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PubMed2004

Albendazole versus metronidazole treatment of adult giardiasis: An open randomized clinical study.

AIM: To investigate the efficacy and tolerability of albendazole and metranidazole treatment in giardiasis. METHODS: The open comparative randomized trial was carried out prospectively from December 1999 to July 2001 in Duzce City of Turkey. The diagnosis was based on the presence of signs and symptoms compatible with giardiasis including a positive stool examination of giardia cysts or trophozoite. Metranidazole group consisted of 29 patients and was given metranidazole 500 mg, three times a day for 5 d and albendazole group was consisted of 28 patients and was given albendazole 400 mg/d for 5 d. RESULTS: There were no significant differences in demographical and therapeutical effects and patient's compliance between both groups. But side effects were seen more in metranidazole group than in albendazole group. CONCLUSION: Albendazole is as effective as metranidazole in adults' giardiasis. Albendazole has less side effect potentials than metranidazole in the treatment of giardiasis.

Adult↗
PubMed1980

Is predisposition to giardiasis associated with the ABO groups?

Since an excess of blood group A in giardiasis has been repeatedly reported, we studied 190 patients with parasitologically confirmed giardiasis. Their blood group distribution did not differ from that of the Finnish population, and the statistically insignificant deviations were a surplus of group B and a shortage of group A. Among 85 participants of four travel groups which experienced an epidemic of giardiasis, the blood group distributions of the infected and the noninfected persons were not different. Thus, blood group A did not predispose to the acquisition of Giardia lamblia infection. To disclose an impact on the course of the disease, the patients were classified according to symptoms or duration of infection, but the ABO distributions did not differ from the expected. Our patients were adults, probably contracting giardiasis for the first time during a trip abroad, while the excess of group A has been reported in children in enedemic areas.

ABO Blood-Group System↗
PubMed1977

A communitywide outbreak of giardiasis with evidence of transmission by a municipal water supply.

Three hundred fifty residents of Rome, New York, had laboratory-confirmed cases of giardiasis between 1 November 1974 and 7 June 1975. A random household survey showed an overall attack rate for giardiasis (defined as a diarrheal illness of 5 days or more) of 10.6%. A significant association was discovered between having giardiasis and using city water and between having illness and drinking 1 or more glasses of water a day. The presence of human settlements in the Rome watershed area suggested that the water supply could have been contaminated by untreated human waste. The infectivity of municipal water was confirmed by producing giardiasis in specific pathogen-free dogs fed sediment samples of raw water obtained from an inlet of a city reservoir. A microscopic examination of the water sediments uncovered a Giardia lamblia cyst in one sample. This was the first time that a G. lamblia cyst has been found in municipal water in an epidemic and the first time that such water has been shown to infect laboratory animals.

Animals↗
PubMed1999

[The frequency of giardiasis in various children's environment].

Giardiasis is an intestinal parastic disease, occurring in many world regions. Its incidence is variable and depends on such factors as studied population and diagnostic methods. In this study the incidence of Giardiasis was assessed in children living in various environments and living conditions. Stool examination was made using microscopic and immunoenzymatic methods. Among 208 examined children 42 (20.2%) were infected with Giardia lamblia. Giardiasis was the most common in children living in orphanage--41.4%. Incidence of Giardiasis among children from day--care centers was the lowest--3.7%. Children aged 12-14 years were infected in 42.7% and aged 0-2 years only in 12.5%. There was no significant difference between boys and girls.

Adolescent↗
PubMedDate not supplied

Lack of an association between endemic giardiasis and a drinking water source.

Waterborne outbreaks of giardiasis have been documented in many areas of North America associated with contaminated surface water supplies. The Greater Vancouver Water District (GVWD) administers the distribution of surface waters to 1.4 million people. We wished to determine if endemic giardiasis was associated with this water supply. One hundred and eighty cases, an equal number of laboratory (enteric) controls and 94 neighbourhood (friend) controls were interviewed by questionnaire. The cases and controls were similar in age, sex and community of residence. Risk factors for giardiasis included having a child under six in the house and travel, both in B.C. but outside of the GVWD, and in Africa, the Americas, south of the U.S. or Asia. The cases drank 3.6 cups of water per day, the enteric controls 3.5 and the friend controls 3.7. These amounts are similar to those reported ingested in outbreak studies. Water consumption was not a risk for endemic giardiasis.

