Parasitosis debidas a protozoarios intestinales: una actualización sobre su abordaje y tratamiento farmacológico en Costa Rica

Autores

Alberto Solano-Barquero, Dennis León-Alán

RESUMEN

En Costa Rica, las parasitosis intestinales son consideradas por muchos profesionales de la salud una causa de preocupación menor, aun cuando se carece de evidencia epidemiológica actualizada sobre estas. Es común, en nuestro país, encontrar cargas parasitarias mucho mayores a las supuestas para el promedio nacional, en comunidades que reúnen algunos factores de riesgo para parasitosis intestinales. Los efectos a corto y largo plazo de las parasitosis sobre el desarrollo físico y cognitivo en los niños están bien documentados, de ahí la importancia de dar un abordaje y tratamiento correctos y oportunos a las personas que las padecen, pero sobre todo, mejorar las condiciones que permitan prevenir la transmisión de estas infecciones. El objetivo de esta revisión es brindar información actualizada sobre el tratamiento de las parasitosis intestinales debidas a protozoarios más comunes en Costa Rica.

Palabras clave

Parásitos intestinales, diagnóstico, técnicas diagnósticas, amebiasis, giardiasis, diagnóstico, abordaje, terapéutico, tratamiento, fármacos, farmacoterapia, antiparasitarios, Giardia, Entamoeba histolytica, Blastocystis hominis.

ABSTRACT

It is widely accepted in Costa Rica that intestinal parasites are a minor source of concern, even though a sufficient state of knowledge about their epidemiology is lacking. It is frequent to find heavier parasitic loads in children than those expected in comparison with the national average in some communities with several risk factors for intestinal parasites. Short and long term effects of parasitic infections on children’s growth and cognitive development are well documented. For that reason, a correct and timely approach and treatment must be offered to people infected with these parasites. Moreover, it is very important to develop the adequate conditions in order to prevent the transmission of these infections. In this paper, some actualized information on the correct approach and management of the most common intestinal protozoal parasites in Costa Rica is given, including the pharmacotherapy.

