UNIVERSITATEA DE MEDICINA SI FARMACIE"IULIU HATIEGANU"

FACULTATEA DE MEDICINA CLUJ -NAPOCA

Cercetri epidemiologice, clinico-
paraclinice i terapeutice n giardioz la
om i animale








REZUMAT AL TEZEI DE DOCTORAT






Doctorand Adriana Gabriela J arca
Conducator de doctorat Prof.Univ.Dr.Monica J unie




2011

CUPRINS


INTRODUCERE..................................................................................................................... 9
I. STADIUL ACTUAL AL CUNOATERII...........................................................................11
CAPITOLUL 1. ETIOLOGIE............................................................................................11
CAPITOLUL 2. CARACTERISTICI BIOLOGICE ALE PARAZITULUI GIARDIEI spp. 15
2.1. Morfologia trofozoidului ........................................................................................16
2.2. Morfologia chistului ...............................................................................................20
2.3. Ciclul biologic........................................................................................................21
CAPITOLUL 3. EPIDEMIOLOGIE ..................................................................................23
3.1. Incidena Giardiei spp. la om..................................................................................23
3.2. Incidena Giardiei spp. la diferite specii de animale................................................26
3.3. Ci de transmitere a parazitului Giardia spp. ..........................................................31
CAPITOLUL 4. PATOGENIE...........................................................................................39
CAPITOLUL 5. TABLOUL CLINIC AL GIARDIOZEI....................................................45
5.1. Tabloul clinic al giardiozei la om............................................................................45
5.2. Tabloul clinic al giardiozei la animale.....................................................................50
CAPITOLUL 6. DIAGNOSTICUL POZITIV AL GIARDIOZEI .......................................53
6.1. Ancheta epidemiologic .........................................................................................53
6.2. Diagnosticul de laborator: ......................................................................................53
6.2.1. Modificri bio-umorale...................................................................................53
6.2.2. Examinri imagistice ......................................................................................54
6.2.3. Examinri microscopice i imunologice..........................................................55
6.2.4. Examinri histologice i anatomo-patologice..................................................60
6.3. Diagnosticul diferenial al giardiozei ......................................................................61
CAPITOLUL 7. TRATAMENT I PROFILAXIE.............................................................63
7.1. Tratamentul giardiozei la om..................................................................................66
7.2. Tratamentul giardiozei la animale...........................................................................67
7.3. Profilaxia giardiozei ...............................................................................................68
7.4. Prognostic..............................................................................................................69
II. CERCETRI PROPRII......................................................................................................70
CAPITOLUL 8. IPOTEZA DE LUCRU............................................................................70
8.1. Premise..................................................................................................................70
8.2. Motivaia cercetrii.................................................................................................71
CAPITOLUL 9. SCOP I OBIECTIVE.............................................................................73
CAPITOLUL 10. MATERIAL I METODE.....................................................................74

10.1. Descrierea loturilor studiate..................................................................................75
10.2. Condiii i factori favorizani ai giardiozei n studiul nostru ..................................77
10.3. Tehnici de laborator utilizate n studiul nostru.......................................................79
10.3.1. Metoda Willis...............................................................................................79
10.3.2. Metoda Blagg modificat..............................................................................79
10.3.3. Metoda imunoenzimatic coproELISA .........................................................80
10.4. Analiza statistic utilizat n studiul nostru ...........................................................88
CAPITOLUL 11. CERCETRI EPIDEMIOLOGICE N GIARDIOZ LA ADULI I
COPII DIN MUNICIPIUL ORADEA................................................................................91
11.1. Scopul studiului....................................................................................................91
11.2. Material i metode................................................................................................91
11.2.1. Material i metode utilizate n scopul cercetrii epidemiologice la copiii i
adulii internai n Clinica de Boli Infecioase din Oradea .........................................91
11.2.2. Material i metode utilizate n scopul cercetrii epidemiologice la copiii din
diferite comuniti din Oradea ..................................................................................92
11.3. Rezultatele investigaiilor epidemiologice n giardioz la om................................93
11.3.1. Rezultatele investigaiilor epidemiologice n giardioz, efectuate la Clinica de
Boli Infecioase din Oradea, judeul Bihor ................................................................93
11.3.2. Rezultatele investigaiilor epidemiologice n giardioz realizate n cadrul
diferitelor comuniti de copii din Municipiul Oradea.............................................121
11.4. Discuii...............................................................................................................133
11.5. Concluzii............................................................................................................139
CAPITOLUL 12. CERCETRI CLINICO-PARACLINICE I TERAPEUTICE N
GIARDIOZ LA OM......................................................................................................141
12.1. Scopul studiului..................................................................................................141
12.2. Material i metode utilizate.................................................................................141
12.3. Rezultate............................................................................................................147
12.3.1. Rezultatele investigaiilor clinico-paraclinice i terapeutice n giardioz la
copii i aduli din cadrul Clinicii de Boli Infecioase din Oradea .............................147
12.4. Discuii...............................................................................................................156
12.5. Concluzii............................................................................................................159
CAPITOLUL 13. CERCETRI EPIDEMIOLOGICE PRIVIND GIARDIOZA LA CINI
I PISICI .........................................................................................................................160
13.1. Scop i obiective.................................................................................................160
13.2. Material i metod ..............................................................................................160
13.2.1. Perioada studiului .......................................................................................160
13.2.2. Animale i probe biologice recoltate ...........................................................161

13.2.3. Metode.......................................................................................................162
13.3. Rezultate............................................................................................................164
13.3.1. Prevalena infeciei cu Giardia spp. la cini ................................................164
13.4. Discuii...............................................................................................................173
13.4.1. Cini...........................................................................................................173
13.4.2. Pisici ..........................................................................................................176
13.4.3. Concluzii ....................................................................................................178
CAPITOLUL 14. CONCLUZII GENERALE...................................................................179
CAPITOLUL 15. BIBLIOGRAFIE..................................................................................182





INTRODUCERE

Giardioza, produs de Giardia spp., constituie o parazitoz de mare importan epidemiologic i
clinic datorit naltei sale prevalene i patogeniti att n rndul animalelor ct i a omului, n special n
populaia infantil.
Giardioza este o zoonoz digestiv, produs de protozoarul din genul Giardia, specia cea mai frecvent
implicat fiind Giardia duodenalis.
Interesul pentru acest protozoar flagelat s-a implementat ncepnd cu a doua jumtate a secolului XX,
cu recunoaterea potenialului patogen n 1962 i demonstrarea n 1987 c infecia experimental uman cu
Giardia lamblia urmeaz postulatele lui Koch.
Fiind una dintre cele mai rspndite zoonoze din ar i din lume, cu importante implicaii economice i
sociale, comitetele mixte de experi a Organizaiei Mondiale a Sntii (OMS) a specificat de nenumrate ori
necesitatea supravegherii internaionale a zoonozelor. n unele ri au fost nfiinate organisme interministeriale,
multidisciplinare pentru a promova cooperarea n cadrul campaniilor de lupt mpotriva zoonozelor. La noi n
ar, Legea sanitar-veterinar (Legea 601974) stipuleaz necesitatea colaborrii dintre medicii umani i
veterinari pentru prevenirea i combaterea zoonozelor i a toxiinfeciilor alimentare. Principalele probleme
epidemi-zoonotice, pe care le ridic prezena zoonozelor parazitare sunt cele referitoare la supravegherea,
prevenirea i limitarea acestora.
Acest parazit flagelat a fost descoperit n anul 1681, de ctre Antony von Leeuwenoek, un fizician ceh,
n propriile materii fecale, i consider c parazitul este doar un comensal al tubului digestiv i nu agentul
etiologic incriminat n apariia bolii.
Dup aproximativ 200 de ani, n anul 1859, Lamb readuce n actualitate acest parazit, descriindu-l.
n literatura recent, aprut n urma Congresului Internaional de Parazitologie, VIII-1994, se folosesc
denumirile de Giardia lamblia de ctre majoritatea autorilor i Giardia intestinalis de ctre autorii australieni i
unii autori olandezi.

I. STADIUL ACTUAL AL CUNOATERII

Principalele probleme epidemio-zoonotice, pe care le ridic prezena zoonozelor parazitare sunt cele
referitoare la supravegherea, prevenirea i limitarea acestora.
Studiul realizat n lucrare, care a avut n vedere cunoaterea rspndirii parazitului i a evoluiei sale n
zona de nord-vest a Romniei, n perioada actual, a fost necesar n principal datorit lipsei, n ultimii 20 de ani,
a unor studii privind incidena giardiozei la om i animale i faptului c i n prezent n zona amintit prezena
animalelor de companie (cini i pisici) n apartamente sau gospodrii a luat amploare.
Partea introductiv, format din 7 capitole, conine o descriere a biologiei, epidemiologiei i patologiei
parazitului Giardia duodenalis. n acest parte a tezei sunt prezentate urmtoarele: ncadrarea sistematic i
taxonomic a parazitului, morfologia formelor adulte a parazitului Giardia duodenalis, forma de rezisten
chistul, aspecte epidemiologice legate de infecia cu parazitul Giardia n populaia general i la animale, strns
legate ntre ele, rspndirea geografic, rezervorul de infecie, mecanismul de transmitere i cile de ptrundere
n organism a parazitului i potenialul biotic, aspecte legate de patogenitate i manifestri clinice, metode de
diagnostic, profilaxia i tratamentul n giardioza la om i animale.

