Summary objective To examine the relationship of past and current intestinal helminth infections with asthma, allergic rhinoconjunctivitis, atopic dermatitis and atopy. methods Cross-sectional study of 1320 children aged 4–14 years from... more
Summary objective To examine the relationship of past and current intestinal helminth infections with asthma, allergic rhinoconjunctivitis, atopic dermatitis and atopy. methods Cross-sectional study of 1320 children aged 4–14 years from two Cuban municipalities. Helminth infections were determined by stool examination and parental questionnaire. Asthma, rhi-noconjunctivitis and atopic dermatitis were diagnosed by International Study of Asthma and Allergies in Childhood questionnaire, asthma additionally by spirometry, atopy by skin prick testing. results Questionnaire-based frequencies were 21 % for asthma, 14 % for allergic rhinoconjunctivitis and 8 % for atopic dermatitis. According to spirometry, 4 % had asthma; 20 % had a positive skin prick test. A history of infection for Enterobius vermicularis was associated with increased risk of atopic dermatitis (OR 1.88, P = 0.001) and allergic rhinoconjunctivitis (OR 1.34, P = 0.046), and hookworm with increased risk of allergic rhinoco...
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Five-nitroimidazole (5-NI) compounds are among the most commonly used medications in the treatment of giardiasis. However, after more than five decades of their initial indication for such treatment, there are some concerns about the... more
Five-nitroimidazole (5-NI) compounds are among the most commonly used medications in the treatment of giardiasis. However, after more than five decades of their initial indication for such treatment, there are some concerns about the efficacy of 5-NIs in giardiasis. This study sought to compare the efficacy of any 5-NI with any other antigiardial drug for the treatment of Cuban children with giardiasis. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched CUMED, EBSCOhost and PubMed databases. Two reviewers independently assessed trial eligibility, trial quality and extracted appropriate data. The primary outcome was the parasitological cure. The effect estimate was the pooled relative risk (RR) with 95% confidence intervals (CI). We included seven RCTs in the systematic review, involving a total of 1046 children. When the effect of 5-NIs was compared with that of benzimidazole compounds, the pooled effect was significant and favored...
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Citation: Rodriguez-MoralesAJ,Paniz-MondolfiAE, Faccini-Martı́nez ÁA, Henao-Martı́nez AF, Ruiz-Saenz J, Martinez-Gutierrez M, Alvarado-Arnez LE, Gomez-Marin JE, Bueno-Marı́ R, Carrero Y, Villamil-GomezWE, Bonilla-Aldana DK, Haque U,... more
Citation: Rodriguez-MoralesAJ,Paniz-MondolfiAE, Faccini-Martı́nez ÁA, Henao-Martı́nez AF, Ruiz-Saenz J, Martinez-Gutierrez M, Alvarado-Arnez LE, Gomez-Marin JE, Bueno-Marı́ R, Carrero Y, Villamil-GomezWE, Bonilla-Aldana DK, Haque U, Ramirez JD, Navarro J-C, Lloveras S, Arteaga-Livias K, Casalone C, Maguiña JL, Escobedo AA, Hidalgo M, Bandeira AC, Mattar S, Cardona-Ospina JA and Suárez JA (2021) The Constant Threat of Zoonotic and Vector-Borne Emerging Tropical Diseases: Living on the Edge. Front. Trop. Dis. 2:676905. doi: 10.3389/fitd.2021.676905 SPECIALTY GRAND CHALLENGE published: 04 May 2021 doi: 10.3389/fitd.2021.676905
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Gastro-oesophageal reflux disease, eosinophilic oesophagitis and oesophageal motility disorders are among the most common diseases accompanying oesophageal eosinophilia. They have similarities and their limits are frequently not well... more
Gastro-oesophageal reflux disease, eosinophilic oesophagitis and oesophageal motility disorders are among the most common diseases accompanying oesophageal eosinophilia. They have similarities and their limits are frequently not well defined. This article reviews the main characteristics relating to their similarities and differences, highlighting existing controversies among these diseases, in addition to current knowledge. In the case of a patient with symptoms of oesophageal dysfunction, it is suggested to carry out an integral analysis of the clinical features and diagnostic test results, including histology, while individualising each case before confirming a definitive diagnosis. Future investigation in paediatric patients is necessary to assess eosinophilic infiltration in the various layers of the oesophageal tissue, along with its clinical and pathophysiological implications.
