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Giardia infection during pregnancy and lactation
161
TRANSACTIONSOF THE ROYAL SOCIETYOF TROPICALMEDICINE AND HYGIENE (1987) 81
Correspondence To the Editor Giardia infection during pregnancy and lactation
It has been shown that female mice experimentally infected with Giardia muris, which had ceasedto pass parasites in their stools, again began to shed Giardia cysts during pregnancy and lactation (STEVENS & FRANK, 1978). From a single case report of asymptomatic G.lamblia infection in a lactating woman, it has been suggested that appearanceof G. lamblia in stools may also be related to pregnancy or lactation in humans (BOLAND & OWEN, 1982). We have followed a cohort of 33 Bangladeshi village women and their infants for one year to study infection and disease with G. lamblia (ISLAM et al., 1983). The women were visited in their homes every 2 weeks and questioned about symptoms of diarrhoea (defined as >4 loose stools/day for at least one day). Every month, 3 consecutive stool samples were collected for microscopic examination. If any of the 3 samples was positive for G. lamblia, the woman was considered to be infected for the given month. 82% of these women excreted cysts and/or trophozoites at least once during the study year (ISLAM et al., 1983). We followed 18 of the women during their pregnancies, starting 3 months before delivery. 44% of these pregnant women (8/18) excreted G. lamblia cysts, trophozoites, or both, at least once during their pregnancies and 29% (12/42) of all samplesexamined were positive. We compared the excretion of G. lamblia by pregnant women to excretion by 11 non-pregnant, non-lactating women and that by 29 non-pregnant, lactating women. Both groups were followed for 3 months, the lactating women during the Brst three months after delivery. 36% (4/11) of non-pregnant, non-lactating women had stools positive for G. lamblia at least once during the observation period and 21% (7/33) of all samples examined were positive. 52% (15/29) of non-pregnant, lactating women excreted G. lamblia at least once during the first three months post-partum with 42% (27164)of all samples positive. There was a significant difference in the overall excretion of G. lamblia between non-pregnant, lactating women and non-pregnant, non-lactating women (pCO.05; &i-square analysis). Of all samples examined there was a trend for more frequent excretion of G. lamblia cysts, trophozoites or both, in the early months post-parturn? than during late pregnancy. There was no sign&ant difference between the various groups in the percentagesof women infected at least once during the observation period. Excretion of G. lamblia cysts or trophozoites each month post-partum in the non-pregnant, lactating group was compared to excretion in the non-pregnant, nonlactating group; lactating women had G. lamblia significantly more frequently in their stools during the second and third months post-partum (~~0.05). In this endemic area, where the majority of women were found to excrete G.lamblia at least once during the study year, it may be difficult to iind differences between the various groups under study. However, our data suggest that ln the early months postpartum, lactating women may excrete G. lamblia more frequently than do pregnant or non-lactating
women. Further studies of G. lamblia infection $-ut~~ pregnancy and lactation are certainly warINGERLJUNGSTR~M National Bacteriological Laboratory, S-105 21 Stockholm, Sweden
BARBARASTOLL* ASMA ISLAM
International Centre for Diarrhoeal Disease Research, G.P.O. 128, Dhaka-2, Bangladesh. *Present address: Uniformed Services University of the Health Sciences, School of Medicine, 4301 Jones Bridge Road, Bethesda, Md 20814, USA.
References
Boland, C. R. & Owen?R. L. (1982). Are lactating mothers a source of giardiasts?New England&ma1 of Medicine, 307.
820.
Islam, A., Stall, B. J., Ljungstriim, I., Biswas, J., Nazrul, H. & Huldt, G. (1983). Giardia lamblia infectionsin a cohort of Bangladeshi mothers and infants followed for one year. 3ournal of Pediatrics, 103, 996-1000. Stevens, D. P. & Frank, D. M. (1978). Local immunity in murine giardiasis: is milk protective at the expense of maternal gut? Transactions of the Association of American Physicians,
Accepted
91, 268-272.
for publication 8th February, 1986
Visceral leishmaniasis of adults in Sicily: a truce interrupted? Visceral leishmaniasis (VL), a diseasealmost exclusively of children in Italy (between 1909 and 1940, 6000 cases, 199/year), decreased rapidly after the campaign of malaria eradication with DDT (FENICIA, 1937; MANSUETO, 1984). Nevertheless, the disease has not disappearedcompletely, and a few casesoccur every year, almost all in children (MANSUETO,1984).
