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Giardiasis: symptoms and treatment in adults and children, prevention

Giardiasis is a disease caused by simple flagellates (lamblias), which parasitize in the small intestine. The causative agent was first isolated in 1681 by Leuvenook, who identified it from the feces of a person with diarrhea.

But a detailed description was given only in 1859 by Lamble, who worked at the Kharkov Imperial University. The name of this scientist is still borne by the disease. However, in the English literature it is called otherwise - jiardiasis (in the Latin name of the causative agent).

The World Health Organization recommends lambliasis to refer any occurrence of lamblia in the body, regardless of whether there are clinical manifestations or whether they are absent (asymptomatic carriage).

The disease is more common in childhood - the frequency ranges from 15 to 20%. In adults, it is about 5 times lower and is 3-4%. The highest incidence of invasion occurs in countries with a hot climate - Asia, Africa and North America.

Content

Etiology and pathogenesis

Ljamblí photo

Ljamblí photo

The cause of the disease is the penetration of lamblia into the human body. These protozoa can be represented by two main forms:

  • vegetative - in which they are in the upper intestine, which is a favorable environment for their life;
  • cystic - formed in the presence of adverse conditions. Usually this happens when the protozoans enter the large intestine. In this form they enter the external environment with faeces, where they remain viable for a long time.

Earlier it was believed that lamblia can live in the gallbladder and biliary tract in the form of cysts. However, at the present time this point of view is recognized as erroneous, because did not find objective confirmation. Therefore, the concept of lambliasis hepatitis and cholecystitis is not legal.

Lamblias 3D photo

3D model of a parasite

The source of infection is a person, mostly a child. A patient or a carrier releases up to 900 million cysts per day. In this case, the infecting dose is only 10-100 pieces. It is important that the cystic form is very stable in the external environment:

  • acids and alkalis can not destroy cysts;
  • active chlorine does not cause their death;
  • Only boiling and freezing to -13 ° C can cause the death of lamblia.

Infection with vegetative forms is not possible, because in the external environment they are not stable. Immediately after leaving the small intestine, these forms die.

Transmission of Giardiasis is carried out in 3 main ways:

  1. Water - drinking water from open reservoirs or un-boiled from the tap.
  2. Contact-household, sold through various items that are invaded by lamblias (children's toys, dishes, bed linens or underwear).
  3. Alimentary, associated with the use of food products, seeded with cysts.

Infection of children can occur and with direct contact with each other, if the sanitary-hygienic regime is violated. Stability of cysts in the external environment determines the potential likelihood of infection of all family members of a sick child and all contactees in a kindergarten or a school of peers.

Therefore, before the exact cause of the intestinal infection of children and adults is determined, they must be examined for lambliasis. To this end, the analysis of blood and feces on lamblia is taken.

However, regardless of the pathway of infection, the cysts must enter the gastrointestinal tract directly. They are resistant to the action of hydrochloric acid, so easily pass the gastric barrier and enter the small intestine. Here one cyst is divided into 2 trophozoites (vegetative form). Giardia is rapidly multiplying, so their numbers are steadily increasing.

The danger of Giardiasis is the nature of the digestive system:

  • chronic inflammation of the duodenum;
  • signs of atrophy of epithelial villi small intestine;
  • violation of the motility of the duodenum with its overflow of the contents coming from the stomach;
  • duodenogastric reflux - entry into the stomach of the contents located in the duodenum;
  • dysfunction of the bile ducts;
  • mechanical damage of enterocytes (epithelial cells of the intestine), which occurs due to suction of trophozoites;
  • violation of the formation of digestive enzymes in the small intestine;
  • development of malabsorption syndrome, i.e. impaired absorption;
  • a change in the species composition of the normal microflora of the large intestine with an increase in the number of Escherichia coli, which is a frequent cause of pyelonephritis;
  • allergic mood of the body, which predisposes to the development of atopic dermatitis (as a concomitant disease it is observed in 80% of cases of lambliasis).