Although Giardia, the aetiological agent of giardiasis, is one of the most prevalent intestinal parasitic infections world-wide, for industrialised countries, it is mainly appreciated as an imported disease with the minimal local... more
Although Giardia, the aetiological agent of giardiasis, is one of the most prevalent intestinal parasitic infections world-wide, for industrialised countries, it is mainly appreciated as an imported disease with the minimal local transmission. However, the current evidence challenges this perception; Giardia has relevance beyond the high prevalence areas. This infection may be asymptomatic or cause gastrointestinal complains and long-term sequelae, including irritable bowel syndrome, chronic fatigue and impaired child growth and cognitive development. Its detection and diagnosis present a challenge to physicians who may not be familiar with this infection. To improve interventions to control this parasitosis, it is necessary to maintain a high index of suspicion and remain vigilant in finding cases at risk for infection. A better understanding of the characteristics of populations importing infections alongside improved methods to reliably classify infections as imported or acquired...
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Treatment failures in patients suffering from giardiasis are not uncommon feature. The most frequent approach in these cases is to treat these patients with longer repeated courses and/or higher doses of the primary therapy, or using... more
Treatment failures in patients suffering from giardiasis are not uncommon feature. The most frequent approach in these cases is to treat these patients with longer repeated courses and/or higher doses of the primary therapy, or using drugs from a different class to avoid potential cross-resistance. However, a higher rate of adverse events may limit this strategy. In this context, combination therapy (CT) is emerging as a valuable option against refractory giardiasis. In the attempt to evaluate the benefits of CT, a number of experimental studies, clinical series, and randomized clinical trials (RCTs), as well as several veterinary studies have been performed, with varying results. Here, we present a critical analysis of the available information regarding CT for the treatment of Giardia infection, as well as the authors' opinion with respect to its use. RCTs of combination therapy are limited and the optimal combinations and administration strategies need yet to be clarified. An...
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Research Interests: Parasitology, Humans, Infant, Albendazole, Giardiasis, and 3 moreFeces, Tinidazole, and Child preschool
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Giardia lamblia is the commonest food and water transmitted protozoan intestinal pathogen both in underdeveloped countries and industrialized nations. In Cuba, according to the last national intestinal parasites survey (n 1⁄4 5850), the... more
Giardia lamblia is the commonest food and water transmitted protozoan intestinal pathogen both in underdeveloped countries and industrialized nations. In Cuba, according to the last national intestinal parasites survey (n 1⁄4 5850), the prevalence of G. lamblia infection was estimated to be at 6.02% (95%CI 5.40–6.63) [1], representing not only a risk for local population, but also for foreign visitors. During 2014, we received 23 foreign visitor outpatients that were identified with giardiasis at the Central Clinic "Cira García" (CCCG), in Havana, Cuba. The sex ratio female/male of patients was 15/8 with a median age of 12 (range: 1–69) year-old at the time of diagnosis. They came from Angola 12 (52%), Argentina (13%) and Brazil (8%), among other countries (Table 1). The main complaint was abdominal pain (30%), followed by diarrhoea and urticaria (22%). Other symptoms included flatulence (17.4%), nausea (13%) and vomiting (13%). In 22% patients were asymptomatic and diagnosed during exploratory tests. Underlying diseases were present in 26% patients: gallstones (9%), colitis (4%), urinary tract infection (4%), diverticulitis (4%) and anaemia (4%). Giardiasis was confirmed by faecal microscopic examination, complemented with microscopic examination of duodenal fluids and in vitro immunochromatographic test for the qualitative detection of Giardia intestinalis-antigen by Giardia–Dipstick test.
