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

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

Nodular lymphoid hyperplasia (NLH) has been firmly associated with syndromes of hypogammaglobulinemia but not with selective absence of IgA. We report the case of a 5-yr-old girl with the triad of selective IgA deficiency, NLH of the small bowel, and giardiasis. Results of an extensive immunologic investigation, including immunohistochemical examinations of small bowel biopsies, support the hypothesis that the basic defect responsible for IgA deficiency in this patient was the failure of precursor IgM-bearing lymphocytes to differentiate into IgA-producing plasma cells. Furthermore, the abundance of IgM-bearing cells in biopsy specimens demonstrates the existence of a compensatory mechanism in the intestine to substitute IgM for the absent IgA.
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PMID:Selective immunoglobulin A deficiency associated with modular lymphoid hyperplasia. 51 69

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.
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PMID:Current perspectives on giardiasis. 110 21

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

Fifteen cases of nodular lymphoid hyperplasia (NLH) of the bowel in patients aged 17 months to 15 years are reported. Fourteen patients had NLH confined to the small bowel and one had involvement of both the small bowel and colon. Mean age at diagnosis was 10 years. The most common presenting symptoms were intestinal manifestations (86%). Diagnosis was suspected upon roentgenographic studies in one case and digestive endoscopy in ten cases. Histologic confirmation was obtained in all fifteen patients. Immunohistochemical studies, done in 8 patients, demonstrated a paucity of IgA plasmocytes in one patient with an immune deficiency and a polyclonal plasmocyte population with mainly IgA plasmocytes in the seven other patients. Five patients had a deficiency in humoral immunity, with variable expression hypogammaglobulinemia in three patients and IgA deficiency in two; intestinal giardiasis was found in eight patients. Histologic outcome was documented in five cases; evidence of NLH disappeared in only one patient. Metronidazole improved clinical symptoms in most instances.
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PMID:[Lymphoid hyperplasia of the intestine in children. 15 cases]. 149 85

Among 10 children with giardiasis, eight had iron deficiency; iron deficiency anemia was the main complaint in three. Evaluation of iron absorption by the oral iron load test demonstrated a subnormal response (i.e., increase in serum iron levels of less than 100 micrograms/dl) in all eight patients with iron deficiency. In contrast, in two iron-sufficient patients with giardiasis the response to an oral iron load was normal. Xylose absorption was abnormal in five of the 10 patients. After metronidazole dosing, iron absorption became normal in seven patients but remained abnormal in one patient, who also had IgA deficiency. Xylose absorption became normal in all five patients who underwent a second test, but remained abnormal in the patient with IgA deficiency. Concomitant morphologic-studies of jejunal biopsy material from these patients revealed moderate changes in the intestinal mucosa of two patients. We conclude that malabsorption of iron is a complication of giardiasis.
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PMID:Iron malabsorption in giardiasis. 400 42

Eight adults presenting with giardiasis to a gastrointestinal unit during a two year period were studied in detail. Symptoms were varied, diarrhoea occurring in only five patients. Four of the eight gave a history of travel to endemic zones, and three of those who gave no such history had possible predisposing conditions (gastric surgery (2), and borderline IgA deficiency (1]. Most patients exhibited mild malabsorption of fat and vitamin B12, and some abnormality of jejunal disaccharidases was usual. Jejunal histology varied from normal to partial villous atrophy, and the intraepithelial lymphocyte count was raised in those patients with the most marked histological abnormality. Treatment with metronidazole was uniformly successful, and most of the above abnormalities reverted to normal within a month of treatment.
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PMID:Clinical studies in adults presenting with giardiasis to a gastro-intestinal unit. 401 71

An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of Giardia lamblia in human feces. The assay could detect between 37 and 375 trophozoites from cultures and between 12.5 and 125 cysts purified from human stool. Stool specimens were positive by ELISA in 36 (92%) of 39 patients with giardiasis; negative specimens came from patients with low numbers of parasites in their stool. In 10 patients stools became negative by ELISA after successful treatment. Stool specimens were positive by ELISA in three (2%) of 128 patients without demonstrable Giardia organisms in their stools; one positive specimen was from a child with IgA deficiency and diarrhea who responded clinically to metronidazole. The ELISA is a simple, sensitive, and specific diagnostic test for G lamblia that will be useful in diagnosis, in follow-up treatment, and in large-scale studies directed at defining the epidemiology and pathophysiology of G lamblia infection.
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PMID:Enzyme-linked immunosorbent assay for the detection of Giardia lamblia in fecal specimens. 636 69

23 patients with gastroenteritis and 9 with severe malabsorption syndrome related to giardiasis were investigated in a semi-prospective fashion as follows: (1) conjugated bile acid levels measured in duodenal aspirate (thin layer chromatography) in 6 patients with steatorrhea. (2) intraepithelial lymphocytes count (results expressed as the number of intraepithelial lymphocytes per 100 epithelial cells) in small intestinal biopsies from the 32 patients, 11 of which had immunoglobulin deficiency (9 IgA deficiency). The results indicate that there is no decrease in the percentage of conjugated bile acids (mean percentage 90%; normal = 80); a significantly increased percentage of intra-epithelial lymphocytes is documented in giardiasis (11.1% +/- 6.7), versus 2.3% +/- 0.5 in acute gastroenteritis (9 patients) and 6.3 +/- 0.5 in chronic diarrheas (6 patients) (p less than 0,001). This percentage, however, is significantly lower than in untreated coeliac sprue (23 patients) (12.17 +/- 11.6) (p less than 0,01). Conversely a high intraepithelial lymphocyte count does not correlate with the degree of intestinal villous atrophy (3 patients had severe and 6 partial villous atrophy) (r = 0.170). IgA deficiency should be suspected in patients with giardiasis presenting with intestinal villous atrophy (5 patients). Steatorrhea in our patients does not appear related to bile acid deconjugation. To explain enterotoxicity in giardiasis, more than a direct effect of the ventral disk of the parasite on intestinal mucosa, one should incriminate the host immune cell mediated response as shown by lymphocytic infiltration of the epithelium on small bowel biopsies.
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PMID:[Enteropathogenic mechanisms involved in giardiasis in children (author's transl)]. 710 70

Two patients had IgA deficiency, giardiasis, and the HLA-B8 antigen. The family of patient 1 included members with juvenile-onset diabetes mellitus, adrenal insufficiency, pernicious anemia, and hypothyroidism, a combination of unusual diseases that has been reported previously to occur as a syndrome with IgA deficiency and the HLA-B8 antigen. This coincidence makes it likely that these two patients and the one family previously described have a common pathogenic base, the inheritance of an abnormal immune-response gene that is acquired with the HLA-B8 antigen as a result of genetic dysequilibrium.
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PMID:Selective IgA deficiency and the HLA-B8 antigen. Report of two cases with familial data. 721 94


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