The old and new therapeutic approaches to the treatment of giardiasis: Where are we?

Giardia lamblia is the causative agent of giardiasis, one of the most common parasitic infections of the human intestinal tract. This disease most frequently affects children causing abdominal pain, nausea, vomiting, acute or chronic diarrhea, and malabsorption syndrome. In undernourished children, giardiasis is a determining factor in retarded physical and mental development. Antigiardial chemotherapy focuses on the trophozoite stage. Metronidazole and other nitroimidazoles have been used for decades as the therapy of choice against giardiasis. In recent years many other drugs have been proposed for the treatment of giardiasis. Therefore, several synthetic and natural substances have been tested in search of new giardicidal compounds. This study is a review of drugs used in in vitro and in vivo tests, and also drugs tested in clinical trials (nonrandomized and randomized)

PREVALENCE OF INTESTINAL PARASITISM AND ASSOCIATED SYMPTOMATOLOGY AMONG HEMODIALYSIS PATIENTS

;Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF), we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively). Blastocystis was the most common infection in the control group (41.9%), however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38). The most common symptoms in this group were flatulence (36.4%), asthenia (30.0%) and weight loss (30.0%). In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703). A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p < 0.05). Comparing symptomatic with asymptomatic, there was no association in either group between symptoms or the prevalence of parasitic infection, nor with the type of parasite or with multiple parasitic infections. Patients with chronic renal failure are frequent targets for renal transplantation, which as well as the inherent immunological impairment of the disease itself, results in immunosuppression by medication. For this reason, carriers of intestinal parasites with pathogenic potential can develop serious clinical complications influencing the success of transplantation. This fact, coupled with the high prevalence of intestinal parasites and the dissociation between symptoms and infection in CRF patients, suggests that the stool test should be incorporated in routine propedeutics. Furthermore, preventive measures for the acquisition of parasites through the fecal-oral contamination route should be introduced.Doenças parasitárias infectam grande número de indivíduos em todo o mundo. Manifestações clínicas mais severas podem se apresentar em pacientes imunocomprometidos. Considerando o importante comprometimento imunológico observado em pacientes com insuficiência renal crônica (IRC), foi determinada a prevalência e sintomas associados a parasitoses intestinais nesses pacientes em comparação a controles saudáveis. Foram coletadas amostras fecais de cada participante e processadas para identificação microscópica dos parasitas pelo método de concentração por formol-éter. Foi utilizada a técnica de ELISA para identificar coproantígenos de Cryptosporidium. Foram analisadas 110 amostras fecais de pacientes em hemodiálise e 86 de um grupo controle comunitário. Cryptosporidium e Blastocystis foram as infecções mais freqüentes nos pacientes em hemodiálise (26,4% e 24,5%, respectivamente). Blastocystis foi a infecção mais freqüente no grupo controle (41,9%), entretanto nenhum indivíduo positivo para Cryptosporidium foi identificado. Considerando os pacientes com IRC, 73,6% eram sintomáticos, sendo 54,3% positivos para algum parasita, contra 44,8% nos assintomáticos (p = 0,38). Os sintomas mais frequentes neste grupo foram flatulência (36,4%), adinamia (30,0%) e perda de peso (30,0%). No grupo controle, 91,9% eram sintomáticos, sendo 60,8% positivos para algum parasita, contra 71,4% nos assintomáticos (p = 0,703). Em relação aos sintomas, houve diferença significativa entre os dois grupos, sendo que flatulência, plenitude pós-prandial, e dor abdominal foram mais freqüentes no grupo controle que nos pacientes em hemodiálise (todos p < 0,05). Comparando-se sintomáticos com assintomáticos, não houve associação entre a sintomatologia e a prevalência de parasitose, nem com o tipo de parasita, e nem com o poliparasitismo, nos dois grupos. Considerando que pacientes com IRC são frequentes alvos de transplante renal, resultando em imunossupressão por medicamentos, que é somada à deficiência imunológica inerente à própria doença. Os portadores de parasitas intestinais com potencial patogênico podem desenvolver sérias complicações clínicas que influenciam o sucesso do transplante. Este fato, aliado a alta prevalência de parasitas intestinais e dissociação entre os sintomas e infecção nesses pacientes, sugerem a incorporação do exame de fezes na propedêutica de rotina dos mesmos, juntamente com medidas preventivas para a aquisição de parasitas com rota de contaminação fecal-oral