Keywords

Intestinal parasites, diagnostic, techniques ,amoebiasis, giardiasis, management, therapeutics, treatment, drugs, pharmacotherapy, antiprotozoal medication, Giardia, Entamoeba histolytica, Blastocystis hominis.
1. Ministerio de Salud de Costa Rica, INCIENSA. CCSS, INEC, ICD. (2012). Encuesta Nacional de Nutrición 2008-2009. Fascículo 5: Parásitos Intestinales“. San José, Ministerio de Salud. 2. Abrahams-Sandí E, Solano M y Rodríguez B (2005). Prevalencia de parásitos intestinales en escolares de Limón Centro. Costa Rica. Revista Costarricense De Ciencias Médicas.26, 33-38. 3. Cerdas C, Araya E, y Coto S. (2003). Parásitos intestinales en la escuela 15 de agosto, Tirrases de Curridabat, Costa Rica, mayo-junio de 2002. Revista Costarricense De Ciencias Médicas.24, 127-133. 4. Lazarte CE, Soto A, Alvarez L, Bergenståhl B, Medrano N y Granfeldt Y. (2015). Nutritional status of children with intestinal parasites from a tropical area of Bolivia, emphasis on zinc and iron status. Food and Nutrition Sciences.6, 399-411. 5. Guerrant RL, Oriá RB, Moore SR, Oriá MO y Lima AA. (2008). Malnutrition as an enteric infectious disease with long-term effects on child development. Nutrition reviews.66, 487-505. 6. Kvalsvig J. (2003). Parasites, nutrition, child development and public policy. World Health Organization. 7. McHardy IH, Wu M, Shimizu-Cohen R, Couturier MR y Humphries RM. (2014). Detection of intestinal protozoa in the clinical laboratory. Journal of clinical microbiology. 52, 712-720. 8. Morgan, FU, PallantL, Dwyer BW, Forbes DA, Rich G y Thompson RCA. (1998). Comparison of PCR and microscopy for detection of Cryptosporidium parvum in human fecal specimens: clinical trial. Journal of Clinical Microbiology.36, 995-998. 9. Spadafora LJ, Kearney MR, Siddique A, Ali IK, Gilchrist CA, Arju T, Hoffstrom B, Nguyen FK, Petri WA, Haque R y Cangelosi GA. (2016). Species-specific immunodetection of an Entamoeba histolytica cyst wall protein. PLoS neglected tropical diseases.10, e0004697. 10. Castro-Castillo A y Guerrero-Bermúdez OM. (2004). Técnicas de diagnóstico parasitológico. Editorial de la Universidad de Costa Rica, Costa Rica. 11. Hiatt RA, Markell EK y Ng E. (1995). How many stool examinations are necessary to detect pathogenic intestinal protozoa? The American journal of tropical medicine and hygiene53, 36-39. 12. Brunton L y Chabner B. (2011). Goodman & Gilman’s The pharmacological basis of therapeutics. New York: McGraw-Hill Medical. 13. Robertson DB, Maibach, HI, Katzung, B y Trevor A. (2015). Basic and Clinical Pharmacology. Nueva York: Mc Graw-Hill. 14. Mehta PN. (2013). Drugs for intestinal helminths. Pediatric Infectious Disease. 5, 22-25. 15. Kappagoda S, Singh U y Blackburn BG. (2011). Antiparasitic therapy. Mayo Clinic Proceedings.86, 561-583. 16. Nowak P, Mastalska K y Loster J. (2015). Entamoeba histolytica:Pathogenic Protozoan of the Large intestine in Humans. J Clin Microbiol Biochem Technol.1, 10-17. 17. Nair GV y Variyam EP. (2014). Non invasive intestinal amebiasis: Entamoeba histolytica colonization without invasion. Current opinion in infectious diseases.27, 465-469. 18. Lamp KC, Freeman CD, Klutman NE y Lacy MK. (1999). Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clinical pharmacokinetics.36, 353-373. 19. Blessmann J, Ali IKM, Nu PAT, Dinh BT, Viet TQN, Le Van A, Graham-Clark G y Tannich E. (2003). Longitudinal study of intestinal Entamoeba histolytica infections in asymptomatic adult carriers. Journal of clinical microbiology.41, 4745-4750. 20. Blessmann J y Tannich E. (2002). Treatment of asymptomatic intestinal Entamoeba histolytica infection. New England Journal of Medicine.347, 1384-1384. 21. Gathiram V yJackson TFH. (1987). A longitudinal study of asymptomatic carriers of pathogenic zymodemes of Entamoeba histolytica. S. Afr. Med. J. 72, 669-672. 