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{{Giardiasis}}
{{Giardiasis}}
{{CMG}} {{AE}} {{YD}}; {{SSK}}


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==Overview==
Giardiasis must be differentiated from other causes of abdominal pain, bloating, acute or chronic diarrhea, and weight loss, such as other infectious causes of gastroenteritis, including bacterial, viral, fungal, and parasitic pathogens, in addition to non-infectious causes, including [[acute pancreatitis]], [[appendicitis]], [[bowel obstruction]], [[diverticulitis]], [[drug reaction]], [[hyperthyroidism]], [[inflammatory bowel disease]], [[celiac disease]], [[lactose intolerance]], [[Whipple disease]], [[tropical sprue]], and [[lymphoma]].


==References==
==Differentiating Giardiasis from other Diseases==
{{Reflist|2}}
*Giardiasis must be differentiated from other causes of acute or chronic diarrhea, bloating, abdominal pain, and fever (less common).
*Differential diagnosis of giardiasis includes the following:
===Infectious Differential Diagnoses===
*Bacterial infections (e.g. [[E. coli enteritis|''E. coli'' infection]], [[shigellosis]], [[salmonellosis]], ''[[Campylobacter jejuni|C. jejuni'' infection]])
*Viral infections (e.g. [[Norovirus infection|norovirus]], [[Rotavirus infection|rotavirus]], [[Astrovirus infection|astrovirus]], [[HIV infection|HIV]])
*Fungal infections (e.g. ''[[Candidiasis|Candida spp.]]'')
*Parasites (''[[Amoebiasis|E. histolytica]]'', ''[[Cryptosporidium|Cryptosporidium spp.]]'', [[Cyclospora]])
===Non-infectious Differential Diagnoses===
The following are the non-infectious differential diagnoses of ''E. coli enteritis'':
*[[Acute pancreatitis]]
*[[Adrenal insufficiency]] and [[Adrenal insufficiency|Waterhouse-Friedrichsen syndrome]]
*[[Allergy]] (e.g. [[Allergy|insect bite allergy]] or [[anaphylaxis]])
*[[Appendicitis]]
*[[Bowel obstruction]]
*[[Celiac disease]]
*[[Diverticulitis]]
*[[Drug reaction]] (e.g. [[antimicrobial agents]], [[antihypertensive therapy]], [[chemotherapy]], [[anticonvulsants]])
*[[Endometriosis]]
*[[Familial Mediterranean fever]]
*[[Gastrointestinal perforation]]
*[[Hyperthyroidism]]
*[[Ileus]]
*[[Inflammatory bowel disease]] ([[Crohn's disease]] or [[ulcerative colitis]])
*[[Intussusception]]
*[[Ischemic colitis]]
*[[Ketoacidosis]]
*[[Lactose intolerance]]
*[[Lymphoma]]
*[[Mesenteric ischemia]]
*[[Necrotizing enterocolitis]]
*[[Ogilvie syndrome]]
*[[Peritonitis]]
*[[Pneumonia]]
*Poisoning and toxicity (e.g. [[carbon monoxide poisoning]], [[organophosphate poisoning]], [[Digitoxin|digitoxin toxicity]])
*[[Ruptured abdominal aortic aneurysm]]
*[[Spider bite]]
*[[Tropical sprue]]
*[[Volvulus]]
*[[Urinary tract infection]]
*[[Whipple disease]]
To view a comprehensive list of abdominal pain differential diagnoses, click [[Abdominal pain causes|'''here''']].<br>
To view a comprehensive list of diarrhea differential diagnoses, click [[Diarrhea causes|'''here''']].
 
Giardiasis must be differentiated from other diseases that may cause [[chronic diarrhea]], [[weight loss]], and [[abdominal pain]] especially in [[Immunocompromised|immunocompromised patients]].
{| style="border: 0px; font-size: 120%; margin: 3px; width:1000px;" align="center"
 
|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 200px;" | Prominent clinical findings
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Giardiasis|Chronic giardiasis]]<ref name="pmid11113253">{{cite journal |vauthors=Thompson RC |title=Giardiasis as a re-emerging infectious disease and its zoonotic potential |journal=Int. J. Parasitol. |volume=30 |issue=12-13 |pages=1259–67 |year=2000 |pmid=11113253 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Giardiasis|Chronic giardiasis]] may develop after acute episode of giardiasis or without any acute events.
* Loose foul smelling stools
* [[Flatulence]]
* [[Fatigue]]
* [[Weight loss]]
* [[Steatorrhea]]
* Some patients develop acquired [[lactose intolerance]] (manifested by exacerbation of symptoms following ingestion of dairy products)
 
| style="padding: 5px 5px; background: #F5F5F5;" |
* Microscopic identification of the organism in the stool
* [[Hypoalbuminaemia]]
* [[Vitamin B12]] and [[Folate deficiency|folate deficiencies]] (as the organism inhabits the [[duodenum]])
 
