Giardiasis-associated arthralgia in children

BACKGROUND: Giardiasis is the most common intestinal parasitosis in Mexico. Usual symptoms of the acute infection are diarrhea, abdominal pain, nausea, and weight loss. Children are more frequently affected than adults. Various extra-intestinal manifestations have been reported, among which are arthritis and arthralgia. METHODS: A series of 10 children with arthralgia and cysts of Giardia lamblia in feces seen during 13 years of private practice were presented. Ages ranged between 5 and 11 years, and 70% of the children are males. RESULTS: The joints involved in all cases were the knee and the ankle. No joint flogosis or changes in local temperature were observed. Other associated symptoms were abdominal pain (100%), abdominal distension (70%), flatulence (50%), less consistent stools (50%), anemia (30%), and increased erythrocyte sedimentation rate (60%). C-reactive protein and rheumatoid factor were negative in all cases. Arthralgia disappeared after treatment with metronidazole when coproparasitoscopic analyses were negative. CONCLUSIONS: Arthralgia associated with giardiasis in children is a rare entity, relatively benign, and leaves no sequelae.     

DETECTING GIARDIA LAMBLIA ANTIGEN IN FECAL MATTER WITH COUNTERIMMUNO-ELECTROPHORESIS IN DIAGNOSIS OF GIARDIASIS

Feces specimens from 35 patients with parasitologically confirmed giardiasis, 41 with acute gastroenteritis, 23 with acute bacillary dysentery, 40 normal persons as well as 15 jirds experimentally infected with Giardia lamblia were used for detecting parasite antigen by counterimmunoelectrophoresis (CIE). It revealed that 33 (94%) of the 35 patients with giardiasis and 14 (93%) of 15 infected jirds were positive, while the other cases, either normal person or normal jird were negative. CIE was also performed in 4 with giardiasis before and after metronidazole treatment. Prior to metronidazole administration, they were all CIE positive, but from the second day on, all became CIE negative. Apparently, detecting giardia antigen in feces specimens by CIE is not only sensitive in detecting current infection but also helpful in evaluating the effects of antigiardia agents on giardiasis.     

饮食干预治疗儿童缺铁性贫血的临床效果分析

目的探讨饮食干预对治疗儿童缺铁性贫血的临床效果。方法对150例缺铁性贫血患儿随机分为治疗组和对照组各75例,对照组采用药物单一治疗,治疗组在药物治疗的基础上采取饮食干预。比较2组治疗后血常规、血清铁及总铁结合力。结果治疗组临床疗效及RBC、HGB、MCV、MCH、ST、TiBC均优于对照组,且P均〈0.01,有统计学意义。结论通过药物治疗的同时进行饮食干预,临床疗效较好,值得推广。     

Prevalence and risk factors for giardiasis among primary school children in Damascus, Syria

OBJECTIVE: To evaluate the prevalence of giardiasis in primary school children in Damascus city and the countryside, and to investigate the possible risk factors for giardiasis infection. METHODS: A cross-sectional study was carried out on school children from 23 primary schools in Damascus, between March and June 2006. Data were collected from 1469 children of both genders from urban and rural regions using structured questionnaires, anthropometric measurements, and laboratory analysis of fecal samples. The parasites were detected using a single-stool sample by direct wet examination under light microscope. RESULTS: Two hundred and six (14%) of 1469 children were infected with Giardia lamblia, while 119 (8.1%) were found infected with other sorts of intestinal parasites. No correlation was found between giardiasis and age, gender, residence in urban or rural areas, availability of piped water or sewage system. In contrast, both mother's (p=0.003) and father's (p=0.018) levels of education, and the number of siblings in-home (p=0.014) were found significant predictors of giardiasis. As for children's nutritional status, 6.6% were found to have significant stunting, 1.8% had underweight, and 4.7% had wasting. Giardiasis, however, was not found a predictor of these conditions. CONCLUSION: The Damascus region could be classified as medium-prevalence area for Giardia infections. Thus, the local administrators need to pay more attention to the prevention of parasitic infections along with improvement in education, environmental, and sanitary conditions.     

Giardiasis and other intestinal parasitic infections in a Manitoba residential school for the mentally retarded.

A case of severely symptomatic giardiasis in a school for the mentally retarded prompted an epidemiologic survey of the institution. The rate of parasitic infection in the children were just under 50%. Multiple infections were common and one child harboured five different protozoa. The yield included known pathogens (Giardia lamblia, Metorchis conjunctus and Diphyllobothrium sp.), protozoa of potential pathogenicity (Dientamoeba fragilis) and other protozoa, the significance of which has yet to be determined. The prevalence of G. lamblia in the index ward was significantly higher than in a control ward matched for age and mobility of the children. The epidemiologic data suggested person-to-person transmission of G. lamblia within the institution. Recommendations for the control of protozoal intestinal infections in custodial institutions are presented.     