Adolescent↗
PubMed2000

Beta 2-microglobulin and neopterin in patients with giardiasis.

The aim of the study was to evaluate serum beta 2-microglobulin (beta-2m) and neopterin (NPT) in in patients with giardiasis. Twenty-two patients with giardiasis were examined and compared with twelve healthy subjects as a control group. Serum beta-2m and NPT concentration were determined twice: at the moment of diagnosis of giardiasis and six months after antiparasitic treatment with metronidazole. It was shown that serum beta-2m concentration in patients with giardiasis was remarkably elevated. It decreased significantly, but six months after treatment it was still higher as compared to the control group. However, serum NPT before anti-parasitic treatment was slightly lower than in the control group, but after elimination of Giardia an increase of NPT concentration above control values was observed. It is concluded that Giardia infection leads to long-lasting disturbances in the immunological status of the host and may influence macrophage function and downregulate their parasiticidal effects.

Adult↗
PubMed1989

Detecting giardia lamblia antigen in fecal matter with counterimmuno-electrophoresis in diagnosis of giardiasis.

Feces specimens from 35 patients with parasitologically confirmed giardiasis, 41 with acute gastroenteritis, 23 with acute bacillary dysentery, 40 normal persons as well as 15 jirds experimentally infected with Giardia lamblia were used for detecting parasite antigen by counterimmunoelectrophoresis (CIE). It revealed that 33 (94%) of the 35 patients with giardiasis and 14 (93%) of 15 infected jirds were positive, while the other cases, either normal person or normal jird were negative. CIE was also performed in 4 with giardiasis before and after metronidazole treatment. Prior to metronidazole administration, they were all CIE positive, but from the second day on, all became CIE negative. Apparently, detecting giardia antigen in feces specimens by CIE is not only sensitive in detecting current infection but also helpful in evaluating the effects of antigiardia agents on giardiasis.

Animals↗
PubMed1986

A comparative study of four methods for detecting antibody in asymptomatic giardiasis.

Four immunological methods for diagnosis of giardiasis comprising complement fixation (CF) test, indirect hemagglutination (IHA) test, enzyme-linked immuno sorbent assay (ELISA) and lectin immuno test (LIT) were studied. Fifty sera from asymptomatic giardiasis patients, 40 from patients with other diseases and 50 from healthy controls were evaluated. The seropositive rates in asymptomatic giardiasis were 36% for CF, 58% for LIT, 30% for IHA and 72% for ELISA. The seropositive rates in patients with other diseases were 22.5% for CF, 52.5% for LIT, 12.5% for IHA and 67.5% for ELISA. The results suggest that the test of choice for giardiasis was CF with 88% specificity, nevertheless this test showed low sensitivity (36%). Other two tests, ELISA and LIT were more sensitive than CF with percent sensitivity of 72 and 58 respectively, but these two tests had severe disadvantages in being less specific with percentage specificity of 48 and 60 respectively.

Antibodies↗
PubMed1986

Giardiasis: diagnosis and treatment.

Giardiasis is the number one parasite-caused gastrointestinal illness in the United States. It can be acquired through various water sources or the fecal-oral route. The detection and treatment of giardiasis can be difficult. Nurse practitioners, as primary health care providers, often see patients presenting with gastrointestinal complaints. These complaints could represent one of many illnesses, including giardiasis. Presented is a review of the background and current information available on Giardia necessary for appropriate evaluation and care of patients with suspected giardiasis.

Antiprotozoal Agents↗
PubMed1982

[Enteropathogenic mechanisms involved in giardiasis in children (author's transl)].

