Parasites and Biliary stones

Giardiasis ٥٩
Villous atrophy, epithelial cell damage, and lymphocytic and plasma
cell infiltrates of the mucosa have been described in symptomatic patients
(Wright and Tomkins, 1977). Patchy location of parasites with blunting
of the epithelial cell microvillus border has been seen in biopsy
specimens (Erlandsen and Chase, 1974). Depletion of microvilli can be
shown by using cultured epithelial cells, but this depletion occurs with
Giardia isolates from symptomatic or asymptomatic patients (Chavez et
al., 1995).
Clinical features:
Giardiasis may present with a wide variety of clinical
manifestations. The majority (60–80%) of infected individuals have few
or no symptoms.(Flanagan, 1992). Asymptomatic giardiasis may be
epidemiologically more significant, as asymptomatic individuals are less
likely to be detected or to seek treatment and therefore, are more likely to
serve as carriers of the disease (Meyer and Jarroll, 1980).
Symptomatic giardiasis is characterized by the acute onset of
diarrhea, abdominal pain or cramps, and flatulence. Diarrhea is the
predominant symptom, occurring in 90% of symptomatic individuals
(Gorski, 1985). Patients pass approximately five loose or semiformed
stools per day for 2–3 days. The episodes of diarrhea may be interposed
with periods of normal bowel movements or constipation. The flatulence
is characterized by a sulfur odor, which is frequently emitted from the
breath, stool, or both. If untreated, these symptoms may persist for
months and lead to malabsorption and weight loss. In infants and
children, prolonged infection may lead to impaired growth and
development (Farthing, 1992).
Fever, chills, severe abdominal pain, and bloody stool are
uncommon symptoms of Giardia infection, and, if present, other