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Giardiasis

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

Etiology . The causative agent - intestinal lamblia (Lamblia intestinalis) - was first described in 1859 by Russian scholars. F. Lyamble.

Giardiasis is widespread. In the development of lamblia, two stages are distinguished - the vegetative stage and the cysts stage. Giardia at the vegetative stage are in the form of a pear cut in half with a suction disc, with which they attach themselves to the mucous membrane of the small intestine; at the cysts stage, an irregular oval shape (fig.).


lamblia intestinalis
Intestinal lamblia (Lamblia intestinalis):
1 - vegetative individual; 2 and 3 - cysts.

The parasite Giardia lamblia (G. lamblia) can cause an infection of the digestive tract, in fact, it is an infection of the duodenal mucosa in humans. Symptoms of giardiasis are very diverse. The most characteristic and frequent are mild or moderate symptoms of the abdominal cavity, bloating due to intestinal gas, pain, belching, and rarely colic. Giardiasis should be suspected if the above symptoms last about ten days. Diarrhea, which lasts less than a week without any therapy, is most likely not giardiasis.

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If chronic giardiasis develops in victims, the resorption of fats, lactose, proteins and fat-soluble vitamins is disturbed. Malabsorption syndrome can develop, especially in children. Many infected people do not have symptoms and signs of giardiasis, and the majority of those infected throughout the world are virtually asymptomatic carriers.

Lyamblia is a cosmopolitan parasite that affects people of all ages and different socio-economic conditions. High risk groups for infection: children; staff in infant care centers; Persons in closed communities (psychiatric institutions, centers for high-risk children and adults, prisons); then international travelers; promiscuous individuals (especially homosexuals); immunodeficient patients and their family members are also at increased risk.

Epidemiology . The source of infection is man. Infection occurs through the use of food infected with cysts, especially not subjected to heat treatment (vegetables, berries, fruits), and water, as well as through hands contaminated with cysts and household items.

Pathogenesis . The main habitat of Giardia in the human body is the duodenum and the initial part of the jejunum. Parasites attach to the villi of the mucous membrane of the small intestine and, apparently, feed on the products of parietal digestion . During duodenal sounding, Giardia is washed from the mucous membrane with bile and magnesium sulfate solution, which is injected to produce a reflex of the gallbladder, hence Giardia can get into any portion of the duodenal contents. Detection of Giardia in portions "B" and "C" of duodenal contents is not evidence of their etiological role in the occurrence of cholecystitis and other lesions of the hepato-biliary system, since gallbladder bile is an unfavorable medium for Giardia.

Giardia are not tissue parasites, do not cause destructive changes in the intestinal mucosa. Isolation of tombin by giardia has not been proven, so there is no reason to talk about intoxication with giardiasis.

Mechanical irritation of the intestinal interoceptors by lamblia can lead to a reflex impairment of its function, which, apparently, can be a cause of impaired physiology of digestion in the small intestine. Often, the pathogenic role of Giardia is exaggerated.

The clinical picture (signs and symptoms). The disease is usually mild. Usually, dull, rarely acute, colic-like pains in the epigastrium or in the navel , nausea , flatulence, constipation, alternating with profuse diarrhea , yellow stool, sometimes with a slight mucus.

Laboratory diagnosis is crucial and is based on the detection of vegetative forms of giardia in the duodenal contents, in mushy or liquid stool and cysts in the excreted feces , in native smears and stained with Lugol's solution. In the feces are often found crystals of fatty acids. There is a violation of fat absorption.

The prognosis is favorable.

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Treatment . Adults undergo 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 histamine-resistant achilia, acrihin is not effective. In these cases, it is more appropriate to use furazolidone or metronidazole (flagel).

Furazolidone is prescribed orally for adults but 0.1 g 4 times a day 1 hour after meals for 5 days.

Metronidazole is administered orally by adults at 0.25 g, 2–3 times daily after meals for 5–10 days.

Prevention of giardiasis is the same as that of intestinal infections.