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The occurrence of treatment failures to first-line treatment for giardiasis, one of the most widespread although neglected parasitic disease, has long been recognised. Nowadays, it starts to represent a great challenge to clinicians,... more
The occurrence of treatment failures to first-line treatment for giardiasis, one of the most widespread although neglected parasitic disease, has long been recognised. Nowadays, it starts to represent a great challenge to clinicians, especially in endemic countries. This requires the introduction of new drug interventions, but the development of novel drugs is a time and money consuming effort with most of the compounds never reaching the market. Consequently, alternative strategies are needed, especially for the treatment of giardiasis. Chloroquine (CQ), a synthetic drug developed as antimalarial agent, has been shown to also exert antigiardial activity. Here, we present a mini-research summarizing results on the treatment of human clinical cases with CQ, going through in vitro research, case report, and case series to human clinical trials, highlighting the benefits and mentioning possible adverse effects.
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Las enfermedades causadas por geohelmintos, tales como Ascaris lumbricoides, ancilostomídios y Trichuris trichiura son un problema de salud pública cuya naturaleza y alcance son bien conocidos. Se sabe que la presen-cia de estos agentes... more
Las enfermedades causadas por geohelmintos, tales como Ascaris lumbricoides, ancilostomídios y Trichuris trichiura son un problema de salud pública cuya naturaleza y alcance son bien conocidos. Se sabe que la presen-cia de estos agentes en el interior del organismo condiciona trastornos en el equilibrio nutricional, crecimiento y desarrollo físico de los niños; y más recientemente se notifican dificultades relacionadas con la capacidad de aprendizaje. Por fortuna, estos efectos pueden ser revertidos mediante tratamientos medicamentosos sencillos y poco costosos, entre los que se cuentan antihelmínticos de amplio espectro con probada efectividad y seguridad. Ante todo lo anterior, cabe preguntarse ¿Por qué si hoy estamos tan bien preparados para enfrentar estas infecciones, aún son causa de morbilidad en tantos lugares? En realidad, las evidencias señalan a la quimioterapia como una medida rápida de control; sin embargo, se conoce que entre los parásitos, el ambiente y los hospederos...
Keynote sessions and Symposia: Update in the treatment of intestinal parasitic diseases A.A. Escobedo *. Department of Gastroenterology, Parasitology and Nutrition, Academic Paediatric Hospital, Havana City, Cuba E-mail address :... more
Keynote sessions and Symposia: Update in the treatment of intestinal parasitic diseases A.A. Escobedo *. Department of Gastroenterology, Parasitology and Nutrition, Academic Paediatric Hospital, Havana City, Cuba E-mail address : escobedo@infomed.sld.cu Intestinal parasitic infections (IPIs) 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. An update is presented on the pharmacotherapy on the main intestinal parasitic diseases.
A cross-sectional study was carried out in 200 children aged 5-15 years, to examine the presence of intestinal parasitic infections (IPIs) and to assess the risk factors and clinical features associated with them in children in San Juan y... more
A cross-sectional study was carried out in 200 children aged 5-15 years, to examine the presence of intestinal parasitic infections (IPIs) and to assess the risk factors and clinical features associated with them in children in San Juan y Martinez (SIM), Cuba. Three fresh faecal samples were collected from each child and were examined by direct wet mount, brine flotation, formalin-ether and Kato-Katz techniques. Data relating to demography, source of drinking water, personal hygiene habits and clinical features were also collected Living in the rural area was significantly associated with the highest infection rates (p < 0.01). According to clinical features and laboratory examinations, children with abdominal pain were about four times more likely to have IPIs (OR 4.05, CI, 1.11, 13.18) especially soil-transmitted helminths (STH). We suggest that IPIs, especially STH, in SJM should be strongly suspected in children with abdominal pain from rural areas. Targeted and frequent inte...
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Giardia duodenalis is among the commonest protozoan parasites in the intestinal tract of humans and may cause significant morbidity worldwide. Although there are several antigiardial agents, treatment failures have been commonly reported.... more
Giardia duodenalis is among the commonest protozoan parasites in the intestinal tract of humans and may cause significant morbidity worldwide. Although there are several antigiardial agents, treatment failures have been commonly reported. To compare the efficacy and safety of chloroquine (CQ) versus metronidazole (MTZ) in the treatment of children with confirmed G duodenalis mono-infection. A randomized, controlled, open-label trial was carried out at the Cuban Institute of Gastroenterology. One hundred and twenty-two children were randomly assigned to receive either CQ (10 mg/Kg bodyweight twice a day for five days) or MTZ [15 mg/Kg bodyweight divided in three daily does for five days]. All children were asked to provide three faecal samples on days 3, 5 and 7 after treatment completion. Children were considered to be cured, if no Giardia trophozoites or cysts were found in any of the three post-treatment faecal specimens evaluated by direct wet mounts and/or after Ritchie concentr...
