Difference between revisions of "Giardiasis"

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#redirect [[Duodenum#Giardiasis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Giardia_small_bowel_--_high_mag.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 x5 days, foul smelling feces, flatulence
| Symptoms  = fatigue, abdominal cramps, nausea
| 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]]. It can mimic [[celiac disease]].  It is also known as '''beaver fever'''.
 
==General==
Clinical features - usually two or more of the following:<ref name=pmid1994703>{{Cite journal  | last1 = Hopkins | first1 = RS. | last2 = Juranek | first2 = DD. | title = Acute giardiasis: an improved clinical case definition for epidemiologic studies. | journal = Am J Epidemiol | volume = 133 | issue = 4 | pages = 402-7 | month = Feb | year = 1991 | doi =  | PMID = 1994703 }}</ref>
*Diarrhea - x5 days.
*Flatulence.
*Foul smelling feces.
*Nausea.
*Abdominal cramps.
*Excessive tiredness.
 
Epidemiology:
*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===
====Case 1====
<gallery>
Image:Giardiasis_duodenum_high.jpg | Giardiasis - high mag. (WC)
Image:Giardiasis_duodenum_low.jpg | Giardiasis - low mag. (WC)
</gallery>
====Case 2====
<gallery>
Giardia small bowel -- low mag.jpg | Giardia - low mag.
Giardia small bowel -- intermed mag.jpg | Giardia - intermed. mag.
Giardia small bowel -- high mag.jpg | Giardia - high mag.
Giardia small bowel - alt -- high mag.jpg | Giardia - high mag.
Giardia small bowel -- very high mag.jpg | Giardia - very high mag.
</gallery>
====www====
*[http://path.upmc.edu/cases/case278.html Giardiasis - several 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>
A. Duodenum, Biopsy:
- Abundant micro-organisms consistent with GIARDIA and small
  bowel mucosa with increased intraepithelial lymphocytes, see comment.
- NEGATIVE for dysplasia.
 
B. Stomach, Biopsy:
- Body and antral-type mucosa with mild chronic inactive inflammation.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
 
Comment:
The increased intraepithelial lymphocytes are likely to due to the Giardia; however, other
causes cannot be excluded.
</pre>
 
===Block letters===
<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]]

Latest revision as of 21:32, 14 July 2019

Giardiasis
Diagnosis in short

Giardiasis. H&E stain.
LM 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
LM DDx celiac disease
Stains methylene blue +ve
IHC CD117 +ve (microorganisms)
Site duodenum
Signs diarrhea x5 days, foul smelling feces, flatulence
Symptoms fatigue, abdominal cramps, nausea
Prevalence uncommon
Endoscopy +/-white spots, diffuse changes
Prognosis good, benign
Clin. DDx celiac disease, other causes of diarrhea
Treatment antibiotics

Giardiasis is a rare infection, classically found in the duodenum. It can mimic celiac disease. It is also known as beaver fever.

General

Clinical features - usually two or more of the following:[1]

  • Diarrhea - x5 days.
  • Flatulence.
  • Foul smelling feces.
  • Nausea.
  • Abdominal cramps.
  • Excessive tiredness.

Epidemiology:

  • Uncommon.

Etiology:

  • Flagellate protozoan Giardia lamblia.

Treatment

  • Antibiotics, e.g. metronidazole (Flagyl).

Gross

  • Diffuse changes.
  • May have scattered white spots.[2]

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.[3]
      • Often look like a crescent moon (image of crescent moon) or semicircular[4] -- 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.[5]

DDx:

Images

Case 1

  • Giardiasis - high mag. (WC)

  • Giardiasis - low mag. (WC)

Case 2

  • Giardia - low mag.

  • Giardia - intermed. mag.

  • Giardia - high mag.

  • Giardia - high mag.

  • Giardia - very high mag.

www

Stains

  • Methylene blue +ve.[6]

IHC

Sign out

A. Duodenum, Biopsy:
- Abundant micro-organisms consistent with GIARDIA and small 
  bowel mucosa with increased intraepithelial lymphocytes, see comment.
- NEGATIVE for dysplasia.

B. Stomach, Biopsy:
- Body and antral-type mucosa with mild chronic inactive inflammation.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Comment:
The increased intraepithelial lymphocytes are likely to due to the Giardia; however, other 
causes cannot be excluded.

Block letters

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH BRUNNER'S GLANDS AND MICROORGANISMS CONSISTENT WITH GIARDIA.

See also

References

  1. ↑ Hopkins, RS.; Juranek, DD. (Feb 1991). "Acute giardiasis: an improved clinical case definition for epidemiologic studies.". Am J Epidemiol 133 (4): 402-7. PMID 1994703.
  2. ↑ Biyikoğlu, I.; Babali, A.; Cakal, B.; Köklü, S.; Filik, L.; Astarci, MH.; Ustün, H.; Ustündağ, Y. et al. (Nov 2009). "Do scattered white spots in the duodenum mark a specific gastrointestinal pathology?". J Dig Dis 10 (4): 300-4. doi:10.1111/j.1751-2980.2009.00399.x. PMID 19906109.
  3. ↑ http://www.water-research.net/Giardia.htm
  4. ↑ http://en.wikipedia.org/wiki/Semicircle
  5. ↑ Freeman, HJ. (Mar 2008). "Pearls and pitfalls in the diagnosis of adult celiac disease.". Can J Gastroenterol 22 (3): 273-80. PMID 18354756.
  6. ↑ Rajurkar, MN.; Lall, N.; Basak, S.; Mallick, SK. (Nov 2012). "A simple method for demonstrating the giardia lamblia trophozoite.". J Clin Diagn Res 6 (9): 1492-4. doi:10.7860/JCDR/2012/4358.2541. PMID 23285438.
  7. ↑ Sinelnikov, I.; Sion-Vardy, N.; Shaco-Levy, R. (Mar 2009). "C-kit (CD117) immunostain is useful for the diagnosis of Giardia lamblia in duodenal biopsies.". Hum Pathol 40 (3): 323-5. doi:10.1016/j.humpath.2008.07.015. PMID 18835628.
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