Giardiasis: photo, symptoms, treatment
- Causes of Giardiasis
- How is giardiasis transmitted?
- The mechanism of development of giardiasis
- Classification of Giardiasis
- Symptoms of Giardiasis
- Diagnosis of Giardiasis
- Giardiasis treatment
- Prevention of Giardiasis
Giardiasis is a protozoan invasion, characterized mainly by damage to the small intestine and leading to functional disorders of the digestive system, allergic or neurological manifestations.
Giardiasis is a widespread intestinal infection. According to statistics, in developing countries Giardia infection is detected in 10-15% of adults, in 3-5% in developed countries. Children's invasiveness is much more common and ranges from 30 to 40%, the risk increases when children are in kindergarten or school groups.
Causes of Giardiasis
The causative agent of infection is pathogenic protozoa - Giardia (Lamblia intestinalis). These are unicellular parasites of microscopic class of flagellates, parasitic in two stages of development:
- vegetative, or motile, in the form of mature trophozoites;
- cystic, or motionless, in the form of cysts, otherwise called spores.
The width of the trophozoite is from 5 to 10 microns, the length is not more than 21 microns. Each parasite has a suction disc and 4 pairs of flagella. Trophozoites live mainly in the small intestine, to the wall of which they are attached using a disk. Outside the body are non-viable. They multiply by dividing the nucleus: every 10 or 12 hours the colony of the simplest doubles. They feed on an osmotic way: they are capable of absorbing products of parietal digestion by the surface of the body. Flagella help to make various movements.
In the form of spores exist in the colon and outside the body. Cysts in the environment remain viable for a long time: from 1 to 24 days, depending on the ambient temperature, they are perfectly preserved in moist feces, and when they are dried, they die; up to 3 months live in clean water; about 3 days in the urine. Sensitive to disinfectants, for example, after 30 minutes die from treatment of feces with 5% solution of naphthalizol. Acetic acid is more harmful for spores, which die 5–10 minutes after exposure to a solution of dietary vinegar, diluted 1: 1 with water. After such a time, they die from a temperature of 70 ° C, and when boiling (100 ° C) they die immediately. They are resistant to low chlorine concentrations - they do not react at all to 5% solution of chloramine, although from 30 ml / l after 3 hours about 65% of Giardia dies.
How is giardiasis transmitted?
Carriers of parasites and the source of infection are humans infested with Giardia, and some animals with which humans often come in contact - guinea pigs, cats, rabbits, cows, dogs, pigs and other mammals. With feces, they secrete a large number of mature cysts of these parasites, starting approximately 9–22 days from the moment of infection. Moreover, in humans, this process occurs in waves with a time interval between periods of discharge, ranging from 1 to 17 days. On average, with fecal matter, 1.8 million viable cysts are excreted per gram of feces, this number can reach up to 23 million per gram. Carriers of pathogens - cockroaches, flies, mosquitoes, other insects.
The mechanism of infection of this intestinal infection is fecal-oral with several ways of spore penetration into the human body.
- The waterway is considered the most common. Infection can occur when drinking water from natural open water bodies, inadvertent ingestion when bathing in a river, pool or lake, drinking tap water without additional purification or heat treatment - boiling.
- Food path is in second place. Cysts are well preserved in milk and dairy products, where they calmly survive for 100–112 days. Viable a few hours on bread, fruit, raw and cooked vegetables. Favorable for invasive spores environment with high humidity.
- Contact-household way. Infection occurs through the joint use of the sick and healthy person by some things or household items - dishes, toys, a towel, one bathroom. The source of infection in rural areas can be soil, which is fertilized with manure or non-disinfected feces and / or contaminated with excrement of sick animals or humans.
- age up to 10 years;
- greater grouping or kindergarten groups of large numbers;
- indigestion caused by low acidity of the stomach;
- enzymatic insufficiency of the gastrointestinal tract;
- abnormalities of the digestive tract, in particular the biliary tract;
- stomach resection or other surgical interventions on the stomach and intestines.
