodamine stain were used. RESULTS: A total of 200 patients with acquired immunodeficiency syndrome participated in this study; 40% were infected with at least one pathogenic species. The total prevalence of parasites was 16% for Giardia lamblia, 13% for Entamoeba coli, 7% for Cryptosporidium parvum, 3.5% for Endolimax nana, 2.5% for Ascaris lumbricoides, 2.5% for Strongyloides stercoralis, 2% for Isospora belli, and 0.5% for Blastocystis hominis. Results showed that diarrhea was significantly associated with cryptosporidiosis, giardiasis, and isosporiasis. However, no association was observed between the CD4+ cell counts and the manifestation of any particular parasite. CONCLUSIONS: The data support the value of standard fecal examinations in human immunodeficiency virus-infected patients, even in the absence of diarrhea, since these examinations easily can be performed, with low costs, and frequently disclose treatable conditions.

[An evaluation of the relationship between intestinal parasitoses and the risk factors for HIV in AIDS patients]. / Avaliação da relação entre parasitoses intestinais e fatores de risco para o HIV em pacientes com AIDS.

We conducted a cohort survey on 200 AIDS patients in São Paulo, SP, Brazil, to verify if the presence of enteroparasites is associated with the various risk factors for HIV infection. Diarrhea was significantly more frequent in the group of patients presenting enteroparasitosis (p < 0.00001). Giardia lamblia, found in 32 (16%) cases, was the most prevalent parasite. The presence of parasites in the stool samples was not significantly associated with risk factors for HIV infection, mainly when considering Giardia lamblia and Cryptosporidium parvum (p = 0.99 and 0.69, respectively). The controversy found in the literature indicates that additional studies should be done in the different geographical regions of the country.

[Concurrent leishmaniasis and human immunodeficiency virus (HIV) infection: a study of four cases]. / Concomitância de leishmanioses e infecção pelo vírus da imunodeficiência humana (HIV): estudo de quatro casos.

Few cases of concurrent leishmaniasis and HIV infection have been reported in Brazil, despite both infections being in expansion. Two cases of visceral leishmaniasis and two cases of mucocutaneous leishmaniasis are discussed. Disseminated skin and oral lesions were found in the patients with the cutaneous form of the disease. Prolonged fever, hepatosplenomegaly and pancytopenia were the main manifestations of the visceral form. The CD4 T lymphocyte count was low in all cases. Direct examination of bone marrow aspirate for leishmania and biopsy of cutaneous lesions are the techniques of choice to confirm diagnosis. Pentavalent antimonials and amphotericin B are preferred drugs for the treatment of leishmaniasis, including patients with AIDS. The authors recommend the inclusion of this parasitosis in the differential diagnosis of opportunistic diseases in patients with AIDS.

Enteric parasites and AIDS.

OBJECTIVE: To report on the importance of intestinal parasites in patients with AIDS, showing relevant data in the medical literature, with special emphasis on epidemiology, diagnosis and treatment of enteroparasitosis, especially cryptosporidiosis, isosporiasis, microsporidiasis and strongyloidiasis. DESIGN: Narrative review.

Mebendazole in parasitic infections other than those caused by soil-transmitted helminths.

Mebendazole, a benzimidazole carbamate compound, is currently in use for human medical practice against soil-transmitted helminthiasis (STH) and enterobiasis. However, it has been demonstrated that its spectrum of activity is broad and goes beyond those infections. Several studies provide evidence that this drug, taken at higher doses than used for STH and enterobiasis, could be sufficiently effective on some protozoa, nematodes and cestodes.

Treatment of intestinal protozoan infections in children.

Intestinal protozoan infections are a worldwide problem in both industrialised and unindustrialised countries; in the latter they may be the cause of significant morbidity and mortality. Children, in particular, are more likely to experience considerable morbidity. Most intestinal protozoan infections can cause acute or chronic diarrhoea in healthy individuals and may result in intractable, life-threatening illness in patients with immunosuppressive diseases such as AIDS. Adequate identification and treatment of these infections may provide significant benefit for individual patients and public health. This article presents an update on the pharmacotherapy currently available for amoebiasis, giardiasis and other intestinal protozoan infections.

The treatment of giardiasis in children: single-dose tinidazole compared with 3 days of nitazoxanide.

