Symptoms of Giardiasis

Giardiasis symptoms are very diverse, as a rule, they are nonspecific and are one of the ways to determine the form of the disease. Clinical forms of giardiasis are also variable - from intestinal to anemic, due to the diversity with the high prevalence of this disease. Lamblias (L. Intestinalis) parasitize in the small intestine, more precisely in its upper parts.

Symptoms of Giardiasis are manifested when microscopic flagellate parasites-Giardia Lamblia - intestinal lamblia enter the body and settle in the human intestine. Parasites can not enter the bloodstream, but they have enough of their ability to live the lumen of the upper part of the small intestine and feel comfortable there. It is clear that living in the intestine of such an "uninvited guest" does not pass without a trace.

Previously, it was believed that protozoal parasites could penetrate the gallbladder and liver, and later, through experimental studies, it was proved that bile is an uncomfortable and toxic environment for lamblia. Giardiasis, the symptoms of which directly depend on the number of infecting parasites, in the initial stages develops, as a rule, asymptomatically. Clinical manifestations correspond to the current state of the digestive tract and the activity of the immune system. However, even a small number of parasites that infect the body are able to multiply rapidly due to provoking carbohydrate foods or a decreased level of acidity in the gastrointestinal system. Statistics argue that the predominance of protein foods in the diet significantly reduces the risk of infection with Giardiasis.

Giardiasis is classified as follows: 

1. Asymptomatic form - carriage. 
2. The clinically manifested form is actually lambliasis as a disease.

[1], [2],

The forms of Giardiasis and their main symptoms

In the intestine lamblia fall into the form of motionless and protected from external influences of cysts, which are then transformed into a mobile and able to reproduce the vegetative form of trophozoids. It is the trophozoids that attach to the mucous membrane of the intestines (including the duodenum) and begin to eat intensively and quickly reproduce, forming valuable colonies. Then again comes the cycle of their immobility, during which part of the trophozoids pass into the form of cysts and find themselves in the large intestine, from where they can "break free", that is, get out of the body with calves. And so on a circle ...

While the trophozoids sit in the human intestine, they manage to cause a lot of symptoms, although, according to infectious disease doctors, the disease progresses asymptomatically in almost every fourth case of lamblia infection (the so-called latent lambliasis). According to WHO, the global scale of lesions of Giardia is up to 20% of the population, among children under 7 years - almost 30%.

There are two main forms of giardiasis: acute and chronic.

Clinical forms of Giardiasis

• Intestinal form - dyspepsia, violation of defecation (constipation or diarrhea), secondary malabsorption, flatulence, often - nausea and general fatigue. Often intestinal lambliasis symptoms manifest as a false appendicitis. 
• Hepatobiliary form - low, insufficient bile secretion (cholestasis), DZHVP (dyskinesia of the bile ducts) with all the accompanying symptoms - spasmodic pains, nausea up to vomiting, pains in the right side of the epigastrium, irradiating to the scapula or shoulder. Often in this form, giardiasis symptoms manifest as a typical gastroduodenitis or pancreatitis. 
• Asthenoneurotic form - all neurological symptoms: signs similar to manifestation of vegetovascular dystonia, headache, sleep disorders, weight loss, fatigue. 
• Allergic form (toxic-allergic) - rashes on the skin, urticaria, atopic dermatitis, all signs of an allergic reaction up to Quincke's edema.

Giardiasis, whose symptoms are nonspecific, is difficult to diagnose in the initial stage of infection, since the complaints submitted by patients are extremely similar to those of classic intestinal, hepatic or neurological pathologies. The only relatively characteristic symptom of giardiasis is a chronic digestive disorder. Gastroenterologists specify suspicions of lambliasis with the help of anamnestic information, laboratory diagnostics, including serological methods of investigation, UAC, biochemical analysis of blood serum and coprologic examination. Also, clinical signs of the disease are refined according to the method and routes of lamblia infection.

The mechanism of the invasive process and the accompanying symptoms of giardiasis:

1. If the infection of a healthy organism has occurred by water or food, through contaminated products or water, parasite cysts penetrate the gastrointestinal tract, turning into the small intestine into trophozates (vegetative form). The vegetative forms of lamblia attach to the walls of the small intestine and begin to develop. They feed on Giardia with their entire surface, and also allocate waste products (protozoan excrement). Such a lambliasis symptoms shows slightly pronounced, as the whole process occurs against the background of a relatively healthy organism.
2. If a person with a chronic gastrointestinal disease becomes infected, the lambliasis symptoms are more pronounced. The intestinal wall, which is not healthy initially, is already affected by erosion of one or another degree of severity, lamblia exacerbates the erosive process, provoking inflammation. Often, malabsorption syndrome develops - a decrease in the activity of absorption of lipids (fats), vitamins, which are only dissolved in the lipid coat, proteins and glucose.

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The most common symptoms of Giardiasis

• Signs similar to vitamin deficiency, as the body stops receiving the right amount of vitamins A, D, and antihemorrhagic vitamin K. 
• Symptoms of hypoglycemia due to glucose deficiency - fainting, dizziness, weakness, tremor of the extremities. 
• Anemia and general exhaustion up to cachexia due to poor absorption of proteins or complete absence of proteins. 
• A significant decrease in the activity of immunity due to a violation of the process of formation of immune antibodies with the help of proteins. 
• Dysbacteriosis and chronic diarrhea (up to five times a day). 
• Symptoms of cholecystitis or pancreatitis. Often this stage is accompanied by irradiating pains in the right part of the body, icteric staining of eye proteins, hepatomegaly (increase in liver size). 
• Allergic reactions are explained by intoxication of the body with the products of the vital activity of parasites. This stage is accompanied by allergic rashes, hives, and Quincke's edema is possible.

