title: Giardia duodenalis assemblage, clinical presentation and markers of intestinal inflammation in Brazilian children.
abstract: Data on the relationship between the two genotypes of Giardia duodenalis that infect humans, assemblages A and B, their clinical presentation and intestinal inflammation are limited. We analyzed 108 stool samples previously collected for a diarrhoeal study among Brazilian children, representing 71 infections in 47 children. Assemblage B was most prevalent, accounting for 43/58 (74.1%) infections, while assemblage A accounted for 9/58 (15.5%) infections and 6/58 (10.3%) infections were mixed (contained both assemblage A and B). There was no significant difference in diarrhoeal symptoms experienced during assemblage A, B or mixed infections. Children with assemblage B demonstrated greater variability in G. duodenalis cyst shedding but at an overall greater level (n=43, mean 3.6 x 10(5), range 5.3 x 10(2)-2.5 x 10(6)cysts/ml) than children infected with assemblage A (n=9, mean 1.4 x 10(5), range 1.5 x 10(4)-4.6 x 10(5)cysts/ml; P=0.009). Children with mixed infections shed more cysts (mean 8.3 x 10(5), range 3.1 x 10(4)-2.8 x 10(6)cysts/ml) than children with assemblage A or B alone (P=0.069 and P=0.046 respectively). This higher rate of cyst shedding in children with assemblage B may promote its spread, accounting for its increased incidence. Additionally, second and third infections had decreasing faecal lactoferrin, suggesting some protection against severity, albeit not against infection, by prior infection.
authors.affiliation: Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908, USA. akohli@virginia.edu
authors.forename: Anita
authors.initials: A
authors.lastname: Kohli
authors.forename: Oluma Y
authors.initials: OY
authors.lastname: Bushen
authors.forename: Relana C
authors.initials: RC
authors.lastname: Pinkerton
authors.forename: Eric
authors.initials: E
authors.lastname: Houpt
authors.forename: Robert D
authors.initials: RD
authors.lastname: Newman
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Sears
authors.forename: Aldo A M
authors.initials: AA
authors.lastname: Lima
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
mesh_terms: D000818:Animals; D000953:Antigens, Protozoan / Q000276:immunology* / Q000302:isolation & purification; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000276:immunology*; D003967:Diarrhea / Q000469:parasitology; D004926:Escherichia coli / Q000302:isolation & purification; D005243:Feces / Q000469:parasitology; D005260:Female; D005838:Genotype; D005872:Giardia / Q000276:immunology* / Q000302:isolation & purification; D005873:Giardiasis / Q000453:epidemiology / Q000276:immunology*; D006790:Host-Parasite Interactions / Q000276:immunology*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011204:Poverty Areas; D012680:Sensitivity and Specificity; D017422:Sequence Analysis, DNA
chemical_list: D000953:Antigens, Protozoan; D016054:DNA, Protozoan