PREVALENCE OF INTESTINAL PARASITISM AND ASSOCIATED SYMPTOMATOLOGY AMONG HEMODIALYSIS PATIENTS

Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF), we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively). Blastocystis was the most common infection in the control group (41.9%), however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38). The most common symptoms in this group were flatulence (36.4%), asthenia (30.0%) and weight loss (30.0%). In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703). A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p < 0.05). Comparing symptomatic with asymptomatic, there was no association in either group between symptoms or the prevalence of parasitic infection, nor with the type of parasite or with multiple parasitic infections. Patients with chronic renal failure are frequent targets for renal transplantation, which as well as the inherent immunological impairment of the disease itself, results in immunosuppression by medication. For this reason, carriers of intestinal parasites with pathogenic potential can develop serious clinical complications influencing the success of transplantation. This fact, coupled with the high prevalence of intestinal parasites and the dissociation between symptoms and infection in CRF patients, suggests that the stool test should be incorporated in routine propedeutics. Furthermore, preventive measures for the acquisition of parasites through the fecal-oral contamination route should be introduced

Investigação in vitro do potencial giardicida de quatro análogos do metronidazol.

Exportado OPUSMade available in DSpace on 2019-08-12T12:48:27Z (GMT). No. of bitstreams: 1 disserta__o_mestrado.pdf: 1803088 bytes, checksum: 51523a4ac217439a4b4f14e24df6a377 (MD5) Previous issue date: 21RESUMOA Giardia lamblia é um protozoário intestinal humano de ampla distribuição mundial. A giardíase é responsável por diarréia, síndrome de má absorção e perda de peso, depauperando física e mentalmente crianças de países subdesenvolvidos. É ainda, principal causa de diarréia em países desenvolvidos. Em 1962, o metronidazol passou a ser utilizado no tratamento da giardíase, por apresentar excelente eficácia e baixa toxicidade. Contudo, tem sido observado que isolados de G. lamblia, provenientes de pacientes de diferentes regiões do mundo, apresentam diferenças na sensibilidade ao metronidazol in vitro. Há ainda, relatos de pacientes refratários ao tratamento. Desta forma, a pesquisa de análogos do metronidazol mais efetivos contra o parasita torna-se uma opção importante para o controle desta parasitose. O presente trabalho tem por objetivo investigar o potencial giardicida de quatro análogos nitroimidazóis, X-etil-2-metil-5-nitroimidazol (X = OMs, MTZMs, X = Br, MTZBr , X = N3, MTZN3 , X = I, MTZI), sintetizados a partir do metronidazol. A eficácia dos compostos foi avaliada in vitro, utilizando a amostra Portland de G. lamblia, através da DE50 (dose efetiva que inibe em 50% o crescimento dos trofozoítos) e da CIM (concentração inibitória mínima necessária para inibir ao máximo o crescimento dos trofozoítos). O metronidazol foi utilizado como controle de eficácia.A eficácia do metronidazol, foi avaliada inicialmente por dois métodos quantitativos: contagem dos trofozoítos em câmara de Neubauer e por colorimetria.Considerando a sensibilidade e precisão do método, a técnica colorimétrica apresentou resultados mais precisos quando comparado com a contagem de trofozoítos em câmara de Neubauer.Trofozoítos de G. lamblia, em fase logarítmica de crescimento, foram distribuídos em placas de cultura de células de 24 poços para associação com os derivados nitroimidazóis, em condições anaeróbicas a 37oC. O metronidazol e seus derivados foram associados aos trofozoítos em concentrações crescentes buscando determinar a DE50 e CIM.O metronidazol apresentou DE50 = 1,96 0,13 uM e CIM = 34,10 1,95 uM. Todos os análogos testados apresentaram elevado potencial giardicida quando comparados ao metronidazol