II. CONTRIBUII PERSONALE

Ipoteza de lucru, obiectivele studiului, materialul i metoda de lucru sunt prezentate pe larg n capitolele
8, 9 i 10.
IPOTEZA DE LUCRU
Motivele pentru care a fost ales aceast tem de cercetare sunt reprezentate de cadrul n care se
desfoar activitatea de diagnostic parazitologic legat de contaminarea cu Giardia spp. n ara noastr, n lipsa
unui protocol oficial de urmrire.
Dei n ultimii 10 ani numrul cazurilor de giardioz din lume i din Romnia s-au redus i n asistena
medical a pacienilor au fost nregistrate multe succese, mai rmn nc un numr crescut de cazuri de giardioz
care implic riscuri i costuri importante, att n ceea ce privete omul ct i animalele. Predominena formelor
infraclinice de infecie cu Giardia spp. la om i animal, dificultile n stabilirea diagnosticului parazitologic, dar
i o mare varietate de acuze prin care aceast infecie se poate manifesta, justific realizarea de studii ale cror
rezultate s conduc la o strategie optim de diagnostic, tratament i profilaxie. Asocierea acestor elemente a

constituit un punct de pornire n studierea aspectelor legate de influena infeciei parazitare cu Giardia spp.
asupra populaiei infantile i adulte.
Bolile parazitare la animale sunt importante prin pagubele mari pe care le produc, pe de o parte, dei se
aplic msuri programate i de prevenire a infeciilor parazitare i, pe de alt parte, implic riscul crescut de
transmitere a infeciei parazitare la om i la alte animale, ceea ce duce de asemenea la riscuri pentru sntate i
costuri suplimentare pentru om.
OBIECTIVELE STUDIULUI
Obiectivele prezentei lucrri au fost: precizarea incidenei reale i analizarea n dinamic a infeciei cu
Giardia spp., pe o perioad bine determinat, n diferite comuniti de copii i aduli din Oradea, judeul Bihor,
prin efectuarea unui studiu retrospectiv; desemnarea categoriilor de populaie expuse unui risc crescut de
infectie; o evaluare din punct de vedere clinico-paraclinic i terapeutic a cazurilor de giardioz internate n
Clinica de Boli Infecioase din Oradea, judeul Bihor, pe o perioad bine determinat; estimarea prevalenei
infeciei cu Giardia spp. la cini i pisici cu provenien din mediile urban i rural folosind tehnica
imunoenzimatic coproELISA, evideniind astfel rolul imunodiagnosticului n detectarea corect a bolii precum
i corelarea rezultatelor obinute prin metoda imunoenzimatic coproELISA cu cele ale altor metode de
investigare; identificarea unor factori intrinseci i extrinseci care pot influena prevalena infeciei cu Giardia
spp. la cini i pisici, precum i evaluarea riscului contaminrii umane.
MATERIALUL SI METODA DE LUCRU
Prezentul studiu, din cadrul tezei de doctorat, este un studiu epidemiologic descriptiv al giardiozei pe o
perioad de 10 ani. S-au luat n studiu diferite categorii populaionale din municipiul Oradea, judeul Bihor i un
lot de animale de companie (cini i pisici) din cteva zone din Transilvania.
Prelucrarea statistic i reprezentarea grafic a rezultatelor s-a fcut cu aplicaia Excel (din pachetul
Microsoft Office 2007).
REZULTATE
n capitolul 11 este tratat monitorizarea unor indici epidemiologici ai infeciei cu parazitul Giardia
lamblia n diferite comuniti de copii i aduli din Oradea, judeul Bihor. Actualul studiu prezint dou pri:
cercetri epidemiologice la copiii i adulii internai n Clinica de Boli Infecioase din Oradea, judeul Bihor;
cercetri epidemiologice la copiii din diferite comuniti din Oradea, judeul Bihor.
Prima parte a studiului a fost realizat n perioada 01 ianuarie 2001- 31 decembrie 2010, la Clinica de
Boli Infecioase din Oradea, cazurile nregistrate fcnd obiectul unui studiu retrospectiv, bazat pe documente
medicale (foi de observaie). Au fost inclui n studiu un numr de 2.222 pacieni diagnosticai cu giardioz din
totalul de 42.902 de pacieni internai n Clinica de Boli Infecioase din Oradea, judeul Bihor, n perioada
menionat.
n perioada luat n studiu, incidena infeciei cu Giardia spp. a fost de 5,18%, iar prevalena anual a
giardiozei a variat destul de mult (16,36-0,95). Evoluia prevalenei Giardia spp. la bolnavii internai de-a lungul
celor 10 ani a avut un trend descresctor (de la 16,36% la 0,95%), cea mai mare valoare a fost atins n anul
2001 (16,36%), iar cea mai mic n anul 2010 (0,95%) (Figura 19). Asocierea ntre giardioz i lunile anului este
reprezentat n figura 20. n perioada celor 10 ani s-au nregistrat peste 20% din cazuri n lunilor iunie i iulie
(10,1%, respectiv 10,6%).

16,4%
6,8%
7,9%
5,0%
6,8%
3,4% 3,4%
2,4%
2,1%
1,0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figura 19. Evoluia prevalenei infeciei cu
Giardia spp. la bolnavii internai
n Clinica de Boli Infecioase din Oradea (2001-
2010)

9,4%
9,0%
7,7%
7,9%
7,4%
10,1%
10,6%
9,6%
8,0%
6,7%
6,5%
7,2%
Ianuarie
Februarie
Martie
Aprilie
Mai
Iunie
Iulie
August
Septembrie
Octombrie
Noiembrie
Decembrie
Figura 20. Distribuia cazurilor infeciei cu
Giardia spp. n funcie de lunile anului, la
pacienii internai n Clinica de Boli Infecioase
din Oradea (2001-2010)


58,0%
65,6%
61,4%
62,5%
59,6%
63,1%
59,5%
62,1%
54,0%
55,6%
42,0%
34,4%
38,6%
37,5%
40,4%
36,9%
40,5%
37,9%
46,0%
44,4%
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Femei
Barbati

Figura 25. Distribuia cazurilor de giardioz n funcie de sex comprativ ntre ani la pacienii
internai n Clinica de Boli Infecioase din Oradea (2001-2010)
n perioada celor 10 ani, peste 60% dintre pacienii infectai cu Giardia spp. au fost femei
(60,5%), raportul femei/brbai fiind de 1,5:1. De-a lungul studiului, acest raport a fost cuprins ntre 1,2:1
n anul 2009 (54,0% versus 46,0%) i 1,9:1 n anul 2002 (65,6% versus 34,4%) (Figura 25).
28,8%
35,5%
37,7%
41,2%
35,1%
35,0%
39,2%
37,9%
46,0%
37,8%
71,3%
64,5%
62,3%
58,8%
64,9%
65,0%
60,8%
62,1%
54,0%
62,2%
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Rural
Urban

Figura 27. Distribuia cazurilor de giardioz n funcie de mediu de provenien la pacienii
internai n Clinica de Boli Infecioase din Oradea (2001-2010)
Aproape 65% dintre cazuri provin din mediul urban (64,5%), rezultnd un raport urban:rural de
1,8:1. Acest raport este cuprins ntre 1,2:1 n anul 2009 (54,0% versus 46,0%) i 2,5:1 n anul 2001
(71,3% versus 28,8%) (Figura 27).
Cele mai frecvente simptome bilio-digestive au fost durerea abdominal (83,6%), n special cea
difuz (63,2%), urmat de inapeten (76,8%) i sensibilitatea la palpare (60,2%), n special n
hipocondrul drept (42,2%). Dintre simptomele neuro-psihice, la pacienii cu giardioz, cel mai frecvent a
fost astenia (74,0%), urmat de cefalee (51,4%), ameeli (14,4%), agitaie (10,2%). Urticaria a fost
simptomul alergic cel mai des ntlnit (18,2%), n special la copiii <1 an (100,0%).
n a doua parte a studiului am urmrit incidena giardiozei n comunitilor de copii de la dou
grdinie i de la un Centru de plasament pentru copii cu handicap din Oradea, judeul Bihor. S-au
prelevat un numr total de 116 probe de fecale. Examenul coproparazitologic s-a realizat prin metodele
Willis i Blagg modificat n cadrul Facultii de Medicin Veterinar din Cluj-Napoca i n cadrul
laboratorului Clinicii de Boli Infecioase din Oradea.
Prevalena infeciei cu parazitul Giardia spp. n cele trei instituii studiate a fost de 30,33%. Din
totalul de copii studiai, cea mai mare prevalen a parazitului Giardia spp. s-a ntlnit la grdinia G2- 29
cazuri (58,00%). (Figura 42). Infecia cu Giardia spp. a fost mai mare la biei dect la fete (32,73%
versus 31,15%), dar fr diferene semnificative (p>0,05)