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cryptosporidiosis]]<ref name="pmid17172373">{{cite journal |vauthors=Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L |title=Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City |journal=Am. J. Trop. Med. Hyg. |volume=75 |issue=6 |pages=1095–8 |year=2006 |pmid=17172373 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Incubation period]] is 7-10 days.
* In [[immunocompetent]] patients:
:* Disease might be asymptomatic or cause [[gastroenteritis]] (but without any biliary involvement)
:* [[Gastroenteritis]] usually resolves spontaneously within 14 days.
* In [[immunocompromised]] patients:
:* Disease is usually more severe and prolonged (especially in severly [[Immunocompromised|immunocomprmised patients]] with [[CD4|CD4 count]] < 100 cells/microL).
:* [[Cryptosporidiosis]] may involve the [[biliary tract]] and the [[liver]].
:* [[Weight loss]]
:* [[RUQ|Abdominal RUQ]] [[tenderness]] might be present if [[biliary]] or [[hepatic]] involvement is present.
 
| style="padding: 5px 5px; background: #F5F5F5;" |
* Microscopic identification of the [[organism]] in the stool: The [[oocysts]] appear red on staining with modified acid fast staining
* [[PCR]]: Most specific and sensitive diagnostic tool. [[PCR]] is expensive and used in limited cases.
 
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cystoisospora belli|Cystoisosporiasis (isosporiasis)]]<ref name="pmid1889046">{{cite journal |vauthors=Current WL, Garcia LS |title=Cryptosporidiosis |journal=Clin. Microbiol. Rev. |volume=4 |issue=3 |pages=325–58 |year=1991 |pmid=1889046 |pmc=358202 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Cystoisospora belli|Cystoisosporiasis]] is usually seen in [[Immunocompromised|immunocompromised patients]].
* [[Incubation period]] can last up to 2 weeks
* [[Watery diarrhea]] that is profuse and foul smelling
* Constitutional symptoms ([[headache]], [[Low-grade fever|low grade fever]], [[myalgia]] and [[malaise]])


{{Protozoal diseases}}
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Isospora]] ova or parasites can be visualized on stool microscopic examination.
* [[Endoscopy|Upper GI endoscopy]] may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.


[[Category:Needs content]]
|-
[[Category:Parasitic diseases]]
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Tropical sprue]]<ref name="pmid1091526">{{cite journal |vauthors=Klipstein FA, Schenk EA |title=Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure |journal=Gastroenterology |volume=68 |issue=4 Pt 1 |pages=642–55 |year=1975 |pmid=1091526 |doi= |url=}}</ref>
[[Category:Water-borne diseases]]
| style="padding: 5px 5px; background: #F5F5F5;" |
[[Category:Infectious disease]]
* History of travel to a tropical region (for a period more than a month)
* [[Chronic diarrhea]]
* [[Steatorrhea]]
* Examination may show signs of [[vitamin deficiencies]] (eg [[glossitis]])


| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Megaloblastic anemia]] that might progress into [[pancytopenia]]
* [[Hypoalbuminaemia]]
* [[Vitamin D Deficiency|Vitamin D defeciency]] and [[hypocalcemia]]


|}


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==References==
{{WikiDoc Sources}}
{{Reflist|2}}

Latest revision as of 18:24, 31 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Giardiasis must be differentiated from other causes of abdominal pain, bloating, acute or chronic diarrhea, and weight loss, such as other infectious causes of gastroenteritis, including bacterial, viral, fungal, and parasitic pathogens, in addition to non-infectious causes, including acute pancreatitis, appendicitis, bowel obstruction, diverticulitis, drug reaction, hyperthyroidism, inflammatory bowel disease, celiac disease, lactose intolerance, Whipple disease, tropical sprue, and lymphoma.

Differentiating Giardiasis from other Diseases

  • Giardiasis must be differentiated from other causes of acute or chronic diarrhea, bloating, abdominal pain, and fever (less common).
  • Differential diagnosis of giardiasis includes the following:

Infectious Differential Diagnoses

Non-infectious Differential Diagnoses

The following are the non-infectious differential diagnoses of E. coli enteritis:

To view a comprehensive list of abdominal pain differential diagnoses, click here.
To view a comprehensive list of diarrhea differential diagnoses, click here.

Giardiasis must be differentiated from other diseases that may cause chronic diarrhea, weight loss, and abdominal pain especially in immunocompromised patients.

Disease Prominent clinical findings Laboratory or radiological findings
Chronic giardiasis[1]
Cryptosporidiosis[2]
  • Disease might be asymptomatic or cause gastroenteritis (but without any biliary involvement)
  • Gastroenteritis usually resolves spontaneously within 14 days.
  • Microscopic identification of the organism in the stool: The oocysts appear red on staining with modified acid fast staining
  • PCR: Most specific and sensitive diagnostic tool. PCR is expensive and used in limited cases.
Cystoisosporiasis (isosporiasis)[3]
  • Isospora ova or parasites can be visualized on stool microscopic examination.
  • Upper GI endoscopy may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.
Tropical sprue[4]

References

  1. ↑ Thompson RC (2000). "Giardiasis as a re-emerging infectious disease and its zoonotic potential". Int. J. Parasitol. 30 (12–13): 1259–67. PMID 11113253.
  2. ↑ Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L (2006). "Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City". Am. J. Trop. Med. Hyg. 75 (6): 1095–8. PMID 17172373.
  3. ↑ Current WL, Garcia LS (1991). "Cryptosporidiosis". Clin. Microbiol. Rev. 4 (3): 325–58. PMC 358202. PMID 1889046.
  4. ↑ Klipstein FA, Schenk EA (1975). "Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure". Gastroenterology. 68 (4 Pt 1): 642–55. PMID 1091526.
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