Giardiasis in children
The content of the article:
- Causes
- Forms of the disease
- Symptoms of giardiasis in children
- Diagnostics
- Treatment of giardiasis in children
- Potential consequences and complications
- Forecast
- Prevention
Giardiasis in children is a disease caused by lamblia, unicellular flagellate protozoa (Lamblia intestinalis), parasitizing in the intestines.
The name of the disease is associated with the name of the Russian doctor D. F. Lambla, who first described the causative agent of the infection in 1859. In Western countries, the infectious agent became known from Anthony van Leeuwenhoek, who named the parasite in honor of Professor Alfred Mathieu Giardou from Paris - Giardia intestinalis, therefore, in the international classification of diseases, another name for the infection is adopted - giardiasis.
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Giardiasis is recorded in 12–35% of children attending child care. The prevalence of the disease among the world's population is about 20%.
Causes
Lamblia intestinalis is a unicellular flagellar microorganism. In the body, lamblia can exist in two forms - vegetative and cystic.
Giardia parasitizes on the surface of the intestinal mucosa, damaging the structure of the microvilli of its walls; they are able to penetrate into the tissues of the intestinal wall, damaging the enterocytes. As a result, parietal digestion and intestinal motor activity are disrupted: pathogenic microflora is activated, malabsorption syndrome develops (loss of absorption of one or several types of nutrients), synthesis and excretion of enzymes are disrupted, production of immunoglobulins decreases, and allergic reactions appear.
In the upper part of the small intestine, lamblia exist in a vegetative form, clinging with the help of suckers (suction discs) to the epithelial cells of the small intestine. The vegetative form of lamblia has a pear-shaped body with four pairs of symmetrically located flagella. Getting into the lower part of the large intestine, lamblia encysts and takes the form of an oval capsule with a dense membrane (cysts) that is resistant to adverse environmental conditions. Giardia is released from the large intestine into the external environment with feces and can persist in it for a long time.
The source of infection is a person infected with lamblia. According to the WHO, every fifth person is a carrier of giardiasis. In developing countries, the number of people infected with Giardia can reach 35%.
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The route of transmission is fecal-oral. Infection occurs through the use of contaminated water, thermally unprocessed food, through household items or dirty hands. Flies and other domestic arthropods are carriers of pathogens.
Factors contributing to the development of giardiasis in children:
- immune deficiency;
- reduced acidity of gastric contents;
- the intensity of parietal digestion, characteristic of the child's body;
- violation of the balance of intestinal microflora, including after antibiotic therapy;
- violation of the composition of bile;
- unbalanced diet: a decrease in protein intake against the background of an increased intake of easily digestible carbohydrates.
The occupational risk group includes employees of children's institutions, irrigation and sewage services, specialists in zoos and animal nurseries.
Forms of the disease
Giardiasis in children can take the following forms:
- latent parasitic carrier - there are no clinical manifestations, the pathogen is determined only during laboratory diagnostics;
- clinically pronounced forms of giardiasis (intestinal form, hepatobiliary form and giardiasis as a concomitant disease).
By the nature of the course of infection, giardiasis is distinguished:
- acute - primary invasion, is more often recorded among young children;
- chronic - proceeds with alternating periods of exacerbation and remission.
Symptoms of giardiasis in children
The appearance of the first clinical signs of the disease is preceded by an incubation period, which is usually 1–3 weeks. It is followed by an acute phase, which lasts 5–7 days and is characterized by extensive symptoms.
Symptoms of giardiasis in children depend on the form of the disease and consist of three main clinical syndromes and their combinations:
- gastrointestinal (dyspeptic);
- asthenoneurotic;
- allergodermatological.
Gastrointestinal syndrome manifests itself in the form of signs of damage to the gastrointestinal tract:
- liquid, watery, sometimes frothy, fetid-smelling stools with a greasy sheen;
- pain in the epigastric region, as well as in the right hypochondrium and in the navel, not associated with food;
- flatulence;
- a feeling of fullness in the stomach;
- instability of the stool: diarrhea followed by constipation;
- decreased appetite;
- bitterness in the mouth, heartburn;
- belching with gas with a hydrogen sulfide odor;
- bad breath (halitosis);
- nausea;
- vomiting;
- a slight increase in body temperature.