6,67%
65,00%
36,36%
0,00%
53,33%
22,22%
G1
G2
CP
Fete
Baieti

Figura 44. Prevalena infeciei cu Giardia spp. la lotul de copii, n funcie de instituie i sexul
copiilor
Din studiul actual a rezultat c cei mai puternici factori de risc pentru infecia cu Giardia spp. la
copii sunt: apa mbuteliat (RR=2,062), prezena unor manifestri alergice i antecedentele de infecie cu
Giardia spp. (RR=1,824). Existena antecedentelor personale patologice reprezint de asemenea un factor
de risc pentru infecia cu Giardia spp. (RR=1,499), iar asociarea mai multor boli crete acest risc
(RR=1,683). Vrsta <5 ani i animalele de companie reprezint cele mai mici riscuri (RR=1,234,
respectiv RR=1,179).
n capitolul 12, este prezentat analiza epidemiologic i evaluarea clinico-paraclinic i
terapeutic a lotului de pacieni internai cu diagnosticul de giardioz n Clinica de Boli Infecioase din
Oradea, judeul Bihor. Este un studiu prospectiv, realizat n perioada 01 Ianuarie 2005- 30 Mai 2005.
n aceast perioad au fost internate cu diagnosticul de giardioz un numr de 42 de persoane,
numrul cazurilor variind ntre 6 cazuri n lunile ianuarie i mai i 16 n luna aprilie; distribuia
procentual este variabil n grupe de vrst succesive, pacienii cei mai afectai de boal fiind cei cu
vrsta cuprins ntre 45-75 de ani.
S-a observat asocierea frecvent a giardiozei cu colecistita acut, gastrita acut, i alergodermia;
pacienii diagnosticai cu giardioz au prezentat la internare, mai frecvent dureri abdominale difuze,
astenie, scaune diareice, vrsturi, greuri i erupie cutanat eritematoas; principalii parametrii
hematologici i biochimici sanguini crescui, la bolnavii cu giardioz, au fost: eozinofilele, VSH-ul,
transaminazele (TGO, TGP), glicemia i bilirubina total; giardioza a evoluat, uneori, asociat cu alte
parazitoze digestive- cu amebioza i trichocefaloza; n Clinica de Boli Infecioase din Oradea au fost
utilizate trei preparate antiparazitare, Metronidazol (Flagyl), Eskazol (Albendazol) i Zentel
(Albendazol), cu eficacitate de 100%. Examenul coproparazitologic s-a realizat prin metoda Willis n
laboratorul Clinicii de Boli Infecioase din Oradea, judeul Bihor.
97,62%
95,24%
83,33%
73,81%
71,43%
42,86%
40,48%
35,71%
26,19%
23,81%
16,67%
11,90%
9,52%
9,52%
9,52%
4,76%
4,76%
4,76%
2,38%
Astenie
Dureri abdominale difuze
Scaune diareice
Varsaturi
Greturi
Cefalee
Inapetenta
Febra
Ameteli
Eruptie cutanata eritematoasa
Mialgii
Disfagie
Fatigabilitate
Subicter scleral
Urini hipercrome
Tuse seaca
Intoleranta alimentara
Parestezii
Scaune acrome

Figura 64. Simptomatologia pacienilor internai n Clinica de Boli Infecioase din Oradea n
perioada 01.01.2005-30.05.2005


100,00%
97,62%
35,71%
11,90%
14,29%
19,05%
16,67%
11,90%
4,76%
9,52%
Ex.coproparazitologic pozitiv
Eozinofile
VSH
Glicemie
PCR pozitiva
TGO
TGP
Bilirubina Totala
Sumar de urina modificat
SNF pozitiva

Figura 65. Examene de laborator la pacienii internai n Clinica de Boli Infecioase din Oradea n
perioada 01.01.2005-30.05.2005
Capitolul 13 prezint un studiu realizat n perioada octombrie 2008- mai 2010 la carnivorele
domestice (551 cini i 183 pisici), cu provenien din mediile urban i rural, avnd ca i scop stabilirea
prevalenei infeciei cu Giardia spp. prin dou metode de diagnostic (flotaie cu clorura de sodiu i
coproELISA) ct i identificarea unor factorilor de risc intrinseci (vrst, sex, ras) i extrinseci (mediu,
habitat, deparazitri, manifestri clinice) care pot influena prevalena infeciei. Toate probele de fecale au
fost examinate prin metoda de flotaie Willis i prin metoda imunoenzimatic coproELISA.

Tabelul 37. Prevalena infeciei cu Giardia spp. prin metoda de flotaie i coproELISA la cini
Flotaie CoproELISA
Pozitive n (%) 47 (8.5) 147 (39.2)
Negative n (%) 504 (91.5) 228 (60.8)
IC 95% 6.4- 11.3 34.3- 44.4
Total 551 375
Legend: cELISA coproELISA; n numr de probe


Figura 80. Prevalena infeciei cu Giardia spp. la pisici, pe categorii de vrst
prin metoda coproELISA

Astfel, prevalena infeciei cu Giardia spp. la cini prin metoda de flotaie a fost de 8,5%, la
pisici prin aceast metod nu s-a identificat nici o prob pozitiv; prin metoda imunoenzimatic
coproELISA prevalena infeciei la cini a fost de 39,2% (Tabel 37), iar la pisici de 27,9 %; factori de risc
identificai la cini au fost vrsta (cinii sub 1an: p<0,04-0,001) (Tabel 38), mediul (urban: p<0,02-
0,000007) i categoria de cini (cini crescui n colectiviti: p<0,004-0,0004); factori de risc identificai
la pisici au fost vrsta (pisicile sub 6 luni; p-0,03) (Figura 80) i prezena manifestrilor clinice (p-0,04).
S-a demonstrat sensibilitatea crescut a tehnicii coproELISA (74,29%) comparativ cu metoda de flotaie
Willis (17,69%).

53.8
46.2
30.6
69.4
24.6
75.4
0
2
4
6
8
10
sub 6 luni
6-12 luni peste 12 luni
Pozitive Negative



