The mysterious creatures of Giardia and the disease they cause - Giardiasis is heard by all parents. And all because of all the parasites that can live in the human body, it is the lamblia that are chosen "extreme". Even doctors with diplomas are often blamed on them for rash and diarrhea in a child, for poor sleep and poor school performance. Is Giardia really so dangerous and how to treat giardiasis, we will tell in this article.
About the disease
Giardiasis is a disease caused by the simplest microorganisms - lamblia. They resemble a jellyfish, have flagella and a suction cup, with which they can attach to the walls of the small intestine. It is this part of the digestive tract that is the favorite place of residence of lamblia, where they feel quite comfortable.
In the middle of the 19th century, a Czech doctor and researcher Dusan Lambl discovered quite cute (under a microscope) protozoa. True, he did not immediately blame the organisms named after him for all the problems with human health, this was done by others and much later. The second international name for the disease is giardiasis or gairdiasis... The fact is that in Western countries, doctors categorically disagree with the fact that the Czech Lambl was the discoverer of the parasites. They attribute the discovery to the French scientist Giard, hence the international name for the diagnosis.
The World Health Organization claims that up to 200 million people are infected with lamblia every year in the world, and more than 70% of them are children under 14 years old.
Giardia live in two states - they can be active and dormant. Immobile lamblia exist in the form of cysts. With the help of cysts, in fact, infection, transmission of the parasite occurs. Immobile cysts, getting into a favorable environment for themselves - in the small intestine, “come to life” and begin to multiply.
If a child has a weakened immunity, if he has concomitant diseases, then immunity will not have a quick reaction to new inhabitants of the small intestine. This makes it possible for lamblia to multiply by dividing at a fairly rapid rate. These unicellular parasites are capable of doubling their numbers every 10-12 hours. However, the more lamblia, the less space for them, and individuals begin to enter the large intestine.
In the large intestine, the conditions for the existence of giardia are assessed as extreme, completely unsuitable for themselves, and therefore quickly turn back into immobile cysts and, in this form, go out with feces. In a dormant state, lamblia can exist in soil for more than three weeks, and even longer in water - about 5 weeks.
With water, vegetables and fruits, with unwashed hands, cysts enter the body of another person, begin to multiply, leave in the form of cysts, and the circle is closed.
The presence of lamblia in itself is not considered a disease. We can talk about giardiasis when the rapid reproduction of protozoa leads to certain changes in the child's body, because lamblia in the small intestine feed on useful substances that are needed for the child, and, accordingly, the baby does not receive them. In addition, parasites secrete metabolic products, and this is also not useful for the child's body.
At risk - children from one year to 4-5 years... It is at this age that the world is cognized not only by sight, sound and smell, but also by taste, and therefore the spread of lamblia in the children's collective is just a matter of time, and a small segment of it. Giardia has the most negative effect on children with stomach diseases, especially with ailments accompanied by low acidity. At risk and children - vegetarians who are deficient in protein foods.
In the acute stage, giardiasis can manifest itself with severe symptoms. But in chronic, if the infection occurs over and over again or the treatment was not completed the first time, there may be no symptoms. It is believed that the health of the child is deteriorating markedly, because small parasites, barely visible in a microscope, act around the clock and seven days a week.
Myths and truths about lamblia
It is difficult to say why, but of all the parasites, it was lamblia that were honored to be recognized as one of the main threats to humanity. These unicellular organisms have been studied well enough, and therefore anyone interested, if desired, can learn enough about them.
It is all the more incomprehensible why so many myths soar around lamblia and giardiasis, which, by the way, are actively supported by the medical workers themselves:
- "Giardia is very dangerous!" It is a myth. Even in the active vegetative stage, during the breeding season, protozoa cannot be considered dangerous, since they do not carry any threat to the child's life. The harm that Giardia inflicts on the child's body is greatly exaggerated.
- "Your child has gallbladder problems because he has giardia!" This is no longer just a myth, but the most real medical obscurantism. Nowhere, except in the small intestine, these protozoan parasites cannot exist, and the bile environment for them is completely destructive. Therefore, any problems with the digestive system (cirrhosis, biliary dyskinesia, etc.) should in no way be explained by the presence of lamblia in the feces of a child.
