Persisting symptoms and duodenal inflammation related to Giardia duodenalis infection

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. Over a 15 months period, 124 referred patients were evaluated in a prospect...

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Bibliographic Details
Published in:The Journal of infection Vol. 55; no. 6; pp. 524 - 530
Main Authors: Hanevik, Kurt, Hausken, Trygve, Morken, Mette Helvik, Strand, Elisabeth Astrup, Mørch, Kristine, Coll, Peter, Helgeland, Lars, Langeland, Nina
Format: Journal Article
Language:English
Published: Kidlington Elsevier Ltd 01.12.2007
Elsevier
Subjects:
Animals
Assemblage B
B12
Biological and medical sciences
Biopsy - methods
Cohort Studies
Disease Outbreaks
Duodenal inflammation
Duodenitis - etiology
Duodenoscopy
Duodenum - pathology
Feces - parasitology
General aspects
Giardia
Giardia - drug effects
Giardia duodenalis
Giardiasis - diagnosis
Giardiasis - drug therapy
Giardiasis - physiopathology
Human protozoal diseases
Humans
Infectious Disease
Infectious diseases
Inflammation - etiology
Medical sciences
Metronidazole - administration & dosage
Metronidazole - adverse effects
Parasitic diseases
Parasitic diseases due to ciliates and flagellates
Prospective Studies
Protozoal diseases
Waterborne epidemic
Norway, Hordaland, Bergen
Duodenal inflammation
B12
Giardia duodenalis
Assemblage B
Waterborne epidemic
Protozoa
Protozoal disease
Duodenum
Diarrhea
Diplomonadida
Inflammation
Nausea
Parasitosis
Abdomen
Infection
Antiprotozoal agent
Symptomatology
Antifungal agent
Chronic
Pain
Treatment
Biopsy
Giardiasis
Digestive diseases
Intestinal disease
Parasiticide
Metronidazole
ISSN:0163-4453, 1532-2742, 1532-2742
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Summary: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. Over a 15 months 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. 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. 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.
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ISSN:0163-4453
1532-2742
1532-2742
DOI:10.1016/j.jinf.2007.09.004