Gumliosis (lambliosis; synonym for giardosis) is a disease caused by giardia infestation and often manifested by lesions of the intestine, gall bladder and liver.

Giardiasis occurs everywhere, mainly in children.

Etiology . The causative agent of the disease was first described by the Russian scientist DF Lyamble in 1859. The genus Giardia includes a large number of species. A person is invaded by one species - intestinal lamblia (Lamblia intestinalis). In the development of lamblia, two stages are distinguished — the vegetative stage and the cysts stage (Fig.). The vegetative form of the parasite resembles a pear; it has a large suction cup, which is attached to the epithelium of the intestine and biliary tract. In the intestine, it forms an oval cyst of 10-14 microns in length. The cyst is resistant to external influences and retains its ability to invasion for a long time, in contrast to the unstable vegetative form. Hot climate and chronic diseases of the gastrointestinal tract contribute to invasion.

The main reservoir of parasites is man. Giardia cysts are excreted from the human body along with feces. Infection occurs through food and water contaminated with cysts. Adverse hygienic conditions, in particular the abundance of flies transmitting cysts, contribute to the spread of lamblia.

Pathological anatomy . In the duodenum, then in the small intestine, the vermiform process and less often in the colon, inflammatory changes are observed up to foci of hemorrhagic inflammation and ulcers. Changes in the liver are expressed in the diffuse parenchymal process, interstitial hepatitis and even cirrhosis. The gallbladder is inflamed, its mucous membrane is edematous with infiltrates and growths of connective tissue, may be covered with fibrinous exudate, its epithelium is often desquamous.

Pathogenesis is associated with reproduction in the tissues of vegetative forms of parasites. This occurs when the cysts of the duodenum are dissolved in the cyst membrane. Parasites are attached to the intestinal lining epithelium. Previous inflammatory changes in the intestine contribute to lamblia infestation, and the changes caused by the latter - secondary infection, invasion of protozoa and worms, as well as a protracted course of the disease.

The frequent detection of a significant amount of Giardia in the gallbladder and feces in the absence of pathological changes in the gallbladder and intestines and any complaints in the examined people gives the right to assert that Giardia infection can also occur in the form of asymptomatic carriage.

The products of metabolism and decay of lamblia during absorption into the blood, as well as reflexively, can cause toxic reactions, expressed in the deterioration of the general condition, anemization, neuropsychiatric, vascular, gastric disorders. The sensitizing effect of lamblia is manifested in allergic reactions (urticaria, pruritus, joint pain, fever). The specificity of sensitization is confirmed by intracutaneous samples with a specific allergen.

The clinical picture (signs and symptoms). Clinically distinguish: 1) giardiasis with a predominance of local disorders: intestinal form (duodenitis, enteritis, appendicitis), hepatic form (cholangitis, cholecystitis, hepatitis); 2) giardiasis with a predominance of common manifestations (vegetodistonia, gastrodystia, anemia); 3) a combination of various forms of local disorders (for example, enterocolitis, cholecystohepatitis), a combination of local disorders with disorders of the nervous, cardiovascular and other systems, changes in the blood; 4) lambly carrier.

The disease is manifested by periodic low fever, increased defecation, the appearance of liquid mucous membranes, sometimes hemorrhagic feces, sometimes green in color, frothy. When eating or after it, pain in the abdomen appears, localized with enteritis around the navel and slightly higher, accompanied by rumbling and transfusion in the same area. Radiographically detect at times the deformation of the duodenal bulb. Duodenal-gallbladder symptoms are rare.

The appendicular form occurs in approximately 10% of patients. With the same frequency Giardia found in the contents of the remote vermiform process in patients with chronic appendicitis.

Lamblious enterocolitis has a chronic course with relapses, diarrhea gives way to constipation, less often there is only constipation. In addition to the phenomena of enteritis, there may be pain in the sigmoid and descending colon, which at times is spastic reduced or swollen. In some patients with giardiasis, hypoproteinemia and hypovitaminosis develop. Cholangitis with giardiasis often takes a chronic course. During exacerbations, dull pain in the right hypochondrium, painful tapping on the liver, slight yellowness, low-grade fever appear.