Symptoms of Giardiasis in Adults, photo

Symptoms of Giardiasis in Adults

photos of the first acute manifestations

After the incubation period, which is from 1 to 3 weeks, the first symptoms of giardiasis appear in adults. This invasion can proceed as acute or as a chronic infection.

The onset of the disease is acute - the patient suddenly has a loose stool, in which there is no admixture of mucus and blood (an important diagnostic sign that distinguishes from other intestinal infections). The stool has an unpleasant smell with drops of fat. Pain appears in the epigastric region.

In the intestine, an excess of gas is formed, and an eructation with a hydrogen sulfide smell (odor of a rotten egg) appears. Appetite is reduced, nausea and vomiting are observed, there may be a slight increase in body temperature.

The duration of the acute stage does not exceed 7 days.

In some patients giardiasis can last for several months, that is, it goes into a chronic form. It is characterized by eating disorders and weight loss. In some patients, the manifestations of the disease can disappear on their own in 4 weeks.

If lambliasis has acquired features of a chronic form, it proceeds with periods of exacerbation. They are characterized by:

  • stomach ache;
  • bloating of the intestine;
  • diluted stools;
  • manifestations of hypovitaminosis.

In patients with giardiasis, extraintestinal symptoms may appear. These include rashes on the skin and ulceration of the mucous membrane. In the pathological process, joints can be involved. They swell and become painful. At the heart of this lesion is a malfunction of the immune system.

Symptoms of Giardiasis in Children - photos, features

Symptoms of Giardiasis in Children, photo

Symptoms of Giardiasis in children are very contradictory. They are characterized by great diversity and nonspecificity, so it is very difficult to evaluate in young children. From a practical point of view, this disease in pediatric practice is divided into the following types:

  • acute lambliasis;
  • chronic giardiasis;
  • subclinical forms;
  • asymptomatic carriage.

The acute form occurs in small children and, according to clinical manifestations, resembles a banal intestinal infection (photo). Therefore, its main symptoms are:

  • normal or low-grade fever;
  • spastic pain in epigastrium;
  • bloating;
  • diarrhea persisting for a long time. The chair is plentiful, has a foamy, offensive character;
  • signs of dehydration are absent;
  • duration of the disease from 5 to 7 days;
  • a good response to drug therapy, in some cases spontaneous self-healing may occur.

The chronic form of giardiasis (their prolonged presence in the intestine) is most often observed in people who have a local impairment of the immune status of the intestine - a lack of immunoglobulin secreted by the mucosa.

The main symptoms of the chronic course of Giardiasis are:

  • abdominal pain, having different localization;
  • Periodically occurring disorders of the stool, but diarrhea is never as pronounced as with acute lambliasis;
  • weakness;
  • malnutrition and general development of the child;
  • irritability;
  • sleep disorders;
  • tearfulness;
  • food allergy;
  • atopic dermatitis.

Diagnosis of the disease

Diagnosis of Giardiasis

It is a mistake to focus only on the clinical picture in establishing a diagnosis. The diagnosis of Giardiasis can only be suspected, and not established when the following symptoms are combined:

  1. Stomach ache;
  2. Dyspeptic manifestations;
  3. Asthenoneurotic complaints - tearfulness, irritability, emotional lability;
  4. Reinforcement or appearance of allergic reactions;
  5. Increased level of eosinophils in the blood.

In case of objective examination, increased pigmentation can be detected in the peri-pooch area and along the white line of the abdomen. However, the most informative diagnostic methods are:

  • microscopic examination of feces (examined both colored and native, i.e., unpainted smears);
  • polymerase chain reaction (the biological material is feces). However, the application of this method is limited due to its high cost.

Coenzyme examination (microscopic examination of feces) is characterized by 50% confidence in a single analysis. This is due to the periodicity of cyst release into the environment. Therefore, to increase the accuracy of the survey, the analysis should be done three times at intervals of several days.

