Giardia and giardiasis

First multilocus sequence typing (MLST) of Giardia duodenalis isolates from humans in Romania

Background

Giardia duodenalis is one of the most prevalent and highly diverse human parasites, encompassing a complex of eight genetically distinct assemblages, each further divided into sub-assemblages. While in recent years, G. duodenalis genotype distribution patterns in humans have been intensely studied, there is still very little information available on the diversity of Giardia genotypes and sub-assemblages infecting people in Romania. In the present study, we investigated the genetic diversity of Giardia duodenalis in asymptomatic patients from Romania.

Methods

Over an 11-month period, human feces from 7805 healthy adults were screened by microscopic analysis for G. duodenalis cysts during their obligatory periodic check-ups. DNA extraction was performed from microscopic-positive fecal samples, followed by multilocus sequence typing of four genetic loci of the ITS region, gdh, tpi and bg genes, followed by DNA sequencing and phylogenetic analysis. Statistical analysis was performed using EpiInfo 2000 software.

Results

The prevalence of giardiasis in the present study was 0.42% (33/7805). Twenty-three samples (76.67%) were successfully genotyped at each locus. The bg and tpi genes had the highest typing success rate (100%). The identified assemblages were assemblage A in 27 cases (subtypes A2 and A3), and B in 3 cases.

Conclusions

To our knowledge, the present study is the first report of multilocus sequence typing of G. duodenalis isolated from humans in Romania. The present results may shed light on G. duodenalis infection in humans at a regional and national level, thus increasing awareness against this parasitic infection.

Comparison of microscopic and immunoassay examination in the diagnosis of intestinal protozoa of humans in Mansoura, Egypt

Protozoal diseases are prevalent globally and especially in developing countries that have relatively lower socioeconomic populations such as Egypt. Direct microscopic examination (DME) is used for the detection and identification of protozoa but lacks sufficient reliability, and thus may be detrimental in obtaining accurate diagnostic or epidemiological data. In this study, we determine the prevalence of infections by Giardia intestinalis, Cryptosporidium sp., and Entamoeba histolytica in humans in Egypt. Furthermore, we determine the reliability of DME in determining infections caused by these protozoa and compare the results to enzyme linked Immunosorbent assays (ELISA). Our results indicate that the prevalence of giardiasis, cryptosporidiosis, and entamoebiasis is 38, 22, and 16 %, respectively. The sensitivity and specificity of DME for detection of G. intestinalis is 45 and 99 %, for Cryptosporidium 66 and 99 %, and for Entamoeba 45 and 100 %, respectively. Our findings demonstrate that ELISA is more reliable for diagnostic and epidemiologic study purposes.

Giardia lamblia: interleukin 6 and tumor necrosis factor-alpha release from mast cells induced through an Ig-independent pathway

Giardia lamblia is a common cause of both acute and chronic diarrheal disease in humans worldwide. It has been shown that mast cells, IL-6 and TNF-alpha are substantially involved in the early control of G. lamblia infection in mice. However, no studies have yet been reported concerning the interaction between mast cell and Giardia, as well as the mast cells mediators generated in response to Giardia infection. In this study we demonstrated the direct activation of mast cells by G. lamblia live trophozoites or trophozoite-derived antigens followed by an increase in tryptase expression and a significant release of the preformed mediator histamine. In addition, parasite derived antigens increased TNF-alpha and de novo synthesized cytokine IL-6, at the mRNA and protein level. These results strongly suggest that mast cells might be an important source not only of IL-6 but also of TNF-alpha during Giardia infection, playing an important role in the outcome of the infection.

Release of metabolic enzymes by Giardia in response to interaction with intestinal epithelial cells

Giardia lamblia, an important cause of diarrheal disease, resides in the small intestinal lumen in close apposition to epithelial cells. Since the disease mechanisms underlying giardiasis are poorly understood, elucidating the specific interactions of the parasite with the host epithelium is likely to provide clues to understanding the pathogenesis. Here we tested the hypothesis that contact of Giardia lamblia with intestinal epithelial cells might lead to release of specific proteins. Using established co-culture models, intestinal ligated loops and a proteomics approach, we identified three G. lamblia proteins (arginine deiminase, ornithine carbamoyl transferase and enolase), previously recognized as immunodominant antigens during acute giardiasis. Release was stimulated by cell-cell interactions, since only small amounts of arginine deiminase and enolase were detected in the medium after culturing of G. lamblia alone. The secreted G. lamblia proteins were localized to the cytoplasm and the inside of the plasma membrane of trophozoites. Furthermore, in vitro studies with recombinant arginine deiminase showed that the secreted Giardia proteins can disable host innate immune factors such as nitric oxide production. These results indicate that contact of Giardia with epithelial cells triggers metabolic enzyme release, which might facilitate effective colonization of the human small intestine.

