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At least 19 recordsLinked to original sources

PubMed1978

Giardiasis: association with homosexuality.

Giardiasis is a common gastrointestinal illness among travelers. Recently an increased prevalence of giardiasis in men who had not traveled outside New York City was seen at The New York Hospital and was found to be due to transmission of this disease among homosexuals. Cases of giardiasis for a 5-year period were then reviewed, and it was discovered that 19 male patients who had not traveled or had an immunodeficiency disease were homosexuals. This accounted for 22% of the adult men with giardiasis during that period. Adult women with giardiasis usually were either travelers or had an immunodeficiency disease (96%). It is important to obtain a sexual history in these patients and treat sexual contacts to prevent recurrent infection. Our findings are consistent with venereal transmission of giardiasis.

Adult↗

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↗

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↗

PubMed1977

Prepatency of giardiasis.

Recently acquired giardiasis was suspected in 199 patients because of typical symptoms following a trip to a known endemic area. In 130 cases giardiasis was confirmed by stool examination, although most of the samples obtained less than 3 wk after probable infection were negative for Giardia lamblia. Prepatency was documented in 35 patients who, after one or more negative stool examinations, started to excrete Giardia. The median prepatent period was 14 days, and in most cases the prepatent period was less than 3 wk. The median incubation time of giardiasis was 8 days, and in two-thirds of the cases the symptoms had continued for over a week before the parasite became detectable in faeces. A practical conclusion was that, in suspected cases of giardiasis with negative stool findings during the first 3 wk after possible exposure to Giardia, examination of repeated faecal samples is still effective in confirming the diagnosis.

Disease Outbreaks↗

PubMed1979

Malabsorption of water miscible vitamin A in children with giardiasis and ascariasis.

Vitamin A absorption was studied using a water-miscible oral preparation of vitamin A in 19 children ages 1 1/2 to 9 years old with giardiasis and/or ascariasis, both before and after their eradication with appropriate therapy, and in three children without parasites. Marked impairment of vitamin A absorption was noted when administered in a water miscible form in children with 1) combined infection with Giardia lamblia and Ascaris lumbricoides, 2) giardiasis alone, and 3) in a proportion of children with ascariasis alone. In children with both giardiasis and ascarasis eradication of the infections promptly lead to a significant improvement in vitamin A absorption and restored it to normal. Children with giardiasis alone also showed improved vitamin A absorption after therapy. In children with ascariasis alone successful therpay did not lead to a statistically significant improvement.

Ascariasis↗

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↗

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↗

PubMed1978

Histopathology in giardiasis: a correlation with diarrhoea.

There is controversy both in regard to the severity of small bowel mucosal damage attributable to giardiasis and to the causal relationship of these changes to the associated diarrhoea. In this series of 17 consecutive patients with giardiasis, small bowel histology and diarrhoea were independently assessed and compared. Disaccharidase assays were performed in 16 of these patients and a repeat biopsy obtained in seven cases. On histological examination the villous architecture varied from normal to sub-total villous atrophy. When these changes were compared with the severity of diarrhoea, a direct correlation was obtained, the more severe symptoms being associated with the more severe villous changes. Repeat biopsy after treatment demonstrated improvement in the histology which correlated with improvement in diarrhoea. Lactase activity was low in all patients with moderate or severe diarrhoea as well as in some patients with mild diarrhoea, two of whom had normal histology. This series demonstrates the occurrence of a spectrum of mucosal changes in giardiasis and supports the concept that these changes mediate the diarrhoea associated with this gut parasite.

Adolescent↗

PubMed1979

Immunoglobulins in serum and duodenal juice and peripheral blood lymphocyte subpopulations in patients with 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.

Adolescent↗

PubMed1979

Giardiasis: a common cause of diarrheal disease.

Giardiasis has been reported increasingly among visitors to the Soviet Union and is found at epidemic and endemic levels in the United States. The main source of infection is contaminated water. Children, homosexual males, and patients with gastrectomy, achlorhydria, hypogammaglobulinemia, secretory IgA deficiency, or alteration in immune status are particularly susceptible to severe, often chronic, infection. Symptomatic giardiasis can be acute, subacute, or chronic. Symptoms are explosive, watery, foul-smelling stools or semisolid stools with evidence of steatorrhea; flatulence; abdominal distention; and weight loss. Diagnosis usually can be established by examination of stool or duodenal fluid for cysts or trophozoites. Quinacrine hydrochloride is the drug preferred for treatment, but metronidazole and furazolidone are also useful.

