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Clinical symptoms of Giardia infection in humans : a systematic review
Authors: --- --- ---
Year: 2016 Publisher: Bruxelles: UCL. Faculté de santé publique,

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Abstract

Giardiasis is one of the most common gastrointestinal parasitic diseases worldwide and it is caused by an enteric pathogen named Giardia spp. Giardiasis is the most commonly reported human parasite of gastroenteritis with frequent sporadic cases and community-wide outbreaks via water- and -in smaller proportion- foodborne pathways. Giardiasis encompasses a complex and diverse spectrum of symptom patterns ranging from asymptomatic carriage to acute and chronic health states. Prolonged chronic infections eau enhance extra-intestinal and post-infectious sequelae. Estimation of the population health status, also known as "disease burden", requires well-defined information on clinical outcomes of infection. Unfortunately, regarding the diverse symptomatology and limited knowledge on pathogenesis mechanisms, giardiasis burden is often difficult to estimate and report. Objectives: To accurately estimate the disease burden of giardiasis and explain satisfactory its clinical impact, it is therefore necessary to have information on the nature and frequency of these sequelae. To this end, we aim to be able to get a better understanding of the symptoms of Giardia infection in humans. The aim of this thesis will be to review the clinical impact of giardiasis worldwide using a systematic search approach. To this end we will proceed in a two-step approach as follows: 1.First we will review existing assessments of the disease burden of Giardia. This will give an overview of the current disease models (i.e., lists of giardiasis symptoms .2.Next we will perform a systematic review of clinical symptoms associated with Giardia infection in humans in order to identify the health states which are associated with the giardiasis burden and estimate the occurrence of potential sequelae (acute and chronic) of giardiasis. Methods: In order to address the identified gaps, we chose to perform systematic review of the literature according to PRISMA guidelines. We will focus on prospective studies (i.e., cohort studies, longitudinal studies and outbreak investigations) retrospective studies (i.e., case-control studies) and cross-sectional studies. Findings: To date, we have irrefutable evidence of variability in clinical outcomes associated with Giardia infection. Typically assumed as a re-emerging and neglected disease, giardiasis places a heavy burden in both developed and developing countries. It has been linked to persistent diarrhoea that may contribute to substantial weight loss, retardation of growth and development in infants, cognitive impairment and malabsorption. In addition, it has been confirmed that acute giardiasis is associated with significant post-infectious chronic sequelae in adults such as imitable bowel syndrome, chronic fatigue or functional dyspepsia. These persistent sequelae affect the quality of life by continuing to inflict on patients long lasting discomfort and pain.

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