Person-to-person transmission of Giardia lamblia in day-care nurseries.

In an outbreak of giardiasis at two day-care nurseries in metropolitan Toranto Giardia lamblia appeared to be transmitted person to person. No common source of infection could be found. The proportions of children infected in the two nurseries were 39% and 17%; infection was spread to 7% and 23% of their household contacts. Of the infected children and household contacts 26% and 30% respectively of those for whom detailed information could be obtained were symptomatic. Canadian children were more likely to be infected and symptomatic than were immigrant children attending the nurseries. The most susceptible ages for infection were 1 to 3 years. The results of this study suggest that all children in day-care nurseries who are infected with G. lamblia should be treated, regardless of whether they are symptomatic.     

The BTPABA pancreatic function test in giardiasis

The test for exocrine pancreatic function using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BTPABA test) was assessed in 7 patients with giardiasis and 7 healthy controls. Cumulative percent p-aminobenzoic acid (PABA) recovery in 6 hr was significantly lower in patients with giardiasis, compared with the control group. When an equivalent dose of free PABA was given, there were no differences in PABA recovery between the groups. In patients with giardiasis, the post-treatment values of BTPABA test were significantly higher than the pretreatment values and no differences were found in PABA recovery between patients with giardiasis after eradication and healthy controls. These findings indicate that Giardia lamblia interferes with the action of pancreatic chymotrypsin. It is noteworthy that giardiasis could cause an abnormal BTPABA test.     

胃大部切除术病人营养状况研究

目的：研究根治性胃大部切除术对进展期胃癌病人营养及免疫状况的影响。方法：30例接受根治性胃大部切除术的病人，分别于术前及术后第2．7、14d采血，测定血清视黄醇结合蛋白、转铁蛋白、总铁结合力、血清铁、免疫球蛋白。结果：术后2d，所有的营养和免疫指标均急剧下降（P〈0．01）。术后14d，血清视黄醇结合蛋白已恢复到术前水平（P〉0．05），而血清总铁结合力、血清铁、转铁蛋白及各项免疫指标仍未恢复（P〈0．05）。结论：根治性胃大部切除术对胃癌病人营养水平及免疫功能的影响是暂时性的，可逐渐逆转；胃癌病人术后应注重补铁；胃癌病人免疫状况与营养状况呈正相关性。     

血清铁调素与血液透析患者铁负荷及微炎症状态相关

目的探讨维持性血液透析(MHD)患者血清铁调素水平与铁负荷及微炎症状态的关系。方法选取治疗6个月以上的稳定的MHD患者48例(MHD组),以体格检查健康人20名为健康对照组。采用酶联免疫吸附法(ELISA)测定血清铁调素和白细胞介素(IL)-6水平。采用Spearman相关和线性回归分析铁调素与其他指标的相关性。结果 MHD组患者血清铁调素水平为146.4～455.9μg/L,中位值为225.6μg/L,IL-6水平为35.0～97.2ng/L,中位值为48.0ng/L;健康对照组患者血清铁调素水平为54.5～171.5μg/L,中位值为90.4μg/L,IL-6水平为26.5～51.6ng/L,中位值为43.9ng/L。MHD组患者血清铁调素和IL-6水平均显著高于健康对照组(P值均<0.05)。Spearman相关分析显示,血清铁调素水平与铁蛋白(ρ=0.892)、转铁蛋白饱和度(ρ=0.289)及IL-6(ρ=0.439)水平呈正相关(P值均<0.05),与不饱和铁结合力(ρ=-0.570)、总铁结合力(ρ=-0.552)及转铁蛋白(ρ=-0.532)水平呈负相关(P值均<0.05)。线性回归分析显示,MHD患者血清铁蛋白(未标准化回归系数=0.761,标准化回归系数=0.736,P<0.001)及总铁结合力(未标准化回归系数=-5.654,标准化回归系数=-0.204,P=0.034)水平与铁调素水平独立相关。结论 MHD患者血清铁调素水平显著升高;血清铁调素水平与MHD患者铁负荷及微炎症状态相关;ELISA方法检测铁调素可以应用于临床,结合超敏C反应蛋白及铁代谢指标等指导肾性贫血中铁剂的应用。     

