**Malabsorption in Giardiasis**

**Malabsorption in Giardiasis**

#### Amornnivit Kanokwanvimol Amornnivit Kanokwanvimol Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.70806

#### **Abstract**

[51] Nunez FA, Hernandez M, Finlay CM. Longitudinal study of giardiasis in three day care

[52] Boreham PF, Shepherd RW. Giardiasis in child-care centres. Medical Journal of Australia.

[53] Mascarini LM, Donalisio MR. Giardiasis and cryptosporidiosis in children institutionalized at daycare centers in the state of Sao Paulo. Revista da Sociedade Brasileira de

[54] Beltrami JF, Shouse RL, Blake PA. Trends in infectious diseases and the male to female ratio: Possible clues to changes in behavior among men who have sex with men. AIDS

[55] Abaza SM, Makhlouf LM, el-Shewy KA, el-Moamly AA. Intestinal opportunistic parasites among different groups of immunocompromised hosts. Journal of the Egyptian

[56] Cruz I, Ricardo JL, Nunes JF, Serras AC, Porto MT, Lopes JM, Veloso FT, Freitas J. Giardia and immune deficiency. American Journal of Gastroenterology. 1991;**86**:1554-1555

[57] Holtan NR. Giardiasis. A crimp in the life-style of campers, travelers, and others.

[58] Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, Lofdahl M, MacDonald E, Nichols G, Schonning C, Sudre B, Tronnberg L, Vold L, Semenza JC, Nygard K. Waterborne outbreaks in the Nordic countries, 1998 to 2012.

[59] Rendtorff RC, Holt CJ. The experimental transmission of human intestinal protozoan parasites. IV. Attempts to transmit Entamoeba coli and *Giardia lamblia* cysts by water.

[60] Enserink R, Scholts R, Bruijning-Verhagen P, Duizer E, Vennema H, de Boer R, Kortbeek T, Roelfsema J, Smit H, Kooistra-Smid M, van Pelt W. High detection rates of enteropathogens in asymptomatic children attending day care. PLoS One. 2014;**9**:e89496

[61] Escobedo AA, Almirall P, Alfonso M, Cimerman S, Chacin-Bonilla L. Sexual transmission of giardiasis: A neglected route of spread? Acta Tropica. 2014;**132**:106-111

[62] Manatsathit S, Tansupasawasdikul S, Wanachiwanawin D, Setawarin S, Suwanagool P, Prakasvejakit S, Leelakusolwong S, Eampokalap B, Kachintorn U. Causes of chronic diarrhea in patients with AIDS in Thailand: A prospective clinical and microbiological

[63] Espelage W, an der Heiden M, Stark K, Alpers K. Characteristics and risk factors for symptomatic *Giardia lamblia* infections in Germany. BMC Public Health. 2010;**10**:41

centres of Havana City. Acta Tropica. 1999;**73**:237-242

Medicina Tropical. 2006;**39**:577-579

Education and Prevention. 2005;**17**:49-59

Society of Parasitology. 1995;**25**:713-727

EuroSurveillance. 2015;**20**

Postgraduate Medicine Journal. 1988;**83**:54-6, 59-61

American Journal of Hygiene. 1954;60(3):327-338

study. Journal of Gastroenterology. 1996;**31**:533-537

1984;**141**:263

24 Current Topics in Giardiasis

*Giardia* intestinalis is a flagellated parasite and is regarded as the most common cause of protozoan-associated diarrhoea worldwide. The organisms can be found in 80% of raw water supplies from lakes, streams and ponds and as many as 15% filtered water samples. *Giardia* intestinalis can be found worldwide including both temperate and tropical regions and can cause asymptomatic colonisation or acute or chronic diarrhoea illness. The symptoms vary from vague abdominal discomfort or severe abdominal pain, diarrhoea and weight loss. It is believed that these symptoms are a result of giardiasis-associated malabsorption syndrome, although the pathophysiology underlying intestinal disturbances remains incompletely understood. Interestingly, intestinal malabsorption is a result of epithelial dysfunction that shares similarities with those observed in other enteric disorders such as bacteria enteritis, Crohn's disease and celiac disease. Numerous other mechanisms of intestinal malabsorption have been postulated such as immunologic reactions, altered gut motility and fluid hypersecretion via adenylate cyclase activity. In this chapter, we will go through each mechanism of malabsorption associated with giardiasis and the consequences of this to the patients.

DOI: 10.5772/intechopen.70806

**Keywords:** intestinal malabsorption, giardiasis, epithelia, injury, growth retardation, chronic diarrhoea

## **1. Introduction**

*Giardia* infection is a common intestinal infection worldwide [1, 2]. The worldwide incidence was estimated at 2.8 × 108 infection per year [3]. In the industrialised world, overall prevalence rates are 2–5%. In developing world, infection starts as early as in the infant year and is the major cause of childhood diarrhoea. Prevalence rates of 15–20% in children under 10 years are common [2, 4]. In Thailand, the prevalence of giardiasis ranges from 1.25 to 37.7% [5]. The incidence varies depending on age, living conditions, personal hygiene and environment sanitation. Despite the high prevalence of the infection, physicians often neglect to add giardiasis

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

as one of the differential diagnosis in patients present with chronic diarrhoea. This is due to the lack of expertise in many of our public hospitals.

Patients who are infected with *Giardia* intestinalis have symptoms ranging from asymptomatic to severe chronic diarrhoea. The pathogenesis of malabsorption syndrome–related chronic diarrhoea is not fully understood; however, many theories such as epithelial dysfunction, immunologic reactions, altered gut motility and fluid hypersecretion have been postulated.

Giardiasis can lead to grown retardation in children and severe malnutrition in adult patients. Patients can also present with protein energy malnutrition, vitamin A deficiency and iron deficiency anaemia. A cross sectional study in Malaysia including 281 children aged 2–15 years showed that 56.5% of the infected children have significantly underweight, while 61.3% have growth retardations [6].
