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PubMed1983

Diagnosis of giardiasis by two methods. Immunofluorescence and enzyme-linked immunosorbent assay.

Antibody response in giardiasis was measured by indirect fluorescent antibody (IFA) and enzyme-linked immunosorbent assays (ELISA) on serum samples of 125 patients. Twenty-nine of these patients had symptomatic giardiasis; 30 were asymptomatic (carriers); 40 had other parasitic infections; 16 had inflammatory bowel diseases; ten were normal subjects. It was found that those patients with symptomatic giardiasis had higher IFA titers compared with all patients who did not have giardiasis and patients who had asymptomatic giardiasis. Serum samples with titers of 1:64 or greater in Giardia IFA were absorbed with Giardia and other parasite antigens. Only absorption with Giardia caused the titers to fall significantly. The ELISA technique was less specific than the IFA technique. Giardiasis elicits a specific host antibody response that may be used as an adjunct in its diagnosis.

Antibodies↗
PubMed1980

Vitamin A concentration in children with giardiasis.

Although the vitamin A concentration was somewhat lower in patients with giardiasis than in normal children this difference was not significant; 35% of patients with giardiasis and 22.6% of normal children had vitamin A concentration lower than 20 micrograms/dl. This indicates that there may be malabsorption of vitamin A and that low serum vitamin A levels may be found in patients who were infected with Giardia lamblia. Therefore, apart from antigiardia agent, supplementation of vitamin A should be considered in the treatment of patients with giardiasis with or without clinical signs of vitamin A deficiency. There was no significant difference in pre-treatment and post-treatment serum vitamin A concentrations of patients with giardiasis. The normal children after treatment with oral vitamin A for three weeks showed a significantly higher serum vitamin A concentration (p < 0.01) than patients after antigiardia treatment plus vitamin A given orally for three weeks. It may be concluded that in patients with giardiasis after treatment with antigiardia drugs, impaired absorption of vitamin A did not improve dramatically, or return to normal for at least 3 weeks. There was no significant difference in the beta carotene concentration between patients with giardiasis and normal children.

Carotenoids↗
PubMed1996

Severe giardiasis and cryptosporidiosis in Scotland, UK.

Hospital discharge data from 1990-4 for 26 hospitals were used to estimate and compare the cost and describe the epidemiology of severe giardiasis and cryptosporidiosis in Scotland, UK. The incidence of severe cryptosporidiosis was almost double that of severe giardiasis and the median duration of hospitalization was longer for cryptosporidiosis than giardiasis. Impaired immunity was frequently listed as co-diagnosis with cryptosporidiosis and associated with extended hospitalization. Although both infections were associated with infants, the median age was lower for cryptosporidiosis (5 years compared with 30 years). Whereas hospitalization was not significantly longer for infants with cryptosporidiosis, hospitalization for this age group with giardiasis was longer (4 days compared with 3 days). Comparison with similar data for giardiasis from USA revealed various differences and similarities. These points are discussed in relation to the epidemiology of these infections and published data were used to estimate costs of hospitalization.

Adolescent↗
PubMed2003

Incidence of giardiasis among siblings in Turkey.

BACKGROUND: Giardiasis, a common infection among children, is caused by a flagellated protozoan called Giardia lamblia. It is well known to be contagious in common living places. This is an epidemiologic study investigating the incidence of giardiasis among the siblings of patients with giardiasis living in the same household. METHODS: Stool samples of 50 patients with a G. lamblia positive sibling in the same household, and 50 patients with a G. lamblia negative sibling in the same household, were examined for giardiasis by saline-Lugol, formalin-ethyl acetate concentration and trichrome staining methods. Other causes of diarrhea were excluded by microbiologic laboratory tests. RESULTS: Thirty-eight per cent of siblings of G. lamblia positive patients and 8% of siblings of G. lamblia negative children were found to be positive for G. lamblia cysts and/or trophozoites. The differences between the groups were statistically significant (P < 0.001). CONCLUSION: The results suggested that the examination of G. lamblia among the siblings of patients with giardiasis both in the same age group and living in the same household should be considered.