Variation in Giardia: implications for taxonomy and epidemiology

The taxonomy, life cycle patterns and zoonotic potential of Giardia infecting mammals and birds have been poorly understood and controversial for many years. The development of molecular tools for characterising isolates of Giardia directly from faeces or environmental samples has made an enormous contribution to resolving these issues. It is now clear that the G. duodenalis morphological group is a species complex comprising a series of what appear to be largely host-adapted species, and at least two zoonotic species for which humans are the major host, but which are also capable of infecting other mammals. It is proposed that this new information be reflected in the redesignation of several species of Giardia described previously. The molecular epidemiological tools that are now available need to be applied in different endemic foci of Giardia transmission, as well as in outbreak situations, in order to understand better the frequency of zoonotic transmission as well as to develop more effective approaches to controlling giardiasis.

Systemic and mucosal responses to oral administration of excretory and secretory antigens from Giardia intestinalis

Giardia, a flagellated protozoan that infects the upper small intestine of its vertebrate host, is the most common parasitic protist responsible for diarrhea worldwide. Molecules released by the parasite, particularly excretory and secretory antigens, seemed to be associated with pathogenesis as well as with the expression of Giardia virulence. In the present work, we examined the effect of oral administration of Giardia intestinalis excretory and secretory antigens on systemic and local antibody response as well as on mucosal injuries in BALB/c mice. Significant titers of serum-specific immunoglobulin G1 (IgG1) and specific IgG2a were observed. Systemic and mucosal specific IgA antibodies were also recorded. A transient production of serum-specific IgE antibody and high total IgE levels were also detected, suggesting the presence in excretory and secretory proteins of factors promoting a specific IgE response. The sera of excretory and secretory antigen-treated mice recognized proteins of 50 and 58 kDa as well as electrophoretic bands of 15, 63, and 72 kDa that could support a proteinase activity. The in vitro exposure of G. intestinalis trophozoites to heat-inactivated sera from mice orally inoculated with excretory and secretory antigens induced a decrease of growth, revealing a complement-independent inhibitory activity of specific serum antibodies. Furthermore, histological evaluation performed on the small and large intestines revealed moderate to acute histological changes comparable to those observed in natural or experimental Giardia infection characterized by eosinophilic infiltration, hypercellularity, and enterocytic desquamation. The present results suggested that Giardia excretory and secretory antigens stimulate a preferential Th2 response, which is probably involved in the intestinal alterations associated with giardiasis.

Video-microscopy observations of fast dynamic processes in the protozoon Giardia lamblia

Video-microscopy in combination with digital image processing was used to analyze dynamic processes associated to the life cycle of Giardia lamblia trophozoites. These parasites swim and attach to the epithelial cells, producing the disease known as Giardiasis. Giardia is a multiflagellar cell, presenting 4 pairs of flagella. With the use of analogue and digital tools, we observed that in cells attached to glass slides only 2 of the 4 pairs present active beating (wave propagation). The frequency observed was 17-18 Hz to the anterior and 8-11 Hz to the ventral flagella. These data resulted from several hours of recording using both analogue video and high-speed digital camera. The caudal pair did not show active beating patterns and the same holds true for the posterior one. In this latter pair, oscillations were observed, but they were always associated to the transit of the wave produced by the ventral pair. The analysis performed with free moving cells showed that during its forward dislocation, Giardia lamblia presented either a lateral rocking or a complete rotational (tumbling) movement around its longitudinal axis. A dislocation of the caudal region of the cell both in the lateral and dorso-ventral direction was observed. This movement was completely independent from the flagellar beating and it is likely to be produced by a microtubular complex located in the caudal portion of the cell. The adhesion process of Giardia lamblia was also followed by video-microscopy and the data showed that the ventral disk had an active participation in this process.

