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Giardiasis is not uncommon in Taiwan
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Journal of the Formosan Medical Association (2013) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
CORRESPONDENCE
Giardiasis is not uncommon in Taiwan Han-Yu Chang a, Jui-Ting Hu a,b, Shih-Hung Huang c, Sien-Sing Yang a,b,* a
Liver Unit, Cathay General Hospital, Taipei, Taiwan Faculty of Medicine, Fu-Jen Catholic University College of Medicine, New Taipei, Taiwan c Department of Pathology, Cathay General Hospital, Taipei, Taiwan b
Received 17 August 2013; received in revised form 27 August 2013; accepted 28 August 2013
KEYWORDS giardiasis; malabsorption; weight loss
Dear Editor,
Giardiasis is an important water- and food-borne infectious disease that causes sporadic diarrhea in travelers and daycare center attendees worldwide.1,2 We report a 33-year-old diabetic mother with Giardiasis presenting as malnutrition and severe weight loss from 85 kg to 40 kg over 6 months, who had close contact with her mentally impaired son at a sanatorium. The duodenal biopsy confirmed the Giardia trophozoites among the villi and crypts (Fig. 1). The architecture of the duodenal mucosa was well preserved. Electron microscopy confirmed the presence of Giardia trophozoites in the duodenal villi. She responded to metronidazole therapy, as her symptoms improved and she regained weight to 50 kg in 24 weeks.
* Corresponding author. Liver Unit, Cathay General Hospital, 280, Section 4, Jen-Ai Road, Taipei 10630, Taiwan. E-mail address: [email protected] (S.-S. Yang).
As few as 10e25 cysts can cause Giardia infection following the ingestion of cysts from contaminated water or food.1,2 Giardia cysts transform into trophozoites in the proximal small bowel, where trophozoites replicate on the mucosal surface and usually do not invade the mucosa. Trophozoites may directly invade or release toxic substances to damage the intestinal epithelium. Trophozoites transform into infectious cysts in the distal small intestine and colon. Most cases of Giardiasis are asymptomatic. Chronic Giardiasis may develop malaise, depression, flatulence, loose stools, malabsorption, and weight loss.1,2 The diagnosis of Giardiasis requires the identification of Giardia cysts on three stool specimen examinations. Aspiration and biopsy of the duodenum and small intestine can be helpful. Stool immunoassays are more sensitive than conventional stool microscopy. Giardiasis can be found in 2e5% of individuals in industrialized nations and up to 33% in developing countries. In urban and mountainous areas of Taiwan, fecal specimens from livestock and avian farms and water samples from small water systems, rivers, underground wells, and mountain
0929-6646/$ - see front matter Copyright ª 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved. http://dx.doi.org/10.1016/j.jfma.2013.08.014
Please cite this article in press as: Chang H-Y, et al., Giardiasis is not uncommon in Taiwan, Journal of the Formosan Medical Association (2013), http://dx.doi.org/10.1016/j.jfma.2013.08.014
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H.-Y. Chang et al.
Figure 1 Scattered flagellated and sickle- or pear-shaped Giardia trophozoites in (A) high-power view (200 ) and (B) electron microscopy (10,000 ).
springs were proven to contain Giardia cysts.3,4 In Nantou, eight of 209 schoolchildren had detectable Giardia duodenalis in their fecal samples.5 Therefore, Giardia infection is not uncommon in Taiwan. Careful investigation of potential Giardia infection is important in patients with chronic diarrhea, malnutrition, and immunodeficiency status. Underground, spring, and river water should be filtered to reduce the risk of possible Giardia infection.
References 1. Huang DB, White AC. An updated review on Cryptosporidium and Giardia. Gastroenterol Clin North Am 2006;35:291e314.
2. Ankarklev J, Jerlstro ¨m-Hultqvist J, Ringqvist E, Troell K, Sva ¨rd SG. Behind the smile: cell biology and disease mechanisms of Giardia species. Nature Rev Microbiol 2010;8: 413e22. 3. Hsu BM, Wun HY, Hsu PC. Prevalence and genotyping of Giardia in husbandry systems in Taiwan. Parasitol Res 2007;101: 275e80. 4. Hu LT. Detection of Giardia cysts and Cryptosporidium oocysts in central Taiwan rivers by immunofluorescence assay. J Microbiol Immunol Infect 2002;35:68e70. 5. Liang CH, Tsaihong JC, Cheng YY, Peng SY. Occurrence and genotype of Giardia cysts isolated from faecal samples of children and dogs and from drinking water samples in an aboriginal area of central Taiwan. Exp Parasitol 2012;131: 204e9.
