Cross-sectional epidemiological investigations of Giardia lamblia in children in Pakistan

Giardiasis: An Overlooked Cause of Recurrent Abdominal Pain

Recurrent abdominal pain is defined as at least three episodes of abdominal pain, lasting for three months or more and affecting the daily activities of an individual. Giardiasis is one of the causes of recurrent abdominal pain but is often overlooked. We report the case of an 11-year-old girl who presented with complaints of severe abdominal pain and two episodes of fresh blood in stool in one day. She had recurrent episodes of abdominal pain, occasional bloating, and diarrhea over the past two years. Workup for differentials like appendicitis and ovarian torsion was done. She was initially treated for an ovarian cyst with oral contraceptives, but her symptoms showed no improvement. Therefore, a laparoscopic ovarian cystectomy and appendectomy were attempted. Despite surgical intervention, the abdominal pain failed to resolve. A duodenal biopsy was performed, which showed vegetative growths of Giardia lamblia (G. lamblia). This report highlights the unusual presentation of giardiasis as an acute abdomen, making it a diagnostic challenge. 

Prevalence and multi-locus genotyping of Giardia duodenalis in rabbits from Shaanxi province in northwestern China

Giardia duodenalis is an important parasite with veterinary and public health significance worldwide. The presence and zoonotic assemblages of G. duodenalis have previously been reported in rabbits. In this study, to understand the infection status of G. duodenalis in rabbits from Shaanxi province, a total of 537 fecal samples were collected from two breeds of rabbits in four age groups (<30 days, 31–90 days, 91–200 days and >200 days) from four geographical origins (Fengxiang, Yangling, Tongchuan, and Shanyang). The presence of G. duodenalis in these samples was assessed using molecular assays based on beta-giardin (bg). The glutamate dehydrogenase (gdh) and triosephosphate isomerase (tpi) loci were then amplified in the bg-positive samples for multi-locus genotype (MLG) analysis. The total prevalence of G. duodenalis in these rabbits was 3.54% (19/537). Giardia duodenalis infection was found in both breeds of rabbits, and in all farms and age groups, but with no statistically significant differences related to these factors (p > 0.05). Two assemblages, including B and E, were identified, with the former the predominant assemblage detected in both breeds, and in all age groups and farms. Sequence analysis revealed 2 (named as rbg1-2), 1 (named as rtpi1), and 2 (named as rgdh1-2) haplotypes at the gene loci of bg, tpi, and gdh, respectively, forming a multilocus genotype (MLG) of assemblage B (rbg1, rtpi1, and rgdh1). These findings reveal the significant zoonotic potential and genetic diversity of G. duodenalis in rabbits in Shaanxi Province, PR China.

Intestinal protozoa in hospitalized under-five children with diarrhoea in Nampula - a cross-sectional analysis in a low-income setting in northern Mozambique

Background

In Mozambique, infection by intestinal parasites is reported all over the country. However, infection in children with diarrhoea is mostly focused in the southern region of Mozambique. This work aims to determine the frequency and potential risk factors for infection by Cryptosporidium spp., Giardia lamblia, and Entamoeba histolytica in children under-five years hospitalized with diarrhoea in Hospital Central de Nampula, northern Mozambique.

Methods

A cross-sectional hospital-based surveillance was conducted between March 2015 and January 2018 in children admitted with diarrhoea in Hospital Central de Nampula. Sociodemographic information was obtained through semi-structured interviews applied to the children’s caregivers. A single stool sample was collected from each child to detect antigens from Cryptosporidium spp., G. lamblia, and E. histolytica using an immune-enzymatic technique. Crude and adjusted odds ratios (with 95% Confidence Intervals) were obtained by logistic regression models to identify factors associated with infection by Cryptosporidium spp. and G. lamblia.

Results

The median age and interquartile intervals of our sample population was 12 months (8–20). Intestinal protozoa were detected in 21.4% (59/276). Cryptosporidium spp. was the most common protozoa (13.9% - 38/274), followed by G. lamblia (9.1% - 25/274) and E. histolytica (0.4% - 1/275). Children with illiterate caregiver’s (p-value = 0.042) and undernourished (p-value = 0.011) were more likely to be infected by Cryptosporidium spp. G. lamblia was more common in children living in households with more than four members (p-value = 0.039). E. histolytica was detected in an eleven month’s child, co-infected with Cryptosporidium spp. and undernourished.

Conclusion

Cryptosporidium spp. and Giardia lamblia were the most common pathogenic intestinal protozoa detected in children with diarrhoea hospitalized in the Hospital Central de Nampula. Our findings obtained highlight the importance of exploring the caregiver’s education level, children’s nutritional status for infections with Cryptosporidium spp., and living conditions, namely crowded households for infections with G. lamblia in children younger than five years.