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A coproparasitologic study was performed on 456 children aged 1-5 years from 4 day-care centers located in San Miguel del Padrón municipality during November 1998, with the aim of finding out the behaviour of the main intestinal parasites... more
A coproparasitologic study was performed on 456 children aged 1-5 years from 4 day-care centers located in San Miguel del Padrón municipality during November 1998, with the aim of finding out the behaviour of the main intestinal parasites and particularly how Giardia lamblia was affecting this child population. Three fecal specimens were collected from each child in every other day, which were processed by coproparasitologic methods such as direct testing and Ritchie's concentration technique. The most frequently identified parasite was G. lamblia with 249 positive cases for a prevalence rate of 54.6%. The second one was Blastocystis hominis (29.6%) followed by Endolimax nana(23.9%). Coccidia like Crystosporidium parvum and Cyclospora cayetanensis exhibited low frequencies, 0.6 and 1.5% respectively, being the majority of the cases located in only one day care center. These results confirmed that G. lamblia is the most prevailing parasite in day care centers, with peak frequency...
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To compare the efficacy and safety of five days apostrophe therapy of mebendazole (MBZ) versus quinacrine (QC) on human giardiasis in children. A clinical trial was carried out in paediatric patients (aged 5-15 years) with confirmed... more
To compare the efficacy and safety of five days apostrophe therapy of mebendazole (MBZ) versus quinacrine (QC) on human giardiasis in children. A clinical trial was carried out in paediatric patients (aged 5-15 years) with confirmed symptomatic G. duodenalis mono-infection. Patients were randomly assigned to receive either MBZ [200 mg taken three times per day (TID) (n = 61)] or QC [2 mg/kg bodyweight tid (n = 61)], both for five days. Follow-up faecal samples were obtained at 3, 5 and 7 d after the end of the treatment. Although the frequency of cure was higher for QC (83.6%) than for MBZ (78.7%), the difference was not statistically significant (P > 0.05). Adverse events were reported more in the QC group (P < 0.05), all of them transient and self-limiting. Despite final cure rates ocurring lower than expected, the overall results of this study reconfirmed…
Research Interests: Treatment Outcome, Adolescent, Medicine, Cuba, Humans, and 10 moreChild, Female, Animals, Male, Giardiasis, Clinical Sciences, Feces, Giardia, Mebendazole, and Child preschool
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A study on intestinal parasitism was conducted among 401 children admitted in the Pediatric Teaching Hospital of Cerro, from May to June, 1999. To this end, a representative, randomized and stratified sample by service was taken. 3... more
A study on intestinal parasitism was conducted among 401 children admitted in the Pediatric Teaching Hospital of Cerro, from May to June, 1999. To this end, a representative, randomized and stratified sample by service was taken. 3 samples of feces per child were collected, preserved in formaldehyde, and processed by 3 parasitological methods. There was an intestinal parasitism prevalence of 15% at the hospital and there were no differences between the stratum of children admitted in Gastroenterology and the rest of the services as regards commensals and parasites in general (p > 0.05); however, commensals predominated in the second group (p < 0.01) The intestinal coccidia, Cryptosporidium parvum and Cyclospora cayetanensis prevailed in the Gastroenterology service over the rest of the services (p < 0.01). The age group over 4 (school children) was the most affected, both by protozoa and commensals (p < 0.01), excepting Cryptosporidium parvum that affected the infants mo...
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A cross-sectional study was carried out to determine the prevalence of intestinal parasitic infections and the intensity of soil-transmitted helminths (STHs) among children who attend the educational centres of San Juan y Martinez, Cuba.... more
A cross-sectional study was carried out to determine the prevalence of intestinal parasitic infections and the intensity of soil-transmitted helminths (STHs) among children who attend the educational centres of San Juan y Martinez, Cuba. Ascaris lumbricoides, Blastocystis hominis and Giardia lamblia were the most common parasites found, with prevalence rates of 40.5%, 38.5% and 25%, respectively. In total, 91% of children harboured at least one type of intestinal parasite. The rates and intensity of intestinal parasitic infections found permit us to speculate that the conditions that predispose to acquire intestinal protozoan and STH infections persist in this municipality.