In this case, great importance should be given to transportation time - not later than one hour from the moment of defecation. With a longer time interval, the vegetative forms are destroyed.

Also, blood can be taken for giardiasis for serological examination. It involves determining the titer of antibodies, which can be acute-phase and memory antibodies.

However, serological analysis at the present time can not be considered a basis for establishing an accurate diagnosis. If it is positive, then it is required to carry out either threefold microscopy of feces, or PCR with feces.

Treatment of giardiasis in children and adults

Treatment of giardiasis in children is divided into etiotropic (directed to the pathogen) and symptomatic. The last includes:

  • correction of digestive disorders;
  • restoration of intestinal flora (prescribing probiotics is an important and obligatory direction, since it increases the effectiveness of antiparasitic therapy);
  • fight against secondary disorders.
Treatment of Giardiasis Photo

Treatment of Giardiasis Photo

For etiotropic therapy, anti-cambiotic drugs are prescribed that can be used in children and adults:

  1. Metronidazole. In children's practice, its use is allowed from 12 years;
  2. Tinidazole - children can be from 3 years of age;
  3. Ornidazole;
  4. Furazolidone;
  5. Nifuratel;
  6. Albendazole - can be used from 2 years of age. This is the drug of choice in young children.

It should be noted that in the modern literature there are no clear criteria for initiating antiparasitic therapy. Therefore, this issue is solved individually by a doctor.

The calculation takes the following data:

  • Severity of symptoms and duration of its existence;
  • Presence of allergic manifestations;
  • Presence of concomitant diseases;
  • The state of the immune system of a child or adult;
  • The effectiveness of previous anti-amliasis therapy.

Data on the effectiveness of various regimens for treating Giardiasis in adults and children are controversial. This is due to the different spectra of the effects of pharmacological drugs and the different immune status of a person.

In addition, some medications are losing their effectiveness due to the growing resistance of parasites to them. So, there is information about the insensitivity of lamblia to Metronidazole, Ornidazole and Tinidazole.

Therefore, currently the drug of choice is Nifuratel. It perfectly combines high efficiency, good tolerability and low risk of development of resistance.

At the same time, dietary nutrition is required. It can create unfavorable conditions for multiplication of protozoa and intensify the action of antiplatelet drugs. The food ration should be enriched with proteins, and the amount of carbohydrates should be reduced to a minimum. they promote the reproduction of bacteria.

Consequences and complications of Giardiasis

Giardiasis can lead to the development of specific and nonspecific complications. Therefore, it is required to adhere to an individual approach to treatment and timely prescribe antiparasitic drugs in the presence of indications.

Specific complications include:

  • urticaria ;
  • angioedema;
  • arthritis;
  • ophthalmopathy (eye damage);
  • Myopathy associated with a decrease in the level of calcium in the blood.

Nonspecific complications are:

  • hypovitaminosis;
  • nutritional insufficiency due to impaired absorption in the intestine;
  • stratification of concomitant diseases;
  • asthenovegetative syndrome, etc.

Prevention of Giardiasis

Prevention of Giardiasis

Prevention of re-infection with lamblia means strengthening the hygienic regime. It is also necessary to identify the source of infestation - for this, the members of the family and the children's team are examined.

To prevent primary infection, the following rules must be observed:

  1. To wash hands;
  2. Use only boiled water (boiling kills cysts);
  3. Wash vegetables and fruits;
  4. Timely detection of sick children;
  5. Preventive examination of people engaged in cooking.

Which doctors should be treated with suspicion?

If suspected of giardiasis, you need to contact an infectious disease specialist. The doctor will send for an additional examination and tell you how to properly assemble and transport the material to the laboratory.

With the results obtained, the infectious disease specialist should be visited again, who will establish an accurate diagnosis and determine whether treatment is required or not.

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