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The frequent association of human giardiasis with skin damages made the authors measure IgE serum levels by an ultramicroanalytical system in patients with clinical giardiasis, confirmed parasitologically. Possible stimulation of the total serum IgE response is studied, as well as its association with present allergic signs and the relationship with the cure of patients having giardiasis.
In 1987 and 1988, 340 consecutive patients attended the endoscopy centre of Cochin hospital, Paris, and underwent oesophago-gastroduodenal endoscopy in a search for Giardia lamblia parasitology and histology. Two-hundred and eight of these patients presented with non-ulcer dyspepsia and entered a prospective study aimed at determining the advisability of a systematic search for Giardia lamblia in this population. Six biopsies were positive for giardiasis, including 3 in patients with acquired immunodeficiency, 1 in a case of chronic diarrhoea with atrophic villi and 2 in dyspeptic patients. Giardiasis, therefore, cannot be regarded as a cause of non-ulcer dyspepsia, and a systematic search for the parasite is of little interest in such cases. However, giardiasis remains a cosmopolitan parasitic disease with a non-negligible prevalence in France among subjects at risk, such as communities, children, travellers, homosexuals and immunodeficient patients.
Parasitological analysis was carried out during 1982 and 1983 in 3,076 children aged under 7 years, who were enrolled in 52 day nurseries supported by Municipal Prefecture of São Paulo and 50 food handlers (cooking employees) working at 18 day nurseries. The prevalence of Giardia lamblia infection was studied according to sex, age group and seasonal variations, and attained 32.80% among children and 4.0% among adult population. The occurrence of giardiasis was most frequent in age group corresponding to 1-4 years old. The study of seasonal variations showed that, in 1982, the prevalence of G. lamblia was high in the autumn and in the spring and, in 1983, giardiasis was more prevalent in the autumn and in the summer. Statistical analysis indicated non association between sex and prevalence for Giardia infection, and there was also no significative difference on the distribution of G. lamblia prevalence in the four regions analysed in the present study (p > 0.05). The most probable mode of acquisition of Giardia infection, in the nurseries analysed in the present study was person-to-person, as factors, like environmental contamination and others, associated with the spreading of giardiasis through water, reported in other countries, are unlike from those verified in our Municipality. On the other hand, there is evidence of no significant role of food handlers in Giardia transmission, because of the rate of infection in this group was very low.
A 10-year-old mentally retarded girl was sent to our hospital due to generalized edema, vomiting and poor appetite for several days. Serum albumin level was low, but no proteinuria was detected. Her stool was bulky and foul. Stool examination for parasite with formalin-ether concentration method revealed negative result. Trypsin activity test of stool revealed low trypsin activity as compared with normal specimen. Daily fecal fat exceeded upper normal limit. The diagnosis of giardiasis was confirmed by duodenal juice examination. Intestinal histology revealed mild shortening of the villi with increased mononuclear cell infiltration in the lamina propria. The daily stool amount decreased markedly after treatment with metronidazole 250 mg three times a day for 7 days. The edema subsided during the treatment. Serum albumin bevel returned to normal after the treatment. Giardiasis with malabsorption syndrome has often been overlooked in Taiwan. It is advised that in case of malabsorption syndrome giardiasis should be included in the list of differential diagnosis.
120 patients with Giardia lamblia infection diagnosed by biliary drainage or jejunal mucosa smear are studied. 80 patients showed frequent reinfections by the parasites (recurrent giardiasis). A study is made of T and B lymphoid populations in peripheral blood, which were reduced in all patients with giardiasis in relation with the control group (p less than 0.01). Changes were more pronounced in relapsing than in non-relapsing patients. Retarded in vivo hypersensitivity tests with memory and recognizing antigens did not show significant differences between the experimental and control group. Serum levels of IgG, IgM, and IgA differed (p less than 0.01) between patients and controls at the expense of an IgA increase and IgG and IgM decrease, although these variations were not significant between relapsing and non-relapsing patients. It is concluded that the immunity status of the host is of interest in the clinical picture of patients with giardiasis and therefore must be a factor to be considered in the study of Giardia lamblia infected patients.
A 10-year-old mentally retarded girl from an asylum in northern Taiwan was diagnosed to have giardiasis with malabsorption syndrome at the Department of Pediatrics, National Taiwan University Hospital in 1983. A survey for giardiasis in 239 children living in the same asylum was therefore performed. Stool specimens were collected from all children, and giardia was examined simultaneously by formalin-ether concentration method and polyvinyl alcohol preservation followed by Trichrome stain. Forty one cases (17.2%) of giardiasis were detected by the former method while 48 cases (20.1%) by the latter method. Abnormally low stool trypsin activity was found in 38 of the 42 cases (90.5%) tested and the activity returned to normal in 50% of patients after successful treatment. Endoscopic examination and intestinal biopsy of upper gastrointestinal tract were performed in 12 cases. Among them, 4 were found to have nodular lymphoid hyperplasia, lymphoid hyperplasia in 7, and increased mononuclear cell infiltration in lamina propria in 7. Forty patients were treated with metronidazole 250 mg three times a day for 5 days. Follow-up stool examinations revealed that 12 children (30%) still passed giardia in their stools 4 months after treatment. Reinfection and inadequate sensitivity of the initial screening test may be used to account for such a high rate of treatment failure.