Sometimes giardiasis manifests itself as acute non-calculous cholecystitis with an attack of pain in the epigastric region and right hypochondrium, radiating to the right scapula, a rise in temperature and the transition of pain after a few hours to dull. Muscle tension, even in the region of the gallbladder, is usually absent, and the possibility of deep palpation in the region of the right hypochondrium remains. Urobilinuria occurs in adults and in older children.

There are Giardia cholecystitis, imitating cholelithiasis; sometimes these patients are operated on.

Lyambliozny hepatitis is manifested by an increase and thickening of the liver, pain or sensitivity to palpation, a symptom of Ortner (pain when tapping on the right costal arch with the elbow of the palm or fist), an increase (small) bilirubin, alpha globulins in the subgroup of globulin fractions, urobilin in the urine, increase transaminase activity in the blood, often a violation of the antitoxic function of the liver.

Liver damage can be combined with cholangitis and cholecystitis. Liver cirrhosis with giardiasis is rare. Often there is a lesion of the pancreas, mainly due to a decrease in exocrine function with a decrease in the concentration of lipase, trypsin and diastase. Chronic pancreatitis is rare.

Reflex disorders include frequent changes in the acidity of gastric juice, especially its reduction, dyspepsia, cardiovascular disorders in the form of increased excitability, and occasionally unpleasant sensations in the region of the heart.

Toxicosis of giardiasis is expressed in fatigue, apathy, tearfulness, irritability, headache and muscle pain, the lag of children in development, increased sweating, trembling fingers. Giardiasis is sometimes explained by coronary angioneurosis, thyrotoxicosis, neurodermia, loss of consciousness, and depressive state.

Changes in the blood can be expressed by hypochromic and less often hyperchromic anemia, leukocytosis with a shift of neutrophils, sometimes to promyelocytes, leukopenia, infrequent eosinophilia and lymphocytosis.

The diagnosis of giardiasis is proved by the detection of parasites in the duodenal contents or feces through the study of native or colored drugs. Diagnosis improves with repeated studies at intervals of 2–3, 7–10 days in the counting chamber of Goryaev. Differential diagnosis should be made with chronic disorders of the liver and small intestine, and in children - with appendicitis.

Life prognosis is favorable. Complete cure with the release of parasites sometimes requires persistent re-treatment.

The treatment consists of several courses of taking protistatic drug Akrihin. Different schemes mainly differ in the duration of the course (from 3 to 8 days) and the intervals between them (3-5 days). The drug is taken 3 times a day half an hour before meals. A single dose for an adult and adolescents 14–16 years old is 0.1–0.15 g. In some patients, treatment with Acriquine leads to recovery and relief from Giardia. Mixed diseases require treatment with a combination of agents acting on all diseases. Successfully antiglioptic treatment with furazolidone. A valuable property of this drug is its associated effect on the causative agents of dysentery, salmonellosis and enterocolitis with a mixed infection. A single dose of furazolidone 0.1 g is prescribed 4 times a day for people aged 16–18 years, and 5 times a day for more adults. The treatment is repeated courses for 5 days. Furazolidone is taken after meals and washed down with plenty of liquid.

The proposed complex treatment with 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 meals, without chewing. Children reduce the dose of the drug according to age. If necessary, a second course of treatment can be carried out after 5-8 days.

Treatment with aminoquinol is also recommended: three cycles of 5 days with the drug being taken in a single dose of 0.15 g 3 times a day with a five-day break between cycles. The drug does not cause adverse reactions.

Anti-lamblia therapy should be accompanied by pathogenetic treatment. When indicated, it includes stimulation of the body by plasma, blood, autohemotherapy, vitamin administration, and anemia, gastric disorders. Inflammatory processes in the biliary tract serve as an indication for the appointment of an appropriate diet, antispasmodic and choleretic drugs, thermal procedures.

Prevention of giardiasis is the same as intestinal infections.