Giardiasis: photos, symptoms, treatment
- Causes of Giardiasis
- How is giardiasis transmitted?
- Mechanism of development of Giardiasis
- Classification of Giardiasis
- Symptoms of Giardiasis
- Diagnosis of Giardiasis
- Treatment of Giardiasis
- Prevention of Giardiasis
Giardiasis is a protozoal invasion characterized by a lesion of the small intestine and leading to functional digestive disorders, allergic or neurological manifestations.
Giardiasis is a widespread enteric infection. According to statistics, in developing countries infection with lamblia is detected in 10-15% of adults, 3-5% in developed countries. Children's invasiveness is much more frequent and ranges from 30 to 40%, the risk increases when children are in kindergartens or schools.
Causes of Giardiasis
The causative agent of infection are pathogenic protozoa - lamblia (Lamblia intestinalis). These are unicellular parasites of microscopic dimensions of the flagellum class, parasitizing in two stages of development:
- vegetative, or mobile, in the form of mature trophozoites;
- cystic, or immovable, in the form of cysts, otherwise called spores.
The width of trophozoite is from 5 to 10 μm, the length is not more than 21 μm. Each parasite has a suction disk and 4 pairs of flagella. Inhabit trophozoites mainly in the small intestine, to the wall of which attach with a disk. Outside the body are not viable. They multiply by dividing the nucleus: every 10 or 12 hours the colony of the protozoans doubles. They feed on osmotic means: they are able to suck the products of parietal digestion by the surface of the body. Flagellum helps to make various movements.
In the form of spores exist in the large intestine and outside the body. Cysts in the environment retain their viability for a long time: from 1 to 24 days, depending on the ambient temperature, they are perfectly preserved in moist feces, when killed, they die; up to 3 months live in clean water; approximately 3 days - in urine. Sensitive to disinfectants, for example, after 30 minutes die from the treatment of feces with a 5% solution of naphthalol. Acetic acid is more destructive for spores that die within 5-10 minutes after exposure to a solution of edible vinegar diluted 1: 1 with water. Through such time they die from the temperature of 70 0 C, and at boiling (100 0 C) - immediately. Resistant to a weak chlorine concentration - does not react in any way to 5% of chloramine solution, although about 65% of lamblia die from 30 ml / l after 3 hours.
How is giardiasis transmitted?
Parasite carriers and the source of infection are the person infected with Giardia, and some animals that humans often come in contact with - guinea pigs, cats, rabbits, cows, dogs, pigs and other mammals. With feces, they secrete a large number of mature cysts of these parasites, beginning about 9-22 days after infection. Moreover, in humans, this process takes place wavyly with a time interval between the periods of discharge, fluctuating from 1 to 17 days. On average, 1.8 million viable cysts per gram of feces are allocated with feces, this number can reach up to 23 million in 1 g. Carriers of pathogens - cockroaches, flies, mosquitoes, other insects.
The mechanism of infection with this enteric infection is fecal-oral, with several ways of penetrating the spores into the human body.
- The waterway is considered the most widespread. Infection can occur with the use of water from natural open bodies of water, accidental ingestion when swimming in a river, pool or lake, drinking tap water without additional cleaning or heat treatment - boiling.
- The food path is on the second place. Cysts are well preserved in milk, dairy products, where they calmly survive for 100-112 days. Viable for several hours on bread, fruits, raw and cooked vegetables. A medium with high humidity is favorable for invasive spores.
- Contact and household way. Infection occurs through the joint use of a sick and healthy person with some things or household items - dishes, toys, a towel, one bathroom. The source of contamination in rural areas can be soil, which is fertilized with manure or uninfected feces and / or contaminated with excrement of sick animals or humans.
- age up to 10 years;
- a large crowding in the team or a large number of kindergarten groups;
- impaired digestion caused by decreased gastric acidity;
- enzymatic insufficiency of the gastrointestinal tract;
- anomalies in the development of the digestive tract, in particular bile ducts;
- resection of the stomach or other surgical interventions on the stomach and intestines.
