Is there an association of giardiasis with beta-thalassemia minor?

Abstract

Abstract. Beta–thalassemia minor  is a symptomless carrier state of a hemoglobinopathy which predisposes to bacterial infections. We report three cases presenting with giardiasis, a parasitic infection of gastrointestinal tract caused by Giardia lamblia. Patients presented with recurrent diarrhea and abdominal pain for over a year. An esophagogastroduodenoscopy finding varied from normal to acute duodenitis. Duodenal biopsy demonstrated changes consistent with mild chronic non-specific inflammation with G. lamblia trophozoites. All three patients were diagnosed as β -thalassemia minor hemoglobin electrophoresis. They were treated with Diloxanide furoate 500 mg and Metronidazole 400mg three times daily for five days. Their symptoms resolved and a stool test repeated one week after  the end of treatment was normal. The host immune system both humoral and cellular components have a role in protection and clearance of Giardiasis. However, β -thalassemia minor patients have an observed probability of gardiasis but not a confirmed incidence.

 

Key words: β-Thalassemia-trait, diarrhea, abdominal pain, giardiasis, CD2

Keywords

• β-Thalassemia-trait, diarrhea, abdominal pain, giardiasis, CD2

References

1. Khan SN, Riazuddin S. Molecular characterization of β- thalassemia in Pakistan. Hemoglobin 1998; 22: 333- 345.
2. Gallerani M, Pulga A, Bottini E, et al. Heterozygous beta thalassemia and gastrointestinal pathology. Minerva Med 1986; 77: 709-712.
3. Gibertini P, Rocchi E, Cassanelli M, Pietrangelo A, Ventura E. Porphyria cutanea tarda in beta-thalassemia trait carriers. Dermatologica 1984;169: 131-134.
4. Fargion S, Cappellini MD, Sampietro M, Fiorelli G. Non-specific iron in patients with beta-thalassaemia trait and chronic active hepatitis. Scand J Haematol 1981; 26: 161-167.
5. Friedman S, Ozsoylu S, Luddy R, Schwartz E. Heterozygous beta thalassaemia of unusual severity. Br J Haematol 1976; 32: 65-77.
6. Palm JE, Weiland ME, Griffiths WJ, Ljungström I, Svärd SG. Identification of immunoreactive proteins during acute human giardiasis. J Infect Dis 2003 15; 187: 1849-1859.
7. Zafar MN, Baqai R, Lodi TZ, et al. Giardia lamblia in patients undergoing upper G.I. endoscopy. J Pak Med Assoc 1991; 41: 74-75.
8. Baqai R, Zuberi SJ, Qureshi H, Ahmed W, Hafiz S. Efficacy of albendazole in giardiasis. East Mediterr Health J 2001; 7: 787-790.

9. Mehraj V, Hatcher J, Akhtar S, Rafique G, Beg MA. Prevalence and factors associated with intestinal parasitic infection among children in an urban slum of Karachi. PLoS One 2008; 3: e3680.
10. Qureshi TZ, Anwar M, Ahmed S, Ahmed Khan D, Saleem M. Serum ferritin levels in carriers of beta-thalassaemia trait. Acta Haematol 1995; 94: 7-9.
11. Gallerani M, Cicognani I, Ricci A, et al. Immunological pattern in heterozygote beta- thalassemic subjects. Riv Eur Sci Med Farmacol 1990; 12: 191-195.
12. Springer TA. Adhesion receptors of the immune system. Nature 1990; 46: 425.
13. Gollob JA, Li J, Kawasaki H, et al. Molecular interaction between CD58 and CD2 counter- receptors mediates the ability of monocytes to augment T cell activation by IL-12. J Immunol 1996; 157: 1886-1893.
14. Boussiotis VA, Freeman GJ, Griffin JD, et al. CD2 is involved in maintenance and reversal of human alloantigen-specific clonal anergy. J Exp Med 1994; 180: 1665-1673.
15. Kittner JM, Jacobs R, Buyny S, et al. Adult onset of T- cell deficiency with impaired CD2 expression complicated by Rhodococcus infection: a case report. Ann of Allergy Asthma and Immunol 2007; 98: 294- 298.
16. Finkelman FD, Madden KB, Cheever AW, et al. Effects of interleukin 12 on immune responses and host protection in mice infected with intestinal nematode parasites. J Exp Med 1994; 179: 1563-1572.
17. Walker EM, Walker SM. Effects of iron overload on the immune system. Ann Clin Lab Sci 2000; 30: 354-365.