CONCLUZII GENERALE
Cercetrile epidemiologice privind evoluia giardiozei (lambliazei) n comuniti de copii i
aduli, din municipiul Oradea, n perioada 01 Ianuarie 2001-31 Decembrie 2010, au relevat urmtoarele:
- La 42.902 pacieni internai n Clinica de Boli Infecioase, rata prevalenei giardiozei a fost de 5,18%
cu limite lunare ntre 6,5-10,6%, cu valori mai mari vara (30,3%) i iarna (25,5%);
- infecia a avut o inciden mai mare la femei, (60,5%), raportul femei/brbai fiind de 1,5:1;
- 64,5% dintre cazuri provin din mediul urban, rezultnd un raport urbanrural de 1,8:1;
- infecia a avut o inciden crescut la tineri ntre 15-24 ani, respectiv 16,7% i la aduli ntre 25-34
ani adic 18,2%;
- cele mai frecvente simptome bilio-digetiveau fost durerea abdominal (83,6%), n special cea difuz
(63,2%), urmat de inapeten (76,8%) i sensibilitatea la palpare (60,2%), diaree (19,7%);
- dintre simptomele neuro-psihice, cel mai frecvent a fost astenia (74,0%), urmat de cefalee (51,4%),
ameeli (14,4%), agitaie (10,2%), semnul Chwostek pozitiv (9,4%), tulburri de memorie (6,6%);
- urticaria a fost simptomul alergic cel mai des ntlnit (18,2%), n special la copiii <1 an (100,0%);
- 44,9% din pacieni au avut simptomatologia de mai puin de 7 zile i 28,3% ntre 7-30 zile;
- 39,3% dintre pacieni au urmat tratament cu Metronidazol, 32,5% cu Zentel i 28,2% cu Eskazol.
Cercetrile efectuate la copiii de la Grdinia cu program prelungit G1 i Centrul de Plasament
CP n anul 2005 i la copiii de la Grdinia cu program normal G2 n anul 2011, au relevat urmtoarele:
- cea mai mare valoare a prevalenei infeciei cu Giardia spp. s-a ntlnit la grdinia G2, respectiv
58,00%, urmat de centrul de plasament CP, respectiv 30,00%, n timp ce la grdinia G1 prevalena
a fost de 4,35%, mai mare la biei dect la fete (32,73% versus 31,15%);
- infecia a avut o inciden mai mare la copiii de 0-5 ani (34,92%) fa de cei cu vrste cuprinse ntre
5-10 ani (28,3%);
- prevalena infeciei cu Giardia spp. a fost de 1,5 ori mai mare la copiii cu simptomatologie digestiv
(44,44%) fa de cei fr simptomatologie;
- prevalena cea mai ridicat a infeciei cu Giardia spp. s-a ntlnit la copiii cu diferite forme de alergii
n antecedentele lor patologice (40,91%);
- PR la copiii care au but ap mbuteliat a fost de 44,19%, la copiii consumatori de ap de fntn
30,0% i la copiii ce consum ap de la reeaua oraului 21,43%;
- prevalena infeciei cu Giardia spp. la copiii cu grup sanitar n cas sau n apartament a fost de
32,0%, iar la copii cei cu grup sanitar n curte, de 31,25%;
- incidena infeciei cu Giardia spp. la copiii care au animale de companie este de 36,36 %.
Investigaiile clinice, paraclinice i terapeutice efectuate la pacienii internai n Clinica de Boli
infecioase din Oradea, judeul Bihor, n perioada 01 Ianuarie 2005- 30 Mai 2005, au relevat urmtoarele:
- la 1415 pacieni internai n Clinica de Boli infecioase, rata prevalenei giardiozei a fost de 2,97% cu
limite lunare ntre 1,87-4,89%;
- infecia a avut o inciden crescut la copiii ntre 5-10 ani (11,79%), la tineri ntre 15-20 ani
(14,28%) i la aduli ntre 45-55 ani i 65-75 ani (16,66%);
- 42,86% din pacienii pozitivi au provenit din mediul rural i 57,14% din mediul urban;
- la 47,62% din pacienii infectai cu Giardia spp. s-a relevat asocierea cu colecistita acut, la 23,81%
cu alergodermie, la 23,81% cu gastrita acut i la 11,90% cu hipocalcemia;
- pacienii au prezentat la internare, mai frecvent: dureri abdominale difuze (95,24%), astenie
(97,62%), scaune diareice (83,33%), vrsturi (73,81%), greuri (71,43%) i erupie cutanat
eritematoas (23,81%);
- principalii parametrii hematologici i biochimici sanguini crescui, la bolnavii cu giardioz, au fost:
eozinofilele, VSH-ul, transaminazele (TGO, TGP), glicemia i bilirubina total;
- giardioza a evoluat, uneori, asociat cu alte parazitoze digestive la pacienii spitalizai - amebioza i
trichocefaloza;
- tratamentul antiparazitar cu Flagyl (Metronidazol), Eskazol (Albendazol) i Zentel (Albendazol), a
avut eficacitate maxim (100%)
Cercetrile efectuate n perioada octombrie 2009-decembrie 2010, la cini i pisici, s-au
finalizat cu urmtoarele concluzii:
- prevalena infeciei cu Giardia spp. la cini prin metoda de flotaie a fost de 8,5% (47/551). La pisici
prin aceast metod nu s-a identificat nici o prob pozitiv;

- prin metoda imunoenzimatic coproELISA prevalena infeciei la cini a fost de 39,2% (147/375), iar
la pisici de 27,9 % (51/183);
- factori de risc identificai la cini au fost vrsta (cinii sub 1an; 0,04-0,001) mediul (urban: p<0,02-
0,000007) i categoria de cini (cini crescui n colectiviti: p<0,004-0.0004);
- factori de risc identificai la pisici au fost vrsta (pisicile sub 6 luni; p-0,03) i prezena manifestrilor
clinice ( p-0.04).
REFERINE SELECTIV

6. Thompson R.C.A., 2002a, Towards a better understanding of host specificity and the transmission of
Giardia The impact of molecular epidemiology, In:Olson, B.E., Olson, M.E., Wallis, P.M., Giardia: The
Cosmopolitan Parasite. CAB International, Wallingford, UK, p.55-69.
16. Lallea M., Pozioa E., Gioia Capellib, Bruschic F., Daniele Crottid, SIMONE M. Caccio, 2005,
Genetic heterogeneity at the b-giardin locus among human and animal isolates of Giardia duodenalis
and identification of potentially zoonotic subgenotypes, International Journal for Parasitology 35, p. 207
213.
17.Monis P.T., Caccio S.M., Thompson R.C.A., 2009, Variation in Giardia: towards a taxonomic
revision of the genus, Trends Parasitology, 25(2):p.93-100.
18.Thompson R.C.A., Monis P.T., 2004, Variation in Giardia: implications for taxonomy and
epidemiology, Adv. Parasitology 58: p. 69-137.
35. Cooper M.A., Adam RD., Worobey M., Sterling C.R., 2007, Population genetics provides
evidence for recombination in Giardia, Curr. Biol. 17, 19841988
36. Lujan H.D., 2006, Giardia and giardiosis, Medicina (Buenos Aires) nr. 66(1), p. 70-74.
40. Mc Donnell P.A., Scott K.G., Teoh T.A.,Olson M.E., Upcroft J .A., Buret A.G., 2003, Giardia
duodenalis trophozoites isolated froma parrot Caatua galerita colonize the small intestinal tracts of
domestic kittens and lambs, Veterinaty Parasitology nr. 20, p. 31-46.
106. Chin A.C., Desiree A. T., Scott K.G.E., Meddings J .B., McNaughton W.K., Buret A.G., 2002,
Strain-dependent induction of enterocyte apoptosis by Giardia lamblia disrupts epithelial barrier
function in a caspase-3-dependent manner, Infect. Immun., 70, p. 36733680.
107. OHandley R.M., Ceri H., Anette C., Olson M.E., 2003, Passive immunity and serological
immune response in dairy calves associated with natural Giardia duodenalis infections, Veterinary
Parasitology 113, p. 89.
108. Itoh N., Muraoka N., Saeki H., Aoki M., Itagaki T., 2005, Prevalence of Giardia Intestinalis in
Dogs of Breeding Kennels in J apan., J. Vet. Med. Sci. 67(7), p. 717-718.
109. Thompson R.C.A., 2000, Giardiasis as a re-emerging infectious disease and its zoonotic potential,
Int. Journal Parasitology 30, p. 1259-1267.
110. Sackey M.E., Weigel M.M., Armijos R.X., 2003, Predictors and nutritional consequences of
intestinal parasitic infection in rural Ecuadorian children, Journal of Tropical Pediatry 49, p. 17-23























CURRICULUM VITAE

1. Nume i prenume: J arca Adriana Gabriela
2. Data i locul naterii: 29.09.1976
3. Starea civil: divortata
4. Adresa: Oradea, B-dul Dacia, nr. 54, bl U4, ap 30
5. Telefon: 0723669959
6. Adresa mail: j.adriana9@gmail.com
7. Studii:
Nr. crt. Instituia de nvmnt superior Domeni ul Perioada
Titlul acordat
Grade/diplome obinute
1.
Liceul teoretic E. Gojdu, Oradea

Matematic-Fizic 1991-1995 Diploma de bacalaureat

2.
Facultatea de Medicina i Farmacie,
Universitatea Oradea
Medicina generala 1995-2001 Diplom de licena

3.
Spitalul Clinic Judeean, Oradea Medicina Generala 2001-2002 Medic stagiar

4.
Spitalul Clinic Judeean, Oradea 2003-2008 Medic rezident

5.
Facultatea de Medicina Veterinara,
Cluj-Napoca
UMF Cluj-Napoca-prin transfer
Parazitologie
Veterinar
Parazitologie Uman
2005-2007

2007-2011
Doctorand

6.
Facultatea de Medicina i Farmacie,
Universitatea Oradea
Boli Infecioase 2008 Medic Specialist Boli
Infectioase

8. Specializri, calificri, studii postuniversitare:
Nr.
crt.
Instituia de nvmnt superior T i tl ul cur sul ui Perioada
1.
Departamentul pentru Pregatirea i Perfecionarea
Personalului Didactic, Universitatea din
Oradea,
Master Formarea Profesorilor 2004-2005
2. Facultatea de Medicin Veterinar, Cluj-Napoca Master Diagnostic morfopatologic
i de laborator
2003-2004

3.
Universitatea de Medicina i Farmacie, Timioara Medic specialist 2008

9. Experiena profesional:
Nr.
crt.
I ns t i t u i a Domeni ul Perioada
Titlul/postul
didactic sau
gradul/postul
profesional
1. Spitalul clinic Judetean Oradea Medicina 2002-2003 Medic stagiar
2. Facultatea de Medicina i Farmacie,
Universitatea Oradea
Medicina generala 2003-prezent Preparator universitar
3. Spitalul clinic Judetean Oradea Medicina generala 2003-2008 Medic resident Boli
Infectioase
4. Facultatea de Medicina i Farmacie,
Universitatea Oradea
Boli Infecioase 2008-prezent Medic specialist Boli
Infecioase
5. Spitalul Universitar Chochene,
Secia Parazitologie-Boli Tropicale,
Paris, Frana
Bursa de studii Nicolae
Titulescu

