Surface ultrastructure of giardial infestation

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Although the pathogenetic significance of giardial infestation in man has been questioned,1 several studies have demonstrated that a malabsorption syndrome in children identical to celiac disease is associated with Giardia lamblia infestation.2–4 Furthermore, successful treatment of the parasitic infestation in adults has been described. Until recently mucosal invasion by the parasite had not been demonstrated; 4–10 Brandborg et al11 and others12, 13 have recently documented mucosal invasion by the organism.

This report describes the light microscopy and surface ultrastructure of duodenal mucosa in a patient with giardial infestation and malabsorption.

Case report

A 58-year-old man was examined in the Department of Gastroenterology on October 16, 1975, for persistent diarrhea, left upper quadrant pain, belching, and abdominal distention. The symptoms had begun 2 years earlier; three to ten loose watery brown stools were passed daily. The patient had a 10-kg weight loss during the previous 3 years. An upper gastrointestinal series 8 months previously demonstrated edematous mucosal folds (Fig. 1); a barium enema at that time disclosed mild diverticulosis. The patient appeared thin. No other abnormalities were noted on the physical examination.

Complete blood count, urinalysis, and chest x-ray were normal. The D-Xylose value was normal. Serum carotene was 40 mg/dl. A few Giardia lamblia cysts were present in the stool; a specimen obtained by duodenal aspiration contained many Giardia trophozoites. The patient was treated with metronidazole (Flagyl), 250 mg three times daily orally for 10 days, with prompt resolution of symptoms and weight gain of 3 kg. On April . . .



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