Treatment of giardiasis

Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine.

Albendazole resistance in Giardia is correlated with cytoskeletal changes but not with a mutation at amino acid 200 in beta-tubulin

Albendazole resistance was induced in three different Giardia cultures following growth in successively increasing amounts of drug. One of the lines was previously resistant to high levels of metronidazole and was able to grow in 2 microM albendazole. The other two survived exposure to 0.8 microM, while normally lethal levels of albendazole against Giardia in vitro were around 0.1-0.2 microM. Albendazole-resistant Giardia were cross-resistant to parbendazole. Major chromosome rearrangements were evident in the line resistant to 2 microM albendazole and IFA with antitubulin antibody indicated differences in the cytoskeleton, particularly the median body, between sensitive and resistant lines. This implicates the cytoskeleton in the mechanism of resistance. Substitution of Tyr for Phe is a consistent beta-tubulin amino acid change in the benzimidazole-resistant helminths and fungi so far analyzed. PCR primers were designed from the published Giardia beta-tubulin gene sequence and spanned the region encoding Phe at position 200. Sequence data from albendazole-resistant Giardia demonstrated that the beta-tubulin gene did not carry a mutation in the codon for amino acid 200. These data suggest that Phe at position 200 in beta-tubulin is not necessary for benzimidazole resistance.

Detection of a giardia lamblia coproantigen by using a commercially available immunoenzymatic assay, in belo horizonte, brazil

It is known that fecal examination to detect Giardia lamblia cysts or trophozoites produces a high percentage of false-negative results. A commercially available immunoenzymatic assay (ProSpecT Giardia Microplate Assay, Alexon, Inc., BIOBRAS) to detect G. lamblia specific coproantigen was evaluated for the first time in Brazil. A total of 90 specimens were tested. Each specimen was first tested as unpreserved stool, and then it was preserved in 10% Formalin to be tested 2 months later. The assay was able to identify all the 30 positive patients (sensitivity = 100.0%) by visual or spectrophotometric examination in the unpreserved specimens and was negative in 57 of the 60 patients without G. lamblia (specificity = 95.0%). The assay identified 27 of the 30 positive patients (sensitivity = 90.0%) and was negative in 59 of the 60 negatives (specificity = 98.3%) in the preserved stools according to both readings. A marked difference was observed in the optical densities in both groups, preserved and unpreserved stools, when the G. lamblia-positive specimens were compared to the negative or positive for other intestinal parasites than G. lamblia. The assay seems a good alternative for giardiasis diagnosis, especially when the fecal examination was repeatedly negative and the patient presents giardiasislike symptoms.

Giardia duodenalis: inter-strain variability of proteins, antigens, proteases, isoenzymes and nucleic acids

Giardia duodenalis isolates from asymptomatic or symptomatic patients and from animals present similarities and differences in the protein composition, antigenic profile, pattern of proteases and isoenzymes, as well as in nucleic acids analysis. In the present overview, these differences and similarities are reviewed with emphasis in the host-parasite interplay and possible mechanisms of virulence of the protozoon.

My favorite cell: Giardia

The gut protozoan parasite, Giardia duodenalis, is the best characterized example of the most ancient eukaryotes, which are anaerobic and appear to be primitively amitochondrial. Apart from its obvious medical importance, Giardia is fascinating in its own right. Its prokaryotic-like anaerobic metabolism renders it selectively sensitive to some bacterial drugs, especially the nitroimidazoles, which are activated to form toxic radicals. Other features, including an enzyme that reduces oxygen directly to water, cysteine as the keeper of redox balance, a plasmid, and toxin-like genes are also distinctly prokaryotic-like. But, unlike prokaryotes, Giardia has a sophisticated, highly developed cytoskeleton, bounded nuclei, linear chromosomes capped with telomeric repeats, and telomere positional regulation of gene expression.

