{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:56:24Z","timestamp":1791395784179,"version":"4.3.3"},"reference-count":63,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance and Response System (AFHSC-GEIS)","award":["P0050_17_AF"],"award-info":[{"award-number":["P0050_17_AF"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>This study aimed to estimate the prevalence of intestinal parasitic infections in children and assess the drug susceptibility and genotypes\/assemblages of Giardia lamblia in Thailand. This cross-sectional study was conducted among children aged 3\u201312 years in Sangkhlaburi District, Kanchanaburi Province, Thailand, between 25 September 2017 and 12 January 2018. Parasites were identified by stool microscopic examination, cultivation of intestinal parasitic protozoa, and enzyme-linked immunosorbent assay (ELISA). Drug susceptibility and genotype of G. lamblia were performed, respectively, by a resazurin assay and Triosephosphate Isomerase A and B genes using modified primers and probes. Among the 661 participants, 445 had an intestinal parasitic infection, resulting in a prevalence of 67.32% (95% CI: 63.60\u201370.89%). Blastocystis hominis was the most prevalent protozoa infection (49.32%; 95% CI: 45.44\u201353.22%), while Ascaris lumbricoides was the most prevalent helminth infection (0.91%; 95% CI: 0.33\u20131.97%). The prevalence of G. lamblia was 17.40%, with genotype B being the most common. According to our study, intestinal parasitic infections were commonly found in Thai children. G. lamblia was the most common pathogenic protozoa infection identified and exhibited less susceptibility to metronidazole compared to furazolidone and mebendazole.<\/jats:p>","DOI":"10.3390\/tropicalmed8080394","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T09:24:24Z","timestamp":1690881864000},"page":"394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence of Intestinal Parasitic Infections, Genotypes, and Drug Susceptibility of Giardia lamblia among Preschool and School-Aged Children: A Cross-Sectional Study in Thailand"],"prefix":"10.3390","volume":"8","author":[{"given":"Boonchai","family":"Wongstitwilairoong","sequence":"first","affiliation":[{"name":"Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok 10120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thunyarat","family":"Anothaisintawee","sequence":"additional","affiliation":[{"name":"Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok 10120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6527-0480","authenticated-orcid":false,"given":"Nattaya","family":"Ruamsap","sequence":"additional","affiliation":[{"name":"Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok 10120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2993-9794","authenticated-orcid":false,"given":"Paphavee","family":"Lertsethtakarn","sequence":"additional","affiliation":[{"name":"Department of Bacterial and Parasitic Diseases, US Army Medical 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Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siriporn","family":"Sornsakrin","sequence":"additional","affiliation":[{"name":"Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok 10120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0461-3330","authenticated-orcid":false,"given":"Ladaporn","family":"Bodhidatta","sequence":"additional","affiliation":[{"name":"Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok 10120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Boudreaux","sequence":"additional","affiliation":[{"name":"Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok 10120, 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Soil-Transmitted Helminth Infections. Fact Sheet, Updated January 2017. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/soil-transmitted-helminth-infections."},{"key":"ref_3","first-page":"284","article-title":"Intestinal parasitic infections and micronutrient deficiency: A review","volume":"59","author":"Hesham","year":"2004","journal-title":"Med. J. Malays."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/01.inf.0000132228.00778.e4","article-title":"Global health impact of soil-transmitted nematodes","volume":"23","author":"Cappello","year":"2004","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1017\/S0031182000006491","article-title":"Malnutrition and parasitic helminth infections","volume":"121","author":"Stephenson","year":"2000","journal-title":"Parasitology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1079\/PNS19930042","article-title":"The impact of gastrointestinal parasites on protein-energy malnutrition in man","volume":"52","author":"Lunn","year":"1993","journal-title":"Proc. Nutr. Soc."},{"key":"ref_7","unstructured":"OpenDevelopment Thailand (2023, June 26). SDG 6 Clean Water and Sanitation. Available online: https:\/\/thailand.opendevelopmentmekong.net\/topics\/sdg-6-clean-water-and-sanitation\/."