Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Am J Med. 2011 Dec;124(12):1175.e1-8. doi: 10.1016/j.amjmed.2011.06.012. Epub 2011 Oct 18.
The burden of nonoutbreak-related Giardia infections in the US is poorly understood, with little information on its impact on people's lives and on unusual manifestations of infection. This study was designed with the objectives of better defining the impact of infection, examining the occurrence of extraintestinal manifestations, and determining risk factors for delayed treatment of infection.
Foodborne Diseases Active Surveillance Network surveillance was used to identify persons with nonoutbreak-related, laboratory-confirmed Giardia infection. People were enrolled into the Risk Factor arm and the Delayed Enrollment arm. Detailed questionnaires collected information on clinical manifestations, impact on activities of daily living, health care utilization, and treatment.
The study enrolled 290 people. Multivariate predictors of delayed study enrollment, a surrogate for delayed diagnosis of Giardia, included intermittent diarrheal symptoms, delayed time to first health care visit, and income. Decreased ability to participate in one's activities of daily living was reported by 210 (72.4%) participants. Appropriate therapeutic agent for Giardia was received by 237 (81.7%) by the time of study enrollment. Extraintestinal manifestations of Giardia were reported by 72 (33.8%) persons who enrolled in the Risk Factor arm.
The presence of intermittent diarrhea contributes to delayed health-seeking behavior and to delayed diagnosis of Giardia. More study is needed to determine if this symptom can help distinguish Giardia from other causes of infectious diarrhea. The occurrence of extraintestinal manifestations of Giardia infection does not appear to be rare, and merits further study.
美国非暴发相关贾第虫感染的负担尚未被充分了解，有关其对人们生活的影响以及感染的不常见表现的信息甚少。本研究旨在更好地定义感染的影响，检查肠道外表现的发生，并确定延迟治疗感染的危险因素。
使用食源性疾病主动监测网络监测来识别与暴发无关、经实验室确认的贾第虫感染的人群。人们被纳入风险因素组和延迟登记组。详细的调查问卷收集了有关临床表现、对日常生活活动的影响、卫生保健利用和治疗的信息。
该研究共纳入 290 人。延迟研究登记的多变量预测因素（贾第虫延迟诊断的替代指标）包括间歇性腹泻症状、首次就诊时间延迟以及收入。210 名（72.4%）参与者报告其日常生活活动能力下降。在研究登记时，237 名（81.7%）参与者接受了针对贾第虫的适当治疗药物。72 名（33.8%）参加风险因素组的人报告了贾第虫的肠道外表现。
间歇性腹泻的存在导致寻求卫生保健的行为延迟和贾第虫诊断延迟。需要进一步研究以确定该症状是否有助于区分贾第虫与其他感染性腹泻的病因。贾第虫感染的肠道外表现的发生似乎并不罕见，值得进一步研究。
