Giardiasis

Decreased gastric acidity Immune deficiency Prior gastric surgery 

Abdomen - cramps Abdomen - flatulence Abdomen - fullness Abdomen - pain 

Bowel movements, stool - fatty (steatorrhea) [2] Bowel movements - constipation [10] 

Blood ELISA assay - positive Stool cysts - positive [4] 

Variable duration - weeks to months Rarely fatal 

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Weniger BG, Blaser MI, Gedrose J et al (1983) An outbreak of waterborne giardiasis associated with heavy water runoff due to warm weather and volcanic ashfall. Am J Public Health 73 862-872... 

Problems of recent years involving listeriosis, salmonellosis, giardiasis and Legionnaire s disease have received attention, as have the re-emergence of tuberculosis and the importance of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). 

Please refer to Chapter 75 for information regarding giardiasis. 

Gardner TB, Hill DR. Treatment of giardiasis. Clin Microbiol Rev 2001 14 114-128. 

O For treatment of giardiasis (or as empirical treatment), metronidazole 250 mg three times daily for 7 days or tinida-zole 2 g as a single dose is recommended. 

Space constraints do not allow detailed discussions of the world of parasites, and clinicians and students are directed to some excellent resources for further details on parasites and parasitic diseases.1,2 Discussion in this chapter will include those parasitic diseases that are more likely to be seen in the United States and will include gastrointestinal parasites (primarily giardiasis and amebiasis), protozoan infections (malaria and South American trypanosomiasis), some common helminthic... 

There are two stages in the life cycle of G. lamblia the trophozoite and the cyst. G. lamblia is found in the small intestine, the gallbladder, and in biliary drainage. The distribution of giardiasis is worldwide with children being more susceptible than adults. 

How would you differentiate giardiasis from possible Escherichia co//-induced diarrhea ... 

Patients with symptomatic giardiasis and positive stool samples or positive ELISA tests should be treated with metronidazole for 7 days. Patients who fail initial therapy with metronidazole should receive a second course of therapy. Pregnant patients can receive paromomycin 25 to 30 mg/kg per day in divided doses for 7 days. Giardiasis can be prevented by good hygiene and by using caution in food and drink consumption. 

What specific findings in this patient suggest that he may have giardiasis or amebiasis ... 

Giardiasis For the treatment of giardiasis caused by Giardia duodenalis (also termed Giardia lamblia) in adults and pediatric patients older than 3 years of age. Trichomoniasis For the treatment of trichomoniasis caused by Trichomonas vaginalis in female and male patients. Because trichomoniasis is a sexually transmitted disease with potentially serious sequelae, partners of infected patients should be treated simultaneously in order to prevent reinfection. 

Children Other than for use in the treatment of giardiasis and amebiasis in pediatric patients older than 3 years of age, safety and efficacy of tinidazole in pediatric patients have not been established. 

Antiprotozoals] WARNING Carcinogenic in rats Uses Bone/joint, endocarditis, intra-abd, meningitis, skin Infxns amebiasis trichomoniasis bac-tCTial vaginosis PID giardiasis pseudomembranous colitis (C difficile) Action ... 

Metronidazole is a nitro-imidazole. It is a mixed amoebicide, i.e. it acts at all sites of infection. It has to be activated in the parasite. By reduction in the amoeba of its nitro group reactive intermediates are formed, resulting in oxidative damage and ultimately cell kill. It is effective against many parasitic intestinal and tissue infections such as trichomoniasis, giardiasis and amoebiasis. It is the drug of choice for amoebic dysentery and amoebic liver abscess. 

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