Travelers' diarrhea afflicts some 250 million people yearly. A number of etiologic agents have been identified, including bacteria, viruses, and parasites. Giardia lamblia is one of the pathogens clearly associated with this syndrome. Typical symptoms of giardiasis that include abdominal bloating and cramps are well known, whereas urticaria has rarely been associated with this illness. An American tourist developed acute giardiasis accompanied by urticaria and high fever. No other pathogens were identified, and response to metronidazole therapy was prompt. Giardiasis should be included in the differential diagnosis of acute urticaria and fever in the traveler.
The "string test" permits definitive diagnosis of giardiasis in the physician's office. If giardiasis is present, microscopic examination of the sample of duodenal fluid obtained on the string will reveal Giardia lamblia in the trophozoite stage. Use of this simple test may eliminate some of the difficulties in diagnosing giardiasis.
Forty eight patients with symptomatic giardiasis and 22 apparently healthy matched controls without Giardia lamblia were studied with respect to the following variables--immunoglobulins (Igs) G, A and M in serum, IgA in duodenal juice and T and B in lymphocyte sub-populations. There were no differences observed between the two groups with regard to any of these variables except for serum IgG which was found to be higher in patients. It was concluded that endemic giardiasis has no immunodeficient basis and has nothing in common with the association of giardiasis, mal absorption and immunodeficiency reported from the West. Further, no change in these variables was observed when the tests were repeated after cure.
In 15 months of the years 1979-1980, 158 patients with giardiasis and 69 patients with intestinal amebiasis were diagnosed and treated in the outpatient department of the Swiss Tropical Institute. Repeated examination of merthiolate-iodine-formol-fixed stools was the method of choice for detecting intestinal protozoa. Parasitological investigation of duodenal fluid (Enterotest) was less effective. Fewer than 30% of the cases were symptomatic, usually mentioning diarrhea (73-85%) or abdominal discomfort (20-44%). Treatment was by ornidazole single dose (2 g in adults; 40 mg/kg in children) for asymptomatic cases and a five-day treatment schedule (2 X 500 mg/day in adults, 20 mg/day in children) for symptomatic cases. In amebiasis a luminal amebicide (diloxanide furoate) was prescribed in all instances after the first stool examination. Parasitological cure rates were excellent (95%) in all cases of giardiasis but only 59 and 65% respectively in cases of asymptomatic and symptomatic amebiasis. Drug tolerance was excellent. Ornidazole is the drug of choice for all forms of giardiasis, even in a single dose. As a luminal amebicide, however, its efficacy is not superior to other nitroimidazole derivatives.
Giardia lamblia is the first protozoan to be identified and recognized as an important pathogen in human disease. We studied 8 pediatric patients with giardiasis in order to examine the clinical spectrum, the structural changes of the small intestinal mucosa and mainly the protozoan's ultrastructural features. The most common clinical manifestations were diarrhea, abdominal pain, anorexia, vomiting, failure to thrive. Infection was confirmed by excreted cysts in the stools in one patient, by the presence of trophozoites in duodenal aspirate and on jejunal mucosa. Giardiasis was not associated with hypogammaglobulinemia in our patients and no or only slight mucosal abnormalities were present in jejunal biopsies, except one which showed a flat mucosa. Specimens for transmissions and scanning electron microscopy were taken. We could establish the protozoan's features, its normal distribution, its relationship to intestinal mucosa and structural indications of the normal reaction of intestine with the use of ultrastructural techniques. The trophozoites colonized the proximal intestine, adhered to microvilli of columnar cells near the bases of villi, wedged or lodged in mucus. The sticky mucus producing an effective diffusion barrier to nutrients could explain malabsorption phenomena. Numerous intraluminal lymphocytes were seen, suggesting an immune response. These observations indicate that in giardiasis the clinical spectrum and structural changes of the small intestinal mucosa vary widely, suggesting a different reaction of immune system and/or a different degree of infection.
The relationship between giardiasis and ABO blood groups was studied in a group of 136 children from Eastern Slovakia, with a special attention to ethnic specifics of gipsy children. The study showed no statistically significant differences in the distribution of ABO blood groups between the subgroup of Giardia-infected gipsy children and the gipsy population minority living in the area. On the other hand, the ABO distribution pattern in subgroup of non-gipsy children infected with Giardia intestinalis was found to differ from that in the general non-gipsy Eastern Slovakian population by the absence of blood group AB among children with giardiasis. There was indicated a tendency towards an increased frequency of blood group B in subgroup of Giardia-infected gipsy children and towards group A in subgroup of nongipsy children with giardiasis, but the differences were not statistically significant.
