Characteristics and risk factors for symptomatic Giardia lamblia infections in Germany
Open Access
- 28 January 2010
- journal article
- Published by Springer Science and Business Media LLC in BMC Public Health
- Vol. 10 (1), 41
- https://doi.org/10.1186/1471-2458-10-41
Abstract
In developed countries, giardiasis is considered a travel related disease. However, routine surveillance data from Germany indicate that >50% of infections were acquired indigenously. We studied the epidemiological characteristics of symptomatic Giardia infections acquired in Germany and abroad, and verified the proportion of cases acquired in Germany in order to investigate risk factors for sporadic autochthonous Giardia infections. We identified Giardia cases notified by 41 local health authorities between February 2007 and January 2008 and interviewed them on their clinical symptoms, underlying morbidities, travel abroad and potential risk factors for the disease. We conducted a case-control-study including laboratory-confirmed (microscopy or antigen-test) autochthonous Giardia cases with clinical manifestations (diarrhoea, cramps, bloating) and randomly selected controls from the local population registry matched by county of residence and age-group (0-5, 6-19, > or =20 years). Secondary cases, controls with diarrhoea and persons who had travelled outside Germany in the three weeks prior to disease onset (exposure period) were excluded. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) using conditional logistic regression. Of 273 interviewed cases, 131 (48%) had not travelled abroad during the defined exposure period. Of these 131, 85 (65%) were male, 68 (54%) were living in communities with >100,000 inhabitants and 107 (83%) were aged 20 years or older. We included 120 cases and 240 controls in the case-control study. Cases were more likely to be male (aOR 2.5 CI 1.4-4.4), immunocompromised (aOR 15.3 CI 1.8-127) and daily consumers of green salad (aOR 2.9 CI 1.2-7.2). Contact with animals (pets/farm animals) and exposure to surface water (swimming/water sports) were not associated with symptomatic disease. A substantial proportion of Giardia lamblia cases in Germany are indigenously acquired. Symptomatic cases are significantly more likely to be immunocompromised than control persons from the general population. Physicians should consider Giardia infections among patients with no recent history of travel abroad, particularly if they have immune deficiencies. Green salads may be an important vehicle of infection. Information campaigns highlighting this food-borne risk should emphasise the risk to persons with immune deficiencies.Keywords
This publication has 44 references indexed in Scilit:
- GiardiaandCryptosporidiuminfections in sheep and goats: a review of the potential for transmission to humans via environmental contaminationEpidemiology and Infection, 2009
- The risk of pathogenic intestinal parasite infections in Kisii Municipality, KenyaBMC Public Health, 2008
- Development of a Method for Detection of Giardia duodenalis Cysts on Lettuce and for Simultaneous Analysis of Salad Products for the Presence of Giardia Cysts and Cryptosporidium OocystsApplied and Environmental Microbiology, 2007
- A Waterborne Outbreak of Gastroenteritis with Multiple Etiologies among Resort Island Visitors and Residents: Ohio, 2004Clinical Infectious Diseases, 2007
- Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992–2003Epidemiology and Infection, 2006
- Prolonged outbreak of giardiasis with two modes of transmissionEpidemiology and Infection, 2006
- Children at risk of giardiasis in Auckland: a case–control analysisEpidemiology and Infection, 2003
- Factores de riesgo de la infección por Giardia lamblia en niños de guarderías infantiles de Ciudad de La Habana, CubaCadernos de Saude Publica, 2003
- A Food-Borne Outbreak of Giardia lambliaThe Journal of Infectious Diseases, 1988
- Sexual transmission of intestinal parasites.Sexually Transmitted Infections, 1973