Adolescent↗
PubMed1993

Endemic giardiasis in New Hampshire: a case-control study of environmental risks.

Giardiasis is the most frequently reported diarrheal disease in northern New England. A case-control study of endemic giardiasis and environmental risk factors among residents of New Hampshire involved 273 cases from the state's 1984 disease registry and 375 controls. Giardiasis was associated with a shallow dug well as a residential water source (odds ratio [OR] = 2.4; 95% confidence interval [CI], 1.3-47.0), a recent history of drinking untreated surface water (OR = 3.4; CI, 2.1-5.5), a history of swimming in a lake or pond (OR = 4.6; CI, 2.4-86.0) or swimming in any natural body of fresh water (OR = 4.0; CI, 2.3-70.0), contact with a person thought to have giardiasis (OR = 2.3; CI, 1.4-36.0), and recent contact with a child in day care (OR = 1.5; CI, 1.0-2.1). Multivariate modeling supported these associations. Shallow wells, relatively common in New Hampshire, have not previously been established as important sources of giardiasis.

Adolescent↗
PubMed1991

Acute giardiasis: an improved clinical case definition for epidemiologic studies.

In June 1983, an outbreak of waterborne giardiasis occurred in a group of 93 university students and faculty participating in a geology field course in Colorado. All cases occurred in one subgroup of persons who were heavily exposed to untreated stream water on a field trip, and the risk of illness was strongly related to the amount of untreated stream water consumed. The median incubation period from a brief exposure to the first symptom was 7 days. The authors compared symptoms and stool sample results among 31 Giardia-positive persons in the exposed group and 36 Giardia-negative participants in an unexposed group to assess several case definitions for acute giardiasis. Diarrhea, abdominal cramps, flatulence, foul-smelling stools, nausea, excessive tiredness, bloating, anorexia, and chills were each significantly more common in the first group than in the second. A giardiasis case definition of 5 days or more of diarrhea--the definition used in many epidemiologic studies of giardiasis--had a specificity of 100 percent but a sensitivity of only 32.2 percent compared with a definition based on results of stool examinations. When a case was defined as an illness lasting 7 days or more, with a combination of two or more of six symptoms (diarrhea, flatulence, foul-smelling stools, nausea, abdominal cramps, and excessive tiredness), sensitivity rose to 73 percent, with a specificity of 88 percent. Such a case definition may be an improvement over that of 5 days of diarrhea, especially in outbreaks where there is good laboratory documentation that Giardia is the etiologic agent. The definition should be validated in other outbreaks and in situations where giardiasis must be distinguished from gastrointestinal disease caused by other agents.

Colorado↗
PubMed1983

The BTPABA pancreatic function test in giardiasis.

The test for exocrine pancreatic function using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BTPABA test) was assessed in 7 patients with giardiasis and 7 healthy controls. Cumulative percent p-aminobenzoic acid (PABA) recovery in 6 hr was significantly lower in patients with giardiasis, compared with the control group. When an equivalent dose of free PABA was given, there were no differences in PABA recovery between the groups. In patients with giardiasis, the post-treatment values of BTPABA test were significantly higher than the pretreatment values and no differences were found in PABA recovery between patients with giardiasis after eradication and healthy controls. These findings indicate that Giardia lamblia interferes with the action of pancreatic chymotrypsin. It is noteworthy that giardiasis could cause an abnormal BTPABA test.

4-Aminobenzoic Acid↗
PubMed1987

A prospective study of giardiasis and water supplies in Colorado.

A prospective study of 484 visitors to Vail and Aspen/Snowmass, Colorado, was conducted to determine the risk of acquiring giardiasis. Of the 259 visitors to Vail, no cases of giardiasis were confirmed and only one of 12 water filtrates were positive for Giardia cysts. Of 225 visitors to Aspen/Snowmass two cases of giardiasis were confirmed and 12 of 20 water filtrates were positive for Giardia cysts. The regular occurrence of Giardia cysts in Aspen and Snowmass water was associated with lower rates of giardiasis acquisition than reported during outbreaks of waterborne giardiasis.