Intestinal coinfection with numerous Giardia trophozoites and Vibrio cholerae in hospitalized children with watery diarrhea

During the recent cholera epidemic which affected Peru and other Latin American countries, fresh stool samples of 100 hospitalized children were assessed February through April 1991. The children had been admitted because of profuse watery diarrhea. The microbiologic study of wet mount preparations showed curved bacteria suspicious for cholera agent and confirmed afterward to be Vibrio cholerae 01 scrotype Inaba. In 30% of such cases, besides the curved bacteria, a strikingly large number of trophozoites of Giardia intestinalis were observed. The same samples studied by permanent stains confirmed the presence of Giardia trophozoites. To our knowledge, the association of Giardia with serious epidemic cholera infection has not been previously described. All patients were admitted because of severe dehydration requiring intravenous fluid replacement, which might suggest a synergistic role for the above-noted coinfection. Adequately designed case-control studies are needed to ascertain the frequency and the pathophysiologic and clinical significance of such an unusual association.

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A survey of the giardiasis prevalence was done in children from 2 till 5 years old who frequented two day nurseries ("A " and "B "). Its relation with some epidemiological aspects through the realization of parasitological exams of stool and an inquiry applied to mothers. Inday nursery "A " with a higth standard of life, 20 (66.6%) of 30 inquired children were parasitised and all the children in day nursery "B" had some enteroparasite. Giardia lamblia wasfound in 15 (50%) of the children-in better standart of life and in 19 (63.3%) of the children with a lower one. The ingesting of vegetables was the only allied factor to the high degree of giardiasis, in day nursery "A ". The day nursery "B " suffered influences from other aspects: no potable water in the residences, the inappropriate destiny of the garbage, the ingesting of vegetables habit and collective bedroom. The adequate sanitation and the existence of domestic animals were not related to parasitism by Giardia lamblia.

Macrophage-mediated enterocyte damage in BALB/c mice infected with different strains of Giardia lamblia

The mechanism of mucosal injury in Giardia lamblia-infected animals and humans is not well understood, although the role of gut macrophages in killing the trophozoites is well known. It is speculated, however, that macrophage products have a role in tissue injury and inflammatory response during infection, as in other inflammatory diseases. Therefore, in the present study an attempt was made to examine the mechanism involved in enterocyte damage during giardiasis. This was achieved using co-culture of enterocytes and gut macrophages obtained from infected BALB/c mice. The extent of tissue damage was assessed by measuring the marker enzyme of enterocyte damage, lactate dehydrogenase. To investigate the role of the various proteases and free oxygen radicals released by activated macrophages on enterocyte damage, inhibitors of various proteases and free oxygen radicals were used. Superoxide radical and certain proteases were found to have important roles in bringing about enterocyte damage during this infection in mice. Parasite load, lactate dehydrogenase release, and extent of lipid peroxidation were more pronounced in mice infected with symptomatic strains than in asymptomatic ones. The theory of inflammatory cell-mediated enterocyte damage in Giardia lamblia infection is proposed.

Phylogenetic analysis of the Diplomonadida (Wenyon, 1926) Brugerolle, 1975: evidence for heterochrony in protozoa and against Giardia lamblia as a "missing link"

A suite of 23 ultrastructural characters was used in a phylogenetic analysis of the protozoan order Diplomonadida. A single most parsimonious solution was found, with a length of 38 transformations and a consistency index of 0.84. The cladogram supports previous hypotheses of the relationships of the genera in the suborder Diplomonadina, as well as the inclusion of the genera Enteromonas and Trimitus in the order. Heterochrony is suggested in the change to binary axial symmetry, as hypermorphosis resulting from delayed cytokinesis in the ancestor. Hypotheses regarding a pivotal position for Giardia lamblia in the evolution of eukaryotes are inconsistent with the phylogeny proposed here.

Giardiasis

Giardiasis is one of the most common pathogenic intestinal protozoal infections worldwide. Giardia lamblia is the most frequently identified etiologic agent in outbreaks associated with the ingestion of surface water, often due to ineffective filtration or pretreatment. In addition to humans, other sources of infection include beavers, perhaps muskrats, and possibly domestic animals. A low infecting dose (10 to 25 cysts) is reported to be sufficient to produce human infection. Clinical manifestations range from asymptomatic to a transient or persistent acute stage, with steatorrhea, intermittent diarrhea, and weight loss, or to a subacute or chronic stage that can mimic gallbladder or peptic ulcer disease. Diagnosis is usually based on repeated stool examinations but examination of duodenal fluid or biopsy material may also be necessary. Enzyme immunoassay or indirect immunofluorescence methods for direct detection of antigen or whole organisms in clinical specimens have also been developed. These tests are reported to be more sensitive than routine stool examination. Demonstration of serum immunoglobulin M and G antibodies may help differentiate recent from past infection or help detect recurrence in individuals who have been treated previously. Serum immunoglobulin A levels may be a useful indicator of exposure in waterborne outbreaks of diarrhea. Drugs available for treatment within the United States include metronidazole, quinacrine hydrochloride, and furazolidone.

