Giardiasis

　　Giardia lamblia is a unicellular protozoan with a simple developmental process, including trophozoites and cysts, two life stages.

　　1. Trophozoites:About 9.5 to 21 μm × 5 to 15 μm in size, resembling half of a sliced pear, with the front end钝圆 and the tail end fine, the back convex and the ventral surface flat, forming a sucker that tightly adheres to the intestinal mucosa. There are two nuclei inside, and the body has 4 pairs of flagella, moving flexibly.

　　2. Cysts:Elongated, about 8 to 12 μm × 7 to 10 μm in size, mature cysts contain 4 nuclei located at one end, with thick cyst walls and strong protective abilities in the external environment. General disinfection measures are not easy to kill them. Carriers of the cyst are the main source of infection. A carrier can excrete up to 900 million cysts in a day. The stool can contaminate food and water sources, causing transmission. All age groups can be infected, but children with hypoproteinemia and others with incomplete immune function have a higher chance of infection.

　　If the parasites寄生 in the liver and biliary system, fever, fatigue, aversion to greasy food, right upper quadrant pain may occur. Liver function is mostly normal, and jaundice occurs very rarely. If they invade the rectum, they can cause acute or chronic appendicitis.

　　The incubation period after infection is about 12 to 15 days, with some not showing symptoms. Those with symptoms mainly present with diarrhea and malabsorption. The typical symptoms of the acute phase are explosive diarrhea, large amounts of foul-smelling stool, abdominal distension, abdominal pain, flatulence, vomiting, and the stool does not contain visible pus and blood. However, microscopic examination can find pus cells, red blood cells, and trophozoites or cysts. Generally, the acute phase lasts for 3 to 4 days, but some cases may take a long time to recover, lasting for several months or recurring, leading to absorption disorders and significant weight loss.

　　Strengthen health education and publicity, cultivate health habits, pay attention to dietary management, strengthen fecal management, and treat patients and carriers. This disease seriously affects the daily life of patients, so it should be actively prevented.

　　1. Fecal examination

　　During the acute stage, direct smear examination is easy to find trophozoites or cysts. If the pathogen cannot be found, it is best to send for examination once every other day for a total of 3 times, which is better than sending for examination every day for 3 consecutive days, as the positive rate of the latter is higher.

　　2. Immune diagnosis

　　1. Enzyme-linked immunosorbent assay (ELISA):It has high sensitivity and specificity for detecting giardiasis, with a positive rate of IgG antibodies ranging from 71.1% to 98.9%. It has advantages such as rapidity, objectivity, and simplicity in operation.

　　2. Indirect hemagglutination (IHA) test:It is a widely used serological diagnostic method with high sensitivity, simple operation, rapidity, no need for complex equipment or special reagents, and is a good method for diagnosing giardiasis with a positive rate of 73.4%. The disadvantage is that the specificity and reproducibility of this test are not ideal.

　　3. Indirect fluorescent antibody test (IFAT):The positive rate is higher than that of IHA, reaching 66% to 97%. The positive rate of IFAT in symptomatic patients is significantly higher than that in asymptomatic patients, and it has strong specificity in the diagnosis of giardiasis with no false-positive reactions.

　　4. Agglutination immunoelectrophoresis (AIE) test:It is an effective method for detecting trichomonas antigens in the feces of patients with giardiasis, with advantages such as rapidity, accuracy, simplicity, and no need for special equipment or reagents. It has strong specificity, but its sensitivity is lower than that of ELISA and IFAT methods.

　　Diet should be light and easy to digest, such as vegetable congee, noodles, and soup. Spicy and stimulating foods should be eaten less. The patient's diet should be light and easy to digest, with more fruits and vegetables, a reasonable diet, and attention to adequate nutrition. In addition, patients should also avoid spicy, greasy, and cold foods.

　　Precautions before the treatment of intestinal trichomoniasis

　　1. Traditional Chinese medicine treatment methods for intestinal trichomoniasis

　　Chinese herbal medicine Sophora flavescens and Pulsatilla chinensis also have certain efficacy for this disease.

　　Prescription for trichomonas disease

　　Prescription name: Sophora flavescens decoction

　　Indications: Biliary and intestinal infections caused by trichomonas.

　　Composition of the medicine: 30g of Sophora flavescens.

　　Preparation and usage: Take one dose per day, decocting 150-200ml of the decoction, taken three times a day, and a course of treatment is 7 days.

　　According to the symptoms, appropriate adjustments can be made: The medicine is extremely bitter, and sugar can be added in moderate amounts to reduce the bitterness. It should be taken with ease.

　　The medicine has a bitter and cold taste with slight toxicity, and its functions include clearing heat, astringing, and killing parasites. Modern experiments have proven its efficacy in antibacterial, antiamoebic, and antitrichomonal activities. Clinical practice has shown significant efficacy against trichomonas.

　　Precautions: Some patients may experience nausea, vomiting, or discomfort or burning sensation in the stomach after taking the medicine, or even dizziness. Generally, no special treatment is needed, and it can improve spontaneously after one day. Pay attention to dietary hygiene, avoid swallowing the cyst, prevent infection. Complete treatment of the patient is also an important measure to prevent transmission.

　　Second, Western medical treatment methods for Entamoeba histolytica disease

　　1. Metronidazole (metronidazole, metronidazole) pediatric dosage: 15mg/kg per day, taken three times, 10 days as one course, after a 7-day rest, treatment can be repeated.

　　2. Tinidazole (tinidazole, fasigyn) adult dosage: 2g, taken in one dose, the cure rate reaches 88.8%, the cure rate of those treated twice is close to 100%, and the side effects are few.

　　3. Nimorazole adult dosage: 250mg per time, twice a day, 5 days as one course, children's dosage should be reduced accordingly.

　　4. Metronidazole (metronidazole, trade name:灭滴灵), a broad-spectrum anti-anaerobic and antiprotozoal drug, is used as the first choice for antiprotozoal treatment of Entamoeba histolytica in clinical practice. Oral dosage: adults 0.8g per time, three times a day, for five days in a row; children 15mg/ (kg.d), taken three times, for five days in a row, the cure rate is above 90%. The drug has a stimulating effect on the gastrointestinal tract, often causing nausea and vomiting, and pregnant women should use it with caution or avoid using it.

　　5. Tinidazole (einidazole, metronidazole sulfone imidazole), is also an effective antigiardial drug. Adults take 2g per day, children 50-70mg, all taken in one dose, the cure rate is above 95%, and the side effects are small.

　　6. Furazolidone (furazolidone, trade name: Lysol), is also an effective antigiardial drug. Oral dosage: adults 100mg per time, four times a day; children 6mg/ (Kg.d), taken four times, for 7-10 days, the cure rate can reach 85%-90%.

　　7. Paromomycin (pramomycin), a non-enteral absorbed aminoglycoside, has a lower efficacy than other drugs, but due to its extremely low intestinal absorption, it has small toxic and side effects and is often used for the treatment of patients with giardiasis during pregnancy.