22. Speich B, Marti H, Ame SM, Ali SM, Bogoch II, Utzinger J, Albonico M y Keiser J. (2013). Prevalence of intestinal protozoa infection among school-aged children on Pemba Island, Tanzania, and effect of single-dose albendazole, nitazoxanide and albendazole-nitazoxanide. Parasites & vectors.6, 3. 23. Rossignol JF, Ayoub A y Ayers MS. (2001). Treatment of diarrhea caused by Giardia intestinalis and Entamoeba histolytica or E. Dispar: A randomized, double‐blind, placebo‐controlled study of nitazoxanide. Journal of Infectious Diseases.184, 381-384. 24. Kikuchi T, Koga M, Shimizu S, Miura T, Maruyama H y Kimura M. (2013). Efficacy and safety of paromomycin for treating amebiasis in Japan. Parasitology international.62, 497-501. 25. Ali AA, Abdelrahim, ME, Elmoslamy NA, Said AS y Meabed MH. (2014). Comparison between Nitazoxanide and Metronidazole in the Treatment of Protozoal Diarrhea in Children. Medicine Science.3, 1162-1173. 26. Padilla-Raygoza N, Díaz R y Muñoz M. (2000). Efficacy and safety of quinfamide versus secnidazole in the management of amoebic non-dysenteric colitis in children. Clinical drug investigation.20, 89-93. 27. Padilla-Raygoza N, Alarcón-Ginori A, Figueroa-Ferrari RC y Muñoz-Rodríguez M. (1998). Comparación del efecto de la quinfamida y de la nitazoxanida en el tratamiento de la amibiasis intestinal no disentérica, en niños. Revista Mexicana de Pediatría. 65, 196-199. 28. Davila-Gutierrez CE, Vasquez C, Trujillo-Hernandez B y Huerta M. (2002). Nitazoxanide compared with quinfamide and mebendazole in the treatment of helminthic infections and intestinal protozoa in children. The American journal of tropical medicine and hygiene.66, 251-254. 29. Romero-Cabello R, Robert-Guerrero L, Martínez-Barbabosa I, Vázquez-Tsuji O, Ruiz Sánchez D, Tay-Zavala J y Calderón-Romero L. (2005). Evaluation of the efficacy andsecurity of quinfamide administered in a single dose of 300 mg in adult patients with intestinal amebiasis. Par. Lat.60, 57-60. 30.Schmidt GDyRoberts LS.(2013). Foundations of parasitology.Nueva York: McGrow-Hill. 31.Efstratiou A, Ongerth JE Y Karanis P. (2017). Waterborne transmission of protozoan parasites: Review of worldwide outbreaks-An update 2011–2016. Water Research.114, 14-22. 32. Nash TE, Herrington DA, Losonsky GA Y Levine MM. (1987). Experimental human infections with Giardia lamblia. Journal of Infectious Diseases.156, 974-984. 33. Rendtorff RC. (1954). The experimental transmission of human intestinal protozoan parasites. II. Giardia lamblia cysts given in capsules. American Journal of Hygiene.59, 209-20. 34. Erlandsen SL y Meyer EA.(Eds.). (2013). Giardia and giardiasis: biology, pathogenesis, and epidemiology. Springer Science & Business Media. 35. Pasupuleti V, Escobedo AA, Deshpande A, Thota P, Roman Y y Hernandez AV. (2014). Efficacy of 5-nitroimidazoles for the treatment of giardiasis: a systematic review of randomized controlled trials. PLoS Negl Trop Dis. 8, e2733. 36. Mejia R. (2016). Current Treatment Options for Giardiasis and Cryptosporidiosis. Current Tropical Medicine Reports.3, 115-118. 37. Granados CE, Reveiz L, Uribe LG, Criollo CP.(2012).Drugs for treating giardiasis. Cochrane Database of Systematic Reviews.doi: 10.1002/14651858.CD007787.pub2. 38. Ansell BR, McConville MJ, Ma’ayeh SY, Dagley MJ, Gasser RB, Svärd SG y Jex AR. (2015). Drug resistance in Giardia duodenalis. Biotechnology advances.33, 888-901. 39. Upcroft JA y Upcroft P (1993) Drug resistance and Giardia. Parasitol Today.9, 187–190. 40.Meltzer E, Lachish T y Schwartz E. (2014). Treatment of giardiasis after nonresponse to nitroimidazole. Emerging infectious diseases.20, 1742. 41. Solaymani-Mohammadi S, Genkinger JM, Loffredo CA y Singer SM. (2010). A meta-analysis of the effectiveness of albendazole compared with metronidazole as treatments for infections with Giardia duodenalis. PLoS neglected tropical diseases. 4, e682. 