OBJECTIVES: After a large waterborne outbreak of Giardia infection in Bergen, some patients experienced persisting abdominal symptoms despite metronidazole treatment. This study aimed at investigating possible causes for their symptoms. METHODS: Over a 15 month period, 124 referred patients were evaluated in a prospective cohort analysis with a standardised investigation including duodenal biopsies and aspirate, blood tests and faecal parasite and calprotectin tests. Recovered subjects were recruited for symptom analysis. RESULTS: Persisting Giardia duodenalis infection was found in 40 patients (32.3%). Duodenal biopsies showed signs of inflammation in 57 patients (47.1%). Microscopic duodenal inflammation was present in 34 (87.2%) of the Giardia positive and 23 (28.0%) of the Giardia negative patients. There were significant associations between persistent Giardia positivity, microscopic duodenal inflammation and a positive calprotectin test. Duodenal aspirate and duodenal biopsies performed poorly in diagnosis of persistent giardiasis. CONCLUSIONS: In patients with persisting symptoms after metronidazole treated Giardia infection we commonly found chronic Giardia infection and microscopic duodenal inflammation, especially in illness duration less than 7 months. Both these findings subsided over time. Increasingly, investigations could not determine a definite cause for the persistent symptoms. The very long-term post-giardiasis diarrhoea, bloating, nausea and abdominal pain documented here need further study.
OBJECTIVES: After a large waterborne outbreak of Giardia infection in Bergen, some patients experienced persisting abdominal symptoms despite metronidazole treatment. This study aimed at investigating possible causes for their symptoms. METHODS: Over a 15 month period, 124 referred patients were evaluated in a prospective cohort analysis with a standardised investigation including duodenal biopsies and aspirate, blood tests and faecal parasite and calprotectin tests. Recovered subjects were recruited for symptom analysis. RESULTS: Persisting Giardia duodenalis infection was found in 40 patients (32.3%). Duodenal biopsies showed signs of inflammation in 57 patients (47.1%). Microscopic duodenal inflammation was present in 34 (87.2%) of the Giardia positive and 23 (28.0%) of the Giardia negative patients. There were significant associations between persistent Giardia positivity, microscopic duodenal inflammation and a positive calprotectin test. Duodenal aspirate and duodenal biopsies performed poorly in diagnosis of persistent giardiasis. CONCLUSIONS: In patients with persisting symptoms after metronidazole treated Giardia infection we commonly found chronic Giardia infection and microscopic duodenal inflammation, especially in illness duration less than 7 months. Both these findings subsided over time. Increasingly, investigations could not determine a definite cause for the persistent symptoms. The very long-term post-giardiasis diarrhoea, bloating, nausea and abdominal pain documented here need further study.
Authors: Barbara J Davids; Ching M Liu; Elaine M Hanson; Christine H Y Le; Jonathan Ang; Kurt Hanevik; Marvin Fischer; Matej Radunovic; Nina Langeland; Marcela Ferella; Staffan G Svärd; Majid Ghassemian; Yukiko Miyamoto; Lars Eckmann Journal: Infect Immun Date: 2019-05-21 Impact factor: 3.441
Authors: H P Parkman; M Camilleri; G Farrugia; R W McCallum; A E Bharucha; E A Mayer; J F Tack; R Spiller; M Horowitz; A I Vinik; J J Galligan; P J Pasricha; B Kuo; L A Szarka; L Marciani; K Jones; C R Parrish; P Sandroni; T Abell; T Ordog; W Hasler; K L Koch; K Sanders; N J Norton; F Hamilton Journal: Neurogastroenterol Motil Date: 2009-12-09 Impact factor: 3.598
Authors: Kamran Rostami; David Aldulaimi; Geoffrey Holmes; Matt W Johnson; Marie Robert; Amitabh Srivastava; Jean-François Fléjou; David S Sanders; Umberto Volta; Mohammad H Derakhshan; James J Going; Gabriel Becheanu; Carlo Catassi; Mihai Danciu; Luke Materacki; Kamran Ghafarzadegan; Sauid Ishaq; Mohammad Rostami-Nejad; A Salvador Peña; Gabrio Bassotti; Michael N Marsh; Vincenzo Villanacci Journal: World J Gastroenterol Date: 2015-03-07 Impact factor: 5.742
Authors: Marisol Garzón; Luis Pereira-da-Silva; Jorge Seixas; Ana Luísa Papoila; Marta Alves; Filipa Ferreira; Ana Reis Journal: Pathog Glob Health Date: 2017-03-10 Impact factor: 2.894