1/98. Beaver fever--a rare cause of reactive arthritis. giardia lamblia infection is rarely associated with adult reactive arthritis. We report the first North American case and review the pediatric and adult literature to date. Antimicrobial treatment is essential to eradicate the parasite and control the arthritis. ( info) |
| Malabsorption is a well-known complication of infection with giardia lamblia. However, selective protein-losing enteropathy is rare. We report a child with anasarca due to hypoalbuminemia as a result of gastrointestinal protein loss. Investigations established giardiasis as the etiology. The child returned to normal health after treatment with metronidazole. ( info) |
3/98. giardiasis following gastric surgery. A patient is presented who developed acute life-threatening diarrhoea due to infestation with giardia lamblia. We propose that the severity of the illness may have been related to hypochlorhydria following gastric surgery. ( info) |
| OBJECTIVES: A meta-analytic study was conducted to test the hypothesis that consumption of water from North American backcountry sources poses a statistically significant risk for acquisition of giardiasis. methods: The biomedical literature was surveyed by accessing medline, and identified studies were supplemented with references in current reviews, published dissertations, and prior communications with state health departments. Studies were classified by methodologic design and subjected to predetermined inclusion criteria. Odds ratios with 95% confidence intervals, chi-squares, and P-values for epidemiologic surveys were either computed from raw data or abstracted directly from the included studies. RESULTS: Of 104 articles identified in the initial screening, nine met the inclusion criteria. Neither of two case reports met the criteria of the Centers for disease Control and Prevention (CDC) for waterborne disease outbreak. Two prospective studies were identified, but neither showed a significant association. Of four case-control studies providing data, three reported an odds ratio of greater than one. CONCLUSIONS: Published reports of confirmed giardiasis among outdoor recreationalists clearly demonstrate a high incidence among this population. However, the evidence for an association between drinking backcountry water and acquiring giardiasis is minimal. education efforts aimed at outdoor recreationalists should place more emphasis on handwashing than on water purification. Further studies should attempt to separate the specific risk factor of drinking water from backcountry sources from other behaviors among this group that may contribute to the risk. ( info) |
5/98. Wells' syndrome associated with recurrent giardiasis. Wells' syndrome (WS) is a rare, recurrent, inflammatory dermatosis of uncertain pathogenesis, although a hypersensitivity response to different stimuli has been postulated. Several cases in association with parasitic infections have been described. We present a patient with WS associated with recurrent giardiasis. The course of the dermatosis was strictly related to the course of the parasitic infection. Both diseases disappeared with antiparasitic treatment. To our knowledge, this association is here reported for the first time. ( info) |
| A case of endocarditis caused by tropheryma whippelii is reported. The 69-year-old patient was diagnosed as suffering from severe aortic regurgitation requiring aortic valve replacement, but showed no other symptoms of Whipple's disease. T. whippelii was detected in the explanted aortic valve by broad-range PCR amplification of the 16S rDNA and subsequent sequence analysis of the product. The etiologic agent was classified as a type 2A sequence variant based on the 16S-23S intergenic spacer and the 23S rDNA (domain III) sequences. The histological examination of the aortic valve was compatible with Whipple's disease. A duodenal biopsy revealed an infection with giardia lamblia, but T. whippelii and histological signs of Whipple's disease were not detectable. ( info) |
| A case of metronidazole- and albendazole-resistant giardiasis in a patient with the acquired immunodeficiency syndrome was successfully treated with nitazoxanide (1.5 g twice a day for 30 days). Animal studies and in vitro assays showed that the isolate was resistant to both metronidazole and albendazole and susceptible to nitazoxanide. ( info) |
8/98. Treatment of patients with refractory giardiasis. giardia lamblia is one of the most common parasitic infections. Although standard treatments are usually curative, some immunocompromised patients, including patients with acquired immunodeficiency syndrome as well as healthy patients, have giardiasis that is refractory to recommended regimens. We report our experience with 6 patients with giardiasis, for whom therapy with a combination of quinacrine and metronidazole resulted in cures for 5 of the 6 patients. ( info) |
9/98. nephrotic syndrome due to thrombotic microangiopathy (TMA) as the first manifestation of human immunodeficiency virus infection: recovery before antiretroviral therapy without specific treatment against TMA. BACKGROUND: Among the possible renal complications that can develop a human immunodeficiency virus- (hiv) infected patient, thrombotic microangiopathy (TMA) is one of them. This is a type of vascular lesion more common in hiv patients than in normal population, and sometimes it can be the first manifestation of the hiv infection. methods: We present a patient with TMA in whom the subsequent investigation to find the cause of TMA revealed hiv infection and giardia lamblia in stool. RESULTS: Before antiretroviral therapy was started the patient began to show recovery of the hemolytic anemia, recovery of the nephrotic syndrome and partial remission of the proteinuria, so that he did not receive specific therapy for TMA. CONCLUSIONS: hiv infection should be suspected in patients presenting with TMA, and a hiv test should be routinely performed as part of the initial clinical evaluation of TMA. If the patients have not developed acquired immunodeficiency syndrome, the prognosis of TMA is equal to non-infected ones. ( info) |
10/98. Biliary giardiasis in a patient with human immunodeficiency virus. A 41-year-old man with human immunodeficiency virus (hiv) (CD4 count, 446/mm3) developed a protracted course of abdominal pain, weight loss, and increasing liver function tests after undergoing a metronidazole treatment regimen for Giardia enteritis. Three months later, endoscopic retrograde cholangiography (ERCP) showed dilated common and intrahepatic bile ducts and luminal irregularities of the common bile duct. Seven months after the onset of his acute diarrhea, a repeat ERCP with aspiration demonstrated many Giardia trophozoites and cysts in the bile and continued structural abnormalities consistent with cholangiopathy. A 10-day course of high-dose intravenous metronidazole did not resolve these signs or symptoms. A gallbladder ultrasound showed a thickened wall. Laparoscopic cholecystectomy led to resolution of abdominal pain and normalization of serum alkaline phosphatase over an 8-month period. gallbladder histopathology revealed chronic cholecystitis, but no parasites were seen on hematoxylin and eosin staining or with Giardia antigen enzyme immunoassay testing of the gallbladder. The patient refused to undergo a follow-up ERCP, but a right upper quadrant ultrasound and computed tomography of the abdomen were normal. ( info) |