Giardiasis

Giardiasis (lambliosis; synonym giardiasis) is a disease caused by infestation of Giardia, manifested functional disorders of the small intestine.

intestinal Giardia
Intestinal Giardia:
1 - vegetative individual; 2 and 3 - cysts.

Etiology. Pathogen - intestinal Giardia (Lamblia intestinalis) - first described in 1859 Russian scientist D. F. Emblem.
Giardiasis is widespread. In the development of Giardia distinguish two stages - vegetative stage and cysts. Giardia on the vegetative stage have the form of a cut in half pears with pressively disk, which are attached to the lining of the small intestine; at the stage of cysts - irregular oval shape (Fig.).
Epidemiology. The source of infection is a person. Infection occurs by eating infected cysts food, especially not subjected to heat treatment (vegetables, berries, fruits), and water, and through contaminated cysts hands and household items.
Pathogenesis. The major habitats of Giardia in the human body are duodenum and the initial portion of the jejunum. Parasites attached to the villi of the mucous membrane of thin intestines and, apparently, consume foods wall digestion. When duodenal intubation with mucosal Giardia washed down the bile and solution of magnesium sulfate, which is injected to get reflex gallbladder, therefore Giardia can get to any portion of duodenal contents. Detection of Giardia in portions "b" and "C" of duodenal content is not proof of etiological role in their occurrence cholecystitis and other lesions of the hepato-biliary system, because gallbladder bile is a difficult environment for lamblia.
Giardia are not tissue parasites do not cause destructive changes of the mucous membrane of the intestines. Not proven selection Giardia toxin, so there is no reason to speak about intoxication giardiasis.
Mechanical irritation Giardia interoreceptors small intestine may cause reflex violation of its functions, that, apparently, can be a cause of violations of physiology of digestion in the small intestine. Often pathogenic role of Giardia exaggerating.
The clinical picture. The disease is usually mild. Usually appear stupid, rarely sharp cramping pain in the epigastrium or in the area of the navel, nausea, flatulence, constipation, changing profuse diarrhea, feces yellow, sometimes with a small admixture of mucus.
Laboratory diagnosis is crucial and is based on the detection of vegetative forms of Giardia in the duodenal contents, pasty or liquid stool and cysts are decorated in Calais, in natural and dyed Lugol solution smears. In Calais often found crystals of fatty acids. There is a violation of intake of fat.
The prognosis is favorable.
Treatment. Adults hold a one-day course of treatment with Akrikhin 0.3 g 2 times a day after 6 hours. In patients with resected stomach or with gistaminolitiki ahilia Akrikhin not effective. In these cases it is advisable to use furazolidone or metronidazole (flagyl).
Furazolidone assign inside adult but 0.1 g 4 times a day 1 hour after meals for 5 days.
Metronidazole assign inside adult for the 0.25 g 2-3 times a day after meals for 5 to 10 days.
Prophylaxis of giardiasis is the same as for intestinal infections.

Giardiasis (lambliosis; synonym giardosis)is a disease caused by infestation of Giardia and often manifested by the defeat of the intestine, gall bladder and liver.
Giardiasis is widespread, mainly in children.
Etiology. The disease first described by the Russian scientist D. F. Emblem in 1859 Genus Giardia includes a large number of species. People invazirujutsja one - intestinal Giardia (Lamblia intestinalis). In the development of Giardia distinguish two stages-vegetative stage and cysts (Fig). The vegetative form of the parasite resembles a pear, has a large suction Cup, which is attached to the epithelium of the intestines and bile ducts. In the intestines, it forms oval cyst 10-14 MK long. Cyst resistant to external influences and long retains the ability to invasion, unlike unstable vegetative forms. The hot climate and chronic diseases of the gastrointestinal tract contribute to incursions.
The main parasite reservoir serves the people. Giardia cysts are excreted from the body with faeces. Infection occurs through food and water contaminated with cysts. Contribute to the spread of Giardia adverse health conditions, in particular the flies that transmit cysts.
Pathological anatomy. In the duodenum, then in the small intestine, the vermiform Appendix and less in the colon are observed inflammatory changes until hemorrhagic foci of inflammation and ulcers. Changes in the liver are expressed in diffuse parenchymal process, interstitial hepatitis and even cirrhosis. The gallbladder is inflamed mucosa his swollen with infiltrates and enlargement of the connective tissue, can be covered with fibrinous the exudate, epithelium it often desquamative.
The pathogenesis is associated with reproduction in the tissues of the vegetative forms of parasites. This happens when dissolved shell cysts juice duodenum. Parasites attached to the epithelium of intestinal villi. Prior inflammatory changes in the intestine contribute invasion of Giardia and changes due to last - secondary infections, infestations, protozoa and helminths and protracted illness.
Frequent finding in the gall bladder and bowel movements significant amounts of Giardia in the absence of pathological changes of the gall bladder and intestines, and any complaints in the examined people gives you the right to assert that infection with Giardia may be in the form of asymptomatic carriage.
Products metabolism and decay of Giardia absorbed into the blood, and reflex can cause toxic reactions, as expressed in the deterioration of the General condition, anemizatsii, mental, vascular, gastric disorders. Sensitizing effects of Giardia is manifested in allergic reactions (urticaria, skin itching, joint pain, fever). Specificity of sensitization is confirmed by the intradermal tests with specific allergen.