Diarrhea↗

PubMed1977

Mechanism of malabsorption in giardiasis: a study of bacterial flora and bile salt deconjugation in upper jejunum.

Sixty-three unselected cases of giardiasis, with no evidence of other systemic disease, were screened for evidence of steatorrhoea. No patient had any evidence of protein-energy malnutrition. Seventeen (27%) of the cases had steatorrhoea; three (17-8%) of the 17 patients having steatorrhoea also had D-xylose malabsorption. Vitamin B12 absorption was normal in all. Bacterial culture and qualitative analysis of bile salt in jejunal fluid was carried out in all the 17 cases having steatorrhoea as well as 13 cases with normal absorptive parameters (eight cases of irritable bowel syndrome and five cases of giardia infection) who served as controls. All the patients showing bacterial overgrowth had free bile acids in their duodenal aspirate. Free bile acids could also be detected in jejunal aspirates of five of the seven patients having no bacterial overgrowth. Two control cases of giardia infection with normal small bowel function and sterile duodenal aspirate showed evidence of bile salt deconjugation. The significance of these findings is discussed in relation to the pathogenesis of steatorrhoea in patients with giardiasis. The possible role of giardia in bile salt deconjugation is suggested.

Bacteria↗

PubMed1978

Quantitative histology in giardiasis.

The Weibel graticule was used to assess quantitatively histological changes in proximal jejunal mucosal biopsies from patients with Giardia lamblia infections. Most had malabsorption. A group of patients who had mild abdominal symptoms but no intestinal infection and normal absorption were the controls. There were significant differences in mean surface area (SA) measurements between patients with giardiasis and severe malabsorption and controls (P less than 0.001) and infected patients with normal absorption (P less than 0.05). SA measurements correlated significantly with D-xylose excretion results (r = 0.55; P less than 0.01) and daily facal fat output (r = -0.61; P less than 0.001). Significant correlations between duration of symptoms and SA measurements (r = 0.43; P less than 0.05) and D-xylose excretion (r = 0.43; P less than 0.05) in giardiasis suggest that histological and functional impairment are maximal soon after infection and resolve in time. Treatment with metronidazole or mepacrine was associated with a significant increase in SA (P less than 0.05) in patients with severe malabsorption but there was little change in SA in a similar group of patients who received tetracycline. The Weibel graticule was found to be useful in assessing the severity of histological changes and in following changes after treatment.

Dietary Fats↗

PubMed1978

Tinidazole in the treatment of trichomoniasis, giardiasis and amoebiasis. Report of a multicentre study.

An open multicentre trial was undertaken in 8 countries to assess the efficacy and tolerance of short course treatment regimens of tinidazole Trichomoniasis: of 859 patients with trichomonal vaginitis given a 2g single dose of tinidazole 717 (95.2%) were cured. Side-effects occurred in 82 patients (9.5%) and in 12 were regarded as severe. Giardiasis: of 74 children with symptomatic giardiasis given tinidazole in a single dose of approximately 50 mg/kg body weight, 65 (88%) were parasitologically and symptomatically cured. 2 (2.7%) complained of side-effects, none of which was severe. Intestinal amoebiasis: of 502 patients, comprising 458 adults and 44 children, with symptomatic intestinal amoebiasis who received tinidazole as a single daily dose on 2 to 3 consecutive days, 477 (95%) were parasitologically cured with complete or marked improvement in symptoms. Side-effects occurred in 50 patients (10%) and in 11 were regarded as severe. Amoebic liver abscess: 82 patients were given tinidazole in single doses of 2g on 3 consecutive days. The response was rated as excellent in 60 and good in 17 (overall cure 93.9%). Side-effects occurred in 9 patients (10.9) and in 2 were regarded as severe. These findings confirm the efficacy and tolerance of short regimens of tinidazole given in single daily doses.

Adult↗

PubMed1975

Current perspectives on giardiasis.

