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Query: UMLS:C0017536 (giardiasis)
 1,714 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The practical approach to the investigation of diarrhea must be logical and based on anatomic considerations. The site of the underlying disorder may be determined by the clinical picture, and the logic of investigation will be influenced by the history. Important specific investigation in a case of colonic diarrhea include a careful rectal examination, stool inspection, sigmoidoscopy, rectal biopsy and barium enema study. Colonoscopy has been used, but its role has yet to be defined. In a case of small-bowel steatorrhea or diarrhea quantitative chemical estimation of the daily output of stool fat is useful, and to this investigation is added a small-bowel radiograph series and, if the radiographic findings are abnormal, small-bowel biopsy. Other investigations for small-bowel disease may include the breath test with carbon-14-labelled glycocholic acid, the lactose tolerance test, duodenal aspiration for giardiasis, analysis of serum immunoglobulins and, on occasion, isolation of vasoactive intestinal polypeptide hormone (which may aid the diagnosis of functioning tumours of the pancreas or small bowel). Investigations for pancreatic steatorrhea include abdominal radiography, performance of the secretin test and testing of the response to pancreatic replacement therapy. In some patients it may be useful to use endoscopic retrograde cholangiopancreatography to differentiate pancreatic carcinoma and chronic pancreatitis.
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PMID:Symposium on diarrhea. 3. Investigation of chronic diarrhea. 19 Nov 73

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.
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PMID:Intestinal giardiasis, steatorrhoea and peripheral nerve dysfunction. 21 1

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.
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PMID:Giardiasis: a common cause of diarrheal disease. 49 84

Fifty patients with late-onset idiopathic immunoglobulin deficiency were studied and the frequency of various clinical associations and complications was observed. Men and women were equally affected, although the age at onset in men peaked in the third decade whereas it was more uniformly distributed in women. Sinobronchopulmonary infections were common and were caused by Haemophilus influenzae. Diplococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus: bronchiectasis occurred in 28 per cent. Thirty patients (60 per cent) had diarrhea, which was often associated with steatorrhea, giardiasis, achlorhydria, abnormal Schilling tests and morphologic abnormalities on small bowel biopsy specimens, including nodular lymphoid hyperplasia; three patients had pernicious anemia. In the 20 patients without diarrhea these abnormalities were not observed except for giardiasis in one patient and achlorhydria in two patients. Cholelithiasis occurred in both groups in about a third of the patients tested. A high degree of susceptibility to neoplasia was noted. Thyroid abnormalities, including primary hypothyroidism and Graves' disease, were observed in six patients. Additional occasional findings were vitiligo, keratoconjunctivitis sicca and arthritis. Splenomegaly occurred in 14 (28 per cent) patients. The percentage of B lymphocytes in the blood was determined in 10 patients; it was normal or slightly decreased in eight patients and low in two patients.
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PMID:Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients. 78 41

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.
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PMID:Mechanism of malabsorption in giardiasis: a study of bacterial flora and bile salt deconjugation in upper jejunum. 85 75

Malabsorption was present in 29 of 40 symptomatic patients with giardiasis. Twenty-three had impaired D-xylose absorption; in 20 vitamin B12 absorption was low, and 15 patients had steatorrhoea. More severe malabsorption was associated with more marked histological abnormalities. Metronidazole, 2-0 g as a single daily dose on three successive days, produced a parasitological cure rate of 91%. In contrast, the standard course of mepacrine, 100 mg thrice daily for 10 days, eradicated the parasite in only 63% of patients. Improvements in absorption and jejunal morphology followed anti-giardial treatment. Tetracycline in eight patients failed to eradicate the parasite, intestinal absorption was unaltered, and histological appearances of the jejunal mucosa often deteriorated.
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PMID:Giardiasis: clinical and therapeutic aspects. 87 19

