A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea

Donowitz, Jeffrey R.; Alam, Masud; Kabir, Mamun; Jennie, Z.; Nazib, Forida; Platts-Mills, James A; Bartelt, Luther A.; Petri, William A.

doi:10.1093/cid/ciw391

Cited by 77 publications

(79 citation statements)

References 36 publications

(39 reference statements)

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“…Yet in the past several years, it has become apparent that Giardia infections that occur early in childhood (earlier than age 2) are associated with reduced height and weight attainment [17, 115], with a critical window of preventing infection between birth and 6 months of life having the greatest impact on growth faltering [115]. This window may be critical due to the establishment and shaping of the composition of intestinal microbiota that provide essential amino acids and vitamins used for growth [116].…”

Section: Immunopathologymentioning

confidence: 99%

“…As such, these two recent studies suggest that the prevention of exposure to this parasite is more important in preventing long-term growth deficiencies rather than early intervention therapies, such as the use of metronidazole [117]. Moreover, the cause for the variation in studies examining the association between Giardia and growth development may be due to the presence (or absence) of very early childhood Giardia infections since acquired childhood protection may only limit the severity of giardiasis rather than provide full protection [115]. …”

Section: Immunopathologymentioning

confidence: 99%

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The Intersection of Immune Responses, Microbiota, and Pathogenesis in Giardiasis

Fink

Singer

2017

Trends in Parasitology

104

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Giardia lamblia is one of the most common infectious protozoans in the world. Giardia rarely causes severe life-threatening diarrhea, and may even have a slight protective effect in this regard, but it is a major contributor to malnutrition and growth faltering in children in the developing world. Giardia infection also appears to be a significant risk factor for post-infectious irritable bowel and chronic fatigue syndromes. In this review we highlight recent work focused on the impact of giardiasis and the mechanisms that contribute to the various outcomes of this infection, including changes in the composition of the microbiota, activation of immune responses, and immunopathology.

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Section: Immunopathologymentioning

confidence: 99%

Section: Immunopathologymentioning

confidence: 99%

The Intersection of Immune Responses, Microbiota, and Pathogenesis in Giardiasis

Fink

Singer

2017

Trends in Parasitology

104

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“…The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study found an association with subclinical, non-diarrheal giardiasis and decreases in growth of children [16]. There are few studies attributing gut microbiome changes to giardiasis [17][18][19] and no published studies showing the impact on the human intestinal microbiome using multi-parallel real-time quantitative (qPCR) to detect the presence of Giardia and quantitating the burden of infection [20]. To date, most studies examining intestinal parasitism have not been able to study intestinal worms and protozoans simultaneously and to successfully dissect the relative contribution of each of the significant intestinal helminth or protozoan pathogens to specific diseases.…”

mentioning

confidence: 99%

Impact of intestinal parasites on microbiota and cobalamin gene sequences: a pilot study

et al. 2020

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Background: Approximately 30% of children worldwide are infected with gastrointestinal parasites. Depending on the species, parasites can disrupt intestinal bacterial microbiota affecting essential vitamin biosynthesis.Methods: Stool samples were collected from 37 asymptomatic children from a previous cross-sectional Argentinian study. A multi-parallel real-time quantitative PCR was implemented for Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica and Giardia duodenalis. In addition, whole-genome sequencing analysis was conducted for bacterial microbiota on all samples and analyzed using Livermore Metagenomic Analysis Toolkit and DIAMOND software. Separate analyses were carried out for uninfected, Giardia-only, Giardia + helminth co-infections, and helminth-only groups. Results:For Giardia-only infected children compared to uninfected children, DNA sequencing data showed a decrease in microbiota biodiversity that correlated with increasing Giardia burden and was statistically significant using Shannonʼs alpha diversity (Giardia-only > 1 fg/µl 2.346; non-infected group 3.253, P = 0.0317). An increase in diversity was observed for helminth-only infections with a decrease in diversity for Giardia + helminth co-infections (P = 0.00178). In Giardia-only infections, microbiome taxonomy changed from Firmicutes towards increasing proportions of Prevotella, with the degree of change related to the intensity of infection compared to uninfected (P = 0.0317). The abundance of Prevotella bacteria was decreased in the helminths-only group but increased for Giardia + helminth co-infections (P = 0.0262). Metagenomic analysis determined cobalamin synthesis was decreased in the Giardia > 1 fg/µl group compared to both the Giardia < 1 fg/µl and the uninfected group (P = 0.0369). Giardia + helminth group also had a decrease in cobalamin CbiM genes from helminth-only infections (P = 0.000754). Conclusion:The study results may provide evidence for an effect of parasitic infections enabling the permissive growth of anaerobic bacteria such as Prevotella, suggesting an altered capacity of vitamin B12 (cobalamin) biosynthesis and potential impact on growth and development in children .

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“…8 Similarly, persistent Giardia detection in the first 6 months of life has been associated with malabsorption 9 and reduced linear growth in two studies. 9,56 Cryptosporidium parvum excretion has also been associated with growth faltering, although it is unclear if this association is driven by prolonged excretion after a symptomatic infection. 57 These data suggest that a primary mechanism for the pathogenesis of EE may involve exposure to pathogens through poor hygiene practices and contaminated food and water resulting in enteric infections.…”

Section: Current Definitionsmentioning

confidence: 99%

The Burden of Enteropathy and “Subclinical” Infections

Rogawski

Guerrant

2017

Pediatric Clinics of North America

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Synopsis Environmental enteropathy is a chronic condition of the small intestine that is associated with increased intestinal permeability, mucosal inflammation, malabsorption, and systemic inflammation. It is commonly accompanied by enteric infections and is misleadingly considered a subclinical disease. Potential effects of enteric infections and enteropathy on vaccine responses, child growth, cognitive development, and even later life obesity, diabetes, and metabolic syndrome are increasingly being recognized. Here, we review the evolving challenges to defining environmental enteropathy and enteric infections, current evidence for the magnitude and determinants of its burden, new assessment tools, and relevant interventions.

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A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea

Abstract: This prospective longitudinal birth cohort demonstrated that asymptomatic giardiasis in the first 6 months of life is a risk factor for poor linear growth. Furthermore, asymptomatic giardiasis neither increases nor decreases odds of having an all cause acute diarrheal episode.

Cited by 77 publications

References 36 publications

The Intersection of Immune Responses, Microbiota, and Pathogenesis in Giardiasis

The Intersection of Immune Responses, Microbiota, and Pathogenesis in Giardiasis

Impact of intestinal parasites on microbiota and cobalamin gene sequences: a pilot study

The Burden of Enteropathy and “Subclinical” Infections

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