Giardiasis

A giardiasis is an infection with the flagellated Giardia intestinalis (lamblia). The infection can be asymptomatic or cause symptoms ranging from intermittent flatulence to chronic malabsorption. The diagnosis is made by detecting the pathogen in fresh stool specimens or duodenal fluid or by the detection of Giardia antigen in stool. The treatment is carried out with metronidazole, tinidazole or nitazoxanide or during pregnancy with Furazolidone and paromomycin.

Trophozoites of Giardia attach themselves to the mucosa of the duodenum and proximal jejunum and reproduce by transverse division. Some pathogens are converted into environmentally resistant cysts that spread via the fecal-oral route. Giardiasis is primarily transmitted through water. but it may be a transfer by intake of contaminated food and due to direct human-to-human contact, especially in psychiatric institutions and day care centers or between sexual partners. Giardia cysts can remain viable in surface water and resist the usual Chlorierungsdosierungen. Even wild animals can act as a reservoir. Therefore, both mountain rivers and chlorinated, but insufficient filtered water from the public water supply have been associated with water-borne outbreaks.

A giardiasis is an infection with the flagellated Giardia intestinalis (lamblia). The infection can be asymptomatic or cause symptoms ranging from intermittent flatulence to chronic malabsorption. The diagnosis is made by detecting the pathogen in fresh stool specimens or duodenal fluid or by the detection of Giardia antigen in stool. The treatment is carried out with metronidazole, tinidazole or nitazoxanide or during pregnancy with Furazolidone and paromomycin. Trophozoites of Giardia attach themselves to the mucosa of the duodenum and proximal jejunum and reproduce by transverse division. Some pathogens are converted into environmentally resistant cysts that spread via the fecal-oral route. Giardiasis is primarily transmitted through water. but it may be a transfer by intake of contaminated food and due to direct human-to-human contact, especially in psychiatric institutions and day care centers or between sexual partners. Giardia cysts can remain viable in surface water and resist the usual Chlorierungsdosierungen. Even wild animals can act as a reservoir. Therefore, both mountain rivers and chlorinated, but insufficient filtered water from the public water supply have been associated with water-borne outbreaks. There are seven genetic groups (assemblages) of G. intestinalis. Two infect humans and animals; the others are host specific. The clinical manifestations seem to vary with the genotype. Symptoms and complaints Many cases are asymptomatic. however, asymptomatic people who may be infectious cysts. Symptoms of acute giardiasis usually appear 1-14 days (mean 7 days) on after an infection. They are usually weak and consist of an aqueous, foul-smelling diarrhea, abdominal cramps and bloating, flatulence, belching, intermittent nausea, epigastric discomfort and occasionally a slight malaise and anorexia. An acute giardiasis usually lasts 1-3 weeks. The malabsorption of fat and sugar can lead in severe cases to a significant weight loss. In the chair, there are no blood or leukocytes. Some patients develop chronic diarrhea with smelly chairs, abdominal bloating and malodorous flatulence. There may be a significant weight loss. A chronic giardiasis sometimes resulting in failure to thrive in children. Diagnostic enzyme immunoassay for antigens in stool Microscopic examination of stool enzyme immunoassay to detect parasite antigens in the stool is more reliable than microscopic examination. The demonstration of characteristic trophozoites or cysts in the stool is diagnostic conclusive, but carried the excretion of the parasites only intermittently and during chronic infections only in low numbers. Therefore, the investigation of repeated stool tests may be required for microscopic evaluation. The extraction of material from the upper intestine can allow the detection of trophozoites, but is rarely required. There are specific DNA probes. The DNA tests are available from the Centers for Disease Control and Prevention (CDC) and are likely to be more readily available in the future in reference laboratories. Therapy tinidazole, metronidazole or Nitazoxanide In symptomatic infections can metronidazole 250 mg p.o. 3 times daily in adults (5 mg / kg p.o. 3 times daily in children) can be used for 5-7 days. This can lead to nausea, headaches and a disulfiramartigen effect when combined alcohol is drunk. Tinidazole 2 g p.o. once in adults (50 mg / kg [maximum 2 g] po in children) is as effective and less toxic than metronidazole. None of these medications should be taken with alcohol. Nitazoxanide is orally administered as follows: age 1-3 years, 100 mg two times a day; Age 4-11 years, 200 mg two times a day and age> 12 years (and adults), 500 mg two times daily. It is available in liquid form for children. Furazolidone and quinacrine are effective, but are now rarely used because of potential toxicity. Metronidazole and tinidazole should not be taken during pregnancy. Nitazoxanide is in pregnancy category B. If can not be postponed a therapy because of symptoms, is the nonabsorbable aminoglycoside paromomycin (8-11 mg / kg po 3 times daily for 5-10 days) is an option. Prevention A prevention requires the adequate public Wasserversorgun, hygienic food preparation and related fecal-oral hygiene. Water can be decontaminated by boiling. Giardia cysts are resistant to the usual chlorine concentration. The disinfection with iodine-containing substances is effective in different ways and depends on the level of turbidity and temperature of the water and the contact time from. Some portable filtration systems can remove Giardia cysts from contaminated water, the efficiency of various filter systems however, has not been adequately studied. The treatment of asymptomatic cyst shedders can theoretically prevent the spread of infection, but the cost effectiveness of this measure is unclear. Key points The main source of giardiasis is the transfer of water, including by newly appearing mountain streams and poorly filtered municipal water supply. Giardia cysts are resistant to the usual chlorine concentration and the disinfection with iodine-containing preparations is effective in different ways. An enzyme immunoassay to detect parasite antigens in stool is preferred because it is more sensitive than microscopic examination. In symptomatic patients tinidazole, metronidazole or Nitazoxanide be used.

Health Life Media Team

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