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Giardiasis causing chronic diarrhoea in suburban Copenhagen: incidence, physical growth, clinical symptoms and small
K Hjelt1, A Paerregaard, P A Krasilnikoff
1Department of Paediatrics, University of Copenhagen, Gentofte Hospital, Hellerup, Denmark.
Insights
Giardiasis in children causes chronic diarrhea, leading to significant growth impairment and small intestinal damage. Early diagnosis and intervention are crucial for recovery and catch-up growth.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Giardiasis is a significant cause of chronic diarrhea in children.
- The impact of giardiasis on child growth and intestinal health requires further investigation.
Purpose of the Study:
- To investigate the clinical presentation, growth patterns, and intestinal mucosal changes in children with chronic diarrhea due to giardiasis.
- To assess the prevalence of malabsorption and its correlation with mucosal damage.
Main Methods:
- Prospective study of 29 children with chronic diarrhea caused by giardiasis over six years.
- Evaluation of growth parameters, small intestinal mucosal biopsies, and malabsorption tests (D-xylose, lactose).
Main Results:
- Significant decrease in height and weight observed from diarrhea onset to diagnosis, followed by catch-up growth.
- Intestinal mucosal abnormalities ranged from normal to severe villous atrophy; 25% exhibited D-xylose or lactose malabsorption.
- Persistent diarrhea correlated with younger age, shorter illness duration, and greater weight loss; foreign acquisition of giardiasis indicated a more severe course.
Conclusions:
- Giardiasis significantly impacts pediatric growth and intestinal integrity.
- Malabsorption and mucosal damage are common in pediatric giardiasis and correlate with clinical severity.
- Acquisition of giardiasis abroad is associated with a more severe disease course in children.
Abstract:
During a six-year period, 29 children (aged 0.7-13.5 years, mean 3.3 years) suffering from chronic diarrhoea due to giardiasis were studied. The incidence of this illness was 81 per 1,000,000 children aged 0- < 7 years per year. According to growth charts, relative height and weight of the patients decreased significantly (approximately 0.5 SD) from before the onset of diarrhoea to the time of diagnosis and subsequently increased up to the end of catch-up growth. Small intestinal mucosal specimens were studied. Two patients had severe villous atrophy, 8 moderate abnormalities, 6 only light changes and 13 biopsies were normal. D-xylose or lactose malabsorption was detected in 25% of the patients. The lactose malabsorption was due to hereditary low lactase levels. None of the patients with a Danish ethnic background showed lactose malabsorption. D-xylose absorption and the relative weight loss of the patients correlated with the degree of mucosal damage. Patients with persistent diarrhoea (n = 19) were younger and had a shorter duration of diarrhoeal illness and a more significant weight reduction than those with intermittent diarrhoea (n = 10). However, the age at onset of symptoms was similar in the two groups (medians 1.3 years). Seven patients contracted the disease abroad. They all developed persistent diarrhoea and had a more severe course of the illness than those who acquired the disease in Denmark.