Giardia lamblia is among the commonest intestinal protozoa world-wide and may cause significant morbidity, especially in children. Although 5-nitroimidazole compounds have formed the mainstay of giardiasis treatment for several years, the increasing number of reports of refractory cases given these and other antigiardial agents has raised concern and led to a search for other compounds. The aim of the present study was to compare the efficacy and safety, in the treatment of children infected with G. lamblia, of nitazoxanide, given at a dose of 7.5 mg/kg twice a day for 3 days, with those of tinidazole, given as a single dose of 50 mg/kg. Overall, 166 children, each proven to be infected with G. lamblia by the microscopical examination of a faecal sample, were included in the open and randomized trial, each being allocated to receive nitazoxanide or tinidazole. The parents of each treated child were asked to collect two faecal samples from the child between 5 and 10 days after the completion of treatment, for the parasitological follow-up. Only if no G. lamblia were found in both post-treatment samples from a child was that child considered cured. Among the 137 children who completed the study (74 given nitazoxanide and 63 given tinidazole), the frequency of parasitological cure following a single dose of tinidazole was significantly higher than that following six doses of nitazoxanide (90.5% v. 78.4%; P<0.05). Both treatment schedules were well accepted and well tolerated, with only mild, transient and self-limited side-effects reported. The commonest symptom on enrolment, diarrhoea, generally cleared 2-6 days after the initiation of treatment. Although apparently less efficacious than tinidazole, nitazoxanide remains a good candidate for the treatment of children with G. lamblia infection.

Case report. Histoplasmosis in an AIDS paediatric patient.

Histoplasmosis has been little reported among HIV-infected children. We report a case of a 4-year old boy with AIDS who presented with disseminated histoplasmosis diagnosed by lung biopsy. The patient had a good clinical response to amphotericin B followed by itraconazole oral solution.

Paracoccidioidomycosis in a boy infected with HIV.

Paracoccidioidomycosis has been rarely reported among HIV patients, despite being an endemic mycosis in Latin America. The present report illustrates a case of PM in a teenager infected with HIV. Clinicians must be aware that this mycosis may occur in young HIV infected patients who live in endemic areas.

A randomized trial comparing mebendazole and secnidazole for the treatment of giardiasis.

To compare the efficacy of the two drugs in the treatment of giardiasis, 146 children (aged 5-15 years) with confirmed Giardia lamblia infection were randomly allotted to treatment with mebendazole (200 mg three times daily for 3 days) or secnidazole (30 mg/kg, in a single dose). Parasitological response to treatment was evaluated in each child by the microscopical examination of faecal samples collected 3, 5 and 7 days after he or she had completed treatment. Although the frequency of cure was higher for secnidazole (79.4%) than for mebendazole (78.1%), the difference was not statistically significant (P > 0.05). Both treatment regimens were well tolerated, with only mild, transient and self-limiting side-effects reported. Mebendazole may be preferable to secnidazole in the treatment of giardiasis cases who have an history of intolerance to 5-nitromidazoles, and where infections with Giardia and soil-transmitted helminths frequently co-occur.

Malaria Transmission Associated with Airplane Travel.

Plasmodium falciparum malaria was diagnosed in 3 patients in Sã o Paulo during a 5 day period between August 31, and September 4, 1996, at a time and place where malaria transmission does not occur. After investigation of the 3 cases it was determined that the infections were acquired as a result of an international airplane flight from Lebanon to São Paulo on August 16, which included a 30 minute stop-over in Abidjan, Ivory Coast, Africa. During the epidemiological evaluation, it was found that each of the 3 patients had been seated in the first class cabin. Entomological investigation at the airport revealed the presence of 4 specimens of Anopheles gambiae in airplanes (3 in the first class cabin and 1 in the luggage compartment) used on this route. The species of mosquito identified is predominant in Africa. Two of the patients were seriously ill, but all recovered after treatment with either mefloquine (1 patient) or artesunate (2 patients). A survey of other passengers on the same flight or on similar Aights did not reveal any other eases of malaria. Malaria was not considered during initial evaluation by the attending physicians at the three different hospitals where the patients were admitted. These cases reveal the existence of vector borne disease transmission during airplane travel, and emphasize the importance of obtaining a travel history during the evaluation of an ill patient. In addition, the cases reinforce the need for vigilance in the control of vectors of disease around seaports, airports and hospitals.

Evaluation of Secnidazole Gel and Tinidazole Suspension in the Treatment of Giardiasis in Children.

Giardiasis is a cosmopolitan parasitosis. Diarrhea, abdominal colic, and flatulence are the main clinical symptoms, however, malabsorption, and impairment of growth of children may occur. The 5-nitroimidazoles are the drugs of choice in the treatment of giardiasis. Methods: The efficacy and tolerability of secnidazole and tinidazole were evaluated in a randomized, open-label, clinical trial performed with 267 Giardia lamblia-positive children. Secnidazole, in a new gel formulation, and tinidazole suspension were prescribed as single oral doses of 30mg/kg and 50mg/kg, respectively. Clinical and parasitological follow-up was carried out before, and at 7, 14, and 21 days after treatment. Results: Clinical cure was observed in 77.3% and 75.7% of the patients in the secnidazole and tinidazole groups, respectively. Parasitological cure was obtained in the 91.3% and 89.6% in the secnidazole and tinidazole groups, respectively. A metallic taste after drug ingestion was more commonly reported in the tinidazole group than in the secnidazole group (p<0.05). Conclusions: The authors conclude that both secnidazole gel and tinidazole administered as a single oral dose are effective treatments for children with giardiasis since both high cure rates and good tolerability were observed.