{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T18:16:05Z","timestamp":1763748965667},"reference-count":74,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","license":[{"start":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T00:00:00Z","timestamp":1693958400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Almost all human giardiasis infections are caused by <jats:italic>Giardia duodenalis<\/jats:italic> assemblages A and B. Differentiation between human infections with these assemblages, as well as between single-assemblage (A or B) and mixed-assemblage (A and B) infections, is therefore needed to better understand the pathological impact of infection with either, or both, assemblages. We assessed the prevalence of <jats:italic>G. duodenalis<\/jats:italic> assemblages A and B using 305 fecal samples provided by school-age children situated along the southern shoreline of Lake Malawi. Concurrently, intestinal pathology data were also collected to test for association(s) between assemblage infection status and intestinal health. Prevalence of <jats:italic>G. duodenalis<\/jats:italic> infection was 39.3% by real-time polymerase chain reaction. Of all identified infections, 32% were single <jats:italic>G. duodenalis<\/jats:italic> assemblage A and 32% were single <jats:italic>G. duodenalis<\/jats:italic> assemblage B, whereas 33% were mixed-assemblage infections. Fifteen unique <jats:italic>G. duodenalis<\/jats:italic> assemblage A and 13 unique <jats:italic>G. duodenalis<\/jats:italic> assemblage B \u03b2-giardin haplotypes were identified. There was a positive association between single infection with <jats:italic>G. duodenalis<\/jats:italic> assemblage B and both self-reporting of abdominal pain (odds ratio [OR]: 3.05, <jats:italic>P =<\/jats:italic> 0.004) and self-reporting of diarrhea (OR: 3.1, <jats:italic>P =<\/jats:italic> 0.003). No association between single infection with assemblage A and any form of intestinal pathology was found. Additionally, there was a positive association between mixed-assemblage infections and self-reporting of abdominal pain (OR: 3.1, <jats:italic>P =<\/jats:italic> 0.002). Our study highlights the importance <jats:italic>G. duodenalis<\/jats:italic> assemblage typing and reaffirms the need for improved access to water, sanitation and hygiene infrastructure in rural areas of low- and middle-income countries.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0156","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T14:52:50Z","timestamp":1691419970000},"page":"626-639","source":"Crossref","is-referenced-by-count":4,"title":["Molecular Epidemiology and Assemblage Typing of Giardia duodenalis in School-Age Children Situated along the Southern Shoreline of Lake Malawi, Malawi"],"prefix":"10.4269","volume":"109","author":[{"given":"John","family":"Archer","sequence":"first","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas J.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Juh\u00e0sz","sequence":"additional","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"},{"name":"Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ffion","family":"Doull","sequence":"additional","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James E.","family":"LaCourse","sequence":"additional","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bright","family":"Mainga","sequence":"additional","affiliation":[{"name":"Laboratory Department, Mangochi District Hospital, Mangochi, Malawi;"},{"name":"Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Makaula","sequence":"additional","affiliation":[{"name":"Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sekeleghe A.","family":"Kayuni","sequence":"additional","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"},{"name":"Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi;"},{"name":"Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi;"},{"name":"MASM Medi Clinics Limited, Medical Aid Society of Malawi, Area 12 Medi Clinic and Head Office, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janelisa","family":"Musaya","sequence":"additional","affiliation":[{"name":"Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi;"},{"name":"Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Russell","family":"Stothard","sequence":"additional","affiliation":[{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Adv Parasitol","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/S0065-308X(08)60207-9","article-title":"Giardia and giardiasis","volume":"32","author":"Thompson","year":"1993"},{"key":"b2","series-title":"F1000Prime Rep","first-page":"1","article-title":"Advances in understanding Giardia: determinants and mechanisms of chronic sequelae","volume":"7","author":"Bartlet","year":"2015"},{"key":"b3","series-title":"Pediatr Clin North Am","first-page":"837","article-title":"Cryptosporidium and Giardia Infections in Children: a review","volume":"64","author":"Mmbaga","year":"2017"},{"key":"b4","series-title":"Parasit Vectors","first-page":"1","article-title":"Cryptosporidium and Giardia 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