Research Interests: Soil, Tropical Medicine, Adolescent, Medicine, Cuba, and 8 moreSchools, Humans, Child, Animals, Infant, Prevalence, Nematoda, and Child preschool
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Research Interests: Water, Biology, Medicine, Humans, Animals, and 3 moreGiardiasis, Neglected diseases, and Foodborne diseases
Research Interests: Adolescent, Humans, Child, Young Adult, Giardiasis, and 3 moreAdult, Mebendazole, and Child preschool
Celiac disease (EC) not diagnosed or treated affect histological, immunological and nutritional status of patients who suffer it. These changes allow infection by parasites that cause no symptoms in immunocompetent patients, such as... more
Celiac disease (EC) not diagnosed or treated affect histological, immunological and nutritional status of patients who suffer it. These changes allow infection by parasites that cause no symptoms in immunocompetent patients, such as Blastocystis hominis (Bh). OBJETIVE. To analyze the presence of Bh in symptomatic celiac patients and describe the clinical, histological, immune and nutritional status in these patients. MATERIAL AND METHOD An observational descriptive cross sectional study was performed. Thirty symptomatic celiac patients (18 women, mean age 41 years old, range 19-68 years), assisted at the Institute of Gastroenterology of Cuba from January to December 2009, entered the study. Diarrhea and chronic anemia were the most commonly reported clinical manifestations (22 and 4 patients, respectively). The analysis of more than five Bh per field was more frequent in the group ofpatients studied (63.3%), with statistically significant difference in patients with vilous atrophy a...
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Background. Giardia lamblia is an important cause of diarrhoeal disease throughout the world. Giardiasis— a mild and self-limiting disease that this protozoan causes— is perceived as a harmful disease. Aim. To explore the general level of... more
Background. Giardia lamblia is an important cause of diarrhoeal disease throughout the world. Giardiasis— a mild and self-limiting disease that this protozoan causes— is perceived as a harmful disease. Aim. To explore the general level of awareness about giardiasis, clinical features, mode of transmission, prevention, and consequences and describe the sources and channels of information caregivers would prefer using to be informed about this disease. Methods. A cross-sectional survey was conducted among caregivers attending to the outpatient paediatric hospital setting in Havana. Results. A total of 202 caregivers were interviewed. Nearly 73% considered giardiasis as a modern problem, and 39% considered that it could be a fatal disease. Although 76.7% were aware that small intestine is the organ affected, other localizations were cited. Abdominal pain and diarrhoea were recognized as the commonest symptoms. Around one-third could identify that giardiasis may spread through drinking ...
Research Interests: Cuba, Prospective studies, Humans, Child, Female, and 6 moreMale, Infant, Caregivers, Giardiasis, Newborn Infant, and Child preschool
To compare the efficacy and safety of mebendazole and secnidazole in the treatment of giardiasis in adult patients, a single-centre, parallel group, open-label, randomized non-inferiority trial was carried out. One-hundred and 26... more
To compare the efficacy and safety of mebendazole and secnidazole in the treatment of giardiasis in adult patients, a single-centre, parallel group, open-label, randomized non-inferiority trial was carried out. One-hundred and 26 participants who had symptomaticGiardiamono-infection took part in the study. Direct wet mount and/or Ritchie concentration techniques and physical examinations were conducted at the time of enrolment and at the follow-up visit. The primary outcome measure was parasitological cure, performed at 3, 5, 10 days post-treatment. Negative faecal specimens forGiardiawere ensured by the same parasitological techniques. At follow up (day 10) the parasitological cure rate for theper protocolpopulations was 88.7% (55/62) for MBZ and 91.8% (56/61) for SNZ. For the intention to treat populations the cure rate at the end of treatment was 85.9% (55/64) for MBZ and 90.3% (56/62) for SNZ. Both analyzes showed there was not significant statistical difference between MBZ and ...