1/4. Biliary giardiasis in a patient with human immunodeficiency virus.A 41-year-old man with human immunodeficiency virus (hiv) (CD4 count, 446/mm3) developed a protracted course of abdominal pain, weight loss, and increasing liver function tests after undergoing a metronidazole treatment regimen for Giardia enteritis. Three months later, endoscopic retrograde cholangiography (ERCP) showed dilated common and intrahepatic bile ducts and luminal irregularities of the common bile duct. Seven months after the onset of his acute diarrhea, a repeat ERCP with aspiration demonstrated many Giardia trophozoites and cysts in the bile and continued structural abnormalities consistent with cholangiopathy. A 10-day course of high-dose intravenous metronidazole did not resolve these signs or symptoms. A gallbladder ultrasound showed a thickened wall. Laparoscopic cholecystectomy led to resolution of abdominal pain and normalization of serum alkaline phosphatase over an 8-month period. gallbladder histopathology revealed chronic cholecystitis, but no parasites were seen on hematoxylin and eosin staining or with Giardia antigen enzyme immunoassay testing of the gallbladder. The patient refused to undergo a follow-up ERCP, but a right upper quadrant ultrasound and computed tomography of the abdomen were normal.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/4. coinfection with giardia lamblia and clostridium difficile after use of ranitidine.A 49-year-old man presented with a 3-week history of vomiting and diarrhea. He reported foamy stools but no blood or melena and had crampy epigastric pain. He denied usage of antibiotics. He had been taking ranitidine for intermittent epigastric pain for the last few months and noted an 11-pound weight loss during the 3 weeks before admission. Stool was positive for clostridium difficile toxin and giardia lamblia antigen. Cultures and occult blood tests were negative. Oral metronidazole, 500 mg 3 times a day, was administered, and the patient was hydrated. The diarrhea resolved, and patient was discharged on the fourth hospital day. Prior antibiotic therapy is the most common risk factor for C difficile colitis. This patient developed concomitant infection with C difficile and G lamblia while he used ranitidine. He had no other risk factors for these infections. Hence, we propose that ranitidine-induced hypochlorhydria predisposed this patient to the enteric infections.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/4. giardiasis causing urticaria in a child.We report an association between giardiasis and chronic urticaria and review the few previous cases in the literature. An unusual aspect of our case was the intensification of the urticarial response with antiprotozoal chemotherapy. We discuss the clinical features in terms of the limited current knowledge concerning immunologic mechanisms in giardiasis and the antigenic structure of giardia lamblia.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/4. Selective iga deficiency and the hla-b8 antigen. Report of two cases with familial data.Two patients had iga deficiency, giardiasis, and the hla-b8 antigen. The family of patient 1 included members with juvenile-onset diabetes mellitus, adrenal insufficiency, pernicious anemia, and hypothyroidism, a combination of unusual diseases that has been reported previously to occur as a syndrome with iga deficiency and the hla-b8 antigen. This coincidence makes it likely that these two patients and the one family previously described have a common pathogenic base, the inheritance of an abnormal immune-response gene that is acquired with the hla-b8 antigen as a result of genetic dysequilibrium.- - - - - - - - - - ranking = 7keywords = antigen (Clic here for more details about this article) |