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As a result of prolonged exposure to Giardia toxins, nonspecific neurotic reactions are formed. Asthenoneurotic syndrome is manifested by the development of neurological symptoms:
- irritability, tearfulness, mood lability;
- sleep disturbance;
- fatigue;
- headaches, dizziness;
- pain in the region of the heart;
- bruxism (teeth grinding in sleep);
- tics.
Allergodermatological syndrome manifests itself in the form of skin and allergic reactions:
- dryness and peeling of the skin;
- pallor of the skin, dark circles under the eyes;
- itchy skin;
- hives;
- measles rash;
- cheilitis;
- allergic rhinitis;
- allergic conjunctivitis;
- angioneurotic edema;
- neurodermatitis;
- bronchial asthma;
- follicular keratosis;
- thinning and slowing hair growth;
- plaque on the tongue.
Intestinal forms of giardiasis in children proceed in the form of enteritis, duodenitis, enterocolitis, duodenal dyskinesia. Hepatobiliary forms - in the form of cholecystitis, biliary dyskinesia, cholangitis.
Intoxication with giardiasis in children is accompanied by hepatolienal syndrome, lymphadenopathy, enlargement of the tonsils and adenoids, an increase in body temperature to subfebrile values (up to 38 ° C).
In the chronic course of giardiasis in children, the symptoms are mostly similar, only less pronounced. The main clinical manifestations:
- instability of the stool;
- restless sleep;
- pallor of the skin;
- dryness and flaking of the skin;
- follicular keratosis;
- anemia;
- periodic subfebrile condition for no apparent reason;
- development or exacerbation of allergic diseases;
- aggravation of the course of somatic pathology.
There are differences in the manifestations of giardiasis in children of different age groups.
At 1-3 years, dyspeptic and allergic dermatological syndrome predominates, the clinical picture of the disease resembles food poisoning or an acute form of enteritis.
In most children 4–7 years old, painful symptoms join the dyspeptic syndrome, in half of the cases, reactive changes in the pancreas are observed, and diseases of the gastroduodenal zone are often associated.
Children of the older age group, along with dyspeptic and pain syndrome, often have a chronic course of giardiasis, as well as asymptomatic carriage.
Diagnostics
The indications for examining a child for giardiasis are:
- persistent diarrhea resistant to conventional antidiarrheal drugs;
- allergic reactions of unknown etiology;
- dermatitis, eczema, neurodermatitis;
- obstructive bronchitis, bronchial asthma;
- chronic diseases of the gastrointestinal tract, resistant to conventional therapy;
- lag in physical development;
- immunodeficiency state;
- contact with the parasite carrier.
The main methods for diagnosing giardiasis in children:
- scatological research. The detection of cystic forms in the study of feces in fecal smears indicates giardiasis. Due to the high probability of a false negative result, different preservative solutions are used in fecal microscopy. To increase the likelihood of detecting lamblia in the feces, it is recommended to repeat the analysis at regular intervals;
- duodenal intubation. To study the contents of the gallbladder, a special rubber catheter is used; the vegetative forms of lamblia are identified in the selected biological material;
- general and biochemical blood test. Signs of an inflammatory process are found: leukocytosis, an increase in the erythrocyte sedimentation rate, a decrease in hemoglobin content;
- serological methods - allow detecting antibodies specific to lamblia antigens in the blood;
- immunofluorescence analysis (ELISA) - provides early diagnosis of giardiasis, informative from the 12-14th day of the disease.
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Additional diagnostic methods:
- Ultrasound of the abdominal organs - allows you to determine the signs of obstructed outflow of bile, symptoms of the inflammatory process in the bile duct system or in the pancreas;
- fibrogastroduodenoscopy with further study of duodenal contents - performed with a negative result of parasitological analysis and the presence of a typical clinical picture of infection.