- "If giardiasis is not treated, the child will develop lamblia in the liver and other organs."... This myth, apparently, is financially supported and fueled by manufacturers of pharmacological agents to combat parasites. And some doctors in all seriousness say these words to the parents of their little patients.
As already mentioned, a suitable environment for lamblia to live is the exceptionally small intestine. Parasites cannot survive neither in the liver, nor in the spleen, nor in the stomach.
- "Giardiasis can be treated with folk remedies"... Herbal decoctions, mashed onions and garlic and other recipes from the arsenal of alternative medicine, in principle, can affect Giardia, but such treatment will be long and ineffective, it is unlikely that it will be possible to get rid of parasites to the end. Therefore, it is better to resort to a course of treatment with traditional drugs, it will not take more than 5 days.
- "If you wash your hands often, you won't get infected with lamblia"... It is a myth. Hand washing is a great habit that protects a child from many pathogenic bacteria and some viruses, but it practically does not protect against lamblia. It is enough for the kid to play in the sandpit, in which the cat, the carrier of lamblia, was previously sitting in order to bring microscopic cysts onto the shoes. And only 10 individuals are enough for infection.
- "Because of lamblia, the child began to get sick with ARVI more often"... It is not true. The presence of parasites in the small intestine does not in any way affect the likelihood of contracting the virus and has practically no significant effect on immunity.
- "Giardia - a source of allergies"... Giardia cannot cause an allergic reaction on the skin, since their waste products are not strong toxins or allergens. Skin ailments, including those of allergic origin, should not be associated with giardiasis.
- "Giardiasis can be cured once and for all"... This is a common misconception. After you manage to cope with one batch of parasites, the baby can become infected with a new one, and on the same day.
- "Every fifth child has Giardia"... It's true. About 30% of children aged 3 to 7 years, according to the test results, do have these parasites in their bodies. However, they have no complaints and pathologies, diseases with dire consequences. Their parents learn about lamblia only from the result of the analysis of feces. In this case, there is no question of intestinal giardiasis, because the presence of cysts is not yet a disease.
Symptoms
The presence of cysts cannot be felt in any way. The child does not complain or get sick. The fact that the development of pathology associated with the reproduction of lamblia begins can be said when the parasites begin to irritate the intestinal mucosa. This process can be accompanied by the following symptoms:
- discomfort in the navel, in the upper abdomen, moderate pulling pains that are not distinguished by an acute or pronounced character, sensations are not constant;
- loss or impairment of appetite, change in taste preferences, a feeling of mild nausea;
- the baby's tummy is quite often swollen, after eating you can hear a rumbling;
- stool instability - diarrhea is replaced by constipation and vice versa;
- prolonged diarrhea (several days);
- feces have a yellow or yellowish color and an uneven consistency, in places there are splashes of mucus;
- general weakness, irritability, moodiness of the child;
- if the baby has previously been diagnosed with atopic dermatitis, an exacerbation may begin;
- body temperature is usually normal, very rarely it rises to subfebrile values (37.0 - 37.9 degrees).
The most common symptom is weight loss. As we have already found out, lamblia suck out many useful substances from the small intestine, which get there with food. And if we consider that the child already has a reduced appetite, then the weight will really start to change downward. Babies will experience delayed weight gain or the weight will remain in one place.
In acute giardiasis, if a very large number of cysts immediately enter the child's body, the temperature may rise to 38.0 degrees, and all of the above symptoms will be quite pronounced. Vomiting and severe headaches can be added to them.
Diagnostics
It is possible to establish the presence of lamblia cysts in a child's body only by the results of stool tests, the so-called scatological analysis. However, cysts are not always found in the material, since they do not always end up in the portion of feces that the parents took for sending to the laboratory. To get to the bottom of the truth (if you really want to get to it) you need to bring a stool analysis to the clinic once a week for at least a month. Only then will laboratory assistants be able to answer the question with a probability of up to 90% if the child has lamblia.