2006 Doctorand
6. Facultatea de Medicin Veterinar,
Lisabona, Portugalia

Burs de studii Socrates


2004 Masterand


10. Locul de munc actual / funcia / perioada: Universitatea din Oradea, Facultatea de Medicin i
Farmacie, Catedra Psiho-Neuro-Stiinte si Recuperare, Disciplina Boli Infecioase/ 2003 prezent
11. Vechime la locul de munc actual (total/post actual): 9 ani
12. Brevete de invenii:
13. Lucrri publicate (nr.total): 55
13.1. Teza doctorat: in curs
13.2. Materiale didactice elaborate (cursuri, ndrumtoare laborator, suport curs format
electronic): 2 ndrumtoare laborator
13.3. Cri, monografii, tratate
13.4. Lucrri tiintifice relevante pentru specializarea (max.5 lucrri):
1. Mircean Viorica, Gyorke Adriana, J arca Adriana, Cozma Vasile, Prevalence of Giardia species in
stool samples by ELISA in household cats fromRomania and risk factors, Journal of Feline Medicine
and Surgery, 13, ISBN 1098-612X p. 479-482, 2011.
2. J arca Adriana, Jarca Cosmin, Csep Andrei, Negru Nicoleta, Popoviciu Mihaela, Epidemiologycal
Research on Giardiosis Affected Humans, Analele Universitatii din Oradea, Fascicola Protectia Mediului,
vol XIV, anul 14, edit. Universitatii din Oradea, ISSN 1224-6255, ISSN 1583-4301, p. 1567-1570, 2009.
3. J arca Adriana, Jarca Cosmin, Clinical, paraclinical and epidemiologycal research on giardiosis
affected humans, Analele Universitatii din Oradea, Fascicola Protectia Mediului, vol XIV, anul 14,
Editura Universitatii din Oradea, ISSN 1224-6255, ISSN 1583-4301, p. 1561-1563, 2009.
4. J arca Adriana, Mircean Viorica, Pop R., Titilincu Adriana, Avram A., Cozma V., Comparative value
of some diagnostic methods in giardiosis of dogs, Lucrri tiintifice, Medicin Veterinar Timioara, vol
XLI, ISSN 1221-5295, edit. Imprimeria Mirton, p. 379-384, 2008.
13.5. Experiena acumulat n alte programe naionale/internaionale / granturi / contracte/proiecte
didactice:
1. Cercetri privind diagnosticul, epidemiologia i controlul hidatidozei-echinococozei la animale, n
nord-vestul i centrul Romniei. Proiect CNCSIS cod 756 (2004-2006).
2. Constituirea unei reele naionale privind studiul unor zoonoze parazitare i implicaiile lor n
sigurana alimentelor. Proiect CEEX Modulul 3, Contract 78/2006 (2006-2007).
3. Evaluarea i optimizarea interdisciplinar a metodelor de screening, diagnostic i tratament n
trichineloza i echinococoza chistic uman i animal n centrul i nord-vestul Romniei. Proiect CEEX
Modulul 1, Contract 99/2006 (2006-2008).
14. Membru al asociaiilor profesionale:
2006- Membru n Societatea Medicilor Parazitologi din Romnia,
2008- Membru n Societatea de Boli Infectioase din Romnia,
15. Limbi strine cunoscute:
Limba
Engleza
Franceza
Citit
Bine
Bine
nelegere
Bine
Bine
Vorbire
Bine
bine
Scriere
Stisfacator
Satisfctor

16. Alte competene: operare PC, permis conducere
17. Specializri i calificri: 5-03-2008 - medic specialist
18. Alte meniuni (premii,distincii etc):
19. Prezentarea activitilor didactice anterioare:
- ore laborator la disciplina Boli Infectioase, Catedra Psiho-Neuro-Stiine i Recuperare,
Facultatea de Medicin i Farmacie, Universitatea din Oradea;
20. Activitate administrativ
- Organizarea laboratoarelor de Boli Infectioase, n cadrul Clinicii de Boli Infectioase,
specializarea Boli Infectioase, Universitatea din Oradea;
Declar pe propria rspundere c datele prezentate sunt n conformitate cu realitatea.

Data completrii:
10-01-2012 Semntura
Prep.Univ.Dr. Jarca Adriana Gabriela







UNIVERSITY OF MEDICINE AND PHARMACY "IULIU HATIEGANU"
FACULTY OF MEDICINE CLUJ -NAPOCA














Epidemiological, clinical, paraclinical
and therapeutic research on giardiasis
affected humans an animals







Ph.D. THESI S SUMMARY







Ph.D. student Adriana Gabriela J arca
Ph.D. supervisor Prof.Univ.Dr.Monica J unie





2011

CONTENTS


INTRODUCTION................................................................................................................... 9
I . ACTUAL KNOWLEDGE STAGE ..................................................................................11
CHAPTER 1 ETIOLOGY ...............................................................................................11
CHAPTER 2. Biological features of the Giardia spp. parasite...........................................15
2.1. Trophozoite morfology...........................................................................................16
2.2. Cyst morfology......................................................................................................20
2.3. Biological cycle......................................................................................................21
CHAPTER 3. Epidemiology.............................................................................................23
3.1.Incidence of Giardia spp. parasite amongst humans.................................................23
3.2.Incidence of Giardia spp. Parasite amongst various animal species..........................26
3.3. Giardia spp.parasite contagiousness.......................................................................31
CHAPTER 4. Pathogenesis...............................................................................................39
CHAPTER 5. Giardiasis clinical picture...........................................................................45
5.1. Giardiasis clinical picture on humans......................................................................45
5.2. Giardiasis clinical picture on animals......................................................................50
CHAPTER 6. Positive diagnosis in giardiasis...................................................................53
6.1. Epidemiological investigation.................................................................................53
6.2. Laboratory diagnosis..............................................................................................53
6.2.1. Bio-humoral alterations..................................................................................53
6.2.2. Imaging probes...............................................................................................54
6.2.3. Immunological and microscopic probes..........................................................55
6.2.4. Histological and anatomo-pathological probes................................................60
6.3. Differential diagnosis in giardiasis..........................................................................61
CHAPTER 7. Treatment and prophylaxis..........................................................................63
7.1. Giardiasis treatment on humans..............................................................................66
7.2. Giardiasis treatment on animals..............................................................................67
7.3. Giardiasis prophylaxis............................................................................................68
7.4. Prognosis...............................................................................................................69
I I . OWN RESEARCH ..........................................................................................................70
CHAPTER 8. Work hypothesis.........................................................................................70
8.1. Premise..................................................................................................................70
8.2. Research motivation...............................................................................................71
CHAPTER 9. Purpose and objectives...............................................................................73
CHAPTER 10. Materials and methods..............................................................................74
10.1. Studied batches description...................................................................................75

10.2. Favourising factors and conditions for current research.........................................77
10.3. Laboratory techniques used in current research.....................................................79
10.3.1. The Willis method........................................................................................79
10.3.2. Modified Blagg method................................................................................79
10.3.3. Immuno-enzymatic copro-Eliza method........................................................80
10.4. Statistic analysis in the current research................................................................88
CHAPTER 11. Epidemiological research in giardiasis affected adults and children within
Oradea...............................................................................................................................91
11.1. Purpose of study...................................................................................................91
11.2. Materials and methods..........................................................................................91
11.2.1. Materials and methods used in epidemilogical research purpouses on children
and adults interned in the Infectious Diseases Clinic of Oradea.................................91
11.2.2. Materials and methods used in epidemilogical research purpouses on children
from various communities of Oradea........................................................................92
11.3. Epidemiological investigation results on giardiasis affected humans.....................93
11.3.1. Epidemiological investigation results in giardiasis , carried out at the Infectious
Diseases Clinic of Oradea , Bihor.............................................................................93
11.3.2. Epidemiological investigation results in giardiasis carried out within various
children communities fromOradea.........................................................................121
11.4. Discussion..........................................................................................................133
11.5. Conclusions........................................................................................................139
CHAPTER 12. Clinical , paraclinical and therapeutical research on giardiasis affected
humans............................................................................................................................141
12.1. Purpose of study.................................................................................................141
12.2. Materials and methods........................................................................................141
12.3. Results...............................................................................................................147
12.3.1. Clinical , paraclinical and therapeutical results in giardiasis affected adults and
children fromthe Infectious Diseases Clinic of Oradea , Bihor ...............................147
12.4. Discussions........................................................................................................156
12.5. Conclusions........................................................................................................159
CHAPTER 13. Epidemiological research regarding giardiasis on cats and dogs..............160
13.1. Purpose and objectives.......................................................................................160
13.2. Materials and methods........................................................................................160
13.2.1. Study period...............................................................................................160
3.2.2. Animals and harvested biological probes......................................................161
13.2.3. Methods.....................................................................................................162
13.3. Results...............................................................................................................164

13.3.1. Giardia spp. infection prevalence on dogs...................................................164
13.4. Discussions........................................................................................................173
13.4.1. Dogs...........................................................................................................173
13.4.2. Cats............................................................................................................176
13.4.3. Conclusions................................................................................................178
CHAPTER 14. GENERAL CONCLUSIONS.................................................................179
CHAPTER 15. REFERENCES.......................................................................................182

