Diagnosis of Giardia lamblia infection as a cause of diarrhoea

Giardiasis in intensively reared Saanen kids

Outbreaks of diarrhoea in two groups of Saanen.kids aged 4 to 6 weeks were ascribed to giardiasis, although Cryptosporidia were also present. In all, 45 out of 65 kids were affected, two animals died, and the remainder eventually recovered. Aspects of the epidemiology and diagnosis of giardiasis are discussed. Air dried smears prepared from small intenstinal mucosa, intestinal contents, or freshly-voided faeces proved to be suitable for making a diagnosis, and are the recommended sample when laboratory examination will be delayed beyond a few hours.

Traveller's diarrhoea with a vengeance in children of UK immigrants visiting their parental homeland

Six healthy children, born in the UK, travelled to their parental homeland and developed a severe form of traveller's diarrhoea. This was characterised by rapid loss of weight and chronic diarrhoea. On return to this country, investigation in 5 of them showed an abnormal, small intestinal mucosa. There was a high incidence of pathogens and potential pathogens found in stools and duodenal juice. Immunodeficiency was found in 2 of them. Small intestinal mucosal damage related to gut infection in previously well children appears to be of cardinal importance in the interaction between chronic diarrhoea and malnutrition. This observation may point the way to future research into the primary role of gut infection in the initiation of the cycle of malnutrition and chronic diarrhoea in developing communities.

Jejunal absorption rates of glucose and glycine in post-infective tropical malabsorption

In a prospective study jejunal absorption rates of glucose (from a 200 mmol 1-1 solution) and glycine (from a 100 mmol 1-1 solution) were measured, using a perfusion technique, in nine patients with clinical evidence of post-infective tropical malabsorption (TM group) and in 10 others with trivial symptoms who had also visited the tropics (control group); all were of northern European origin. Seven and one in the two groups, respectively, had Giardia lamblia infections. Mean glucose absorption rate was significantly impaired by TM (P less than 0.01); mean rate for glycine was also depressed but not significantly. Presence of G. lamblia did not affect the severity of malabsorption although numbers studied were small.

Bacterial colonization of jejunal mucosa in giardiasis

Nine of 14 cases of giardiasis and severe malabsorption were found to have numerous bacteria adjacent to the mucosa and within luminal fluid samples from the upper jejunum. Three species of enterobacteria (Klebsiella pneumoniae, Enterobacter cloacae and E. hafniae) were cultured from eight patients and from only one were Bacteroides isolated. Enterobacteria were not cultured from seven of eight patients who had giardiasis but only mild malabsorption (of xylose only) nor from seven patients without malabsorption. Intestinal colonization by enterobacteria may make an important contribution to the development of malabsorption in patients with giardiasis.