Colorado↗
PubMed1987

Risk factors for endemic giardiasis.

In a mail survey, 171 Hitchcock Clinic patients with giardiasis were compared with an age- and sex-matched control group of 684 clinic patients with respect to potential risk factors. Households with shallow well or surface water sources had an odds ratio (OR) for giardiasis of 2.1 (95% confidence interval (95%CI) 1.3-3.2) compared with households with drilled well or municipal water supply. Other observed risks include family member in day care program (OR 2.2 95%CI 1.3-3.7) and family member with diagnosed giardiasis (OR 17, 95%CI 7.4-37). Previously reported risks such as travel out of country (OR 3.2, 95%CI 1.5-7.2) and camping (OR 1.7, 95%CI 0.9-3.2) were also observed. Virtually no giardiasis risk was observed associated with report of dog or barnyard animal proximity. Control for confounding and adjustment for recall and non-response bias does not materially alter the risk estimates. We suggest that shallow well or surface household water source is an important and previously unrecognized giardiasis risk factor.

Adolescent↗
PubMedDate not supplied

Epidemiology of giardiasis in German travelers.

BACKGROUND: Giardiasis has been well characterized in individuals traveling from areas of low to high endemicity. METHODS: Clinical features, travel and medical histories in 352 patients with giardiasis who presented to a German outpatient clinic for Infectious and Tropical Diseases were investigated in order to identify common epidemiological factors and potential strategies of prevention. RESULTS: Compared to the total patient population of the outpatient clinic during the period of investigation (n=13, 566 patients), patients who presented with giardiasis traveled longer (median 28 days versus 19 days, p <.001). While only 19.2% of the total patient population had traveled to the Indian subcontinent prior to referral, 32.1% of the patients with giardiasis acquired the infection there (p <.0001). Similar results were obtained for West Africa: in contrast to 19% of patients with giardiasis (p <. 0001), only 5.4% of the total patient population traveled there. CONCLUSION: The risk of infection appears to be highest when making an extended journey to the Indian subcontinent. Short-time visitors to other parts of Asia and Latin America are apparently at a markedly lower risk. Risk factors such as type, duration and destination of the journey should be considered in pretravel counseling.

Adolescent↗
PubMed2003

Serum iron, zinc and copper levels and lipid peroxidation in children with chronic giardiasis.

This study investigated the levels of iron, zinc, and copper and their demolishing effects against lipid peroxidation in chronic giardiasis. Serum iron, zinc and copper levels, erythrocyte cytosolic superoxide dismutase activity, and malondialdehyde levels were measured in 34 children with chronic giardiasis and were compared with controls. The serum iron and zinc levels and erythrocyte superoxide dismutase activity were significantly lower, and malondialdehyde levels were significantly higher among the children with chronic giardiasis compared to the control group (p < 0.001). There was no significant difference in copper levels between the two groups (p > 0.05). Consequently, the oxidant-antioxidant balance may tilt towards the oxidative side due to weakness of the antioxidant system in giardiasis. If early and proper treatment is not performed, free radical-mediated damage might occur in children with chronic giardiasis.

Child↗
PubMed1977

Quantification of the lymphocytic infiltrate in jejunal epithelium in giardiasis.

The intraepithelial lymphocytes of the jejunal mucosa from patients with giardiasis and from control patients were counted in coded serial sections. Patients with giardiasis and normal intestinal absorption and control patients who had lived and travelled in tropical areas had similar counts, which were higher than those reported for controls from temperate areas. Where giardiasis was accompanied by malabsorption of one substance the mean count was significantly higher than that of controls (P less than 0.02). In those patients with giardiasis and malabsorption of two or three substances the mean count was significantly higher than that of controls (P less than 0.02) and that of patients with giardiasis and normal absorption (P less than 0.05). After treatment, intraepithelial lymphocyte counts declined consistently in patients with malabsorption. An association between raised intraepithelial lymphocyte counts and malabsorption is indicated. The possible significance of this finding is discussed.