污水中隐孢子虫和贾第鞭毛虫检测的结果分析

目的调查深圳市污水中隐孢子虫和贾第鞭毛虫污染情况。方法采用免疫磁分离姬姆萨染色法，对深圳市内3家污水处理厂处理后排出的污水，进行对病原虫的离心沉淀、淘洗、磁分离及染色鉴定。检测污水中的隐孢子虫卵囊和贾第鞭毛虫包囊的含量。结果3家污水处理厂中有2家在处理后的污水中检出隐孢子虫和贾第鞭毛虫。结论目前污水处理厂处理后的水仍可检出致病原虫，表明地面水存在水污染的危险性。     

苦参乙醇提取物体外抗贾第虫药物作用的观察

对苦参乙醇提取物体外抗贾第虫药物作用做了观察。实验结果表明，将此药物与贾第虫滋养体共同培养５ｈ后，导致９９％虫体致死的浓度为５ｇ／Ｌ，随着药物浓度的降低，致死率相应减少；该药的半数致死浓度为１．５ｇ／Ｌ，在此浓度的最短作用时间为３ｈ。对照试验结果显示，在相同时间作用下，阿苯哒唑导致９３．８％虫体致死的浓度为０．２ｇ／Ｌ。     

紫绀型先天性心脏病患儿血清铁及总铁结合力的变化及意义

目的检测紫绀型先天性心脏病患儿血红蛋白、平均红细胞压积、血清铁、总铁结合力及心肌组织铁分布的改变,并探讨其意义。方法入组2011年5-11月于新桥医院心外科行手术治疗的先天性心脏病患儿22例,其中男性14例,女性8例,紫绀型先天性心脏病患儿10例,非紫绀先天性心脏病患儿12例。以静脉血为标本,送本院检验科检验血红蛋白及平均红细胞压积,以亚铁嗪法检测血清铁及总铁结合力,以术中右室流出道心肌为标本,Perls-DAB法检测心肌组织中铁的分布。结果与非紫绀组患儿相比,紫绀组先心病患儿血红蛋白含量及平均红细胞压积都明显升高(P<0.05)。紫绀先天性心脏病患儿血清铁含量明显低于非紫绀患儿[(23.25±4.4)μmol/L vs(31.34±4.2)μmol/L,P<0.01],并伴有总铁结合力的增加[(69.59±5.8)μmol/L vs(52.67±9.2)μmol/L,P<0.01]。紫绀组患儿心肌组织中铁含量明显增加(P<0.01),广泛分布于心肌中。结论紫绀先天性心脏病患儿机体处于铁储备相对缺乏状态,而心肌组织内铁含量增加可能为心肌在缺氧环境下的代偿反应。     

可溶性转铁蛋白受体在慢性肾衰伴缺铁性贫血诊断及治疗中的意义

目的：探讨可溶性转铁蛋白受体（sTfR）在慢性肾功能衰竭（CRF）伴缺铁性贫血诊断及治疗中的意义。方法：对42例CRF患者。20例健康对照者采用血液自动分析法进行血红蛋白（nb）、红细胞压积（Hct）检测；双吡啶比色法测定血清铁（SI）、总铁结合力（TIBC）；双抗体夹心酶联免疫法测定血清铁蛋白（SF）；生物索-亲和索-酶联免疫法测定sTfR。结果：sTfR在CRF伴缺铁组明显升高；与CRF不伴缺铁组比较有显著性差异（P〈0．01）。结论：血清sTfR含量能更加快速、真实地反映体内铁贮存情况，对患者的诊断、治疗具有重要意义。     

血康糖浆治疗小儿缺铁性贫血的临床研究

目的：探讨血康糖浆治疗小儿缺铁性贫血的临床疗效及对大鼠营养不良所致缺铁性贫血影响的作用机理，方法：将78例缺铁性贫血患儿随机分为2组，分别口服血康糖浆及西药速力菲，观察临床疗效，并检测治疗前后血红蛋白等的含量；对实验大鼠进行给药前后RBC值和Hb含量，血清铁含量，总铁结合率测定，结果：观察组总有效率（87．5％），明显高于对照组（70％），2组比较有显著性差异（P＜0．05），血康糖浆能明显升高缺铁性贫血大鼠RBC值和Hb含量，血清铁含量，总铁结合率降低。结论：血康糖浆是治疗小儿缺铁性贫血的有效方剂。     

