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home - Small Bowel - Small Bowel Infections - Giardia Written by Dr Sebastian Zeki

Giardia

n G. lamblia contains an immunodominant antigen which is a heat shock protein; trophozoites express this antigen when put into media that resembles the constituents of the human gastrointestinal tract.The surface protein VSP engenders an antibody response; one study showed that two distinct portions of VSP, a variable N terminal region and a more conserved C terminal region, stimulate differing antibody responses at different stages of infection .Chronic exposure gives partial immunity as per a) Children >adults in endemic areasb) Travellers> residents in endemic areas ....for acute giardiasisMore severe and longer disease if IgA deficiencies Symptoms: As acute but usually loose stools rather than diarrhoea Giardiasis Can develop chronic without previous symptoms 40% Exposure Chronic giardiasis Acute giardiasis Symtpoms:Diarrhea that is sudden in onset and may be initially watery — 90 %.Malaise in 85 % .Steatorrhea in 70 %.Adominal cramps and bloating in 70 %.Flatulence in 75 %.Nausea in 70 %.Weight loss in 65 %.Vomiting in 30 %.Fever -occurs in only 10 to 15 % of patients and may be unrelated to giardiasis. Asymptomatic infection — Occurs in 60% of exposees.Cyst carriage can last >6/12. Treatments:Inidazole.Metronidazole.Quinacrine.Furazolidone.Nitazoxanide.Bacitracin. Diagnostic Methods:Stool microscopy-Loose for trophozoites, formed for cysts (90% sensitivity with 3 stool samples).Immunoassays (95% Se and Sp) including ELISAand non-enzymatic immunoassays.Duodenal aspirates or biopsies , serology, culture and PCR are not used or not useful. Immune mechanisms may dictate the chronicity of giardiasis.........

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