Ethanol and Isopropanol in Concentrations Present in Hand Sanitizers Sharply Reduce Excystation of Giardia and Entamoeba and Eliminate Oral Infectivity of Giardia Cysts in Gerbils
ABSTRACTEnteric protozoan parasites, which are spread by the fecal-oral route, are important causes of diarrhea (Giardia duodenalis) and amebic dysentery (Entamoeba histolytica). Cyst walls ofGiardiaandEntamoebahave a single layer composed of fibrils of β-1,3-linked GalNAc and β-1,4-linked GlcNAc (chitin), respectively. The goal here was to determine whether hand sanitizers that contain ethanol or isopropanol as the active microbicide might reduce transmission of these parasites. We found that treatment with these alcohols with or without drying in a rotary evaporator (to model rapid evaporation of sanitizers on hands) kills 85 to 100% of cysts ofG. duodenalisand 90 to 100% of cysts ofEntamoeba invadens(a nonpathogenic model forE. histolytica), as shown by nuclear labeling with propidium iodide and failure to excystin vitro. Alcohols with or without drying collapsed the cyst walls ofGiardiabut did not collapse the cyst walls ofEntamoeba. To validate thein vitroresults, we showed that treatment with alcohols eliminated oral infection of gerbils by 1,000G. duodenaliscysts, while a commercial hand sanitizer (Purell) killedE. invadenscysts that were directly applied to the hands. These results suggest that expanded use of alcohol-based hand sanitizers might reduce the transmission ofGiardiaandEntamoeba.