Mechanism of development of Giardiasis
Reaching the duodenum and the proximal part of the small intestine, mature cysts turn into vegetative individuals, which attach to the fibers of the epithelium by means of suction discs, while the posterior end remains free. The process of attachment to the mucosa is accompanied by irritation of the nerve endings, destruction of the glycocalyx, mechanical damage to the enterocytes, blockage of the suction surface of villi, a chronic disorder of the processes of transportation, digestion and absorption of nutrients - malabsorption syndrome.
The result of multiplication and life of lamblia are inflammatory bowel diseases (enteritis, duodenitis , colitis), imbalance of microflora ( dysbacteriosis ), secondary fermentopathies, endogenous intoxication syndrome. To the sensitization of the body results in constant absorption of metabolic products and substances formed after the death of parasites into the blood. On a background of a lambliasis allergic reactions quite often arise, to them children with diathesis are especially predisposed.
Morphological changes in the form of activation of the metic division of epithelial cells, edema of the stroma of its villi, pathological changes in villi crypt, etc. After 2 or more months from the onset of the invasion, 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 grooves remaining at the site of each individual's suction. In the submucosal layer and the stroma of the villi, a profuse productive infiltrate is revealed, in which a large number of eosinophils, plasma cells, histocytes are found. At 1 cm 2, the intestinal epithelium may host more than 1 million mature individuals.
The transition to a chronic chronic form and the appearance of uncharacteristic giardiasis is promoted by concomitant infectious diseases, for example typhoid fever or viral hepatitis. After recovery, unstable and relaxed immunity forms.
Classification of Giardiasis
The course of the disease can be:
Forms of Giardiasis:
- subclinical (50% of the total number of invasive);
- asymptomatic lambliasis (diagnosed in 25% of the infected);
- manifest (25-43%).
The forms of the manifest giardiasis in relation to the predominant symptomatology:
- intestinal form manifested by digestive disorders, diseases of different parts of the digestive tract - gastroduodenitis, gastroenteritis, duodenitis, enteritis, other inflammations;
- biliary-pancreatic form with clinical manifestations of stagnation of bile and inflammatory lesions of organs - cholecystitis, reactive pancreatitis , cholangitis, dyskinesia of bile ducts;
- extraintestinal form leads to toxic-allergic symptoms, neurocirculatory dystonia or asthenic syndrome;
- The mixed form is manifested by various characteristics characteristic of the above forms.
Symptoms of Giardiasis
Symptomatic infection is diverse. The disease, depending on the form, can be manifested by several syndromes: gastrointestinal, asteno-neurotic, allergic-dermatological, intoxication or hepatolienna.
The duration of the incubation (latent) period varies from 7 to 21 days. A typical manifestation of giardiasis is gastrointestinal syndrome. Since parasites are localized in the small intestine, this leads to a disruption of many functions of the digestive tract. In the acute form of the manifest giardiasis, pain predominates in the navel and / or the right hypochondrium, signs of dyspeptic disorders include nausea, belching, bloating, a feeling of fullness of the stomach, loss of appetite, etc. The pains do not depend on food intake, sometimes they are sharp. Typical diarrhea with a frequency of bowel movements up to 3-5 times during the day. Watery and frothy stool, observed at the beginning of the disease, then becomes fat and semi-shaped. Often diarrhea alternates with constipation.
The duration of the acute phase is no longer than 7 days, after which recovery occurs or the course of the disease becomes subacute or chronic. With chronic giardiasis, the symptoms are more flattened, the periods of remission are replaced by short-term relapses. The patient for a certain period of time becomes not dangerous to others because he ceases to excrete parasites with feces. The prolonged course of intestinal infection leads to asthenia, weight loss, exacerbation of gastroduodenitis, enteritis, dyskinesia of the duodenum.
The biliary-pancreatic form is characterized by disorders of the biliary-pancreatic system with the phenomena of cholestasis, hyper- and hypotonic sphincter of the gallbladder, inflammation of the bile ducts and the bladder itself. The patient is concerned about bitterness in the mouth, especially in the morning, belching bitter, pain in the right side under the ribs. With palpation, the gallbladder is painful. In 50% of cases, reactive changes in the pancreas are noted.
The severity of the intoxication syndrome depends on the massive distribution and quantity of lamblia, as well as the severity of the course of the disease. Peripheral lymphadenitis , subfebrile temperature, inflammation of adenoids can be observed. The oppression of the nervous system is expressed by irritability, weakness, emotional lability. Children may have fainting, hypotension, bruxism, hyperkinesia.