},{"key":"ref_8","first-page":"218","article-title":"A cross-sectional study of intestinal parasitic infections among schoolchildren in Nan Province, Northern Thailand","volume":"33","author":"Waikagul","year":"2002","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_9","first-page":"83","article-title":"Intestinal parasitic infections among school children in Thailand","volume":"24","author":"Warunee","year":"2007","journal-title":"Trop. Biomed."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.actatropica.2018.01.001","article-title":"Current prevalence of intestinal parasitic infections and their impact on hematological and nutritional status among Karen hill tribe children in Omkoi District, Chiang Mai Province, Thailand","volume":"180","author":"Yanola","year":"2018","journal-title":"Acta Trop."},{"key":"ref_11","first-page":"167","article-title":"Prevalence and Health Effects of Intestinal Parasitic Infection in School Children in Satun Province, Thailand: A Cross-Sectional Study","volume":"69","author":"Sarasombath","year":"2017","journal-title":"Siriraj Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Punsawad, C., Phasuk, N., Bunratsami, S., Thongtup, K., Viriyavejakul, P., Palipoch, S., Koomhin, P., and Nongnaul, S. (2018). Prevalence of intestinal parasitic infections and associated risk factors for hookworm infections among primary schoolchildren in rural areas of Nakhon Si Thammarat, southern Thailand. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-6023-3"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/QCO.0000000000000668","article-title":"Giardiasis treatment: An update with a focus on refractory disease","volume":"33","author":"Hanevik","year":"2020","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1051\/parasite\/2016013","article-title":"Giardia duodenalis genetic assemblages and hosts","volume":"23","author":"Heyworth","year":"2016","journal-title":"Parasite"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"42","DOI":"10.3329\/jhpn.v28i1.4522","article-title":"Giardia intestinalis in Thailand: Identification of genotypes","volume":"28","author":"Tungtrongchitr","year":"2010","journal-title":"J. Health Popul. Nutr."},{"key":"ref_16","first-page":"21","article-title":"Current infection rate of Giardia lamblia in two provinces of Thailand","volume":"36","author":"Wongjindanon","year":"2005","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/s11908-014-0396-y","article-title":"Treatment of giardiasis: Current status and future directions","volume":"16","author":"Watkins","year":"2014","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1111\/j.1198-743X.2004.00829.x","article-title":"Albendazole as an alternative therapeutic agent for childhood giardiasis in Turkey","volume":"10","author":"Yereli","year":"2004","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1556\/1886.2021.00009","article-title":"Antimicrobial resistance of the enteric protozoon Giardia duodenalis\u2014A narrative review","volume":"11","author":"Loderstadt","year":"2021","journal-title":"Eur. J. Microbiol. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.2147\/IDR.S141468","article-title":"Treatment-refractory giardiasis: Challenges and solutions","volume":"11","author":"Lalle","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.biotechadv.2015.04.009","article-title":"Drug resistance in Giardia duodenalis","volume":"33","author":"Ansell","year":"2015","journal-title":"Biotechnol. Adv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.cmi.2015.04.019","article-title":"Increased incidence of nitroimidazole-refractory giardiasis at the Hospital for Tropical Diseases, London: 2008\u20132013","volume":"21","author":"Nabarro","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102090","DOI":"10.1016\/j.tmaid.2021.102090","article-title":"Risk factors for and management of metronidazole-refractory giardiasis in international travellers: A retrospective analysis","volume":"43","author":"Peters","year":"2021","journal-title":"Travel. Med. Infect. Dis."},{"key":"ref_24","unstructured":"World Health Organization (2022, July 20). Child Growth Standards. Available online: https:\/\/www.who.int\/tools\/child-growth-standards."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13099-020-00356-7","article-title":"Enteric etiological surveillance in acute diarrhea stool of United States Military Personnel on deployment in Thailand, 2013\u20132017","volume":"12","author":"Lurchachaiwong","year":"2020","journal-title":"Gut Pathog."},{"key":"ref_26","unstructured":"Center for Disease Control and Prevention (2023, June 29). DPDx\u2014Laboratory Identification of Parasites of Public Health Concern, Available online: https:\/\/www.cdc.gov\/dpdx\/diagnosticprocedures\/stool\/microexam.html."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"528","DOI":"10.58837\/CHULA.CMJ.54.6.1","article-title":"Boeck and Drbohlav Locke egg serum medium fordetection of Blastocystis hominisBlastocystis homin","volume":"54","author":"Saksirisampant","year":"2010","journal-title":"Chulalongkorn Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lujan, H.D., and Sv\u00e4rd, S. (2011). Giardia: A Model Organism, Springer. [1st ed.].","DOI":"10.1007\/978-3-7091-0198-8"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hahn, J., Seeber, F., Kolodziej, H., Ignatius, R., Laue, M., Aebischer, T., and Klotz, C. (2013). High Sensitivity of Giardia duodenalis to Tetrahydrolipstatin (Orlistat) In Vitro. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0071597"},{"key":"ref_30","first-page":"756","article-title":"Activity of Plant Essential Oils against Giardia duodenalis","volume":"48","author":"Popruk","year":"2017","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1128\/JCM.02658-12","article-title":"A laboratory-developed TaqMan Array Card for simultaneous detection of 19 enteropathogens","volume":"51","author":"Liu","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1128\/JCM.05416-11","article-title":"Simultaneous detection of six diarrhea-causing bacterial pathogens with an in-house PCR-luminex assay","volume":"50","author":"Liu","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Llewellyn, S., Inpankaew, T., Nery, S.V., Gray, D.J., Verweij, J.J., Clements, A.C.A., Gomes, S.J., Traub, R., and McCarthy, J.S. (2016). Application of a Multiplex Quantitative PCR to Assess Prevalence and Intensity Of Intestinal Parasite Infections in a Controlled Clinical Trial. PLoS Neglected Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004380"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1128\/AEM.02305-09","article-title":"Genotyping of Giardia duodenalis cysts by new real-time PCR assays for detection of mixed infections in human samples","volume":"76","author":"Almeida","year":"2010","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"763","DOI":"10.4269\/ajtmh.17-0240","article-title":"A Cross-Sectional Study on Intestinal Parasitic Infections in Children in Suburban Public Primary Schools, Saraburi, the Central Region of Thailand","volume":"98","author":"Assavapongpaiboon","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1016\/j.actatropica.2011.02.010","article-title":"Soil-transmitted helminth and other intestinal parasitic infections among school children in indigenous people communities in Davao del Norte, Philippines","volume":"120","author":"Belizario","year":"2011","journal-title":"Acta Trop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1086\/655813","article-title":"Genetic and Household Determinants of Predisposition to Human Hookworm Infection in a Brazilian Community","volume":"202","author":"Quinnell","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Pullan, R.L., Kabatereine, N.B., Quinnell, R.J., and Brooker, S. (2010). Spatial and Genetic Epidemiology of Hookworm in a Rural Community in Uganda. PLoS Neglected Trop. Dis., 4.","DOI":"10.1371\/journal.pntd.0000713"},{"key":"ref_39","unstructured":"World Health Organization (2022, December 29). Malnutrition. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/malnutrition."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Cossa-Moiane, I., Roucher, C., Mac Quene, T., Campos-Ponce, M., de Deus, N., Polman, K., and Doak, C. (2022). Association between Intestinal Parasite Infections and Proxies for Body Composition: A Scoping Review. Nutrients, 14.","DOI":"10.3390\/nu14112229"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1002\/ajhb.20588","article-title":"Impacts of dietary intake and helminth infection on diversity in growth among schoolchildren in rural south China: A four-year longitudinal study","volume":"19","author":"Zhou","year":"2007","journal-title":"Am. J. Hum. Biol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Verhagen, L.M., Incani, R.N., Franco, C.R., Ugarte, A., Cadenas, Y., Sierra Ruiz, C.I., Hermans, P.W.M., Hoek, D., Campos Ponce, M., and de Waard, J.H. (2013). High Malnutrition Rate in Venezuelan Yanomami Compared to Warao Amerindians and Creoles: Significant Associations with Intestinal Parasites and Anemia. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0077581"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/j.1365-3156.2008.02022.x","article-title":"Age patterns in undernutrition and helminth infection in a rural area of Brazil: Associations with ascariasis and hookworm","volume":"13","author":"Brooker","year":"2008","journal-title":"Trop. Med. Int. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"746340","DOI":"10.3389\/fmicb.2021.746340","article-title":"Blastocystis One Health Approach in a Rural Community of Northern Thailand: Prevalence, Subtypes and Novel Transmission Routes","volume":"12","author":"Jinatham","year":"2021","journal-title":"Front. Microbiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1574-695X.2002.tb00615.x","article-title":"Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta, Indonesia","volume":"34","author":"Oyofo","year":"2002","journal-title":"FEMS Immunol. Med. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s00436-005-0003-0","article-title":"The association of Blastocystis hominis and Endolimax nana with diarrheal stools in Zambian school-age children","volume":"98","author":"Graczyk","year":"2005","journal-title":"Parasitol. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1159\/000339205","article-title":"Blastocystis hominis and Endolimax nana Co-Infection Resulting in Chronic Diarrhea in an Immunocompetent Male","volume":"6","author":"Shah","year":"2012","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1093\/jac\/dkg150","article-title":"Isolation, excystation and axenization of Giardia lamblia isolates: In vitro susceptibility to metronidazole and albendazole","volume":"51","author":"Cruz","year":"2003","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1016\/0035-9203(88)90019-3","article-title":"In vitro excystation and subsequent axenic growth of Giardia lamblia","volume":"82","author":"Hautus","year":"1988","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/0035-9203(87)90438-X","article-title":"Comparative studies on the axenic in vitro cultivation of Giardia of human and canine origin: Evidence for intraspecific variation","volume":"81","author":"Meloni","year":"1987","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_51","first-page":"620","article-title":"Treatment of parasitic infections in Thailand","volume":"17","author":"Charoenlarp","year":"1986","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"834008","DOI":"10.3389\/fmicb.2022.834008","article-title":"Characterization of Metronidazole-Resistant Giardia intestinalis Lines by Comparative Transcriptomics and Proteomics","volume":"13","author":"Krakovka","year":"2022","journal-title":"Front. Microbiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.cmi.2017.05.028","article-title":"Nitroimidazole-refractory giardiasis: A growing problem requiring rational solutions","volume":"24","author":"Carter","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/bs.apar.2019.11.003","article-title":"Drug resistance in Giardia: Mechanisms and alternative treatments for Giardiasis","volume":"107","author":"Leitsch","year":"2020","journal-title":"Adv. Parasitol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1093\/infdis\/jix066","article-title":"The Use of Quinacrine in Nitroimidazole-resistant Giardia duodenalis: An Old Drug for an Emerging Problem","volume":"215","author":"Goni","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1092.e1","DOI":"10.1016\/j.cmi.2019.12.017","article-title":"5-Nitroimidazole refractory giardiasis is common in Matanzas, Cuba and effectively treated by secnidazole plus high-dose mebendazole or quinacrine: A prospective observational cohort study","volume":"26","author":"Canete","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.apjtm.2016.07.013","article-title":"Introducing nitazoxanide as a promising alternative treatment for symptomatic to metronidazole-resistant giardiasis in clinical isolates","volume":"9","author":"Galeh","year":"2016","journal-title":"Asian Pac. J. Trop. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.2147\/IDR.S177997","article-title":"Genetic variation in metronidazole metabolism and oxidative stress pathways in clinical Giardia lamblia assemblage A and B isolates","volume":"12","author":"Saghaug","year":"2019","journal-title":"Infect. Drug Resist."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ijpddr.2018.04.008","article-title":"Physiological aspects of nitro drug resistance in Giardia lamblia","volume":"8","author":"Muller","year":"2018","journal-title":"Int. J. Parasitol. Drugs Drug Resist."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Moore, C.E., Elwin, K., Phot, N., Seng, C., Mao, S., Suy, K., Kumar, V., Nader, J., Bousfield, R., and Perera, S. (2016). Molecular Characterization of Cryptosporidium Species and Giardia duodenalis from Symptomatic Cambodian Children. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004822"},{"key":"ref_61","first-page":"32","article-title":"Epidemiology of giardiasis and genotypic characterization of Giardia duodenalis in preschool children of a rural community, central Thailand","volume":"28","author":"Boontanom","year":"2011","journal-title":"Trop. Biomed."},{"key":"ref_62","first-page":"331","article-title":"Prevalence of giardiasis and genotypic characterization of Giardia duodenalis in hilltribe children, Northern Thailand","volume":"29","author":"Saksirisampant","year":"2012","journal-title":"Trop. Biomed."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1093\/infdis\/jiw361","article-title":"Identification of Giardia lamblia Assemblage E in Humans Points to a New Anthropozoonotic Cycle","volume":"214","author":"Fantinatti","year":"2016","journal-title":"J. Infect. Dis."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/8\/394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:23:36Z","timestamp":1760127816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/8\/394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":63,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["tropicalmed8080394"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed8080394","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,1]]}}}