Characteristics and risk factors for symptomatic Giardia lamblia infections in Germany

Abstract

BackgroundIn developed countries, giardiasis is considered a travel related disease. However, routine surveillance data from Germany indicate that >50% of infections were acquired indigenously. We studied the epidemiological characteristics of symptomatic Giardia infections acquired in Germany and abroad, and verified the proportion of cases acquired in Germany in order to investigate risk factors for sporadic autochthonous Giardia infections.MethodsWe identified Giardia cases notified by 41 local health authorities between February 2007 and January 2008 and interviewed them on their clinical symptoms, underlying morbidities, travel abroad and potential risk factors for the disease. We conducted a case-control-study including laboratory-confirmed (microscopy or antigen-test) autochthonous Giardia cases with clinical manifestations (diarrhoea, cramps, bloating) and randomly selected controls from the local population registry matched by county of residence and age-group (0-5, 6-19, ≥20 years). Secondary cases, controls with diarrhoea and persons who had travelled outside Germany in the three weeks prior to disease onset (exposure period) were excluded. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) using conditional logistic regression.ResultsOf 273 interviewed cases, 131 (48%) had not travelled abroad during the defined exposure period. Of these 131, 85 (65%) were male, 68 (54%) were living in communities with >100,000 inhabitants and 107 (83%) were aged 20 years or older. We included 120 cases and 240 controls in the case-control study. Cases were more likely to be male (aOR 2.5 CI 1.4-4.4), immunocompromised (aOR 15.3 CI 1.8-127) and daily consumers of green salad (aOR 2.9 CI 1.2-7.2). Contact with animals (pets/farm animals) and exposure to surface water (swimming/water sports) were not associated with symptomatic disease.ConclusionsA substantial proportion of Giardia lamblia cases in Germany are indigenously acquired. Symptomatic cases are significantly more likely to be immunocompromised than control persons from the general population. Physicians should consider Giardia infections among patients with no recent history of travel abroad, particularly if they have immune deficiencies. Green salads may be an important vehicle of infection. Information campaigns highlighting this food-borne risk should emphasise the risk to persons with immune deficiencies.

Risk factors forGiardiainfection among hospitalized children in Cuba

“…Infection seemed to occur equally commonly among the girls and boys investigated in the present study. Although similar observations have been made in Brazil (Pereira et al, 2007) and Cuban day-care centres (Nú ñ ez et al, 1999), boys appeared at higher risk of Giardia infection than girls in investigations in the U.S.A. (Yoder and Beach, 2007), Germany (Espelage et al, 2010) and in a recent study in another hospital in Havana (Escobedo et al, 2011).…”

“…Such risk factors vary with the setting and population involved. Those identified in earlier investigations include: age (of children; Pereira et al, 2007;Coles et al, 2009); number of children in the household, poor food hygiene, day-carecentre attendance, and/or living on a rural farm within the 6 months prior to hospitalization (Pereira et al, 2007); drinking piped water and/or eating raw vegetables (Mohammed Mahdy et al, 2008); living in households without piped water, storing water in jars, cisterns, tanks or buckets, disposing of sewage in septic tanks or directly on the soil, bathing outside the dwelling, and/or poor food hygiene (Cifuentes et al, 2004); lack of an indoor toilet (Prado et al, 2003;Teixeira et al, 2007); living in a house without access to a sewerage system (Ribeiro Silva et al, 2009); eating raw vegetables, male gender and/or impaired immunity (Espelage et al, 2010); and exposure to nappies (Hoque et al, 2001(Hoque et al, , 2003.…”

Zoonotic Potential and Molecular Epidemiology ofGiardiaSpecies and Giardiasis

“…Female gender as a risk factor for giardiasis could be related to the women's role as caretakers of children and direct contact with infected children and changing diapers. Nursing has been identified as a risk factor for giardiasis in communities where the infection rate is high in children (76). Thus, there might be some differences in the transmission routes of human giardiasis between males and females living in the same area.…”

Polyparasitism-An Emerging Cause of Diarrhea: A Case Report

“…Most common symptom of Giardiasis is diarrhea 10 . It is well documented that in developing countries, infections are associated with poor sanitary conditions, poor water quality and overcrowding 11 .In developing countries, there is a very high prevalence and incidence of infection and data suggest that long-term growth retardation can result from chronic giardiasis 12 .…”