INTRODUCTION


Giardiasis , produced by Giardia spp., forms a parasitosis of great epidemiological and clinical
importance due to it's high prevalence and pathogenicity amongst animals as well as amongst humans ,
especially within infant population.
Giardiasis is a digestive zoonosis , produced by Giardia type protozoan , most commonly involved
species being Giardia duodenalis.
Interest in this flagellate protozoan was implemented in the second half of the 20th century through
recognition of it's pathogenic potential in 1962 and proving , in 1987 , that experimental human infection with
Giardia lamblia is according to Koch's postulates.
Being one of the most spread zoonosis in the country and in the world , with important economic and
social implications , mixed experts committees of The World Health Organization have speciffied in countless
times the neccesity of international supervising of zoonosis. In some countries , multidisciplinary interministerial
bodies have been created for promotion of cooperation within fight campaigns against zoonosis. In our country ,
the Sanitary - veterinary Law (law 60/1974) stipulates the necessity of collaboration between human doctors and
veterinarians for preventing and repelling zoonosis and food poisoning. The main epidemi-zoonotic problems ,
raised by parasitic zoonosis , are those reffering to observation , prevention and limitation.
This flagellate parasite was discovered in 1681 , by Antony von Leeuwenoek , a czech phisicist , in his
own faeces, and considers the parasite a commensal of the digestive system and not the etiological agent
incriminated in the debut of the disease.
After about 200 years , in 1859 , Lamb brings this parasite back into actuality , describing it.
In recent literature , published after The International Parasitology Congress , VIII - 1994 , the
denomination Giardia Lamblia becomes used by most authors and Giardia intestinalis is used by australian
authors and some dutch authors.

I.ACTUAL KNOWLEDGE STAGE

The main epidemio-zoonotic problems , raised by the presence of parasitic zoonosis are those reffering
to observation , prevention and limitations of it.
The study carried out in this thesis , which has had into consideration knowledge of parasite spreading
and its evolution in the N-V area of Romania , in the actual period , has been necessary mainly due to lack , in
the last 20 years , of some studies regarding incidence of giardiasis on humans and animals and also due to the
fact that nowadays in the mentioned area , the presence of pets (cats and dogs) in apartments and households has
recorded a sudden growth.
The introduction part , consisting in 7 chapters , contains a description of the Giardia Lamblia parasite ,
namely its biology , epidemiology and pathology. In this part of the thesis the following are presented: sistematic
and taxonomic placing of the parasite , adult form morphology of the Giardia duodenalis parasite , form of
resistance - the cyst , epidemiological aspects regarding the infection with Giardia parasite within general
population and animals , closely related to each other , geographic spread , infection reservoir , transfer
mechanisms , ways of entry of the parasite , biotic potential, pathogenicity related aspects , clinical
manifestations , diagnosis methods , profilaxis and treatment on giardiasis affected humans and animals.

II. OWN RESEARCH

Work hypothesis , objectives of study , material and work method are widely presented in chapters 8, 9
and 10.
WORK HYPOTHESIS
Reasons for the choice of this research subject are represented by the environment in which parasitic
diagnosis activity in Giardia spp contamination is carried out in our country , due to lack of an official
observation protocol.
Although in the past 10 years the number of giardiasis cases across world and Romania have diminished
and succes has been recorded in medical assistance of the patients , a high number of giardiasis cases still
remain, involving high risk and important costs in humans cases as well as in animal cases. Prevalence of the
infraclinical forms of Giardia spp infection on humans and animals , difficulties in establishing a parasitic
diagnosis , but also a great variety of ways this infection can manifest , justify the studies and their results which
will lead to an optimum diagnosis , treatment and prophilaxis strategy. The association of these elements has
formed a starting point in the study of aspects regarding the influence of parasitic infection with Giardia spp on
adult and infant population.
Animal parasitic diseases are important through the high damages they cause, on one side , although
scheduled measures for prevention of parasitic infections are applied and , on the other side , they involve the
19
high transfer rate of the parasitic infection to humans and other animals , which also leads to health risks and
additional costs for patients.
OBJECTIVES OF STUDY
The objectives of the present thesis have been the following: specification of the real incidence through
a retrospective study and dynamic analysis of the Giardia spp infection , during a well established period , in
different adult and children communities from Oradea , Bihor county; an evaluation from a clinical , paraclinical
and therapeutic point of view , of the giardiasis cases interned at the Infectious Diseases Clinic of Oradea , Bihor
county , during a well established period; estimation of Giardia spp infection prevalence on dogs and cats from
urban and rural environments, using the immuno-enzymatic coproEliza method, highlighting the part played by
immunodiagnosis in correct detection of the disease , as well as corelation of the obtained results through
immuno-enzimatic coproEliza method with the results of other investigation methods; identification of intrinsic
and extrinsic factors which can influence the prevalence of Giardia spp infection amongst dogs and cats, as well
as the evaluation of human contamination risk.
MATERIAL AND METHOD
The present study , component of the Ph.D. degree , is an epidemiologic study describing giardiasis
during a 10 years period. Different population categories from Oradea , Bihor county, have been studied along
with a batch of pets (dogs and cats) from different areas of Transilvania.
Statistic processing and geographic representation have been realised with MS Excel application (part
of MS Office 2007).
RESULTS
In chapter 11 the following are shown: monitoring of some epidemiologic indicators of Giardia lamblia
parasitic infection amongst different adult and children communities interned in the Infectious Diseases Clinic of
Oradea , Bihor county; epidemiologic research on children from different communities of Oradea , Bihor county.
The first part of the study has been carried out between 01st January 2001 and 31st December 2010 , at
the Infectious Diseases Clinic of Oradea, recorded cases being part of a retrospective study, based on medical
documentation(observation sheets). A number of 2.222 of patients diagnosed with giardiasis have been studied
from the total of 42.902 interned at the Clinic of Infectious Diseases of Oradea , Bihor county , during the
mentioned period.
During the study period , incidence of Giardia spp infection has been 5,18% and anual prevalence of
giardiasis has fluctuated (16,36% - 0,95%). Evolution of Giardia spp prevalence amongst the interned patients
during the 10 year period has had a decreasing trend(from 16,36% to 0,95%), the highest value being reached in
2001 (16,36%) and the lowest in 2010(0,95%)(Figure 19). The correlation of giardiasis and the months of the
year is represented in figure 20. During the 10 years period over 20% of cases have been recorded in June and
July (10,1% , namely 10,6%).

16,4%
6,8%
7,9%
5,0%
6,8%
3,4% 3,4%
2,4%
2,1%
1,0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 19. Prevalence evolution of Giardia spp
infection on interned patients at the Infectious
Diseases Clinic of Oradea (2001 - 2010)
9,4%
9,0%
7,7%
7,9%
7,4%
10,1%
10,6%
9,6%
8,0%
6,7%
6,5%
7,2%
Ianuarie
Februarie
Martie
Aprilie
Mai
Iunie
Iulie
August
Septembrie
Octombrie
Noiembrie
Decembrie
Figure 20. Distribution for Giardia spp infection
cases , according to the moths of the years, on
patients interned at Infectious Diseases Clinic of
Oradea(2001 - 2010)

20
58,0%
65,6%
61,4%
62,5%
59,6%
63,1%
59,5%
62,1%
54,0%
55,6%
42,0%
34,4%
38,6%
37,5%
40,4%
36,9%
40,5%
37,9%
46,0%
44,4%
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Femei
Barbati

Figure 25. Distribution of giardiasis cases depending on gender compared by years at the Infectious
Diseases Clinic of Oradea(2001 - 2010)
During the given period of 10 years , over 60% of the Giardia spp infected patients have been women
(60,5%) , women/men ration being: 1,5:1. Along the study this ratio has been between 1,2:1 in 2009 (54% versus
46 %) and 1,9:1 in 2002 (65,6% versus 34,4%)(figure 25).
28,8%
35,5%
37,7%
41,2%
35,1%
35,0%
39,2%
37,9%
46,0%
37,8%
71,3%
64,5%
62,3%
58,8%
64,9%
65,0%
60,8%
62,1%
54,0%
62,2%
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Rural
Urban

Figure 27. Distribution of giardiasis cases depending on the source envinronment on patients interned at
the Infectious Diseases Clinic of Oradea(2001 - 2010)