The recent near-epidemic incidence of Giardia lamblia infection in visitors to the Soviet Union illustrates the importance of this intestinal flagellate as a cause of diarrhea in travelers worldwide. Clinical states range from the asymptomatic cyst-passing stage, to the chronic or subacute stage mimicking gallbladder or ulcer disease, to the transient or, rarer, persistent acute stage with steatorrhea and substantial weight loss. Symptoms may be related to IgA deficiency. Secondary lactose intolerance may follow eradication of the parasite. Diagnosis is usually based on repeated stool examinations or examination of duodenal contents. Quinacrine hydrochloride is the most effective treatment, but metronidazole and furazolidone are also useful. Contaminated water is the most likely source of infection.
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PMID:Giardiasis. 117 8

Giardiasis is still regularly encountered in the United States, both as endemic cases from the local community as well as in patients returning from travel abroad. Giardiasis should be suspected in any child with steatorrhea, unexplained chronic diarrhea (especially if associated with growth failure), weight loss, or abdominal pain and bloating. Duodenal aspiration or small intestinal biopsy may be necessary to make a diagnosis because Giardia lamblia are not found by stool examination in 50% of symptomatic individuals. A diagnosis of giardiasis is important because the disease is curable.
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PMID:Giardiasis in childhood. 119 Jan 62

Giardiasis is one of the most common pathogenic intestinal protozoal infections worldwide. Giardia lamblia is the most frequently identified etiologic agent in outbreaks associated with the ingestion of surface water, often due to ineffective filtration or pretreatment. In addition to humans, other sources of infection include beavers, perhaps muskrats, and possibly domestic animals. A low infecting dose (10 to 25 cysts) is reported to be sufficient to produce human infection. Clinical manifestations range from asymptomatic to a transient or persistent acute stage, with steatorrhea, intermittent diarrhea, and weight loss, or to a subacute or chronic stage that can mimic gallbladder or peptic ulcer disease. Diagnosis is usually based on repeated stool examinations but examination of duodenal fluid or biopsy material may also be necessary. Enzyme immunoassay or indirect immunofluorescence methods for direct detection of antigen or whole organisms in clinical specimens have also been developed. These tests are reported to be more sensitive than routine stool examination. Demonstration of serum immunoglobulin M and G antibodies may help differentiate recent from past infection or help detect recurrence in individuals who have been treated previously. Serum immunoglobulin A levels may be a useful indicator of exposure in waterborne outbreaks of diarrhea. Drugs available for treatment within the United States include metronidazole, quinacrine hydrochloride, and furazolidone.
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PMID:Giardiasis. 173 95

The clinical-pathological characteristics of 11 patients with intestinal nodular lymphoid hyperplasia (INLH) are described. Five fulfilled the criteria for Herman's syndrome and presented all or several of the following alterations: dysgammaglobulinemia, recurrent respiratory tract infections, sinusitis, pneumonia and giardiasis; of the remaining six cases, in five gammaglobulin levels were not quantified and in one they were normal. All the patients in this group suffered from recurrent pharyngotonsillitis, and Giardia lamblia was isolated in four. In both groups the INLH occurred in young patients with an average age of 21 years. Eight of the 11 were men. The most frequent symptoms included diarrhea, steatorrhea and weight loss. Radiologically, INLH usually was a finding affecting the jejunum and/or the ileum. Prominent lymph nodes in mucosa and submucosa were documented histologically in all cases, and a large decrease or absence of plasma cells in the lamina propria was seen in 7 of the 11. In spite of the diversity in the treatment schemes instituted, symptoms persisted for months or years after diagnosis. In two cases (one with dysgammaglobulinemia and one without) associated intestinal lymphoma existed. Other associated diseases included non-deforming joint arthritis, erythema nodosum, and intestinal infection by E. coli and Entamoeba histolytica.
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PMID:[Nodular lymphoid hyperplasia of the intestine. Clinico-pathologic characteristics in 11 cases]. 227 Mar 66


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