Please cite this article in press as: Chang H-Y, et al., Giardiasis is not uncommon in Taiwan, Journal of the Formosan Medical Association (2013), http://dx.doi.org/10.1016/j.jfma.2013.08.014
MODEL
Journal of the Formosan Medical Association (2013) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
CORRESPONDENCE
Giardiasis is not uncommon in Taiwan Han-Yu Chang a, Jui-Ting Hu a,b, Shih-Hung Huang c, Sien-Sing Yang a,b,* a
Liver Unit, Cathay General Hospital, Taipei, Taiwan Faculty of Medicine, Fu-Jen Catholic University College of Medicine, New Taipei, Taiwan c Department of Pathology, Cathay General Hospital, Taipei, Taiwan b
Received 17 August 2013; received in revised form 27 August 2013; accepted 28 August 2013
KEYWORDS giardiasis; malabsorption; weight loss
Dear Editor,
Giardiasis is an important water- and food-borne infectious disease that causes sporadic diarrhea in travelers and daycare center attendees worldwide.1,2 We report a 33-year-old diabetic mother with Giardiasis presenting as malnutrition and severe weight loss from 85 kg to 40 kg over 6 months, who had close contact with her mentally impaired son at a sanatorium. The duodenal biopsy confirmed the Giardia trophozoites among the villi and crypts (Fig. 1). The architecture of the duodenal mucosa was well preserved. Electron microscopy confirmed the presence of Giardia trophozoites in the duodenal villi. She responded to metronidazole therapy, as her symptoms improved and she regained weight to 50 kg in 24 weeks.
* Corresponding author. Liver Unit, Cathay General Hospital, 280, Section 4, Jen-Ai Road, Taipei 10630, Taiwan. E-mail address: [email protected] (S.-S. Yang).
As few as 10e25 cysts can cause Giardia infection following the ingestion of cysts from contaminated water or food.1,2 Giardia cysts transform into trophozoites in the proximal small bowel, where trophozoites replicate on the mucosal surface and usually do not invade the mucosa. Trophozoites may directly invade or release toxic substances to damage the intestinal epithelium. Trophozoites transform into infectious cysts in the distal small intestine and colon. Most cases of Giardiasis are asymptomatic. Chronic Giardiasis may develop malaise, depression, flatulence, loose stools, malabsorption, and weight loss.1,2 The diagnosis of Giardiasis requires the identification of Giardia cysts on three stool specimen examinations. Aspiration and biopsy of the duodenum and small intestine can be helpful. Stool immunoassays are more sensitive than conventional stool microscopy. Giardiasis can be found in 2e5% of individuals in industrialized nations and up to 33% in developing countries. In urban and mountainous areas of Taiwan, fecal specimens from livestock and avian farms and water samples from small water systems, rivers, underground wells, and mountain
0929-6646/$ - see front matter Copyright ª 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved. http://dx.doi.org/10.1016/j.jfma.2013.08.014
Please cite this article in press as: Chang H-Y, et al., Giardiasis is not uncommon in Taiwan, Journal of the Formosan Medical Association (2013), http://dx.doi.org/10.1016/j.jfma.2013.08.014
+
MODEL
2
H.-Y. Chang et al.
Figure 1 Scattered flagellated and sickle- or pear-shaped Giardia trophozoites in (A) high-power view (200 ) and (B) electron microscopy (10,000 ).
springs were proven to contain Giardia cysts.3,4 In Nantou, eight of 209 schoolchildren had detectable Giardia duodenalis in their fecal samples.5 Therefore, Giardia infection is not uncommon in Taiwan. Careful investigation of potential Giardia infection is important in patients with chronic diarrhea, malnutrition, and immunodeficiency status. Underground, spring, and river water should be filtered to reduce the risk of possible Giardia infection.
References 1. Huang DB, White AC. An updated review on Cryptosporidium and Giardia. Gastroenterol Clin North Am 2006;35:291e314.
2. Ankarklev J, Jerlstro ¨m-Hultqvist J, Ringqvist E, Troell K, Sva ¨rd SG. Behind the smile: cell biology and disease mechanisms of Giardia species. Nature Rev Microbiol 2010;8: 413e22. 3. Hsu BM, Wun HY, Hsu PC. Prevalence and genotyping of Giardia in husbandry systems in Taiwan. Parasitol Res 2007;101: 275e80. 4. Hu LT. Detection of Giardia cysts and Cryptosporidium oocysts in central Taiwan rivers by immunofluorescence assay. J Microbiol Immunol Infect 2002;35:68e70. 5. Liang CH, Tsaihong JC, Cheng YY, Peng SY. Occurrence and genotype of Giardia cysts isolated from faecal samples of children and dogs and from drinking water samples in an aboriginal area of central Taiwan. Exp Parasitol 2012;131: 204e9.
Please cite this article in press as: Chang H-Y, et al., Giardiasis is not uncommon in Taiwan, Journal of the Formosan Medical Association (2013), http://dx.doi.org/10.1016/j.jfma.2013.08.014