Incidence, predictors and criteria for the diagnosis of giardiasis in children
Background. The prevalence of giardiasis among children is 355 cases per 100,000, with 80 % of cases of infestation occurring in children under the age of 14 years. The urgency of the high prevalence of protozoal pathology in children is determined by the fact that its manifestations are often masked under various pathological conditions. The purpose was to study the incidence, predictors and criteria for the diagnosis of giardiasis in children. Materials and methods. Research design is a controlled randomized trial. The study included children suffering from giardiasis (n = 55), aged 3 to 17 years. The comparison group consisted of 30 apparently healthy children. A survey of patients and collection of material performed at the outpatient and gastroenterology departments of the MHI “Chernivtsi Regional Clinical Hospital” during 2014–2016. Laboratory and instrumental investigations were conducted in Ukrainian-German laboratory “Bukintermed” and children’s gastroenterology center “Digest”. Indirect (serological one, macroscopy of the duodenal mucosa in endoscopic examination, indirect signs of giardiasis in duodenal biopsy samples) and direct methods were used (microscopy of the feces, duodenal contents, detection of vegetative forms of lamblia in duodenal biopsy samples during histological examination). A parent survey was conducted. Results. A positive result was obtained in 29 out of 565 subjects surveyed for lamblia (5.1 %). More often, additional examination was required for the presence of giardiasis in children suffering from chronic diseases of the upper gastrointestinal and hepatobiliary system, allergic reactions, intestinal dysbiosis and persistent eosinophilia. Children affected with giardiasis were more likely to have a concomitant illness than the children of the comparison group (p < 0.05). In 41.4 % of cases, children lived in conditions that were not satisfactory, did not always follow the rules of sanitary hygiene. We have established antenatal (health during pregnancy, the course of pregnancy, the presence of occupational hazards), intranatal (premature birth, stimulation of labor and cesarean section, birth trauma and asphyxia in children) and postnatal adverse factors (duration of breastfeeding, concomitant pathology). All histological features can be used as possible criteria for giardiasis in children, but with the highest probability, the following sign can be used — the presence of villous epithelium desquamation areas with simultaneous dominance of eosinophils and mast cells in the infiltrate. Conclusions. The incidence of giardiasis in children and adolescents is 5.1 %. Anamnestic factors (social, hygienic, medical and biological ones) established by us can be considered as predictors for the development of giardiasis in children. In the clinical picture of giardiasis, the defeat of the digestive tract dominates — in 96.3 % of children. To improve the accuracy of giardiasis diagnosis in children, it is necessary to use a set of direct and indirect methods of the diagnosis.
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