Improving diagnostic and therapeutic approaches to giardiasis in children

Abstract

Background: Giardiasis remains one of the most common intestinal protozoal infections in children and continues to pose important diagnostic and therapeutic challenges because of intermittent cyst excretion, overlap with other gastrointestinal disorders, and frequent relapse after standard short-course treatment. Aim: To improve the diagnostic algorithm and optimize treatment strategies for giardiasis in pediatric patients. Methods: A prospective clinical study included 105 children aged 5-13 years. Diagnostic verification was performed using clinical assessment, stool microscopy, repeated coproscopy, and enzyme-linked immunosorbent assay (ELISA). In the therapeutic phase, 60 patients with confirmed mono-giardiasis were treated using three different regimens: metronidazole plus nifuroxazide, albendazole monotherapy, and a structured three-stage complex therapy. Results: Giardiasis as mono-infection or combined invasion was identified in 80.0% of examined children. ELISA was positive in 89.0% of cases but yielded 8.9% false-positive results. A single coproscopic examination detected giardiasis in only 55.5% of infected children, whereas repeated stool examination performed 3-5 times over 2 weeks reached 100% detection among children with positive ELISA and verified infection. The best treatment outcome was observed in the three-stage group, with 91.7% eradication after one course and only 2.5% recurrence after 12 weeks. Conclusion: ELISA is useful as a screening method but should be combined with repeated coproscopy for definitive diagnosis. A stepwise therapeutic approach incorporating antispasmodics, ursodeoxycholic acid, lactulose, and albendazole appears to be the most effective strategy for eradication and prevention of recurrence.