Refractory giardiasis in a child with steroid-resistant nephrotic syndrome
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Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia intestinalis and one of the most common parasitic intestinal diseases in humans worldwide. It mainly manifests as a self-limited illness in the case of immunocompetent patients and usually does not require treatment. However, immunodeficiency is a risk factor for the onset of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazole therapy is presented. A 7-year-old male patient with steroid-resistant nephrotic syndrome came to our hospital because of chronic diarrhoea. The patient was on long-term immunosuppressive therapy. Microscopic examination of stool showed a significant number of trophozoites and cysts of G. intestinalis . Treatment with metronidazole for longer duration than recommended has failed to clear the parasite in the present case.
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The authors have appropriately addressed the reviewers’ comments. This manuscript can be accepted for publication.
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community. The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments. Please address all comments made by the reviewers.
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Comments to Author
The authors base their study on the premise that immunodeficiency is a risk factor for developing severe Giardia infection. They report a case of recurrent giardiasis refractory to nitroimidazole treatment: a 7-year-old male patient with steroid-resistant nephrotic syndrome and chronic diarrhea, who on stool microscopic examination showed a considerable number of trophozoites and cysts of Giardia intestinalis. In addition, they mention that treatment with metronidazole for a longer period than recommended has failed to eliminate the parasite for the reported case. The report is descriptive, showing a poor opportunity for meaningful discussion. However, although there are already reports of refractory giardiasis, the experience gained in this case study is valuable for timely intervention in pediatric …
Comments to Author
The authors base their study on the premise that immunodeficiency is a risk factor for developing severe Giardia infection. They report a case of recurrent giardiasis refractory to nitroimidazole treatment: a 7-year-old male patient with steroid-resistant nephrotic syndrome and chronic diarrhea, who on stool microscopic examination showed a considerable number of trophozoites and cysts of Giardia intestinalis. In addition, they mention that treatment with metronidazole for a longer period than recommended has failed to eliminate the parasite for the reported case. The report is descriptive, showing a poor opportunity for meaningful discussion. However, although there are already reports of refractory giardiasis, the experience gained in this case study is valuable for timely intervention in pediatric patients with concurrent immunosuppression, particularly in countries where this intestinal infection is prevalent. As a recommendation to the authors, if possible, they are invited to suggest a pharmacological protocol for patients with refractory giardiasis, to be accompanied by monitoring of adverse reactions and verifying pathogen clearance by lab tests.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
1. Description of the case(s) The author described a child case of refractory giardiasis with immunodeficiency treated by metronidazole. Case reports of recurrent giardiasis refractory to nitroimidazole therapy are scarce but well-known. This case indicates the effectiveness of combination therapy of metronidazole and nitazoxanide. I suggest that the author add detailed information about the patient's background and treatment. 2. Presentation of results ・In the case of the presentation, the author described that the patient was under immunosuppressive treatment, and in the discussion, the patient had taken steroids and tacrolimus. The author should add the detail of the immunosuppressive therapy in the case of presentation. ・The author should add the total treatment duration of metronidazole. This …
Comments to Author
1. Description of the case(s) The author described a child case of refractory giardiasis with immunodeficiency treated by metronidazole. Case reports of recurrent giardiasis refractory to nitroimidazole therapy are scarce but well-known. This case indicates the effectiveness of combination therapy of metronidazole and nitazoxanide. I suggest that the author add detailed information about the patient's background and treatment. 2. Presentation of results ・In the case of the presentation, the author described that the patient was under immunosuppressive treatment, and in the discussion, the patient had taken steroids and tacrolimus. The author should add the detail of the immunosuppressive therapy in the case of presentation. ・The author should add the total treatment duration of metronidazole. This information seems to help compare other similar cases. 3. How the style and organization of the paper communicates and represents key findings appropriate 4. Literature analysis or discussion The author described thorough information about characteristics of giardiasis and treatment of refractory giardiasis. The sentences were clear and logically consistent. 5. Any other relevant comments none
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes