Last update:
12-Jun-2001

Arch Hellen Med, 17(6), November-December 2000, 622-626

SHORT COMMUNICATION

Severe malabsorption syndrome due to Giardia intestinalis

K. TZANETOU,¹ Z. MANIKA,² E. DOLAPSAKI,¹ Ch. KAKARI-TSIROPINA,¹
P. TSIODRA,³ E. MALAMOU-LADA,¹ A. EFSTRATOPOULOS^3
1Laboratory of Microbiology,
²Laboratory of Pathology,
³3rd Department of Internal Medicine, “G. Gennimatas” District General Hospital of Athens, Athens, Greece

The case is reported of a 28 year-old patient from Libya with chronic diarrhea and severe malabsorption syndrome, characterized by steatorrhea, generalized edema, hypoalbuminemia macrocytic anemia and weight loss. The histopathologic findings in biopsy samples of the small intestine (duodenum and jejunum) included (a) infiltration of the mucosal epithelium by lymphocytes (intraepithelial lymphocytes), (b) infiltration of the lamina propria by inflammatory cells (plasma cells, lymphocytes, neutrophils and eosinophils), (c) crypt hyperplasia and (d) total intestinal villus atrophy (flattening). Detection of the parasite Giardia intestinalis in the feces, the dramatic response to treatment with metronidazole, but not tetracycline, and unresponsiveness to a gluten-free diet, were the strongest criteria for the documentation of giardiasis as the cause of chronic diarrhea and malabsorption syndrome in this patient. In conclusion, Giardia intestinalis must be included among the possible causes of malabsorption syndrome. Because of its intermittent excretion, repeated stool specimens must be examined for parasite detection, which is essential for the diagnosis of giardiasis and its differentiation from celiac disease and tropical sprue.

Key words: Giardia intestinalis, Malabsorption syndrome.