The clinical picture. Clinically are distinguished: 1) giardiasis dominated local violations: intestinal form (duodenitis, enteritis, appendicitis), hepatic form (cholangitis, cholecystitis, hepatitis); 2) giardiasis dominated common manifestations (vegetodystonia, gastrostomy, anemia); 3) a combination of different forms of local violations (for example, enterocolitis, holetsistopatii), a combination of local violations with disorders of the nervous, cardiovascular and other systems, changes in blood; 4) labionasal.info.
The disease is periodic, low fever, frequent defecation, the advent of liquid mucous, sometimes bleeding bowel movements, sometimes green, frothy. When eating or after pain in the abdomen, located at enteritis around the navel and is somewhat higher, accompanied by rumbling and transfusions in the same area. Radiographically find at times deformation of the duodenal bulb. Duodenal-gelnhaeuser symptoms are rare.
Appendicular form occurs in approximately 10% of patients. With the same frequency Giardia find in the content of the remote vermiform process in patients with chronic appendicitis.
Lamblia enterocolitis have chronic relapses, diarrhea alternate with constipation, rarely are only constipation. In addition to the phenomena enteritis, pain can be observed in the sigmoid and descending colon intestine, which at times spasticeski reduced or overblown. Some patients giardiasis develop hypoproteinemia, hypovitaminosis. Cholangitis giardiasis often takes chronic. During exacerbations appear dull pain in the right hypochondrium, a pain when tapped on the liver, small yellowness, low-grade fever.
Sometimes giardiasis is manifested as acute acalculous cholecystitis with an attack of pain in the epigastric region and right hypochondrium, radiating to the right shoulder blade, a rise in temperature and the transition pain several hours later in a blunt. Muscle tension even in the gall bladder is usually absent and still deep palpation in the right hypochondrium. Urobilinemia observed in adults and older children.
Meet lamblia cholecystitis, imitating cholelithiasis; sometimes these patients operate.
Giardiasis hepatitis is manifested by the increase and hardening of the liver, soreness or sensitivity to palpation, a symptom Ortner (pain effleurage on the right costal arch elbow part of the palm or fist), increase (small) bilirubin, alpha-globulin in the subgroup globulin fractions, urobilin in the urine, by increasing the activity of transaminases in the blood, often a violation of antitoxic function of the liver.
Liver damage may be combined with cholangitis and cholecystitis. Cirrhosis giardiasis are rare. Often the damage to the pancreas, mainly by reducing exocrine function with a decrease in the concentration of lipase, trypsin and diastase. Chronic pancreatitis is a rare.
To reflex offences include frequent changes of gastric juice acidity, especially its reduction, diarrhoea phenomenon, cardiovascular disorders in the form of increased excitability, occasionally unpleasant feelings in the heart area.
Toxicosis giardiasis is manifested in fatigue, peticesti, slezlivo, irritability, headaches and muscle pains, lag children in development, increased sweating, trembling fingers. Giardiasis is sometimes attributed to coronary angioneurosis, thyrotoxicosis, neurodermia, loss of consciousness, depression.
The change of blood can be expressed hypochromic and less hyperchromic anemia, leucocytosis with a shift of neutrophils sometimes to promielozitov, leukopenia, infrequent eosinophilia and limfotsitoz.
Diagnosis of giardiasis is proved by the discovery of parasites in the duodenal contents or stool by research native or dyed products. Diagnostics is improved in many studies with intervals of 2-3, 7-10 days in the accounts chamber Goryaeva. The differential diagnosis should be carried out with chronic disorders of the liver and small intestine, and the children - with appendicitis.
Forecast for life favorable. Full recovery with the release of parasites sometimes requires persistent re-treatment.
Treatment consists of several courses of reception protestantische preparation of Akrikhin. Various schemes mainly differ in the length of the course (from 3 to 8 days) and in intervals between them (3-5 days). The drug 3 times a day for half an hour before meals. Single dose for adults and adolescents 14-16 years 0,1 - 0,15 g In some patients, treatment with Akrikhin leads to recovery and exemption of Giardia. Mixed disease requiring treatment by a combination of acting against all diseases. Successfully protivolyamblioznye treatment furazolidonom. Valuable property of this drug is associated effect on pathogens of dysentery, Salmonella and enterocolitis a mixed infection. A single dose of furazolidone 0.1 g for people aged 16-18 years appoint 4 times a day, for more than adults to 5 times a day. Treatment refresher courses for 5 days. Furazolidone after taking food and drink plenty of fluids.
The proposed complex treatment of furazolidone (daily dose of 0.4 g) with erythromycin (daily dose of 800 000-1 000 000 IU); take 3-4 times a day before meal, not liquid. Children dose reduced accordingly. If necessary, a second course of treatment can be carried out after 5-8 days.
Recommended as treatment for aminohinol: three cycles of 5 days from the reception of the drug in one dose of 0.15 g 3 times a day for five days between cycles. The drug does not cause adverse reactions.
Protivolyamblioznye therapy should be accompanied pathogenetic treatment. If indicated it includes stimulation of the body with transfusions of plasma, blood, autohemotherapy, the introduction of vitamins, struggles with anemia, gastric disorders. Inflammation of the bile ducts are an indication of the diet, inflammatory and choleretic drugs, thermal procedures.
Prophylaxis of giardiasis is the same as intestinal infections.