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Giardia in children are not viruses, worms, or bacteria. These are the simplest unicellular organisms from the flagellate genus, the order of diplomonadids. Giardia is about 10-25 micrometers in size. They have four flagella, two medial bodies, and a double set of chromosomes. Giardia have a suction apparatus, with which they attach to the villi of the small intestine. This type of protozoan parasite belongs to anaerobes, that is, for their vital activity they do not need oxygen at all. Giardia in children feed on nutrients that are intended for the host organism. Moreover, they do this in a very sophisticated way: they absorb already digested nutrients with their entire cell surface. The number of lamblia in the intestines can reach an absolutely fantastic amount:over one million lamblia can be found on one square centimeter of the small intestine mucosa.
Giardia multiplies in the human small intestine by longitudinal division, but the formation of cysts occurs in the large intestine. Giardia cysts come out together with feces, sometimes with liquid feces in them you can find parasites that have formed quite recently during the division of lamblia. They are called trophozoites. Trophozoites released with feces immediately die in the external environment, only cysts survive. Infection with giardiasis occurs through cysts, they are able to maintain their vital functions in the environment for up to 3-4 months. In water, lamblia cysts persist for 1-3 months at temperatures from +4 to +20 ° С.
- Giardia in children - description
- Treatment of giardiasis
- Giardiasis treatment: to be or not to be?
Giardia in children - description
Giardiasis is a parasitic disease from the category of dirty hands. The infection is common in countries with low sanitary culture. That is, not only in poor, economically disadvantaged countries, but also in countries with a low level of sanitary culture. Russia and all the countries of the post-Soviet space can be included in this category.
There are a number of factors that firmly determine the endemicity of giardiasis:
- Poor drinking water quality. Poor water quality is, first of all, its poor disinfection. Studies have found that Giardia is quite resistant to chlorine, so chlorination of water is not a solution. Ozonation of water kills some of the simplest, but not all.
- Dog poop on the street. Abroad, you can often see the following picture: the owner of the dog cleans up the feces in a special bag after her. Unfortunately, this level of culture is still unattainable for many countries. After all, lamblia cysts live safely in animal feces, are common on the streets and are brought into houses with shoes. In addition, feces are washed away by rains and carried into groundwater and reservoirs.
- Failure to comply with sanitary standards in villages and towns. Unfortunately, until now in rural areas, toilets with cesspools prevail. Feces fall into underground waters, washed away by rains and melt water, then fall into reservoirs that feed large cities.
- Fecal runoff. Very often, illegal dumping of faeces into water bodies occurs, which leads to widespread infection and spread of lamblia.
It becomes clear why it is so easy to get infected with giardiasis, and in fact children are most often infected with it. Infection with parasites is due to children's physiology. Preschool children are very active, it is impossible to keep track of them, they can catch an infection at any time. As they pull various objects into their mouths, lick their fingers and bite their nails, play in the sandbox and contact peers.
Diagnosis of giardiasis is carried out by several methods:
- Stool analysis. It is currently considered the most reliable test for detecting lamblia in a child. The feces contain cysts of this microorganism, but live parasites can only be detected in fresh, still warm feces. However, it is necessary to collect feces very quickly, since living trophozoites very quickly turn into cysts, and cysts die within 2 hours after defecation. Therefore, doctors suggest taking a stool test in a preservative to keep the "live" parasites in the stool. In order to obtain a reliable analysis, it is necessary to carry it out several times, since cysts not detected the first and even the second time may appear in subsequent fecal analyzes.
- Analysis of duodenal juice. It should be noted right away that this research is carried out mainly abroad. It is very difficult for a child to conduct such a study. Its essence lies in swallowing a capsule that is filled with special reagents. The capsule is attached with special threads on the cheek and lowered into the gastrointestinal tract. Once in the stomach, it dissolves, and the reagents react with the juice of the duodenum. If giardia is present in the body, then the reagents let you know about it.
- Serological blood test. This blood test is carried out to identify immune defense complexes. The doctor adds antigen to the serum. As a result, an antigen-antibody immune reaction occurs. Having identified antibodies, you can diagnose giardiasis with confidence.
But the most reliable and correct way to diagnose parasites in children is to re-analyze the feces.