Adult↗
PubMed1996

Evidence that intestinal intraepithelial lymphocytes are activated cytotoxic T cells in celiac disease but not in giardiasis.

To further define intraepithelial lymphocytes (IELs) in celiac disease (CD) and giardiasis, IELs were probed for the presence of cytolytic granules containing granzyme B (GrB) and T-cell-restricted intracellular antigen (TIA)-1. The expression of TIA-1, GrB, CD3 (T-cell-receptor-associated complex), and Leu-7 (subset of natural killer cells) was studied by a sensitive three-step immunoperoxidase technique. Stained IELs were determined quantitatively, and results were expressed as number of stained IELs per 100 epithelial cells (ECs). The relative content in labeled lamina propria lymphocytes was determined and expressed as the percentage of all lamina propria cells counted. When compared with controls, CD3+ and GrB+ IELs were significantly increased (P < 0.0004) in CD paralleled by an increase in TIA-1+ IELs (P < 0.0004). In CD, the highest numbers of IELs containing GrB were found in subjects with a flat mucosa (median, 38 IELs/100 ECs, P < 0.0004), followed by cases with shortened and blunted villi (median, 8 IELs/100 ECs, P < 0.0004) and, finally, CD patients with an intact villous architecture (median, 0.5 IELs/100 ECs, P < 0.02). Except for cases with giardiasis, Leu-7+ IELs were virtually absent in all groups as were GrB+ IELs in the controls and in subjects with giardiasis. In the lamina propria of CD subjects, GrB+ lymphocytes were also significantly increased (P < 0.001), whereas controls and cases with giardiasis were essentially free of GrB+ cytotoxic T lymphocytes. The percentage of CD3+ lamina propria lymphocytes was nearly equal in all groups. In humans and mice, extensive studies revealed a GrB expression to be absolutely restricted to activated cytotoxic T lymphocytes and natural killer cells. TIA-1, on the other hand, is considered a marker of resting T lymphocytes possessing cytolytic potential. We therefore conclude that IELs are cytotoxic T cells that are in a resting state in the normal small bowel and in giardiasis. In CD, they become activated as suggested by the GrB positivity of their granules.

Adolescent↗
PubMed1998

Synovitis secondary to giardiasis in children.

Giardia lamblia, a gastrointestinal protozoan, is one of the most common disease-causing parasites in the world. Giardiasis is primarily encountered in areas with poor sanitation, but it is also seen in more developed countries. A possible sequela of Giardia infections of the bowel is reactive arthritis or synovitis. Few reports of synovitis secondary to giardiasis exist in the literature. Arthropathy secondary to giardiasis is uncommon, but may be underdiagnosed. In this study, Giardia synovitis was diagnosed in two children at a major children's hospital over a 20-year period. Both were boys, aged 7 years, 6 months and 1 year, 8 months at the time of presentation. The knee was the affected joint in both patients, and both cases were initially misdiagnosed as septic arthritis. The synovitis subsided with treatment of the giardiasis, one with cefuroxime and the other with cefuroxime and metronidazole. The diagnosis of Giardia synovitis should be suspected by the presence of Giardia cysts in the stool, similar symptoms in other family members, a synovial white count under 40,000, and an increase in the eosinophil count. Although uncommon, giardiasis can cause severe synovitis that may be confused with a septic joint.

Animals↗
PubMed2003

Geographical and temporal distribution of human giardiasis in Ontario, Canada.