Giardia lamblia infestation can cause severe diarrhea and malabsorption, and the diagnosis is usually made by identification of cysts in the feces, but small intestinal biopsy or smears may be required. A wide spectrum of roentgen changes may be seen. In patients with a normal immune status, the small bowel is normal or shows an inflammatory bowel disease pattern. Eradication of the parasite reverses these changes. In some patients with IgA deficiency, nodular lymphoid hyperplasia occurs, and this is usually not reversible. Other patients with hypogammaglobulinemia or dysgammaglobulinemia and giardiasis may show a sprue pattern. This pattern most often persists after eradication of the parasite. Although the triad of giardiasis, IgA deficiency, and nodular lymphoid hyperplasia has a particularly high association, these, together with diarrhea, malabsorption, and various altered immune states may occur in any combination.

Adult↗

PubMed1976

An outbreak of giardiasis in a group of campers.

Thirty-four of 54 campers on a 2 week trip in mountains of Utah had diarrhea during and after their trip. Twenty-two (79%) of 28 symptomatic campers' stools examined contained Giardia lamblia cysts, whereas 4 (29%) of 14 asymptomatic campers' stools had cysts. The temporal distribution of cases and the absence of clustering among food preparation subgroups suggested a common source exposure. Although the epidemiologic data and fecal coliform counts implicated the remote mountain stream used as water source by the group as the vehicle of transmission, Giardia lamblia cysts were not recovered from stream water nor were they found in intestines or feces of sampled mammals living in the drainage area. Twenty-five other campers had stools examined before and after a subsequent hiking trip in another area of Utah; none had Giardia cysts before, but 6 (24%) had them after return. Questionnaires returned by 133 of the campers showed that 5% had an illness compatible with giardiasis within 2 weeks after their trip. These surveys show that campers exposed to mountain stream water are at risk of acquiring giardiasis.

Camping↗

PubMed1978

Giardiasis in American travelers to Madeira Island, Portugal.

A high incidence of diarrhea was reported in a group of approximately 1,400 Americans who traveled to the Portuguese island of Madeira in October 1976. A mail questionnaire survey revealed that 39% of the responding 859 travelers experienced diarrhea; in 42% of these diarrhea lasted for longer than 1 week. The most frequent accompanying symptoms were abdominal cramps (75%), abdominal distention (72%), nausea (70%), and weight loss (40%). Of all travelers surveyed, 33% developed an illness resembling giardiasis with a median incubation period of 4 days. Of 35 ill patients who had a stool culture, enteric pathogens were recovered from 4 (3 Shigella and 1 Salmonella). On the other hand, of 58 ill patients whose stools were examined for parasites, Giardia lamblia was recovered from 27 (47%). Analysis of the epidemiologic data showed that drinking tap-water on the island was significantly associated with illness; eating ice cream or raw vegetables on the island was also implicated. There was no evidence of continuing transmission of giardiasis in American tourists visiting Madeira 8--12 months after the outbreak.

Aged↗

PubMed1979

Giardiasis in infancy and childhood: a prospective study of 160 cases with comparison of quinacrine (Atabrine) and metronidazole (Flagyl).

The therapeutic effects of quinacrine (Atabrine) and metronidazole (Flagyl) were compared in a 3-year prospective study of 160 infants and children (86 boys and 74 girls ranging in age from 4.5 months to 13 years) with giardiasis. The most common symptom was recurrent abdominal pain. In each study group stool examinations were done 5 days, 1 month, and 6 months after treatment. There were no treatment failures with metronidazole, whereas four of those treated with quinacrine had positive stools 5 days after treatment, indicating possible failure. There were no recurrences at 1 month; after 6 months, however, Giardia infection was found in 13% of both treatment groups. These recurrences were seen mainly in children from families with other infected members. Considering the low failure rate, the minimal side effects, and the relatively more tolerable flavor, metronidazole seems to be preferrable in the treatment of giardiasis. A dosage of 15-25 mg/kg a day for 5 days is recommended.

Adolescent↗

PubMed1977

Intestinal giardiasis, steatorrhoea and peripheral nerve dysfunction.

Two patients presented with similar peripheral neuropathic symptoms. Muscle denervation was shown by electromyography and muscle biopsy. Motor and sensory nerve conduction studies were normal. Both patients had intestinal giardiasis: 1 had asymptomatic steatorrhoea, and the other had diarrhoea and abdominal pain. Treatment with metronidazole abolished the gastrointestinal symptoms. After a delay of several months the neurological symptoms also gradually improved. No other cause of peripheral neuropathy was apparent on investigation, and the relationship between the intestinal giardiasis and the peripheral neuropathy is discussed.

Adult↗