Differentiation of Giardia duodenalis from other Giardia spp. by using polymerase chain reaction and gene probes

Giardia spp. are waterborne organisms that are the most commonly identified pathogenic intestinal protozoans in the United States. Current detection techniques for Giardia species in water include microscopy and immunofluorescence techniques. Species of the genus Giardia are classified on the basis of taxonomic criteria, such as cell morphology, and on host specificity. We have developed a polymerase chain reaction- and gene probe-based detection system specific for Giardia spp., which can discriminate between the relevant species of the G. duodenalis type pathogenic to humans and other Giardia species that are not human pathogens. This method can detect a single Giardia cyst and is therefore sensitive enough for environmental monitoring.

Evidence for unusually short tubulin mRNA leaders and characterization of tubulin genes in Giardia lamblia

We have cloned alpha- and beta-tubulin cDNAs from Giardia lamblia and have used these to determine the gene copy number in the organism and to isolate alpha- and beta-tubulin genomic clones. Studies of the gene organization demonstrate that two copies of beta-tubulin are linked in a head-to-head configuration. The DNA from these two copies and that from one alpha-tubulin copy has been sequenced upstream of the translation initiation codon, and analyzed for consensus to typical eukaryotic promoter sequences. Characterization of the alpha- and beta-tubulin mRNAs in this parasite by primer extension and S1 nuclease mapping has revealed an unusually short (6 nucleotides) 5' untranslated region.

Giardia intestinalis: electrophoretic evidence for a species complex

The technique of allozyme electrophoresis was applied to 29 Australasian stocks and 48 clones of Giardia intestinalis from humans as a means of increasing the number of genetic markers currently available for identification and classification. Fifty different enzymes were examined and of these 26 loci were found to be suitable for use as genetic markers. The data indicate the presence of four discrete genetic groups within the sample of G. intestinalis examined. The groups had fixed genetic differences at 23-69% of loci established. The evidence suggests that G. intestinalis is a species complex. The results have important implications for the systematics of human isolates of Giardia, as well as for studies on the epidemiology and demography of giardiasis in Australia and elsewhere.

Enzyme immunoassay for the detection of Giardia lamblia

An enzyme immunoassay (EIA) was developed for direct detection of Giardia lamblia antigens in fecal specimens. The EIA was evaluated by testing specimens from 1,331 subjects in the USA and Egypt. For the 353 specimens from human subjects in the USA there was a 97% overall agreement between the results of the EIA and direct microscopic examination, yielding a sensitivity and specificity of 92% and 99% respectively. Due to adverse field conditions the EIA did not perform as well in the specimens collected and tested in Egypt. The sensitivity and specificity for 585 human specimens from Egypt were 74% and 97% respectively.

Biology of Giardia lamblia. Detection of N-acetyl-D-glucosamine as the only surface saccharide moiety and identification of two distinct subsets of trophozoites by lectin binding

Lectins and glycosidases of known sugar specificity were used as probes to analyze the surface carbohydrate moieties of G. lamblia trophozoites and in particular to determine whether chitin or oligomeric D-GlcNAc is present in the trophozoite form of the parasite as well as on the cyst. Of 13 lectins with varying sugar specificity, only D-GlcNAc-specific lectins bound specifically to the trophozoite surface as determined by light microscopy and EM. A striking finding was the identification of two distinct subsets of trophozoites, distinguished by reactivity with WGA and detected by light microscopy and EM as well as by flow cytometry. Unlike the cyst wall, the trophozoite D-GlcNAc residues were resistant to chitinase treatment. In contrast N-acetyl-beta-D-glucosaminidase abolished WGA binding suggesting that the lectin binds to terminal beta-linked D-GlcNAc residues. These residues were identified as being present on surface glycoproteins by Western blotting of parasite membrane proteins using WGA as a probe. This study identifies D-GlcNAc as the only saccharide moiety detectable by lectin binding on the surface of G. lamblia trophozoites and demonstrates that in contrast to the cyst, chitin is not present in the trophozoite. In addition two distinct subsets of trophozoites were identified based on reactivity with WGA and may represent varying stages of differentiation from trophozoite to cyst.