The mechanism of development of giardiasis
Reaching the duodenum and proximal small intestine, mature cysts are transformed into vegetative individuals that attach themselves to the villi of the epithelium using suction discs, while the posterior end remains free. The process of joining the mucous membrane is accompanied by irritation of nerve endings, destruction of glycocalyx, mechanical damage of enterocytes, blocking of the suction surface of the villi, chronic disruption of the processes of transportation, digestion and absorption of nutrients - malabsorption syndrome.
The result of lamblia reproduction and vital activity are inflammatory bowel lesions (enteritis, duodenitis , colitis), microflora imbalance ( dysbacteriosis ), secondary fermentopathies, endogenous intoxication syndrome. Sensitization of the body is caused by constant absorption into the blood of metabolic products and substances formed after the death of the parasites. Against the background of giardiasis, allergic reactions often occur, and children with diathesis are especially susceptible to them.
Morphological changes are noted in the form of activation of the method of epithelial cell division, swelling of the stroma of its villi, pathological changes in the villi of crypts, etc. After 2 or more months from the beginning of the invasion, there is swelling, inflammation of varying degrees of intensity, atrophic, degenerative and or motor disorders. The brush border of the villi is dotted with a multitude of C-shaped furrows remaining in the place of suction of each individual. In the submucosal layer and the stroma of the villi, abundant productive infiltrate is detected, in which a large number of eosinophils, plasma cells, histocytes are found. On 1 cm 2 epithelium of the intestine can be located more than 1 million mature individuals.
Concomitant infectious diseases, such as typhoid fever or viral hepatitis, contribute to the transition to a protracted chronic form and the appearance of symptoms unusual for giardiasis. After recovery, an unstable and unstressed immunity is formed.
Classification of Giardiasis
The course of the disease may be:
Forms of giardiasis:
- subclinical (50% of the total number of infested);
- asymptomatic lambliae (diagnosed in 25% of those infected);
- manifest (25–43%).
Forms of manifest giardiasis regarding the prevailing symptoms:
- intestinal form, manifested by digestive disorders, diseases of different parts of the digestive tract - gastroduodenitis, gastroenteritis, duodenitis, enteritis, and other inflammations;
- biliary-pancreatic form with clinical manifestations of bile stasis and inflammatory lesions of organs - cholecystitis, reactive pancreatitis , cholangitis, biliary dyskinesia;
- extraintestinal form leads to toxic-allergic symptoms, neurocirculatory dystonia or asthenic syndrome;
- mixed form is manifested by various features characteristic of the above forms.
Symptoms of Giardiasis
Symptoms of infection are manifold. The disease, depending on the form, can manifest itself in several syndromes: gastrointestinal, astheno-neurotic, allergic dermatological, intoxication, or hepatolienal.
The duration of the incubation (latent) period ranges from 7 to 21 days. A typical manifestation of giardiasis is gastrointestinal syndrome. Since the parasites are localized in the small intestine, this leads to the disruption of many functions of the digestive tract. In the acute form of manifest giardiasis, pains in the navel and / or right hypochondrium predominate, signs of dyspeptic disorders - nausea, belching, abdominal distension, feeling of overcrowding in the stomach, loss of appetite, etc. sometimes acute. Diarrhea with a frequency of bowel movements up to 3-5 times during the day is characteristic. The watery and frothy stools, observed at the onset of the illness, then become greasy and half-shaped. Often, diarrhea alternates with constipation.
The duration of the acute phase is not longer than 7 days, after which recovery begins or the course of the disease becomes subacute or chronic. In chronic giardiasis, the symptoms are smoother, the periods of remission are replaced by short-term relapses. The patient for a certain period of time becomes not dangerous to others because it ceases to excrete with the feces of parasites. A prolonged course of intestinal infection leads to asthenia, weight loss, exacerbation of gastroduodenitis, enteritis, duodenal dyskinesia.
The biliary-pancreatic form is characterized by disorders of the biliary-pancreatic system with symptoms of cholestasis, hyper- and hypotoneus of the gallbladder sphincter, inflammation of the bile ducts and the bladder itself. The patient is worried about bitterness in the mouth, especially in the morning, burping bitter, pain in the right side under the ribs. On palpation, the gallbladder is painful. 50% of patients have reactive changes in the pancreas.
