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Maternal (Expert Forum)
Re: Giardia
Patient medical question and answer from The Maternal and Child Health Forum. Health topic area and articles about newborn care
Re: Giardia
by HFHS.MD-HSW, Jan 01, 1995 12:00AM
Posted By HFHS.MD-HSW on April 15, 1998 at 07:58:18:
In Reply to: Giardia posted by turgut on April 13, 1998 at 17:23:20:
Dear Doctor,
We live in Turkey, and we have an adorable now-13 month old son.
This is our second child. About six months ago, he started crying a lot,
burping and having foul-smelling diapers. It turned out that he had Giardia.
I have been reading about it ever since. For six months now, he has been
going thru all known Giardia medicines - including some that have been
brought from The States. Right now he is on Nidazol for a week, following
a 3-week treatment of Humatin. While he improves significantly while he is on
medication, once he is off (we Are strict about the number of days and
times of medication), he gets sick again. We had periodic (diaper) lab
tests, and only on one of them (out of a dozen or so) he was clear, only
to test positive a few weeks later. The whole family's stools got tested,
we were all negative.
We are very careful about sanitation, including tap water, washing fruits
and vegetables, etc. We now even put Lysol while cleaning the house.
Naturally, we are going crazy with this thing.
At this point, we are ready to call it quits, as we worry of the
effects of all this medication (six months of it!) must be having
on this toddler.
I was wondering if our experiences are common, and what the effects can
be if we were to stop the treatments (and perhaps wait until he is older)
I read somewhere that the diarrhea, gas, etc symptoms diminish with time,
and even some people recover from Giardia altogether. Is that true?
Many thanks for your help..
turgut
=
Dear friends in Turkey:
Giardia is a ubiquitous parasite which may reside silently in some persons even while causing severe malnutrition in others. Children are more likely than adults to be infected.
Day care centers are often significant reservoirs of infection. Dogs may be carriers of the organism. Water is often a source of epidemics. The usual levels of chlorine used to purify water are insufficient to eradicate the parasite. Water filtration is required.
Cyst excretion is irregular. Hence, several stool specimens may be required to diagnose Giardia in asymptomatic carriers. At times,diagnosis even requires small bowel biopsy.
Assuming the presence of water filtration and the performance of routine careful handwashing in addition to the other steps listed in your letter,you appear to be doing the right things to minimize the transmission of Giardia in your home.
Otherwise healthy children may pass the infective cysts for many months. If this were the situation in your household, observation alone would suffice. Asymptomatic individuals are often best not treated given the lack of adverse outcomes of untreated infection in such individuals as well as the cost and side-effects of medication. Most cases of asymptomatic infection are likely to be self-limited. However, according to your note, your son becomes sick soon after completing a course of medication. I will assume your son has received appropriate doses of furazolidone, metronidazole, tinidazole, and quinacrine used alone, as well as a trial of quinacrine and metronidazole combined. If my supposition is incorrect, there may some benefit in exhausting all such therapeutic alternatives.
I have one additional thought. Giardia is notoriously difficult to eradicate in youngsters with immunoglobulin deficiency. If quantitative immunoglobulins have not been assessed (with a focus on IgA), such a study may shed further light.
I wish you the best. I spent a very enjoyable vacation in your country in 1961.
This information is supplied for educational purposes only. Your child's physician has the ultimate responsibility to work with you to assure the best outcome for your son.
HFHS M.D.-HSW
In Reply to: Giardia posted by turgut on April 13, 1998 at 17:23:20:
Dear Doctor,
We live in Turkey, and we have an adorable now-13 month old son.
This is our second child. About six months ago, he started crying a lot,
burping and having foul-smelling diapers. It turned out that he had Giardia.
I have been reading about it ever since. For six months now, he has been
going thru all known Giardia medicines - including some that have been
brought from The States. Right now he is on Nidazol for a week, following
a 3-week treatment of Humatin. While he improves significantly while he is on
medication, once he is off (we Are strict about the number of days and
times of medication), he gets sick again. We had periodic (diaper) lab
tests, and only on one of them (out of a dozen or so) he was clear, only
to test positive a few weeks later. The whole family's stools got tested,
we were all negative.
We are very careful about sanitation, including tap water, washing fruits
and vegetables, etc. We now even put Lysol while cleaning the house.
Naturally, we are going crazy with this thing.
At this point, we are ready to call it quits, as we worry of the
effects of all this medication (six months of it!) must be having
on this toddler.
I was wondering if our experiences are common, and what the effects can
be if we were to stop the treatments (and perhaps wait until he is older)
I read somewhere that the diarrhea, gas, etc symptoms diminish with time,
and even some people recover from Giardia altogether. Is that true?
Many thanks for your help..
turgut
=
Dear friends in Turkey:
Giardia is a ubiquitous parasite which may reside silently in some persons even while causing severe malnutrition in others. Children are more likely than adults to be infected.
Day care centers are often significant reservoirs of infection. Dogs may be carriers of the organism. Water is often a source of epidemics. The usual levels of chlorine used to purify water are insufficient to eradicate the parasite. Water filtration is required.
Cyst excretion is irregular. Hence, several stool specimens may be required to diagnose Giardia in asymptomatic carriers. At times,diagnosis even requires small bowel biopsy.
Assuming the presence of water filtration and the performance of routine careful handwashing in addition to the other steps listed in your letter,you appear to be doing the right things to minimize the transmission of Giardia in your home.
Otherwise healthy children may pass the infective cysts for many months. If this were the situation in your household, observation alone would suffice. Asymptomatic individuals are often best not treated given the lack of adverse outcomes of untreated infection in such individuals as well as the cost and side-effects of medication. Most cases of asymptomatic infection are likely to be self-limited. However, according to your note, your son becomes sick soon after completing a course of medication. I will assume your son has received appropriate doses of furazolidone, metronidazole, tinidazole, and quinacrine used alone, as well as a trial of quinacrine and metronidazole combined. If my supposition is incorrect, there may some benefit in exhausting all such therapeutic alternatives.
I have one additional thought. Giardia is notoriously difficult to eradicate in youngsters with immunoglobulin deficiency. If quantitative immunoglobulins have not been assessed (with a focus on IgA), such a study may shed further light.
I wish you the best. I spent a very enjoyable vacation in your country in 1961.
This information is supplied for educational purposes only. Your child's physician has the ultimate responsibility to work with you to assure the best outcome for your son.
HFHS M.D.-HSW