Avaliação dos efeitos de análogos do metronidazol sobre o protozoário giardia lamblia

Exportado OPUSMade available in DSpace on 2019-08-14T09:25:37Z (GMT). No. of bitstreams: 1 resumo_haendel.pdf: 72228 bytes, checksum: 82be9810958c0aa51e56c6806ecc1580 (MD5) Previous issue date: 3Uma variedade de agentes quimioterápicos pode ser utilizada para o tratamento da giardíase. Porém, a maioria desses agentes apresenta efeitos adversos consideráveis e são muitas vezes contra-indicados. Além disto, a Giardia parece ter uma grande habilidade para desenvolver resistência a estes agentes, o que torna a investigação de novos fármacos uma área atrativa e promissora. Neste trabalho, avaliamos a atividade giardicida de algumas substâncias obtidas a partir da modificação da cadeia alifática do metronidazol (MTZ), que constitui hoje a droga mais usada no tratamento da giardíase. Escolhemos estas substâncias não só pelo valor promissário, no que tange a atividade giardicida, concedido pelo MTZ, mas também pela facilidade de modificação da cadeia lateral do MTZ para obtenção destes análogos. O efeito do MTZ e seis de seus análogos (MTZ-MS, MTZ-I, MTZ-Br, MTZ-N3, MTZ-NH2.HCl e MTZ-Tr) sobre o crescimento dos trofozoítos de G. lamblia, cepa Portland-1, foi determinado in vitro. Os análogos MTZ-MS, MTZ-I, MTZ-Br e MTZ-N3, apresentaram atividade inibitória maior, ou seja, IC50 menor que o MTZ. Entre eles o MTZ-Br e MTZ-I foram os mais ativos. Os análogos MTZ-Tr e MTZ-NH2.HCl foram os que apresentaram menor atividade anti-giardia. Visando investigar o potencial citotóxico dos análogos sintetizados, avaliamos o efeito dos mesmos sobre a proliferação de células mononucleares do sangue periférico humano (CMSP) comparado ao MTZ. Os análogos nitroimidazóis não apresentaram efeito citotóxico sobre CMSP. O efeito dos análogos MTZ-I e MTZ-Br em infecções experimentais de gerbils foi obtido determinando a DE50 (dose necessária para matar 50% dos trofozoítos de G. lamblia) comparada a do MTZ. Os animais infectados experimentalmente por trofozoítos de G. lamblia foram tratados com concentrações que variaram de 0.1 a 6.0 µmol/kg do MTZ e dos análogos. MTZ-I e MTZ-Br apresentaram atividade giardicida superior a do MTZ. Os efeitos dos análogos sobre a morfologia e ultra-estrutura dos trofozoítos foram avaliados por Microscopia Eletrônica de Transmissão. Vacuolização, dilatação de vesículas periféricas, internalização de flagelos e de disco adesivo, formação de figuras de mielina e extração citoplasmática foram as principais alterações observadas em trofozoítos incubados com os análogos do MTZ. Alterações similares foram observadas em trofozoítos tratados com MTZ, sinalizando a eficácia dos análogos. Estes resultados somados à excelente atividade giardicida do MTZ-I, MTZ-Br, MTZ-Ms e MTZ-N3, comprovam que esses análogos nitroimidazóis são importantes opções terapêuticas

Antigiardial activity of the hexane extract of Maytenus gonoclada mart.

