WHERE ARE STRONGYLOIDIS AND GIARDIA INFECTIONS?
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
When I was a student, I was given the impression that the stool test is done to exclude amoeba, strongyloidis stercoralis and giardia parasites which are all very common infestations in day-to-day practice.
After practising for so many years, I hardly ever see a case of proved amoebiasis or a case of proved strongyloidis stercoralis or giardia infestation.
Now with the coming of AIDS, the incidence of strongyloidis stercoralis is increasing. The problems in the diagnosis arise because often a single stool test does not show strongyloidis stercoralis or giardia.
Strongyloidis stercoralis infestation is known to cause jejunitis and dilatation involving upper jejunum with symptoms of upper abdominal colicky pain with vomiting. Barium meal examination may show a dilated segment of upper jejunum. The diagnosis can be confirmed only by upper jejunal mucosal biopsy during gastroscopy examination.
Giardia infection can be diagnosed confidently by a blood test of anti Giardia IgM antibodies. Patients having giardia infection often complain of distended abdomen, severe flatulence (borborygmy), severe lactose intolerance, attacks of diarrhoea often with noisy stools. Repeat examination specially of a fresh sample may show giardia lamblia.
Nowadays, a single dose of Ivermectin (still not easily available in India) can eradicate strongyloidis infection while giardia responds to any preparation of metronidazole or tinidazole.
The purpose of my writing this article is to draw attention of the family physicians to the fact that after looking out for all the above parasites, I find that like amoebiasis, GI infestation with strongyloidis stercoralis and giardia lamblia is very UNCOMMON in private practice. (Are we missing some cases?)
In the next few years, with increasing incidence of AIDS we are likely to see fulminating amoebic and strongyloidis infections.
I am thankful to Dr. Deepak Amarapurkar for sharing his experiences with me.