Often pediatricians prescribe a referral for a serological blood test. To do it, the child needs to be raised early, not fed, and prepare for his protests, since blood is taken exclusively from a vein. Whether or not to take this test is up to the parents to decide, since it is not considered informative in terms of the development of giardiasis... A certain amount of specific antibodies to lamblia in the blood during serological analysis can, in principle, be detected, but only 3-4 weeks after infection. And since the fact of infection can not be identified in time, serological analysis cannot be considered a reliable diagnosis.
A rather unpleasant diagnostic method is duodenal examination. It can be assigned to a child who is already 10 years old. During the probing, the child will need to swallow a one and a half meter probe, which will take bile samples. The method was previously widespread, since medicine sincerely believed that lamblia was the culprit for problems with the gallbladder and duodenum.
Numerous recent studies have shown the inconsistency of such a relationship, and therefore, parents have the right to refuse painful diagnostic probing as uninformative, even if the doctor insists on it. Surely the doctor is a follower of the old fundamental medical school.
A simpler and more indicative method is enterotest.
The child is given a gelatin capsule to drink. There is a nylon thread inside the capsule. It will be released after the capsule dissolves in the stomach. The thread will pass through the small intestine, Giardia will definitely stick to it, if any, and then it will come out with feces through the large intestine... Emptying is provoked by taking a laxative 2 hours after swallowing the capsule.
Another method is a biopsy of the small intestine. For the analysis, a small fragment of the shell is taken, in it the presence or absence of lamblia is determined microscopically. In addition to this fact, doctors manage to establish what changes have caused the parasites in the small intestine. The procedure is rather laborious and expensive, it is prescribed very rarely, mainly when there is a suspicion of a tumor in the small intestine. Giardia in this situation is found in parallel.
Treatment
Not every giardiasis needs special treatment. If a child simply has cysts of lamblia in the feces, this is by no means an indication for starting taking medications for parasites. Doctors most often choose expectant tactics. In most cases, during infection, there are cysts in the analyzes, but there is no pronounced toxic effect on the body.
The child's immunity "works" on this problem from the very penetration of lamblia into the small intestine. And with a high degree of probability he will be able to win a confident victory over the parasite without outside help.
The World Health Organization gives very specific instructions for this case - you need to start treating giardiasis with medicines only when the diarrhea has not stopped for 7-10 days. In this case, lamblia should be detected and confirmed.
In more difficult cases, when prolonged diarrhea is not the only symptom, the doctor may prescribe a three-stage treatment regimen.
Elimination of intoxication and assistance to immunity
At this stage, which usually lasts about 2-3 weeks, a special meal is recommended for the child. The child's menu includes products and dishes that the lamblia "do not like". These are various cereals, vegetable oil, dried fruits and fresh vegetables, applesauce, fermented milk products - to improve intestinal motility. The better the intestines work, the more productive it is to empty, the more parasites will leave it. Banned - carbohydrates. They feed giardia very well, and therefore it is better to put off high-carbohydrate food for later.
To relieve possible skin manifestations, antihistamines are prescribed in an age-specific dosage. The best remedy for a child of the earliest age - 1 year, 2 years - "Suprastin". It is recommended to take it in pills. Choleretic drugs and enterosorbents can be prescribed as an auxiliary therapy. As a choleretic, children from 5 years old are often prescribed a herbal preparation "Hofitol».
Antiparasitic therapy
This is the main stage at which the doctor will have to choose a remedy to fight parasites. Modern drugs do not need to be taken for weeks, in most cases they take effect after 3-5 days. When choosing a medicine, the doctor will draw the parents' attention to drugs that have an effect on the protozoa, to which lamblia are also directly related. These drugs include "Trichopol", "Metronidazole", "Furazolidone", "Tiberal", "Macmiror".
The combined preparation, which contains both metronidazole and furazolidone, is very popular - "Emigil-F"... Children over 5 years old are given it in tablets, and for babies up to a year old - in suspension. Quite often, children with acute giardiasis are prescribed a drug "Nemozol"... It is available only in tablets. The doctor calculates the age dose based on the weight of the child. The average course of treatment is 5 to 7 days.
Some other well-known antihelminthic agents, for example, "Pirantel" for giardiasis, are ineffective, since they have a rather limited spectrum of action that does not extend to the simplest microorganisms.