42. Ortiz JJ, Ayoub A, Gargala G, Chegne NL y Favennec L. (2001). Randomized clinical study of nitazoxanide compared to metronidazole in the treatment of symptomatic giardiasis in children from Northern Peru. Alimentary pharmacology & therapeutics.15, 1409-1415. 43. Escobedo AA, Alvarez G, González ME, Almirall P, Cañete R, Cimerman S y Pérez R. (2008). The treatment of giardiasis in children: single-dose tinidazole compared with 3 days of nitazoxanide. Annals of Tropical Medicine & Parasitology.102, 199-207. 44. Coyle CM, Varughese J, Weiss LM y Tanowitz HB. (2011). Blastocystis: to treat or not to treat. Clinical infectious diseases.doi.org/10.1093/cid/cir810 45. Mohamed AA, Zaghlool DA, EL-Malky MA, El-Bali MA, Abdel-Fatah MA, Mowafy NM, Zaghlool DA, Bakri RA y Al-Harthi, S. A. (2017). Subtyping of Blastocystis sp. isolated from symptomatic and asymptomatic individuals in Makkah, Saudi Arabia. Parasites & vectors.10, 174. 46. Nigro L, Larocca L, Massarelli L, Patamia I, Minniti S, Palermo F y Cacopardo B. (2003). A placebo-controlled treatment trial of Blastocystis hominis infection with metronidazole. Journal of travel medicine.10, 128-130. 47.Moghaddam DD, Ghadirian E y Azami M. (2005). Blastocystis hominis and the evaluation of efficacy of metronidazole and trimethoprim/sulfamethoxazole. Parasitology research.96, 273-275. 48. Ok UZ, Girginkardeşler N, Balcioğlu C, Ertan P, Pirildar T,Kilimcioğlu AA. (1999). Effect of trimethoprim‑sulfamethaxazolein Blastocystis hominis infection. Am J Gastroenterol. 94, 3245‑7. 49. Sekar, U y Shanthi, M. (2013). Blastocystis hominis: treatment and controversies. Tropical Parasitology. 3: 35-39. 50. Van Hellemond JJ, Molhoek, N, Koelewijn R, Wismans PJ yVan Genderen, P. J. (2013). Is paromomycin the drug of choice for eradication of Blastocystis in adults?Journ. Inf. Chem.19, 545-548. 51. Rossignol JF, Kabil SM, Said M, Samir H y Younis AM. (2005). Effect of nitazoxanide in persistent diarrhea and enteritis associated with Blastocystis hominis. Clinical Gastroenterology and Hepatology.3, 987-991. 52. Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA y Vandenplas Y. (2011). Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitology research.108, 541-545. 53. Poulsen CS y Stensvold CR. (2016). Systematic review on Endolimax nana: A less well studied intestinal ameba. Tropical parasitology.6, 8-29. 54. Graczyk TK, Shiff CK, Tamang L, Munsaka F, Beitin AM y Moss WJ. (2005). The association of Blastocystis hominis and Endolimax nana with diarrheal stools in Zambian school-age children. Parasitology Research.1, 38-43. 55. Shirley DAT, Moonah SN y Kotloff KL.(2012). Burden of disease from cryptosporidiosis. Current opinion in infectious diseases.25, 555-563 56. Rossignol JF. (2006). Nitazoxanide in the treatment of acquired immune deficiency syndrome‐related cryptosporidiosis: results of the United States compassionate use program in 365 patients. Alimentary pharmacology & therapeutics.24, 887-894. 57. Florescu DF Y Sandkovsky U. (2016). Cryptosporidium infection in solid organ transplantation. World Journal of Transplantation.6, 460-471 58. Ali S y Kumar S. (2015). Treatment Outcomes with Nitazoxanide in Immunocompetent Adults Naive Patients with Cryptosporidiosis; Do We Need Combination Therapy with Paromomycin or Azithromycin?. Tropical Medicine & Surgery.3, doi:10.4172/2329-9088.1000198 59. Abubakar II, Aliyu SH, Arumugam C, Hunter PR y Usman N. (2007). Prevention and treatment of cryptosporidiosis in immunocompromised patients. The Cochrane Library. DOI: 10.1002/14651858.CD004932.pub2 60. Hulverson MA, Choi R, Arnold SL, Schaefer DA, Hemphill A, McCloskey MC, Betzer DP, Müller J, VidadalaRSR, Whitman GR, Rivas KL, Barret LK, Hackman RC, Love MS, McNamara CW, Shaughnessy TK, Kondratiuk A, Kurnik M, Banfor PN, Lynch JJ, Freiberg GM, Kempf DJ, Maly DJ, Riggs MW, Kayode KO y Van Voorhis WC. (2017). Advances in bumped kinase inhibitors for human and animal therapy for cryptosporidiosis. International journal for parasitology. 47, 753-763.