Treatment of giardiasis in children
Treatment of the acute form of giardiasis in children is carried out in a hospital setting.
Antiparasitic therapy with drugs is used, the active substance of which destroys the membrane of parasites, prevents their reproduction and absorption of nutrients (Metronidazole, Macmiror, Ornidazole, Albendazole, Tinidazole, Akrikhin, Niridazole, Tiberal, Furazolidone). The specific drug and its dosage are prescribed by the gastroenterologist, taking into account the individual characteristics of the organism and the presence of concomitant pathology.
There is a danger of increased intoxication in the first days of treatment, since the products of massive decay of parasites occurring under the influence of therapy are absorbed into the circulatory system. Because of this, on the second or third day of treatment, sometimes there is a temporary deterioration in health in the form of nausea, vomiting, skin rashes, itching. The body's reaction to intoxication lasts no longer than 5-7 days, while antiparasitic therapy is being carried out, measures are taken to suppress it.
The indicators of recovery are the disappearance of clinical symptoms: cessation of abdominal pain, cleansing of the tongue, elimination of skin manifestations, normalization of stool and liver size.
The next stage in the treatment of giardiasis is rehabilitation, during which efforts are directed at restoring the impaired functions of the gastrointestinal cycle. To consolidate the positive effect of treatment, nutritional therapy, vitamin therapy are prescribed. The diet for giardiasis in children is designed to reduce the negative effect of the metabolic products of parasites. Confectionery, pastries, milk, eggs, mushrooms, fatty, fried, smoked, spicy foods are excluded from the child's diet, and the use of sugar is significantly limited. Protein-rich foods, cereals on the water, grated vegetable soups, stewed vegetables, dairy products, unsweetened fruits, berry compotes and fruit drinks are recommended.
After the completion of the rehabilitation period, it is necessary to repeat the tests for the presence of lamblia. With a persistent course of giardiasis, several cycles of therapy with different drugs are carried out.
Chronic giardiasis is usually treated in three stages. The first stage is preparatory. It consists in measures to improve the enzymatic function of the intestine, normalize the secretion of bile, reduce intoxication of the body, and strengthen the immune system. The administration of enterosorbents, enzyme preparations based on pancreatin, cholekinetics and cholespasmolytics is shown. For children receiving artificial feeding, lactose-free or low-lactose formulas are recommended. Then a specific anti-lambliasis treatment is carried out, after that - rehabilitation.
Potential consequences and complications
Giardiasis in children rarely leads to severe complications. Nevertheless, with a massive invasion or a prolonged chronic infectious process, the development of the following conditions is not excluded:
- irritable bowel syndrome;
- secondary fermentopathy;
- steatorrhea (impaired absorption of fats in the intestine);
- significant weakening of the immune system, leading to susceptibility to infectious diseases;
- the appearance or aggravation of allergic reactions;
- development of anemias associated with an increase in the absorption barrier of various substances from the intestine through the intestinal mucosa;
- dehydration of the body;
- infectious toxic shock.
Forecast
The prognosis is favorable, carrying out anti-lambliasis therapy contributes to the complete elimination of pathogens, and rehabilitation measures allow to restore the impaired functions of the gastrointestinal tract in full.
Prevention
In order to prevent infection with lamblia and the development of giardiasis, it is necessary, first of all, to adhere to sanitary and hygienic rules.
For this purpose it is recommended:
- sanitary improvement of catering establishments and public toilets;
- teaching the child the rules of personal hygiene, forming the habit of washing hands before eating, after using the toilet, after returning from a walk;
- protection of food products from contamination, sufficient heat treatment;
- refusal to use ready-made food products purchased at points of sale questionable from the point of view of hygiene;
- providing good-quality water, boiling water;
- destruction of flies and other carriers of lamblia;
- conducting regular medical examinations in preschool institutions (both children and staff);
- washing toys once a week with boiled water and a disinfectant;
- refusal to swim in unknown bodies of water.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