Allergy and dermatological manifestations are expressed by a strong itch of dry and flaky skin, erythema, papular rash, urticaria, follicular keratosis. On the background of infection, allergic conjunctivitis , rhinitis, atopic dermatitis , cheilitis, bronchial asthma, blepharitis or other pathologies are often diagnosed.
Oppression of the nervous system in the chronic course of infection is expressed in malaise, severe weakness, rapid fatigue towards evening, crying, irritability, headaches. Young children sometimes have heart pain and dizziness. Against the background of Giardiasis may develop neurosis without specific clinical features.
Diagnosis of Giardiasis
Diagnosis and treatment of Giardiasis deals with infectious diseases. Recognition of this protozoal invasion is difficult due to the variety of clinical manifestations and their nonspecificity. The diagnosis requires mandatory laboratory confirmation.
Necessary diagnostic methods for suspected lambliasis:
- Protozoological study of feces . When studying under the microscope native smears or stained with Lugol from freshly isolated feces, trophozoites and lamblia cysts are found. For reliability, multiple analyzes are required, conducted 2 to 7 times with an interval between taking 1 to 2 days.
- Duodenal sounding with microscopic analysis of contents. Also confirms the presence of duodenal juice lamblia.
- PCR-diagnostics of feces for the purpose of detection of pathogen antigens in the biomaterial under study.
- Immunoenzyme analysis of blood - laboratory isolation of serum from specific antibodies of IgM class to lamblia.
- Immunodiffusion is a new method of immune diagnostics, more specific in comparison with ELISA, based on the study of the precipitation reaction and allows to identify antibodies to the pathogen.
- Immunoenzyme analysis of ELISA. Used in the diagnosis of Giardiasis and other infections.
- Immunoelectrophoresis is a combined method that combines immunoprecipitation and electrophoresis. The antigenic composition of the biomaterial is investigated.
- Morphological examination of a biopsy taken during endoscopy.
Additional diagnosis, used for various syndromes, for the detection of pathology:
- Biochemical and general blood analysis.
- Feces for dysbiosis.
- Ultrasound of internal organs.
Treatment of Giardiasis
Before starting treatment, you need to make sure the correctness of the established diagnosis, otherwise it will be ineffective. Treatment of giardiasis is phased. Immediate administration of antiparasitic drug therapy is not advisable, as this can lead to a worsening of the state due to the development of toxic complications and / or exacerbation of the symptoms of the disease.
The first preparatory stage is to eliminate endotoxicosis, stagnation of bile, correction of the immunological status, worsening of the conditions for reproduction of lamblia. The duration of this period depends on the severity of the symptoms and on average lasts from 1 to 2 weeks. It is important to adhere to a rational diet that limits the use of proteins and carbohydrates. The diet consists of cereals, various fruits, vegetables, bran, vegetable oil. Limit the consumption of sugar, bread and other baking, meat. Useful unloading days, during which dyubazh is made with xylitol or mineral water for bile ducts and cleansing of bile ducts. During the whole period the patient takes enterosorbents, cholagogue, antihistamines, enzymes.
The second stage is etiotropic antiparasitic therapy, consisting of taking one of the antiprotozoals - nimorazole, metronidazole, furazolidol, albendazole, tinidazole or another drug from the group of nitroimidazole derivatives. More often 2 courses are required. Enterosorbents and cholagogue continue to be taken throughout anti-amliasis therapy.
At the third recovery stage, the normal balance of the intestinal microflora is restored, the immunity is adjusted and strengthened. Assign immunostimulants, plant adaptogens, vitamins, drugs for the treatment of dysbiosis. At this stage, you can apply phytotherapy: infusions of tansy, oat broth, etc.
Prevention of Giardiasis
- timely detection of both patients and lamblias carriers;
- drinking water quality control;
- compliance with the rules of the sanitary and hygienic regime - washing hands before eating, washing vegetables thoroughly, regular inspections of employees of children's institutions, workers of food enterprises;
- protection of reservoirs, soil and other environmental objects from contamination by parasites.
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