Taylor-Leigh Siebritz
Taylor-Leigh Siebritz
Once Giardia lamblia parasites are ingested, the trophozoites can migrate to the duodenum. Here, the trophozoites do not invade, but rather encyst. The resistant cysts are then passed in the faeces and can infect another close-contact, via faecal-oral routes (Leibzon & Shaposhnikov, 2015). With endoscopy and biopsy techniques, an infection can be comfirmed and specified. Despite most Giardia intestinalis infections being asymptomatic, the disease can become severely detrimental to gastrointestinal (GIT) health when enterocyte damage and brush border loss occurs, particularly of the small intestinal epithelial cells. Eventually, shortened microvilli and altered epithelial barrier function, i.e. villous atrophy, ensues (Vithanage & Haroon, 2023).
An endoscope, which is a flexible tube attached to a small light and camera, is slowly inserted into the mouth and throat. Gently, the performing physician will guide the endoscope to the duodenum, by passage through the oesophagus and stomach. The camera projects video image to a connected monitor screen (John Hopkins Medicine).
Using an endoscopic procedure, a sample of the duodenal tissue can be extracted for microscopic examination. A healthy duodenum biopsy shows sloughed epithelial cells and extruded mucin.
A lab clinician/technician will observe for features including:
- villous blunting or expansion
- intraepithethial lymphocytes and/or lymphoid aggregates in the lamina propia
- pear- or crescent shaped, mostly pale eosinophilic trophozoites freely floating in duodenum lumen or bound to mucosal surface (Minquan, et al., 2021).
The contents of the duodenum can also be observed using the Enterotest, which is especially recommended in areas of high false-negatives and asymptomatic re-infections.
A gelatin capsule, that is attached to a small weight and a long string is swallowed - the proximal end of the string remains stuck to the cheek. The capsule dissolves in the stomach and the weight is carried to the duodenum with digestion. Examination of any contents (bile, blood, mucus) can reveal formerly undetected trophozoites (CDC, 2024).