Almost 65% of cases originate from urban environment (65,4%) , resulting a urban/rural ratio of 1,8:1.
This ratio takes values between 1,2:1 in 2009 (54% versus 46%) and 2,5:1 in 2001(71,3% and 28,8%)(figure 27).
The most frequent biliary-digestive symptoms have been: abdominal pain (83,6%), especially diffuse
(63,2%) , followed by loss of apetite (76,8%) and pain on palpation (60,2%) , especially in the right
hypochondrium (42,2%). Amongst neuro-physical symptoms, on giardiasis affected patients , most frequent has
been asthenia (74%) , followed by headaches(51,4%), dizziness(14,4%), restlessness(10,2%). Nettle rash has
been the most common allergic symptom(18,2%) , especially on children less than 1 year old(100%).
In the second part of the study the incidence of giardiasis has been observed on children from 2
kindergartens and one Placement Center for Children with Handicaps from Oradea , Bihor county. A total
number of 116 fecal probes have been taken. The copro-parasitic test has been made with Willis and modified
Blagg method within the Faculty of Veterinary Medicine of Cluj-Napoca and the laboratory from the Infectious
Diseases Clinic of Oradea.
Prevalence of the Giardia spp infection in the 3 mentioned institutions has been 30,33%. From the total
of studied children , the highest prevalence of Giardia spp parasite has been recorded in the G2 kindergarten ,
namely 29 cases (58%)(figure 42). Infection with Giardia spp parasite has been higher on male cases than on
female cases (32,73% versus 31,15%) but without any significant differences.
21
6,67%
65,00%
36,36%
0,00%
53,33%
22,22%
G1
G2
CP
Fete
Baieti

Figure 44.Prevalence of the Giardia spp infection on the children batch , depending on institution and
gender
From the current study it has been observed that the strongest rosk factors for Giardia spp infection on
children are: bottled water(RR=2,062) , presence of some allergic manifestations and previous history of Giardia
spp infection(RR=1,824). Existence of personal previous pathologic history also represents a risk factor for the
Giardia spp infection (RR=1,499) and association of other diseases increases this risk(RR=1,683). Age below 5
and presence of pets represent the lowest risk (RR=1,234 , respectively RR=1,179).
In chapter 12 , the following are shown: epidemiologic analysis and clinical-paraclinical and therapeutic
evaluation of the batch of patients interned with giardiasis diagnose in the Infectious Diseases Clinic of Oradea ,
Bihor county. It is a prospective study, carried out between 01-January-2005 and 30-May-2005.
During this period a number of 42 persons have been interned with giardiasis diagnose , the number of
cases being between 6 in January and May and 16 in April; the procentual distribution varies with successive age
categories , the most affected patients being those between 45 and 75 years old.
The frequent association of giardiasis with acute colecystitis , acute gastritis and allergodermia has been
observed; patients diagnosed with giardiasis have shown on internment: frequent diffuse abdominal pain ,
asthenia , diarrhea , vomiting , nausea and erythematosus skin eruption; the main haematological and
biochemical blood parameters with high values in giardiasis affected patients have been: eozinophils , VSH ,
transaminases(TGO and TGP), glucose and total bilirubin; giardiasis has sometimes evolved associated with
other digestive parasitosis - amebiosis and trichocefalosys; in the Infectious Diseases Clinic of Oradea 3
antiparasitic compounds have been used: Metronidazole(Flagyl) , Eskazol(Albendazole) and Zentel
(Albendazole) with 100% efficiency. The coproparasitic test has been carried out using Willis method in the
laboratory of the Infectious Diseases Clinic of Oradea, Bihor county.
97,62%
95,24%
83,33%
73,81%
71,43%
42,86%
40,48%
35,71%
26,19%
23,81%
16,67%
11,90%
9,52%
9,52%
9,52%
4,76%
4,76%
4,76%
2,38%
Astenie
Dureri abdominale difuze
Scaune diareice
Varsaturi
Greturi
Cefalee
Inapetenta
Febra
Ameteli
Eruptie cutanata eritematoasa
Mialgii
Disfagie
Fatigabilitate
Subicter scleral
Urini hipercrome
Tuse seaca
Intoleranta alimentara
Parestezii
Scaune acrome

Figure 64. Simptomatology for the patients interned at the Infectious Diseases Clinic of Oradea between
01.01.2005 and 30.05.2005

22
100,00%
97,62%
35,71%
11,90%
14,29%
19,05%
16,67%
11,90%
4,76%
9,52%
Ex.coproparazitologic pozitiv
Eozinofile
VSH
Glicemie
PCR pozitiva
TGO
TGP
Bilirubina Totala
Sumar de urina modificat
SNF pozitiva

Figure 65. Laboratory tests for the patients interned at the Infectious Diseases Clinic of Oradea
between 01.01.2005 and 30.05.2005
Chapter 13 presents a study carried out between October 2008 and May 2010 on domestic carnivores
(551 dogs and 183 cats), originating from rural and urban environments , with the purpose of determining the
prevalence of Giardia spp infection using 2 methods of diagnosis (Sodium chlorate flotation and coproEliza) as
well as identifying some intrinsic risk factors (age , gender , race) and extrinsic (environment , habitat,
disinfestation , clinical manifestations) which can influence the infection prevalence. All the fecal probes have
been analyzed using the Willis flotation method and immunoenzymatic coproEliza method.

Table 37. Giardia spp infection prevalence using the flotation method and coproEliza on dogs
Flotation CoproELISA
Positive n (%) 47 (8.5) 147 (39.2)
Negative n (%) 504 (91.5) 228 (60.8)
IC 95% 6.4- 11.3 34.3- 44.4
Total 551 375
Legend: cELISA coproELISA; n number of probes



Figure 80. Giardia spp infection prevalence on cats , depending on age category and coproEliza method

Thereby , Giardia spp infection prevalence determined through flotation method has been 8,5% on dogs
and no positive probe has been determined on cats; through immunoenzymatic coproEliza the determined
prevalence on dogs has been 39,2% (Table 37) and on cats - 27,9%; identified risk factors on dogs have been:
age (under 1 year old: p<0,04-0,001)(Table 38) , environment (urban: p<0,02-0,000007) and dog category(dogs
from communities: p<0,004-0,0004); identified risk factors on cats have been age (under 6 months old: p - 0,03)
(figure 80) and presence of clinical manifestations (p-0,04). High responsiveness of the coproEliza
method(74,29%) has been proven in comparison to Willis flotation method(17,69%).




53.8
46.2
30.6
69.4
24.6
75.4
0
2
4
6
8
10
Under 6 months
6-12 months Over 12 months
Positive Negative
23
GENERAL CONCLUSIONS

Epidemiological research regarding the evolution of giardiasis (lambliasis) in children and adult
communities from Oradea , between 01-Jan-2001 and 31-Dec-2010 , has shown the following:
- On 42.902 of the interned patients at the Infectious Diseases Clinic , prevalence rate of giardiasis has
been 5,18% with monthly limits from 6,5% to 10,6% and high values during summer(30,3%) and
winter(25,5%)
- The infection has had a greater incidence on women(60,5%), women/men ratio of 1,5:1;
- 64,5% of cases originate from urban environment , thus resulting a urban/rural ratio of 1,8:1;
- Infection has had a increased incidence on young patients aged 15 to 24 , respectively 16,7% and adults
aged 25 to 34 , namely 18,2%
- Most frequent bilio-digestive symptoms have been abdominal pain(83,6%) , especially diffuse
pain(63,2%), followed by loss of apetite (76,8%) and pain on palpation (60,2%), diarrhea (19,7%)
- Amongst neuro-physical symptoms , most frequent has been asthenia (74%), headache(51,4%),
dizziness(14,4%), restlessness(10,2%), positive Chowstek sign (9,4%), memory disorder (6,6%)
- Nettle rash has been the allergic symptom most frequently met(18,2%), especially on children under 1
years old (100%)
- 44,9% of patients have had the symptoms for less than 7 days and 28,3% from 7 to 30 days
- 39,3% of patients have taken Metronidazole treatment , 32,5% Zentel treatment and 28,2% Eskazole
treatment
Research carried out on children from G1 Kindergarten and Placement Center CP in 2005 and on
children from G2 Kindergarten in 2001 , have shown the following:
- The highest value of prevalence for Giardia spp infection has been recorded in Kindergarten G2 ,
namely 58% , followed by the Placement Center CP , namely 30% , while at Kindergarten G1 prevalence
has been 4,35%, with higher values on males cases than on female cases (32,73% versus 31,15%)
- Infection has had a higher incidence on children aged 0-5 (34,92%) in comparison to those aged 5-10
(28,3%)
- Prevalence of Giardia spp infection has been 1,5 times higher on children with digestive
symptoms(44,44%) in comparison to those without other symptoms
- Highest infection prevalence with Giardia spp has been observed on children suffering from different
allergies in their pathologic history (40,91%)
- PR of children which have consumed bottled water has been 44,19% , of children which have
consumed fountain water - 30% and of children which have consumed water from the city network -
21,43%
- Prevalence of Giardia spp infection on children owning an indoor bathroom has been 32% and on
children owning an outdoor bathroom - 31,25%
- Prevalence of Giardia spp infection on children owning pets has been 36,36%
Clinical , paraclinical and therapeutic investigations carried out on patients interned at the Infectious
Diseases Clinic of Oradea , Bihor County , between 01-Jan-2005 and 30-May-2005 , have shown the following:
o On 1415 of the patients , giardiasis prevalence rate has been of 2,97% with monthly limits between
1,87% and 4,89%
o Infection has had an high incidence on children aged 5 to 10 (11,79%), on youngsters aged 15 to 20
(14,28%) and on adults aged 45 to 55 and 65 to 75 (16,66%)
o 42,86% of the positive patients came from rural environment and 57,14% from urban environment
o On 47,62% of the Giardia spp infected patients association with acute cholecystitis has been revealed ,
on 23,81% association with allergo-dermia , on 23,81% association with acute gastritis and on 11,90%
association with hypocalcaemia
o Patients have frequently shown the following on internment: diffuse abdominal pain - 95,24% ,
asthenia- 97,62% , diarrhea - 83,33% , vomit - 73,81% , nausea - 71,43% and erythematous skin
eruption - 23,81%
o The main high haematological and biochemical blood parameters, on giardiasis affected patients have
been: eosinophils , VSH , transaminases (TGO,TGP), glucose and total bilirubin
o Giardiasis has often evolved on hospitalized patients in association to other digestive parasitosis -
amebiosis and trichocefalosis
o Antiparasitic treatment with Flagyl (Metronidazole) , Eskazol (Albendazole) and Zentel (Albendazole)
has had maximum efficiency (100%)
Research carried out between Oct-2009 and Dec-2010 , on dogs and cats , have been finalized with the
following conclusions:
- Prevalence of the Giardia spp infection on dogs tested through flotation method, has been 8,5%(47/551)
No positive probes have been identified on cats through this method
24
- Tested through immunoenzymatic coproEliza method , infection prevalence on dogs has been 39,2%
(147/375), and on cats - 27,9%(51/183)
- Identified risk factors on dogs have been: age (under 1 year old: 0,04 - 0,001), environment (urban:
p<0,02 - 0,000007) and dog category (raised in communities: p<0,004 - 0,0004)
- Identified risk factors on cats have been: age(under 6 months old: p - 0,03) and presence of clinical
symptoms(p - 0,04)