The symptoms of giardiasis are very diverse, and sometimes it may be completely absent.
The most typical symptoms of giardiasis in children:
- stomach ache;
- digestive disorders;
- diarrhea and constipation (they often replace each other);
- persistent nausea;
- flatulence and bloating;
- decreased appetite;
- growing weakness;
- fast fatiguability;
- weight loss.
The most important symptom of giardiasis is prolonged diarrhea (more than 10 days). At the same time, no symptoms are observed anymore. However, in clinical studies of feces, lamblia cysts can be detected. In this case, treatment should be started immediately. If the diarrhea has gone away on its own, then the child's body has coped with the infection on its own. In this case, no treatment is required.
Treatment of giardiasis
The first question that parents ask after diagnosis: how to remove lamblia from a child? However, you should not panic and rush to extremes, all the more you should not independently treat the child with hastily bought anthelmintic drugs. First of all, lamblia are not helminths, so antihelminthic drugs cannot have the desired effect. For the treatment of giardiasis, antiprotozoal and antimicrobial drugs are used, as well as many other aids to maintain and restore the body.
Treatment of giardiasis in children is carried out in three stages.
The first stage involves adherence to a strict diet, taking antihistamines, choleretic drugs, sorbents and enzymes, which are prescribed only by a specialist. All these steps are aimed at improving the child's digestive system, eliminating intoxication, improving the production of enzymes, bile outflow, and adjusting the immunological status. This stage lasts up to 2 weeks.
The second stage involves direct treatment with antiprotozoal and antimicrobial drugs. In the course of treatment, the child has exacerbated symptoms of giardiasis:
- stomach ache;
- decreased appetite;
- rash on the skin;
- upset stool and constipation.
This fact is considered the norm, therefore, treatment cannot be canceled. In the case of mixed invasions, the child is immediately prescribed anthelmintic therapy with drugs of a wide spectrum of actions that destroy both protozoa and helminths. The course of treatment lasts about 7 days.
The third stage involves measures aimed at restoring the body. During this period, the child continues to be given enzymes, probiotics are prescribed to normalize the intestinal flora, immunomodulators, a diet high in pectin is prescribed. This stage lasts 2-3 weeks.
Parents should definitely remember that it is strictly forbidden to treat their children on their own. Anti-lambliasis drugs are prescribed only by a doctor. Since important nuances must be taken into account:
- the effectiveness of anti-lambliasis drugs;
- compliance with age prescriptions (the medicine must be suitable for age);
- good tolerance by the child's body, without side effects and complications;
- lack of pronounced sensitivity to the drug.
All anti-lambliasis drugs are divided into:
- Nitroimidazoles are antiprotozoal and antimicrobial drugs. This group includes: Albendazole, Ornidazole, Tinidazole, Tibiral, Fasizhin, Metronidazole, Flagil, Klion, Trichopol, Metrogyl, Niridazole;
- Nitrofurans are antibacterial drugs for a wide range of medical applications. These include: Furazolidone, Nifurozide, Nifuroxazide, Nifuratel, Furadonin, Furagin;
- Preparations based on acridine derivatives: Quinacrine, Mepacrine.
Currently, the most effective anti-lambliasis agent is Nemozol. Nemozole affects not only the simplest microorganisms, but also helminths, their eggs and larvae. It is currently the most effective antiparasitic agent with a wide spectrum of action. In numerous studies, its high efficiency has been proven, moreover, it is used in cases where strains of lamblia show resistance to other antiprotozoal drugs. Sometimes it is necessary to repeatedly change the drug so that it begins to cause the death of protozoa, but lamblia has no resistance to Nemozole. In the chronic form of giardiasis, treatment courses are carried out several times.
The drug is widely used for giardiasis, and its dose and duration of treatment depends on the child's age, weight and degree of infection. However, in some cases, taking only Nemozole may be insufficient, since the treatment of giardiasis is carried out according to a certain scheme in several stages. The drug is prescribed for mixed parasitic infections. Contraindications are: pregnancy and lactation, diseases of the retina, individual intolerance, liver dysfunction. Nemozole is available in tablet form, in the form of a syrup, and even in the form of injections.
With giardiasis, you must follow a diet that will help alleviate the patient's condition. The correct diet will help not only eliminate the symptoms of giardiasis, but also completely cure the disease, even without drug treatment. What do I need to do?