Plants of the Maytenus genus have been used in folk medicine in Brazil for treatment of gastrointestinal motility disturbances such as diarrhea. The present study was performed to evaluate antigiardial activity of the hexane extract and triterpenes isolated from the branches of Maytenus gonoclada Mart. (Celastraceae). The hexane extract and triterpenes were examined for antigiardial activity using the colorimetric method against Giardia lamblia (ATCC 30888). The hexane extract exhibited antigiardial activity. This result may partly explain and support the use of plants of the Maytenus genus for the treatment of diarrhea in folk medicine in Brazil

Effects of metronidazole analogues on Giardia lamblia: experimental infection and cell organization

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-08-25T17:29:28Z No. of bitstreams: 1 Busatti HGNO Effects of metronidazole....pdf: 715403 bytes, checksum: 9650be5fc2f4e165b07301eb04885ced (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-08-25T17:49:57Z (GMT) No. of bitstreams: 1 Busatti HGNO Effects of metronidazole....pdf: 715403 bytes, checksum: 9650be5fc2f4e165b07301eb04885ced (MD5)Made available in DSpace on 2017-08-25T17:49:57Z (GMT). No. of bitstreams: 1 Busatti HGNO Effects of metronidazole....pdf: 715403 bytes, checksum: 9650be5fc2f4e165b07301eb04885ced (MD5) Previous issue date: 2013Fundação de Amparo à Pesquisa do Estado de Minas–FAPEMIG (grant number APQ 01766–10), FAPESB, PP-SUS, CNPq, and FIOCRUZUniversidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departament de Parasitologia. Belo Horizonte, MG, Brazil / Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento Produtos Farmacêuticos. Belo Horizonte, MG, Brazil / Universidade de Itaúna. Faculdade de Farmácia.Departamento de Parasitologia. Itaúna, MG, Brazil.Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento Produtos Farmacêuticos. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departament de Parasitologia. Belo Horizonte, MG, Brazil.Universidade Federal de Uberlândia. Instituto de Ciências Biomédicas. Laboratório de Parasitologia. Uberlânida, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departament de Parasitologia. Belo Horizonte, MG, Brazil.The chemotherapeutic agents used for the treatment of giardiasis are often associated with adverse side effects and are refractory cases, due to the development of resistant parasites. Therefore the search for new drugs is required. We have previously reported the giardicidal effects of metronidazole (MTZ) and its analogues (MTZ-Ms, MTZ-Br, MTZ-N(3), and MTZ-I) on the trophozoites of Giardia lamblia. Now we evaluated the activity of some giardicidal MTZ analogues in experimental infections in gerbils and its effects on the morphology and ultrastructural organization of Giardia. The giardicidal activity in experimental infections showed ED(50) values significantly lower for MTZ-I and MTZ-Br when compared to MTZ. Transmission electron microscopy was employed to approach the mechanism(s) of action of MTZ analogues upon the protozoan. MTZ analogues were more active than MTZ in changing significantly the morphology and ultrastructure of the parasite. The analogues affected parasite cell vesicle trafficking, autophagy, and triggered differentiation into cysts. These results coupled with the excellent giardicidal activity and lower toxicity demonstrate that these nitroimidazole derivates may be important therapeutic alternatives for combating giardiasis. In addition, our results suggest a therapeutic advantage in obtaining synthetic metronidazole analogues for screening of activities against other infectious agents

Immunocytochemistry Improving the Diagnosis of Trichomonas vaginalis Infections

The aim of this study was to evaluate the immunocytochemistry (ICC) to diagnose trichomoniasis, particularly asymptomatic infections. By culture serial dilutions, ICC was able to detect 1 trophozoite/mL, while the culture was positive up to 100 trophozoites/mL. The ICC in vivo detection capability was assessed in vaginal secretions of mice experimentally infected and in vaginal swabs from asymptomatic HIV-positive pregnant women compared with culture. All vaginal secretion samples from mice were positive according to both methods. Swabs from fifty-five asymptomatic women were positive in four (7.27%) of them by culture. Beyond these four, another ten (25.45%) women were positive by immunocytochemistry, proving their higher sensitivity (p=0.002), noticing 3.5 times more positives. ICC had better performance in both successive dilutions as in asymptomatic women, showing higher sensitivity and specificity. In this way, its facility of execution and cost-effectiveness support its practicality, as a routine procedure to diagnose trichomoniasis not only when the parasite load is lower but probably in all clinical scenarios