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Difference between revisions of "Giardiasis"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Giardiasis_duodenum_high.jpg | |||
| Width = | |||
| Caption = Giardiasis. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = flagellate protozoa - pale/transluence on H&E, 12-15 micrometers (long axis) x 6-10 micrometers (short axis); +/-loss of villi, intraepithelial lymphocytes, inflammatory cells - especially close to the luminal surface | |||
| Subtypes = | |||
| LMDDx = [[celiac disease]] | |||
| Stains = methylene blue +ve | |||
| IHC = CD117 +ve (microorganisms) | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[duodenum]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = diarrhea | |||
| Symptoms = | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = +/-white spots, diffuse changes | |||
| Prognosis = good, benign | |||
| Other = | |||
| ClinDDx = celiac disease, other causes of diarrhea | |||
| Tx = antibiotics | |||
}} | |||
'''Giardiasis''' is a rare infection classically found in the duodenum that can mimic [[celiac disease]]. It is known as '''beaver fever'''. | |||
==General== | |||
*Uncommon. | |||
*Etiology: | |||
**Flagellate protozoan ''Giardia lamblia''. | |||
*Treatment | |||
**Antibiotics, e.g. metronidazole (Flagyl). | |||
==Gross== | |||
*Diffuse changes. | |||
*May have scattered white spots.<ref name=pmid19906109>{{Cite journal | last1 = Biyikoğlu | first1 = I. | last2 = Babali | first2 = A. | last3 = Cakal | first3 = B. | last4 = Köklü | first4 = S. | last5 = Filik | first5 = L. | last6 = Astarci | first6 = MH. | last7 = Ustün | first7 = H. | last8 = Ustündağ | first8 = Y. | last9 = Akbal | first9 = E. | title = Do scattered white spots in the duodenum mark a specific gastrointestinal pathology? | journal = J Dig Dis | volume = 10 | issue = 4 | pages = 300-4 | month = Nov | year = 2009 | doi = 10.1111/j.1751-2980.2009.00399.x | PMID = 19906109 | URL = http://onlinelibrary.wiley.com/doi/10.1111/j.1751-2980.2009.00399.x/pdf }}</ref> | |||
==Microscopic== | |||
Features: | |||
*+/-Loss of villi. | |||
*Intraepithelial lymphocytes. | |||
**+Other inflammatory cells, especially PMNs, close to the luminal surface. | |||
*Flagellate protozoa -- '''diagnostic feature'''. | |||
**Organisms often at site of bad inflammation. | |||
**Pale/translucent on H&E. | |||
**Size: 12-15 micrometers (long axis) x 6-10 micrometers (short axis) -- if seen completely.<ref>[http://www.water-research.net/Giardia.htm http://www.water-research.net/Giardia.htm]</ref> | |||
***Often look like a crescent moon ([http://en.wikipedia.org/wiki/File:Crescent_Moon.JPG image of crescent moon]) or semicircular<ref>[http://en.wikipedia.org/wiki/Semicircle http://en.wikipedia.org/wiki/Semicircle]</ref> -- as the long axis of the organism is rarely in the plane of the (histologic) section. | |||
Note: | |||
*Changes are typically diffuse, i.e. if multiple biopsies are done the changes are present in all fragments.<ref name=pmid18354756>{{Cite journal | last1 = Freeman | first1 = HJ. | title = Pearls and pitfalls in the diagnosis of adult celiac disease. | journal = Can J Gastroenterol | volume = 22 | issue = 3 | pages = 273-80 | month = Mar | year = 2008 | doi = | PMID = 18354756 }}</ref> | |||
DDx: | |||
*[[Celiac disease]] - near perfect mimic; missing giardia organisms. | |||
===Images=== | |||
<gallery> | |||
Image:Giardiasis_duodenum_high.jpg | Giardiasis - high mag. (WC) | |||
Image:Giardiasis_duodenum_low.jpg | Giardiasis - low mag. (WC) | |||
</gallery> | |||
www: | |||
*[http://path.upmc.edu/cases/case278.html Giardiasis - several crappy images (upmc.edu)]. | |||
==Stains== | |||
*Methylene blue +ve.<ref name=pmid23285438>{{Cite journal | last1 = Rajurkar | first1 = MN. | last2 = Lall | first2 = N. | last3 = Basak | first3 = S. | last4 = Mallick | first4 = SK. | title = A simple method for demonstrating the giardia lamblia trophozoite. | journal = J Clin Diagn Res | volume = 6 | issue = 9 | pages = 1492-4 | month = Nov | year = 2012 | doi = 10.7860/JCDR/2012/4358.2541 | PMID = 23285438 }}</ref> | |||
==IHC== | |||
*CD117 +ve.<ref name=pmid18835628>{{Cite journal | last1 = Sinelnikov | first1 = I. | last2 = Sion-Vardy | first2 = N. | last3 = Shaco-Levy | first3 = R. | title = C-kit (CD117) immunostain is useful for the diagnosis of Giardia lamblia in duodenal biopsies. | journal = Hum Pathol | volume = 40 | issue = 3 | pages = 323-5 | month = Mar | year = 2009 | doi = 10.1016/j.humpath.2008.07.015 | PMID = 18835628 }}</ref> | |||
==Sign out== | |||
<pre> | |||
DUODENUM, BIOPSY: | |||
- SMALL BOWEL MUCOSA WITH BRUNNER'S GLANDS AND MICROORGANISMS CONSISTENT WITH GIARDIA. | |||
</pre> | |||
==See also== | |||
*[[Duodenum]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Duodenum]] | |||