- Exclude fast carbohydrates from the child's diet. It is well known that all parasites love sweet and starchy foods. Therefore, immediately after the diagnosis is made, fast carbohydrates should be removed from the child's diet. Also, for the duration of the treatment, you need to limit the child in sweet fruits and dried fruits: bananas, grapes, dates, do not add raisins to the porridge. Do not give your child fresh white and rye bread, but give crackers, biscuit biscuits.
- Leave slow carbohydrates in the child's menu. A variety of cereals are very useful: oat, buckwheat, wheat, rice, corn. They only need to be cooked in water.
- Sour foods. An acidic environment has a detrimental effect on lamblia, since these protozoa cannot continue their life in such an environment. Therefore, children should regularly be given sour juices, fruit drinks, compotes and sour fruits: citrus fruits, cherries, plums, kiwi, apples.
- Pectins. Most of this substance is found in apples and some berries: lingonberries, cranberries, blueberries, currants, blueberries. In addition, fruits and berries with pectin improve intestinal motility and stabilize metabolism.
- Eliminate spicy, fried and fatty foods from the child's diet. Even completely healthy people should eat as little as possible, as it puts an additional burden on the digestive system. All food should be boiled, stewed or steamed. Also, you can not give children onions, garlic, a variety of ketchups.
- Protein food. The child's diet must necessarily contain foods rich in protein, so the use of lean fish, chicken, turkey, veal is encouraged. However, you should not give your child sausages.
- Dairy products. The child's diet must include fermented milk products: yoghurts, biokefir, low-fat cottage cheese. Bifidobacteria and lactobacilli contribute to the normalization of intestinal microflora.
- Frequent meals. The child should eat up to 6 times a day.
- Drinking regime. The child should drink plenty of fluids, but sugary juices and sodas should be avoided.
To fully restore the body, the diet is followed for 3 months.
Giardia in children does not leave behind strong immunity, so you can get infected with them again. Prevention of this disease is reduced to the observance of elementary rules of personal hygiene and general sanitary standards:
- Frequent hand washing, especially before meals and after using the toilet (within 5 minutes).
- It is necessary to teach a child from an early age to observe the rules of personal hygiene.
- Do not use other people's towels, do not allow the child to sleep in someone else's bed and use someone else's bedding.
- Give your child only filtered, boiled water to drink.
- Systematically (twice a year) take a feces test to detect lamblia cysts.
- Do not buy pies, hot dogs and other food for your child on the street.
- Do not allow your child to eat outside. Many parents let their children go out with an apple, a cookie, a sandwich.
- Thorough washing of fruits, vegetables and berries.
- Teach your child to wash their hands after contact with a pet, do not let him sleep with the animal in the same bed.
- Fighting bad habits in children (biting nails, keeping hands in your mouth, sucking fingers, taking foreign objects in your mouth).
- Do not allow your child to swim in unknown bodies of water.
If giardiasis is detected in a child, it is necessary to take anti-epidemic measures in the children's team or in the family. A sick child should be isolated, family and team members should be examined, and also forced to undergo preventive treatment.
No one is immune from giardiasis. The persistence of lamblia cysts in the environment contributes to infection with this simplest microorganism at any time.
Giardiasis treatment: to be or not to be?
There are many controversies surrounding the treatment of giardiasis. Some experts believe that there is no need for any schemes and stages of treatment. It is enough to take anti-infectious drugs that reliably destroy giardia and their cysts. Others believe that it is imperative to treat, and it is necessary in stages and in a comprehensive manner.
Therefore, infectious disease specialists share three opinions:
- Giardiasis does not need to be treated. Many doctors do not consider giardiasis a disease and claim that the body can cope with this infection on its own. However, this parasitic infection does not give persistent immunity, which means that a child who once fell ill with giardiasis and underwent a course of treatment can be re-infected with this disease. Since lamblia cysts can re-enter the child's body.
- Giardiasis should always be treated with a variety of methods. A number of experts claim that giardiasis must be treated in stages, schematically, using additional and auxiliary methods of treatment.
- Treat giardiasis only when the child has pronounced symptoms. Most experts are inclined to this opinion, including the World Health Organization (WHO).