Fig. Visceral periods.
leishmaniasis
of adults in Sicily in three different
TRANSACTIONSOF THE ROYAL SOCIETYOF TROPICALMEDICINE AND HYGIENE (1987) 81
Correspondence To the Editor Giardia infection during pregnancy and lactation
It has been shown that female mice experimentally infected with Giardia muris, which had ceasedto pass parasites in their stools, again began to shed Giardia cysts during pregnancy and lactation (STEVENS & FRANK, 1978). From a single case report of asymptomatic G.lamblia infection in a lactating woman, it has been suggested that appearanceof G. lamblia in stools may also be related to pregnancy or lactation in humans (BOLAND & OWEN, 1982). We have followed a cohort of 33 Bangladeshi village women and their infants for one year to study infection and disease with G. lamblia (ISLAM et al., 1983). The women were visited in their homes every 2 weeks and questioned about symptoms of diarrhoea (defined as >4 loose stools/day for at least one day). Every month, 3 consecutive stool samples were collected for microscopic examination. If any of the 3 samples was positive for G. lamblia, the woman was considered to be infected for the given month. 82% of these women excreted cysts and/or trophozoites at least once during the study year (ISLAM et al., 1983). We followed 18 of the women during their pregnancies, starting 3 months before delivery. 44% of these pregnant women (8/18) excreted G. lamblia cysts, trophozoites, or both, at least once during their pregnancies and 29% (12/42) of all samplesexamined were positive. We compared the excretion of G. lamblia by pregnant women to excretion by 11 non-pregnant, non-lactating women and that by 29 non-pregnant, lactating women. Both groups were followed for 3 months, the lactating women during the Brst three months after delivery. 36% (4/11) of non-pregnant, non-lactating women had stools positive for G. lamblia at least once during the observation period and 21% (7/33) of all samples examined were positive. 52% (15/29) of non-pregnant, lactating women excreted G. lamblia at least once during the first three months post-partum with 42% (27164)of all samples positive. There was a significant difference in the overall excretion of G. lamblia between non-pregnant, lactating women and non-pregnant, non-lactating women (pCO.05; &i-square analysis). Of all samples examined there was a trend for more frequent excretion of G. lamblia cysts, trophozoites or both, in the early months post-parturn? than during late pregnancy. There was no sign&ant difference between the various groups in the percentagesof women infected at least once during the observation period. Excretion of G. lamblia cysts or trophozoites each month post-partum in the non-pregnant, lactating group was compared to excretion in the non-pregnant, nonlactating group; lactating women had G. lamblia significantly more frequently in their stools during the second and third months post-partum (~~0.05). In this endemic area, where the majority of women were found to excrete G.lamblia at least once during the study year, it may be difficult to iind differences between the various groups under study. However, our data suggest that ln the early months postpartum, lactating women may excrete G. lamblia more frequently than do pregnant or non-lactating
women. Further studies of G. lamblia infection $-ut~~ pregnancy and lactation are certainly warINGERLJUNGSTR~M National Bacteriological Laboratory, S-105 21 Stockholm, Sweden
BARBARASTOLL* ASMA ISLAM
International Centre for Diarrhoeal Disease Research, G.P.O. 128, Dhaka-2, Bangladesh. *Present address: Uniformed Services University of the Health Sciences, School of Medicine, 4301 Jones Bridge Road, Bethesda, Md 20814, USA.
References
Boland, C. R. & Owen?R. L. (1982). Are lactating mothers a source of giardiasts?New England&ma1 of Medicine, 307.
820.
Islam, A., Stall, B. J., Ljungstriim, I., Biswas, J., Nazrul, H. & Huldt, G. (1983). Giardia lamblia infectionsin a cohort of Bangladeshi mothers and infants followed for one year. 3ournal of Pediatrics, 103, 996-1000. Stevens, D. P. & Frank, D. M. (1978). Local immunity in murine giardiasis: is milk protective at the expense of maternal gut? Transactions of the Association of American Physicians,
Accepted
91, 268-272.
for publication 8th February, 1986
Visceral leishmaniasis of adults in Sicily: a truce interrupted? Visceral leishmaniasis (VL), a diseasealmost exclusively of children in Italy (between 1909 and 1940, 6000 cases, 199/year), decreased rapidly after the campaign of malaria eradication with DDT (FENICIA, 1937; MANSUETO, 1984). Nevertheless, the disease has not disappearedcompletely, and a few casesoccur every year, almost all in children (MANSUETO,1984).
Fig. Visceral periods.
leishmaniasis
of adults in Sicily in three different