23 patients with gastroenteritis and 9 with severe malabsorption syndrome related to giardiasis were investigated in a semi-prospective fashion as follows: (1) conjugated bile acid levels measured in duodenal aspirate (thin layer chromatography) in 6 patients with steatorrhea. (2) intraepithelial lymphocytes count (results expressed as the number of intraepithelial lymphocytes per 100 epithelial cells) in small intestinal biopsies from the 32 patients, 11 of which had immunoglobulin deficiency (9 IgA deficiency). The results indicate that there is no decrease in the percentage of conjugated bile acids (mean percentage 90%; normal = 80); a significantly increased percentage of intra-epithelial lymphocytes is documented in giardiasis (11.1% +/- 6.7), versus 2.3% +/- 0.5 in acute gastroenteritis (9 patients) and 6.3 +/- 0.5 in chronic diarrheas (6 patients) (p less than 0,001). This percentage, however, is significantly lower than in untreated coeliac sprue (23 patients) (12.17 +/- 11.6) (p less than 0,01). Conversely a high intraepithelial lymphocyte count does not correlate with the degree of intestinal villous atrophy (3 patients had severe and 6 partial villous atrophy) (r = 0.170). IgA deficiency should be suspected in patients with giardiasis presenting with intestinal villous atrophy (5 patients). Steatorrhea in our patients does not appear related to bile acid deconjugation. To explain enterotoxicity in giardiasis, more than a direct effect of the ventral disk of the parasite on intestinal mucosa, one should incriminate the host immune cell mediated response as shown by lymphocytic infiltration of the epithelium on small bowel biopsies.

Adolescent↗
PubMed1998

A study on the relation between proton pump inhibitor and gastric giardiasis.

Thirty patients treated with proton pump inhibitor and still having symptoms related to gastritis or peptic ulcers were subjected to upper gastrointestinal endoscopy and gastric biopsy for detection of giardiasis in these cases. Results showed presence of 3 (10%) cases of gastric giardiasis, intestinal metaplasia and presence of H. pylori in these cases. It is concluded that there may be a relation between the presence of gastric giardiasis and the intake of proton pump inhibitor. The endoscopists have to search for gastric giardiasis especially in the presence of H. pylori and/or intestinal metaplasia.

Adult↗
PubMed1975

Giardiasis in childhood.

Giardiasis is still regularly encountered in the United States, both as endemic cases from the local community as well as in patients returning from travel abroad. Giardiasis should be suspected in any child with steatorrhea, unexplained chronic diarrhea (especially if associated with growth failure), weight loss, or abdominal pain and bloating. Duodenal aspiration or small intestinal biopsy may be necessary to make a diagnosis because Giardia lamblia are not found by stool examination in 50% of symptomatic individuals. A diagnosis of giardiasis is important because the disease is curable.

Celiac Disease↗
PubMed1983

Five v ten days' therapy with furazolidone for giardiasis.

In previous uncontrolled studies it has been reported that five days' treatment with furazolidone is effective for giardiasis. Efficacy of five v ten days of treatment was evaluated in a prospective, randomized study of 22 children with giardiasis. Eleven of 12 patients (92%) treated for ten days were cured based on clinical and parasitological response; one patient did not tolerate furazolidone and was treated with quinacrine hydrochloride. Only two of ten patients (20%) treated with a five-day regimen were cured. Of the other eight patients, five had prompt relapse of diarrhea after furazolidone treatment was stopped, diarrhea persisted in two, and diarrhea diminished but Giardia persisted in one. Six of eight patients in whom the five-day regimen failed were re-treated with furazolidone for ten days, and five patients were cured. Therapy with furazolidone for less than seven to ten days cannot be recommended for children with giardiasis.

Child, Preschool↗
PubMed1981

Quantitative histological and immunohistochemical findings in jejunal biopsy specimens in giardiasis.