Giardiasis, the symptoms of which can manifest more clearly in connection with the development of the disease, can last for years. Clinical manifestations are not characteristic and specific for this disease.

Acute lambliasis

Acute giardiasis appears usually 7-10 days after infection, but the incubation period can last a whole month. Diagnostically significant symptoms of Giardiasis include:

• diarrhea (diarrhea);
• spasms and bloating in the abdomen;
• nausea;
• vomiting;
• temperature increase;
• pain in the epigastric region;
• increased fatigue and general malaise;
• decreased appetite and weight loss.

It should be borne in mind that diarrhea with giardiasis is abundant, watery, offensive, has a yellowish color, can contain elements of mucus. And feces with lambliasis has a pale color, a sharp smell and oily. This is all - a typical sign of steatorrhoea, that is, increased excretion of fats from the body, caused by a violation of their absorption in the intestine (malabsorption).

The temperature with giardiasis does not rise at all, but if it rises, it does not last long and, as a rule, does not exceed + 37.8-38 ° C.

Pain in giardiasis - in the epigastric region, closer to the right hypochondrium - may be trailing or sharp, but necessarily cramping. Often they can even be taken for pain with inflammation of the appendix. In addition, increased pain with giardiasis provokes food with a high fat content.

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Chronic lambliasis

Chronic lambliasis develops from an incurable acute form, which could be asymptomatic. Symptoms of giardiasis in the chronic form of the disease are as follows:

• periodic diarrhea, followed by constipation;
• flatulence;
• belching is rotten or bitter;
• nausea;
• pain in the epigastric region;
• yellow coating on the tongue;
• poor appetite;
• decrease in hemoglobin level in the blood (anemia);
• pallor of the skin;
• headaches and dizziness;
• increased irritability, a feeling of fatigue, restless sleep.

Infectionists and gastroenterologists differentiate also intestinal, hepatic and biliary-pancreatic forms of giardiasis. With intestinal lambliasis, the symptoms are similar to duodenal inflammation (duodenitis) or inflammation of the small and large intestines (enterocolitis). The hepatic form of giardiasis has a clinical picture of inflammation of the gallbladder (cholecystitis) and inflammation of the bile duct (cholangitis). And for the biliary-pancreatic form, signs of inflammation of the pancreas (pancreatitis) are characteristic.

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Giardiasis and allergy

The ability of lamblia to cause an allergic reaction of the body should be considered separately. And that's why.

In addition to the already listed signs, in almost 40% of cases of chronic form of this parasitic disease symptoms of giardiasis on the skin may appear. In addition, there is often a cough with giardiasis, almost similar to asthmatic bronchitis.

With intestinal manifestations, physicians are disassembled by fecal analysis (and, if necessary, by the contents of the duodenum) for the presence of trophozoites and lamblia cysts in it - to confirm the alleged invasion. But when against a background of all intestinal symptoms arise rashes with giardiasis or acne with giardiasis, it is necessary to conduct a serological test with intradermal tests, that is, to determine the presence of IgM and IgG antibodies in the serum. If antibodies are detected, then patients may call their disease a serologic giardiasis, although doctors do not have such a term.

Why is there a rash with a lambliasis, reminiscent of a rash with rubella and representing atopic dermatitis? Accompanied by a strong itching of skin hives with giardiasis is an allergy. And the sensitivity of the body (sensitization) connects giardiasis and hair loss, and skin peeling, and inflammation of the ciliary edge of the eyelids (blepharitis).

The products of vascular activity of lamblia, the destroyed shells of cysts resembling the chitin of arthropods, the iron-sulfur proteins produced by mitosomes, as well as the protein substances of the lamblia cells, create a powerful "bridgehead" for the response of the human immune system to foreign protein components. And then we see the external manifestations of this reaction: rash with giardiasis and cough with giardiasis.

Consequences and complications of Giardiasis

The consequences of Giardiasis occur in the absence of treatment. And if the disease is identified and adequate therapeutic measures are taken (taking drugs such as Metronidazole, Tinidazole, Albendazole or Nitazoxanide), then a week later the person will be completely healthy.

But the complications of Giardiasis, which turned into a chronic disease, are very serious. Colonization of the intestine - especially with weakened immunity - leads to inflammation of the intestinal mucosa and atrophy of their villas, which causes a violation of intestinal absorption. Because of this, there is a loss of body weight and deterioration of well-being.

Some studies have shown that giardiasis should be considered as a cause of vitamin B12 deficiency as a result of problems caused by the nutrient absorption system in the intestine. And the deficiency of this vitamin, as you know, can produce persistent iron deficiency anemia.

Therefore, if an adult or child has symptoms of giardiasis, or reminds him of signs without pronounced symptomatology, it is necessary to pass a survey and free his body from parasites.

According to the statistics, subclinical giardiasis is detected randomly in 45-49% of patients with a comprehensive examination of the abdominal organs and instrumental methods of intestinal research. Giardiasis, the symptoms of which manifest clearly, are diagnosed in 15-35% of the estimated number of infected patients. Symptoms of dyspepsia are typical for children up to 12-15 years, in older age groups, typical signs of lambliasis are pain syndromes in the epigastric region. In middle-aged and elderly people, lambliasis symptoms are allergic and neurological. Cases of self-healing without invasive medication are frequent. In addition, the activation of immunity in the complex treatment of the underlying or concomitant diagnosed disease, can contribute to a cure for undiagnosed giardiasis. Also, the independent neutralization of Giardiasis invasion can occur due to the restoration of normal gastric acidity and intestinal microflora.