Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
Division of Infectious Diseases, University of North Carolina-Chapel Hill.
J Pediatric Infect Dis Soc. 2017 Jun 1;6(2):153-160. doi: 10.1093/jpids/piw082.
BACKGROUND.: Giardia are among the most common enteropathogens detected in children in low-resource settings. We describe here the epidemiology of infection with Giardia in the first 2 years of life in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED), a multisite birth-cohort study.
METHODS.: From 2089 children, 34916 stool samples collected during monthly surveillance and episodes of diarrhea were tested for Giardia using an enzyme immunoassay. We quantified the risk of Giardia detection, identified risk factors, and assessed the associations with micronutrients, markers of gut inflammation and permeability, diarrhea, and growth using multivariable linear regression.
RESULTS.: The incidence of at least 1 Giardia detection varied according to site (range, 37.7%-96.4%) and was higher in the second year of life. Exclusive breastfeeding (HR for first Giardia detection in a monthly surveillance stool sample, 0.46 [95% confidence interval (CI), 0.28-0.75]), higher socioeconomic status (HR, 0.74 [95% CI, 0.56-0.97]), and recent metronidazole treatment (risk ratio for any surveillance stool detection, 0.69 [95% CI, 0.56-0.84]) were protective. Persistence of Giardia (consecutive detections) in the first 6 months of life was associated with reduced subsequent diarrheal rates in Naushahro Feroze, Pakistan but not at any other site. Giardia detection was also associated with an increased lactulose/mannitol ratio. Persistence of Giardia before 6 months of age was associated with a -0.29 (95% CI, -0.53 to -0.05) deficit in weight-for-age z score and -0.29 (95% CI, -0.64 to 0.07) deficit in length-for-age z score at 2 years.
CONCLUSIONS.: Infection with Giardia occurred across epidemiological contexts, and repeated detections in 40% of the children suggest that persistent infections were common. Early persistent infection with Giardia, independent of diarrhea, might contribute to intestinal permeability and stunted growth.
在资源匮乏环境中检测到的儿童常见肠道病原体中包括贾第虫。我们在此描述了 Etiology、Risk Factors、and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project（MAL-ED）中贾第虫感染的流行病学情况，该项目是一项多地点出生队列研究。
从 2089 名儿童中，在每月监测和腹泻发作期间收集了 34916 份粪便样本，使用酶免疫测定法检测贾第虫。我们量化了贾第虫检测的风险，确定了危险因素，并使用多变量线性回归评估了其与微量营养素、肠道炎症和通透性标志物、腹泻和生长的关系。
根据地点不同，至少有一次贾第虫检测的发生率不同（范围，37.7%-96.4%），在生命的第二年更高。纯母乳喂养（首次在每月监测粪便样本中检测到贾第虫的 HR，0.46 [95%置信区间（CI），0.28-0.75]）、较高的社会经济地位（HR，0.74 [95% CI，0.56-0.97]）和最近使用甲硝唑治疗（任何监测粪便检测的风险比，0.69 [95% CI，0.56-0.84]）具有保护作用。生命的前 6 个月中贾第虫的持续存在（连续检测）与巴基斯坦瑙沙罗夫费罗兹腹泻率的降低有关，但在任何其他地点都没有。贾第虫的检测也与乳果糖/甘露醇比值增加有关。6 个月前贾第虫的持续存在与 2 岁时体重年龄 z 评分的 -0.29（95%CI，-0.53 至 -0.05）缺陷和长度年龄 z 评分的 -0.29（95%CI，-0.64 至 0.07）缺陷有关。
贾第虫感染发生在不同的流行病学环境中，40%的儿童重复检测表明持续感染很常见。早期持续感染贾第虫，与腹泻无关，可能导致肠道通透性和生长迟缓。