The severity of intoxication syndrome depends on the massiveness of the spread and the number of Giardia, as well as the severity of the disease. Peripheral lymphadenitis , subfebrile temperature, inflammation of the adenoids may occur. Depression of the nervous system is expressed by irritability, weakness, emotional lability. Children may have fainting, hypotension, bruxism, hyperkinesis.
Allergies and dermatological manifestations are expressed by severe itching of dry and scaly skin, erythema, papular rash, urticaria, follicular keratosis. Along with infection, allergic conjunctivitis , rhinitis, atopic dermatitis , cheilitis, bronchial asthma, blepharitis, or other pathologies are often diagnosed.
The depression of the nervous system during the chronic course of infection is expressed in malaise, severe weakness, fatigue in the late afternoon, tearfulness, irritability, and headaches. Small children sometimes have heart pains and dizziness. On the background of giardiasis, the development of neurosis is possible without specific clinical features.
Diagnosis of Giardiasis
Diagnosis and treatment of giardiasis is engaged infectious diseases. Recognition of this protozoan invasion is difficult due to the variety of clinical manifestations and their non-specificity. The diagnosis requires mandatory laboratory confirmation.
Required diagnostic methods for suspected giardiasis:
- Protozoological study of feces . When studying under a microscope native or Lugol-stained smears from freshly isolated feces, trophozoites and Giardia cysts are found. For reliability, repeated analyzes are required, from 2 to 7 times with an interval between delivery in 1–2 days.
- Duodenal intubation with microscopic content analysis. Also confirms the presence in the duodenal juice Giardia.
- PCR diagnostics of feces in order to detect pathogen antigens in the biomaterial under study.
- Immunoassay of blood - laboratory isolation of serum specific serum IgM antibodies to Giardia.
- Immunodiffusion is a new, more specific immune diagnosis method than ELISA, based on the study of precipitation reaction and allowing to detect antibodies to the pathogen.
- ELISA analysis. Used in the diagnosis of giardiasis and other infections.
- Immunoelectrophoresis is a combined method combining immunoprecipitation and electrophoresis. The antigenic composition of the biomaterial is investigated.
- Morphological study of biopsy taken during endoscopy.
Additional diagnostics used in various syndromes to identify pathology:
- Biochemical and complete blood count.
- Feces on dysbiosis.
- Ultrasound of the internal organs.
Before starting treatment, you need to make sure that the diagnosis is correct, otherwise it will be ineffective. Treatment of giardiasis step by step. Immediately the appointment of antiparasitic drug therapy is impractical because it can lead to deterioration due to the development of toxic complications and / or exacerbation of symptoms of the disease.
The first preparatory stage is the elimination of endotoxemia, stagnation of bile, correction of the immunological status, deterioration of conditions for the reproduction of Giardia. The duration of this period depends on the severity of symptoms and on average lasts from 1 to 2 weeks. It is important to follow a rational diet that limits the consumption of proteins and carbohydrates. The diet consists of cereals, various fruits, vegetables, bran, vegetable oil. Limit the consumption of sugar, bread and other pastries, meat. Fasting days are useful, during which dubazh with xylitol or mineral water is made to separate bile and cleanse the biliary tract. During the entire period the patient takes enterosorbents, choleretic, antihistamines, enzymes.
The second stage is etiotropic antiparasitic therapy, consisting of taking one of the antiprotozoal drugs - nimorazole, metronidazole, furazolidole, albendazole, tinidazole or another drug from the group of nitroimidazole derivatives. More often 2 courses are required. Enterosorbents and choleretic continue to be taken throughout anti-gi-blio therapy.
At the third recovery stage, the normal balance of intestinal microflora is restored, the immunity is corrected and strengthened. Assign immunostimulants, herbal adaptogens, vitamins, drugs for the treatment of dysbiosis. At this stage, you can use herbal medicine: infusions of tansy, oatmeal decoction, etc.
Prevention of Giardiasis
- timely identification of both patients and lambliositeli;
- drinking water quality control;
- observance of the rules of the sanitary and hygienic regime - washing hands before eating, thorough washing vegetables, regular inspections of employees of children's institutions, employees of food enterprises;
- protection of water bodies, soil and other environmental objects from pollution by parasites.
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