Background

Giardiasis is highly prevalent in children and is often mildly symptomatic. First-line treatment is metronidazole, but treatment failure is not uncommon. We describe a paediatric series, to identify risk factors for treatment failure and to analyse the safety and effectiveness of other treatment strategies.

Methods

Retrospective observational study, including children diagnosed with giardiasis from 2014 to 2019. Diagnosis was based on direct visualisation by microscopy after concentration using an alcohol-based fixative, antigen detection and/or DNA detection by polymerase chain reaction in stool. Treatment failure was considered when GI was detected 4 weeks after treatment.

Results

A total of 120 patients were included, 71.6% internationally adopted, median age 4.2 (2.3–7.3) years. Only 50% presented with symptoms, mainly diarrhoea (35%) and abdominal pain (14.1%); co-parasitism was frequent (45%). First-line treatment failure after a standard dose of metronidazole was 20%, lowering to 8.3% when a higher dose was administered (p < 0.001). Quinacrine was administered in 10 patients, with 100% effectiveness. Children <2 years were at higher risk of treatment failure (OR 3.49; 95% CI 1.06–11.53; p = 0.040).

Conclusions

In children with giardiasis, treatment failure is frequent, especially before 2 years of age. Quinacrine can be considered as a second-line treatment. After treatment, eradication should be confirmed.

中文翻译：

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儿童肠道贾第鞭毛虫病：在参考单位的五年经验

背景

贾第鞭毛虫病在儿童中非常普遍，通常症状较轻。一线治疗是甲硝唑，但治疗失败并不少见。我们描述了一个儿科系列，以确定治疗失败的风险因素并分析其他治疗策略的安全性和有效性。

方法

回顾性观察研究，包括 2014 年至 2019 年诊断为贾第虫病的儿童。诊断基于使用酒精固定剂浓缩后通过显微镜直接观察、抗原检测和/或通过粪便中的聚合酶链反应检测 DNA。当治疗后 4 周检测到GI时，认为治疗失败。

结果

共纳入 120 名患者，71.6% 国际采用，中位年龄为 4.2 (2.3-7.3) 岁。仅50%出现症状，主要是腹泻（35%）和腹痛（14.1%）；共寄生很常见（45%）。标准剂量甲硝唑后的一线治疗失败率为 20%，当给予更高剂量时降低至 8.3%（p < 0.001）。10 名患者使用了奎纳克林，有效率 100%。小于 2 岁的儿童治疗失败的风险较高（OR 3.49；95% CI 1.06–11.53；p = 0.040）。

结论

在患有贾第虫病的儿童中，治疗失败很常见，尤其是在 2 岁之前。奎纳克林可被视为二线治疗。治疗后，应确认根除。