婴幼儿皮肤念珠菌病与缺铁性贫血相关性探讨

目的探讨婴幼儿皮肤念珠菌病与缺铁性贫血的相关性,以及补铁治疗在婴幼儿皮肤念珠菌病中的作用。方法回顾性分析101例婴幼儿皮肤念珠菌病患儿的临床资料,筛查出60例缺铁性贫血患儿,并将其随机分为观察组和对照组各30例,所有患儿均给予营养治疗和外用氟康唑粉扑治疗,观察组在此基础上口服右旋糖苷铁分散片,30d后比较疗效。结果经治疗后,观察组缺铁性贫血治疗有效率为90.00%(27/30),明显高于对照组的66.67%(20/30),差异具有统计学意义(P<0.05);观察组皮肤念珠菌病治疗有效率为96.67%(29/30),明显高于对照组的80.00%(24/30),差异具有统计学意义(P<0.05)。结论缺铁性贫血可能是婴幼儿皮肤念珠菌病的一个重要诱因,而补铁治疗可增加患儿机体抵抗力,提高治疗效果。     

抗幽门螺杆菌感染在治疗缺铁性贫血中的临床价值

目的探讨抗幽门螺杆菌（HP）感染在缺铁性贫血（IDA）治疗中的临床价值。方法将伴有HP阳性慢性胃炎的IDA患者116例随机分成A、B两组,A组给予铁剂联合HP根除治疗;B组仅予补铁治疗。观察两组患者治疗前后红蛋白（Hb）、血清铁（SI）、血清铁蛋白（SF）等血液学指标的变化。结果 A组的治疗效果明显优于B组,差异有统计学意义（P〈0.05）。结论抗HP加铁剂是治疗HP感染相关性IDA的有效方法,具有重要临床价值。     

多维铁治疗婴幼儿缺铁性贫血的临床观察

目的观察多维铁口服液治疗婴幼儿缺铁性贫血的临床疗效。方法将120名患儿随机分为两组,实验组(n=60)予多维铁口服溶液,对照组(n=60)予硫酸亚铁,并观察治疗前后红细胞(RBC)、血红蛋白(Hb)、血清铁蛋白(SF)的变化及不良反应,并进行对比分析。结果两组治疗后RBC、Hb、SF较治疗前明显升高;实验组总有效率明显高于对照组;不良反应发生率低于对照组,差异均有统计学意义(P<0.05)。结论多维铁口服溶液能改善婴幼儿的缺铁性贫血,减轻并发症,提高补铁的效果。     

肠道贾第虫病42例的临床分析

目的 :观察贾第虫病的临床表现及甲硝唑对贾第虫病的治疗作用。方法 :用甲硝唑治疗 42例贾第虫病患者 ,剂量为 0 .4g,日 3次 ,连服 7～ 10 d为一疗程 ,其中服 1个疗程的有 3 5例 ,服 2个疗程的有 5例 ,服 3个疗程的有 2例。结果 :经治疗后 ,全部患者的症状如腹泻及 (或 )腹痛等胃肠道症状均消失 ,粪检结果恢复正常。患者服药期间的不良反应轻 ,仅有轻微的胃肠道反应 ,如恶心、厌食等。结论 :甲硝唑治疗贾第虫病具有疗效好、耐受性好的优点     

肾性贫血患者血清铁参数检测的临床意义

目的:探求肾性贫血患者血清铁参数的临床诊断价值和其改变的原因。方法:采用ACT、化学分析和ELISA测定78例慢性肾衰患者的Hb、红细胞比容和血清铁参数。结果:慢性肾衰病人血清中SI、TIBC、TS显著高于健康群体(n=50,P<0.05),病人的血清(SF)显著低下(P<0.05)。结论:肾性贫血反映铁代谢紊乱,转运发生障碍。     

血清可溶性转铁蛋白受体及转铁蛋白在儿童缺铁性贫血合并感染中的诊断价值

目的探讨血清可溶性转铁蛋白受体（sTfR）、转铁蛋白（Tf）在儿童缺铁性贫血合并急性感染（iron deficiency with acute infection，IDAI）中的变化和诊断价值。方法采用速率散射免疫比浊法，测定IDAI组、单纯缺铁性贫血（IDA）组、IDAI组治疗后及健康对照组的血清sTfR、Tf、铁蛋白（SF）水平。常规铁染色观察骨髓储存铁。结果IDAI组和IDA组患儿sTfR、Tf均显著高于对照组（P〈0．01），两组间无显著差异（P〉0．05），IDAI组治疗后血红蛋白（Hb）上升至100g／L以上，但与对照组还有差距时（P〈0．05），sTfR、Tf值降至对照组水平（P〉0．05）。结论sTfR、Tf对诊断缺铁性贫血特异强，测定结果不受感染因素干扰，是临床判断贫血合并感染儿童是否缺铁和监测疗效的可靠指标，临床应用价值优于SF和骨髓储存铁。