Giardia lamblia: electrophysiology and ultrastructure of cytopathology in cultured epithelial cells

The pathogenicity of Giardia lamblia is a subject of debate. Some studies of human biopsy material have mentioned the presence of trophozoites inside the intestinal mucosa, while in others, flagellates have only been found attached to the epithelium. To study the possible cytopathic effects of G. lamblia cultured under axenic conditions, trophozoites of the human 1/Portland and WB strains were placed in contact with monolayers of Madin Derby Canine Kidney cells, a well characterized cell strain with morphological and functional properties similar to those of a transporting epithelium. After 24 and 48 hr of interaction, the effect of the parasite on epithelial cells was assessed by transmission, scanning, and freeze fracture electron microscopy. In addition, the possible action of living trophozoites and sonicates of G. lamblia on the transepithelial resistance of MDCK monolayers mounted in Ussing chambers was analyzed for periods varying up to 48 hr. The results demonstrate that G. lamblia trophozoites do not invade epithelial monolayers. Furthermore, the parasites fail to produce cytoplasmic changes on target cells and have no effect on transepithelial resistance as judged both electrophysiologically and by the failure to open the occluding junctions that bind together epithelial cells. Damage induced by the parasites to cultured cells was limited to focal distortion or depletion of microvilli at the site of adhesion, which may progress to leave circular areas devoid of microvilli, different from the adhesion marks reported by others for G. muris. Therefore, under the in vitro conditions described here, giardias showed no toxic or invasive effect.

Lectin activation in Giardia lamblia by host protease: a novel host-parasite interaction

A lectin in Giardia lamblia was activated by secretions from the human duodenum, the environment where the parasite lives. Incubation of the secretions with trypsin inhibitors prevented the appearance of lectin activity, implicating proteases as the activating agent. Accordingly, lectin activation was also produced by crystalline trypsin and Pronase; other proteases tested were ineffective. When activated, the lectin agglutinated intestinal cells to which the parasite adheres in vivo. The lectin was most specific to mannose-6-phosphate and apparently was bound to the plasma membrane. Activation of a parasite lectin by a host protease represents a novel mechanism of host-parasite interaction and may contribute to the affinity of Giardia lamblia to the infection site.

Identification of chitin as a structural component of Giardia cysts

The intestinal parasite Giardia lamblia is a significant cause of diarrheal disease, which is perpetuated by the infective cyst form of the parasite. Although a rational approach to the control of giardiasis would be to inhibit cyst formation, nothing is known of the chemical composition of the cyst wall or of its biosynthesis. In these studies, we have shown that chitin is a major structural component of G. lamblia and G. muris cyst walls. This conclusion is based on the finding that chitinase specifically destroys the cyst wall, as revealed by electron microscopy. The presence of chitin was also shown directly by lectin binding studies. Of 12 lectins with diverse carbohydrate recognition specificity, only the N-acetylglucosamine-specific lectins wheat germ agglutinin, succinylated wheat germ agglutinin, and tomato lectin bound to cyst walls, as shown by fluorescence microscopy and cytochemistry. Wheat germ agglutinin binding was completely abolished by treatment of the cysts with purified chitinase. This effect was specific since it could be prevented by incubating the enzyme with chitin before treatment of the cysts. Treatment of cysts with N-acetyl-beta-glucosaminidase partially inhibited wheat germ agglutinin binding, whereas other glycosidases and proteases had no effect. These findings indicate that chitin is a major structural component of Giardia cyst walls and raise the possibility that inhibitors of chitin synthesis may be of use in preventing encystation and thus controlling spread of the disease.

