Nelson L Machado

Asymptomatic giardiasis does not affect iron absorption in children with iron deficiency anemia.

OBJECTIVE Malabsorption of iron has been reported in children with symptomatic giardiasis. The aim of this study was to evaluate intestinal absorption of iron in children with asymptomatic giardiasis and iron deficiency anemia. SUBJECTS Based upon results of blood hemoglobin and stool examination, two groups were established: asymptomatic giardiasis and anemia, and anemia without intestinal parasitosis (control group). Patients were aged 1-6 years. There was no difference in age, weight, height, or iron nutritional status between the asymptomatic giardiasis and control groups on admission to the study. MEASURES Intestinal absorption of iron was evaluated using the iron tolerance test and the hemoglobin response to iron therapy. The serum iron tolerance test was based on the increment of iron level 2 hours after administering an iron load of 1 mg/kg of elemental iron in the form of ferrous sulfate, in comparison to the fasting iron level. Hemoglobin response to oral iron therapy was determined by the increment of hemoglobin on day 30 of therapy with ferrous sulfate (5 mg/kg/day of elemental iron). RESULTS There was no statistical difference between the asymptomatic giardiasis and control groups with reference to the iron tolerance test (159.1 +/- 73.1 micrograms/dl and 154.5 +/- 76.5 micrograms/dl, respectively) and to the hemoglobin response to iron therapy (1.5 +/- 0.7 g/dl and 1.8 +/- 1.1 g/dl, respectively). The presence or absence of trophozoites of Giardia lamblia on duodenal aspirate did not affect intestinal absorption of iron. CONCLUSION Asymptomatic giardiasis did not affect the intestinal absorption of iron and the hemoglobin response to oral iron therapy in iron-deficient anemic children.

Protracted diarrhea in infancy: clinical aspects and ultrastructural analysis of the small intestine.

Summary: Protracted diarrhea is a clinical entity characterized by diarrhea lasting >2 weeks, starting before 3 months of age, with severe nutritional aggravation and negative stool culture for enteropathogens. This report deals with the ultrastructural abnormalities found in the intestinal mucosa of children with protracted diarrhea. Forty children (mean age 5.1 months) were studied. They were submitted to the following tests of intestinal function: D-xylose, triglyceride tolerance, small bowel biopsy (light and electron microscope), sigmoidoscopy, and sweat test. D-Xylose absorption and triglyceride tolerance test in these patients were both significantly tower than controls. Ultrastructural analysis of the small bowel of 12 patients showed various degrees of alterations, mainly shortening of the micovilli, increased number of multivesicular bodies, and vacuolation of mitochondria and endoplasmic reticulum. These lesions were totally reversible after clinical and nutritional recovery, as could be proven in two children. The most common cause of protracted diarrhea in these patients was secondary carbohydrate intolerance and dietary protein cows milk and soy bean intolerance, which resulted in colitis or malabsorption as a consequence of intestinal mucosa injury due to acute gastroenteritis.

Giardiasis in childhood and its effects on the small intestine.

Summary: The effects of Giardia lamblia on small bowel function were studied. Thirty‐three asymptomatic children were studied before and after treatment with metronidazole (Nimorazol®). Patients had a small intestinal biopsy, bile salt determinations, and the following absorptive tests: D‐xylose, triglyceride, and lactose and sucrose tolerance tests. Before treatment, 87% had unconjugated bile salts in duodenal fluid but afterwards only 60% did. Small bowel biopsy changes did not correlate with the pre‐ and posttreatment periods. Triglyceride absorption showed significant differences between patients at different periods of the study; D‐xylose absorption did not reveal differences between the periods of the study but was significantly impaired when compared with controls. Lactose malabsorption was detected in 56% and sucrose in 7% of the patients. G. lamblia may have some pathogenic role, although nonspecific to intestinal function. It probably acts more in a synergistic way with other pathogenic agents that inhabit the intestinal lumen of children living under unfavorable conditions producing the picture of tropical enteropathy.

IRON ABSORPTION AND RESPONSE TO ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA ASSOCIATED TO ASYMPTOMATIC GIARDIASIS.

Symptomatic giardiasis may impair intestinal iron absorption. Aiming to evaluate iron absorption in children with asymptomatic giardiasis, 2 groups were established:anemia (HB<11g/dL) and giardiasis (n=19);and anemia without giardiasis (n=19), which were selected from 240 well-nourished children presenting probable clinical signs of anemia and negative results of occult blood and for other parasites in three parasitological examinations in the feces. Patients ranged from 1 to 6 years and all were well-nourished. The presence of G.lamblia trophozoites was investigated in duodenal fluid. Iron absorption was evaluated by increase in the serum iron levels 2 hours after the administration of 1mg/Kg ferrous sulfate (iron absorption test-IAT). The response to iron therapy (5mg/Kg/day of ferrous sulfate) was determined by higher levels of hemoglobin within a 30-day period. Nodifferences were observed between the 2 groups regarding hemoglobin, serum iron, transferrin, ferritin and 1-hour blood D-xylose levels. Taking the IAT into account, children with giardiasis reached values of 159±73ug/dL,whereas the control group presented values of 155±76ug/dL (p=0,39). The rise of hemoglobin consisted of 1,5±0,7g/dL for giardia carries and 1,8±1,0g/dL within the control group (p=0,24) All things considered, the asymptomatic giardiasis does note give rise to iron malabsorption.