The diagnosis of giardiasis is frequently difficult to make. The routine procedure of multiple stool examinations fails to detect Giardia lamblia trophozoites or cysts in 30-50% of cases. Small bowel biopsy and aspirate are believed to be the best way to make the diagnosis of giardiasis if the organism is not found in the stool and the diagnosis is still suspected. We describe two patients whose diagnosis of giardiasis was established by endoscopic brush cytology of the duodenal mucosa. The first patient had negative stool examinations, duodenal biopsy, and duodenal aspirate.
UNLABELLED: We investigated a patient (W.B.) with chronic symptomatic Giardiasis despite seven separate courses of either quinacrine or metronidazole who was cured by combined quinacrine and metronidazole. After isolating Giardia lamblia from W.B., we cultured the trophozoites to make the following observations. In vitro drug testing showed that (a) W.B.'s organisms were not more drug resistant than three other isolates and that (b) W.B.'s organisms were more sensitive to combined quinacrine and metronidazole than to either drug alone. Isolates of Giardia lamblia from W.B. and 3 other patients did not produce detectable enterotoxin in four different assays. W.B. had normal levels of circulating immunoglobulins, detectable intestinal immunoglobulin A, circulating immunoglobulin G anti-Giardia lamblia antibodies, and lymphocyte responsiveness to solubilized giardia lamblia. However, monocytes-macrophages from W.B. exhibited reduced killing for Giardia lamblia compared with normal subjects. CONCLUSIONS: (a) The chronicity of our patient's infection was not due to the organism having unique properties of drug resistance. (b) Combined quinacrine and metronidazole, which cured our patient's chronic giardiasis, should be tried in patients in whom infection persists after single drug therapy. (c) The diarrhea in our patient was probably caused by a mechanism other than Giardia lamblia-induced secretion by currently recognized enterotoxins. (d) Reduced cellular cytotoxicity for Giardia lamblia may have contributed to the persistence of our patient's infection and should be suspected in other patients with chronic giardiasis.
Patients referred to the Parasitology Laboratory of Ankara Univ. Med. School were examined with respect to giardiasis. The incidence rate of giardiasis was found to be rather high. When compared with the previous findings, no changes in the rate have been noted so far. Furthermore, when stool specimens from patients with giardiasis were examined bacteriologically, it was found that this protozoon could cause malabsorption and some changes in the intestinal flora.
We present a morphometric analysis of findings from a histopathologic study of duodenal giardiasis in relation to the trophozoite count in the duodenal aspirate. Of 30 patients with giardiasis whose conditions were studied, a mean trophozoite count of 10(3)/mL or greater was found in 21, and a mean trophozoite count of less than 10(3)/mL was found in nine--these two types of trophozoite counts in these 30 patients represented the acute phase (group 1) and the clearance phase (group 2) of giardiasis, respectively. Group 1 patients had a low mean villus height that was significantly less than that found in the control subjects. Group 2 patients had a high mean crypt depth that was significantly greater than that found in the control subjects. Partial villus atrophy was seen in only seven of the group 1 patients, including five with villus epithelial cell lesions. Groups 1 and 2 showed minor differences of an inflammatory response that was significantly greater than that shown in the control subjects.
Serodiagnosis of giardiasis by counterimmunoelectrophoresis assay (CIEP) and indirect immunofluorescence test (IFAT) were evaluated versus stool examination. Giardia lamblia antibodies were detected in sera of 46.9% and 53.1% using CIEP and IFAT respectively out of 49 giardiasis-infected children (5-10 years) diagnosed microscopically. Among the control group (22 children) 13.6% and 18.2% were positive by CIEP and IFAT respectively. The findings of the study showed that we can not rely on serology to diagnose giardiasis specially in cases with low excretion rates.
Efficacy of albendazole for treating giardiasis in dogs was assessed in 3 experiments. In experiment 1, Giardia cysts were cleared from feces of 5 of 7 dogs (as determined by the zinc-sulfate concentration technique) after the dogs received a single dose of albendazole (25 mg/kg of body weight, PO), whereas feces of 3 of 7 dogs became clear of cysts without treatment. In experiment 2, feces of 5 of 5 dogs became clear of cysts after albendazole treatment (25 mg/kg, PO, q 12 h for 4 doses); feces of 1 of 5 untreated control dogs became clear. In experiment 3, feces of 18 of 20 dogs became clear of cysts after albendazole (25 mg/kg, PO, q 12 h for 4 doses) was given; none of the 20 control dogs had feces clear of cysts. Signs of toxicosis were not observed in any dog. These results indicate that a single dose of albendazole (25 mg/kg, PO) is not effective for treating giardiasis in dogs. However, 4 doses of albendazole (25 mg/kg, PO, q 12 h) are highly effective and non-toxic for treatment of giardiasis in dogs.