Jejunal mucosa biopsies from non-immune deficient patients with Giardia lamblia infestation were examined and showed three different groups of mucosal changes, distinguishable on morphological and immunohistochemical grounds. In three patients no morphological or immunohistochemical abnormalities were found (group A). In five patients a normal villous architecture was seen. These biopsies had increased numbers of interepithelial lymphocytes and of immunoglobulin containing cells in the lamina propria, with a relative increase of the number of IgA and IgG containing cells (group B). Two patients with a malabsorption syndrome due to giardiasis had marked villous atrophy, documented by morphometric measurements and large numbers of interepithelial lymphocytes and of immunoglobulin containing cells in the lamina propria, especially IgA and IgG (group C). These findings differ considerably from those in patients with immunodeficiency or gluten sensitive enteropathy. This suggests that when villous atrophy of the jejunal mucosa is found immunohistochemistry of jejunal biopsy specimens may be helpful in the differential diagnosis between mere giardiasis and giardiasis superimposed on immunodeficiency or gluten sensitive enteropathy.

Atrophy↗
PubMed1995

Proton-pump inhibition and gastric giardiasis: a causal or casual association?

Two patients who developed gastric giardiasis after 2 weeks of treatment with omeprazole 20 mg b.i.d. followed by omeprazole 20 mg per day for 2-6 weeks are described. In one patient, gastric giardiasis occurred in the presence of only mild intestinal metaplasia. In the other patient, Giardia lamblia infection had resolved 4 weeks after the cessation of omeprazole treatment, which, to our knowledge, is the first case reported in the literature. It is tempting to speculate that gastric giardiasis can develop in the absence of mucosal abnormalities during hypochlorhydria induced by treatment with a high dose of a proton-pump inhibitor. Specific treatment may not be required if the drug can be stopped and no other gastric disease causing hypochlorhydria is present.

Aged↗
PubMed1978

Bacterial colonization of jejunal mucosa in giardiasis.

Nine of 14 cases of giardiasis and severe malabsorption were found to have numerous bacteria adjacent to the mucosa and within luminal fluid samples from the upper jejunum. Three species of enterobacteria (Klebsiella pneumoniae, Enterobacter cloacae and E. hafniae) were cultured from eight patients and from only one were Bacteroides isolated. Enterobacteria were not cultured from seven of eight patients who had giardiasis but only mild malabsorption (of xylose only) nor from seven patients without malabsorption. Intestinal colonization by enterobacteria may make an important contribution to the development of malabsorption in patients with giardiasis.

Enterobacteriaceae↗
PubMedDate not supplied

The relative merits of faecal and duodenal juice microscopy in the diagnosis of giardiasis.

We compared the diagnostic accuracy of microscopical examination of multiple faecal specimens with duodenal juice examination in the diagnosis of giardiasis. Of 292 patients who had stool microscopy and duodenal aspirate, Giardia were identified in either stools or duodenal fluid from 73 patients (25%). Giardiasis was diagnosed in 62 (73%) with the first faecal specimen, but examination of 3 specimens increased the diagnostic yield to 85%. Giardia, however, were found in only 32 of 73 duodenal aspirates examined (44%). This finding is contrary to the widely held belief that duodenal fluid examination is superior to stool microscopy for the diagnosis of giardiasis. The 2 approaches are complementary, however, since Giardia was found in duodenal fluid, only, from 15% of patients.

Body Fluids↗
PubMed1999

Longitudinal study of giardiasis in three day care centres of Havana City.

The prevalence, incidence and reinfection of giardiasis were studied in 365 children attending three day care centres (DCCs) in Havana City. Three stool samples were obtained from each child every 6 months during an 18-month period. We identified three distinct groups of children according to their patterns of infection. In the largest group (51%) children were never found infected. In the second group, they were found infected once or twice during the study period, and in the third and the smallest group (9%) they were found infected in most or all the study periods. This last group seems to be children 'predisposed' to Giardia lamblia infection. The prevalence of giardiasis (20%) remained almost constant throughout the study period. The incidence declined from 16 to 11%, and reinfection increased from 36 to 49%. All the children had normal nutritional status and the only clinical manifestation that correlated strongly with the frequency of cross-sectional surveys positive to Giardia was the number of diarrhoeal episodes recorded during the last 6 months of the study period. Further studies will be necessary to ascertain the causes that determine the 'predisposition' to giardiasis in children.

Animals↗