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Giardiasis.
Aetiology
Organism is Giardia lam blia.
Infection occurs by ingestion of cysts through contaminated water or by faecal-oral route.
Trophozoites attach to the mucosa of duodenum and jejunum, causing alteration in small bowel functions. Most often, there is no local destruction or invasion. Malabsorption which occurs in many patients, is due to loss of brush border enzyme activities while in some cases, there is flattening of villi.
Patients with hypogammaglobulinaemia suffer from prolonged and severe infection that may be unresponsive to standard treatment.
Clinical features
Incubation period is 1-3 weeks.
Starts as diarrhoea, nausea, vomiting, anorexia, weakness and abdominal pain. Fever and blood in stool are rare. e Symptoms may persist from a few days to weeks or months to years.
Individuals with chronic giardiasis may present with or without having experienced antecedent acute symptoms. Diarrhoea may not be a prominent symptom in these patients who often have increased flatus, loose stools, malabsorption, weight loss and growth retardation.
Investigations
Repeated examination of stool for cysts.
Detection of giardia antigen in stool.
Duodenal or jejunal fluid microscopy will demonstrate the organism.
Jejunal biopsy shows the giardia on the mucosa.
Long-standing cases show steatorrhoea, malabsorption of xylose and vitamin B1, and lactose intolerance.
Treatment
Tinidazole 40 mg/kg as a single dose, repeated after 1 week.
Metronidazole 2 g daily for 3 days or metronidazole 200 mg thrice daily for 7 days. e Quinacrine hydrochloride.
Metronidazole 800 mg TID for 3 weeks in refractory cases.
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