BACKGROUND: Giardia is the most frequently identified intestinal parasite in North America. Although information on geographical distribution of giardiasis is critical in identifying communities at high risk, little has been done in this area. Therefore, the objective of this study was to investigate the geographical and temporal distribution of human giardiasis in Ontario in order to identify possible high risk areas and seasons. Two spatial scales of analyses and two disease measures were used with a view to identifying the best of each in assessing geographical patterns of giardiasis in Ontario. Global Moran's I and Moran Local Indicators of Spatial Associations were used to test for evidence of global and local spatial clustering, respectively. RESULTS: There were seasonal patterns with summer peaks and a significant (P < 0.001) decreasing temporal trend. Significant (P < 0.05) global spatial clustering of high rates was observed at the Census Sub-division spatial scale but not at the Census Division scale. The Census Sub-division scale was a better scale of analyses but required spatial empirical Bayesian smoothing of the rates. A number of areas with significant local clustering of giardiasis rates were identified. CONCLUSIONS: The study identified spatial and temporal patterns in giardiasis distribution. This information is important in guiding decisions on disease control strategies. The study also showed that there is benefit in performing spatial analyses at more than one spatial scale to assess geographical patterns in disease distribution and that smoothing of disease rates for mapping in small areas enhances visualization of spatial patterns.

Journal Article↗
PubMed2000

Drugs for treating giardiasis.

BACKGROUND: There can be a high rate of recurrence of disease after initial drug treatment for giardiasis. These drugs also have a range of adverse effects. OBJECTIVES: The objective of this review was to assess the effects of drug treatments for giardiasis. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline and Embase, Current Contents, reference lists of articles. SELECTION CRITERIA: Randomised and quasi-randomised trials of drug therapy for giardiasis compared with placebo or another drug. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Thirty-four trials were included. Only one trial was without serious methodological flaws. Compared with placebo, drug treatment was associated with an improved cure rate (odds ratio 11.5, 95% confidence interval 2.3 to 58). Metronidazole treatment longer than three days had a better parasitological cure rate than other long treatment courses (odds ratio 2.4, 95% confidence interval 1.3 to 4.4), but there was significant heterogeneity between the trials. Single dose therapy appeared equally effective as longer treatment courses (odds ratio 0.33, 95% confidence interval 0.08 to 1.34). Within the single dose regimens, tinidazole had a comparable parasitological cure rate to other short therapies (odds ratio 3.4, 95% confidence interval 0.95 to 12), but had a higher clinical cure rate (odds ratio 5.3, 95% 2.7-10.7). REVIEWER'S CONCLUSIONS: A single dose of tinidazole appears to give the highest clinical cure rate for giardiasis with relatively few adverse effects.

Antiprotozoal Agents↗
PubMed1976

Giardiasis: an overview for the clinician.

Since the clinician confronting a case of giardiasis may find the current literature confusing and weighted towards rare immunoglobulin deficiency syndromes, a classification is proposed to answer questions pertinent to understanding and managing this infection. Current thinking of giardiasis must involve the realization that (1) asymptomatic carriers exist; (2) that the majority of symptomatic patients have no structural disease explaining their symptoms; and (3) that those patients with anatomic lesions and giardiasis probably have an underlying predisposing condition. A short review of the association of giardiasis and immunodeficiency will then be presented, along with current concepts of diagnosis and therapy.

Adult↗
PubMed1985

Giardiasis as a chronic disease.

In an effort to better describe the incidence and characteristics of chronic giardiasis in an urban private practice outpatient setting, we reviewed our experience of 65 cases. In the entire group, the mean duration of symptoms was 1.9 years. A history of foreign travel was described by 45%. No association with homosexuality was noted. Chronic giardiasis, defined as that population symptomatic for six months or longer, constituted 58% of the entire group (38 cases). For these patients the mean duration of symptoms was 3.3 years. When compared to acute giardiasis, an increased frequency of constipation and upper gastrointestinal complaints was noted in the chronic population. Symptomatic cure was obtained in 71% of chronic cases and 93% of acute. Palliative results were noted in 18% of chronic cases and 4% of acute. We conclude that giardiasis is frequently a chronic disease in our population with symptoms lasting years. The incidence is similar in both sexes and a history of foreign travel is often absent. A disproportionate incidence in male homosexuals was not noted in our study.

Adult↗