These funds are prescribed in pill courses. If the situation is close to critical, and the child's diarrhea against the background of giardiasis lasts for more than 10 days, then “heavy artillery” - drugs that need to be taken once, for example, “Tinidazole”, can be used.
Along with these drugs, you should continue to take antiallergic drugs and enterosorbents. From enterosorbents in childhood, "Polysorb", "Smecta", "Enterosgel", "Polyphepan" are approved for use. These funds are an effective defense against toxins that are produced by dying parasites as a protective reflex.
Consolidation of results
The third stage repeats the first one a lot, since it is aimed at creating such conditions in the body under which lamblia will be extremely uncomfortable to settle in it again. Of course, it is impossible to reduce such a risk to zero, because giardia is widespread, but at least you can try. Throughout the month, the child must adhere to a special diet, which will include a large amount of fresh fruits and vegetables, as well as cereals, mashed potatoes, cottage cheese and kefir. The doctor will definitely advise one of the multivitamin complexes that is suitable for the baby's age - the loss of vitamins caused by giardiasis must be compensated and replenished.
If the disease is accompanied by prolonged diarrhea, then probiotics and prebiotics are often prescribed at the final stage of therapy. In some cases, children are shown enzyme preparations.
Efficiency
Drugs that form the basis of antiparasitic treatment, such as "Metronidazole", "Furazolidone" and all funds based on them gradually lose their effectiveness due to the fact that parasites appear that are very resistant to the active substance of these drugs. Giardia, which left the body at the stage of antiparasitic treatment, and did not die, but only became cysts, acquire such resistance.
The next time they cause an infection, giardiasis will be much more difficult to respond to drug therapy. The modern pharmaceutical industry is working on this issue, and new drugs appear on the market almost every year. Doctors are usually aware of new products, and will definitely suggest another remedy for lamblia if Metronidazole does not work.
To make the treatment more effective, doctors recommend that all family members undergo it at the same time.
If parasites have been identified in a child, and they have led to the disease, then both adults and other children in the family should take the drugs prescribed for the baby. The dosage for each family member is determined by the doctor.
Sometimes there is a need for a second course of treatment. In order to make sure that all parasites have left the body, the child must take feces for analysis several times after the end of the first course. Dispensary observation is supposed to him for six months, during this time it is advisable to analyze the fecal masses for lamblia cysts at least three times.
Prevention
From the point of view of infection with giardiasis, every inhabitant of the planet is dangerous, since many adults are long-time carriers of lamblia. Childhood immature immunity does not resist invasion well, and therefore even a small number of cysts will be sufficient for infection. Prevention of this unpleasant disease is divided into two directions - personal prevention and public prevention.
The whole society needs to take into account that the main source of cysts is pets.
To prevent children from playing in the sandbox, next to which someone's dog or cat went to the toilet, the owners of four-legged animals just need to learn how to clean up after their pets what they usually leave in the yards. This measure alone could reduce the incidence of giardiasis by several orders of magnitude.
At the social level, it is desirable to control the condition of water bodies, to protect them from parasite infestation. In children's groups (schools and kindergartens), it is necessary to regularly conduct a scatological examination of all pupils and students in order to timely identify carriers of lamblia who do not have any symptoms.
Individual measures for the prevention of giardiasis are to observe hygiene rules. Washing your hands is not enough, you still need to teach the child not to drag them into his mouth. Proper hand washing should last at least 30 seconds, using baby soap. In the house where the child lives, as well as in the places where he is, a merciless war must be waged against flies and cockroaches. These insects are the main carriers of lamblia cysts. The fewer flies and cockroaches in the apartment, the lower the risk of contracting parasites.
Cysts can enter the child's body with water, including drinking. Tap water is not the best option for baby drinking, given the fact that standard, conventional water chlorination practically does not kill Giardia cysts.
You should not give your child water from unknown and unverified sources - springs. There, in addition to lamblia, there are also more terrible microorganisms.
Thus, the main prevention consists in boiling drinking water, thoroughly washing vegetables and fruits bought in a store or on the market with a brush, as well as curbing children's attempts to take other people's toys for play, let alone drag them into their mouths.
About what giardiasis is and how to deal with it, Dr. E.O. Komarovsky will tell in the next video.