Susceptibility of domestic cats to infections with Giardia lamblia cysts and trophozoites from human sources

The object of this study was to determine the importance of domestic cats in the epidemiology of human giardiasis. Of six laboratory-reared cats inoculated with cultured Giardia lamblia trophozoites from humans, only one showed the presence of cysts in the feces, and cysts were found on only 1 of the 80 days of observation. In a second experiment, eight cats were inoculated with G. lamblia cysts isolated from a human being. Over an 8-week period of observation, two of eight cats were found to have passed cysts in their feces, one on only one day and the other on 2 days. Postmortem examination of all of the cats found to be passing G. lamblia cysts at some time during the experiments did not reveal any small-intestinal trophozoites. These results suggest that domestic cats are relatively insusceptible to G. lamblia from humans and, consequently, that cats probably are not significant reservoir hosts of Giardia spp. infective for human beings. Moreover, it appears that the Giardia spp. which parasitize cats are distinct from those of human beings.

Immunodiagnosis of giardiasis by ELISA and studies on cross-reactivity between the anti-Giardia lamblia antibodies and some heterologous parasitic antigens and fractions

Specific antibodies against Giardia lamblia in 92 sera from asymptomatic carriers were investigated by ELISA. Using cyst antigen, antibodies were detected in 91 of the sera, by means of alkaline phosphatase-labelled antispecies immunoglobulin. The E/405nm values of the positive sera ranged between 0.350 and 1.700, whereas in the 78 control sera they were 0.270 +/- 0.220. Cross-reactivity between the anti-G. lamblia antibodies and 18 heterologous parasitic antigens and fractions was also studied. Cross-reactions were observed with antigens of Toxoplasma gondii, Sarcocystis spp., Leishmania donovani, Fasciola hepatica Y, F. hepatica I, Echinococcus granulosus AM, Cysticercus tenuicollis, Taenia saginata, Dipylidium caninum Y, D. caninum I, Trichuris suis Y, T. suis I, Trichinella spiralis and Litomosoides carinii. No cross-reactions were observed with the antigens and fractions of Entamoeba histolytica, Dicrocoelium dendriticum, Schistosoma mansoni and Echinococcus granulosus Y. The results show that the ELISA could be easily and very successfully applied for routine diagnosis of giardiasis.

Parasitic bowel disease: three pathogens important in primary care

A high index of suspicion and careful application of diagnostic methods are essential for accurate diagnosis of parasitic bowel diseases. The varied clinical spectrum of giardiasis, amebiasis, and strongyloidiasis emphasizes the need to consider these pathogens when patients present with gastrointestinal complaints. Giardiasis should be suspected in patients, especially returned travelers, with unexplained increase in stool frequency, particularly with bloating, flatulence, or vague systemic symptoms. Amebiasis must be considered in the differential diagnosis of any patient who presents with persistent diarrhea or signs of inflammatory bowel disease. Unexplained diarrheal illnesses associated with upper abdominal symptoms and eosinophilia should raise suspicion of the presence of strongyloidiasis. These findings in a patient with a compromised immune system or in a candidate for immunosuppressive therapy should prompt a thorough investigation to rule out this parasite, since disseminated strongyloidiasis often is fatal.

Aspects of intestinal parasitism in villagers from rural peninsular India

In 1977, a parasitological survey was undertaken of stool samples collected from 335 people from 5 villages in semi-arid regions of peninsular India. Stools, which were collected from various individuals in a stratified sample of 40 matched households from each village, were examined by standard diagnostic procedures. Eggs of Ascaris lumbricoides and protozoan cysts, which were identified on morphological grounds as belonging to Entamoeba spp., were most common. Other protozoan cysts were considered to be those of Balantidium coli, and eggs of hookworm and Hymenolepis nana were also observed in some of the stool specimens. The prevalence of parasitic infections varied between villages. The village with the highest prevalence of Ascaris (70%) appeared to have the greatest demands made on its meager drinking-water supply. This village is located in a dry, windy and dusty region and it is speculated that, in addition to well-established transmission mechanisms, the villagers may be exposed, perhaps through contamination of uncovered drinking-water wells and inhalation, to wind-borne Ascaris eggs. In 1967, a WHO Expert Committee Report on the Control of Ascariasis pointed out that information on the frequency of dust-borne infection with Ascaris in man was inadequate.