SELECTIVE REFERENCES


6. Thompson R.C.A., 2002a, Towards a better understanding of host specificity and the transmission of
Giardia The impact of molecular epidemiology, In:Olson, B.E., Olson, M.E., Wallis, P.M., Giardia: The
Cosmopolitan Parasite. CAB International, Wallingford, UK, p.55-69.
16. Lallea M., Pozioa E., Gioia Capellib, Bruschic F., Daniele Crottid, SIMONE M. Caccio, 2005, Genetic
heterogeneity at the b-giardin locus among human and animal isolates of Giardia duodenalis and identification
of potentially zoonotic subgenotypes, International Journal for Parasitology 35, p. 207213.
17.Monis P.T., Caccio S.M., Thompson R.C.A., 2009, Variation in Giardia: towards a taxonomic revision of
the genus, Trends Parasitology, 25(2):p.93-100.
18.Thompson R.C.A., Monis P.T., 2004, Variation in Giardia: implications for taxonomy and epidemiology,
Adv. Parasitology 58: p. 69-137.
35. Cooper M.A., Adam RD., Worobey M., Sterling C.R., 2007, Population genetics provides evidence for
recombination in Giardia, Curr. Biol. 17, 19841988
36. Lujan H.D., 2006, Giardia and giardiosis, Medicina (Buenos Aires) nr. 66(1), p. 70-74.
40. Mc Donnell P.A., Scott K.G., Teoh T.A.,Olson M.E., Upcroft J .A., Buret A.G., 2003, Giardia duodenalis
trophozoites isolated froma parrot Caatua galerita colonize the small intestinal tracts of domestic kittens and
lambs, Veterinaty Parasitology nr. 20, p. 31-46.
106. Chin A.C., Desiree A. T., Scott K.G.E., Meddings J .B., McNaughton W.K., Buret A.G., 2002, Strain-
dependent induction of enterocyte apoptosis by Giardia lamblia disrupts epithelial barrier function in a caspase-
3-dependent manner, Infect. Immun., 70, p. 36733680.
107. OHandley R.M., Ceri H., Anette C., Olson M.E., 2003, Passive immunity and serological immune
response in dairy calves associated with natural Giardia duodenalis infections, Veterinary Parasitology 113, p.
89.
108. Itoh N., Muraoka N., Saeki H., Aoki M., Itagaki T., 2005, Prevalence of Giardia Intestinalis in Dogs of
Breeding Kennels in J apan., J. Vet. Med. Sci. 67(7), p. 717-718.
109. Thompson R.C.A., 2000, Giardiasis as a re-emerging infectious disease and its zoonotic potential, Int.
Journal Parasitology 30, p. 1259-1267.
110. Sackey M.E., Weigel M.M., Armijos R.X., 2003, Predictors and nutritional consequences of intestinal
parasitic infection in rural Ecuadorian children, Journal of Tropical Pediatry 49, p. 17-23























25
CURRICULUM VITAE

1.Name and surname: J arca Adriana Gabriela
2. Date and birth place: 29.09.1976 , Oradea , Bihor
3. Marital status: divorced
4. Adresss: Oradea, B-dul Dacia, nr. 54, bl U4, ap 30
5. Phone no: 0723669959
6. E-mail adress: j.adriana9@gmail.com
7. Studies:
Crt.no. Higher education institution Domai n Period
Granted title/Obtained
degrees and diplomas
1.
National College E. Gojdu, Oradea

Mathematics-physics 1991-1995 Baccalaureate degree

2.
Faculty of Medicine and Pharmacy ,
University of Oradea
General medicine 1995-2001 License degree

3.
Clinical County Hospital of Oradea General medicine 2001-2002 Internship degree

4.
Clinical County Hospital of Oradea 2003-2008 Resident medic

5.
Faculty of Veterinary Medicine, Cluj-
Napoca
By transfer to UMF Cluj-Napoca
Veterinary
parasitology
Human parasitology
2005-2007

2007-2011
Ph.D.

6.
Faculty of Medicine and Pharmacy ,
University of Oradea
Infectious diseases 2008 Infectious diseases specialist

8. Specialization , qualifications and postgraduate studies:
Crt.no. Higher education institution Course title Period
1.
Department for Training and Improvement of
Teaching Staff , University of Oradea
Master - professor's formation 2004-2005
2. Faculty of Veterinary Medicine , Cluj-Napoca

Master - Morfo-pathologic and
laboratory diagnosis
2003-2004

3.
University of Medicine and Pharmacy ,
Timisoara
Specialist MD 2008

9. Professional experience:
Crt.
no.
I nsti tuti on Domai n Period
Title/didactic degree
or professional
degree/position
1. Clinical County Hospital of Oradea Medicine 2002-2003 Internship medic
2. Faculty of Medicine and Pharmacy ,
University of Oradea
General medicine 2003-present Assistant professor
3. Clinical County Hospital of Oradea General medicine 2003-2008 Resident MD in
Infectious Diseases
4. Faculty of Medicine and Pharmacy ,
University of Oradea
Infectious diseases 2008-present Specialist MD in
Infectious diseases
5. Universitary hospital of
Chochene,Parasitology department -
Tropical diseases, Paris, France
Study scholarship Nicolae
Titulescu

2006 Ph.D.
6. Faculty of Veterinary Medicine ,
Lisbon , Portugal
Study scholarship
"Socrates


2004 Master
26

10. Actual job / position / period: University of Oradea , Faculty of Medicine and Pharmacy, Department of
Psycho-Neurological Science and Recovery , Infectious Diseases class/ 2003-present
11. Actual job age (total/actual job): 9 years
12. Invention patents:
13. Published work (total no.): 55
13.1. Ph.D. thesis:
13.2. Developed didactic material(courses, laboratory books , course support - electronic format): 2
laboratory books
13.3. Books , monographs , treaties:
13.4. Scientific works relevant for specialty (max.5 works):
1. Mircean Viorica, Gyorke Adriana, J arca Adriana, Cozma Vasile, Prevalence of Giardia species in stool
samples by ELISA in household cats fromRomania and risk factors, Journal of Feline Medicine and Surgery,
13, ISBN 1098-612X p. 479-482, 2011.
2. J arca Adriana, Jarca Cosmin, Csep Andrei, Negru Nicoleta, Popoviciu Mihaela, Epidemiologycal Research
on Giardiosis Affected Humans, Annals of the University of Oradea, Environmental Protection Fascicule, vol
XIV, 14th year, University of Oradea publishing, ISSN 1224-6255, ISSN 1583-4301, p. 1567-1570, 2009.
3. J arca Adriana, Jarca Cosmin, Clinical, paraclinical and epidemiologycal research on giardiosis affected
humans, Annals of the University of Oradea, Environmental Protection Fascicule, vol XIV, 14th year, published
by University of Oradea, ISSN 1224-6255, ISSN 1583-4301, p. 1561-1563, 2009.
4. J arca Adriana, Mircean Viorica, Pop R., Titilincu Adriana, Avram A., Cozma V., Comparative value of
some diagnostic methods in giardiosis of dogs, Scientific works,Veterinary medicine Timisoara, vol XLI, ISSN
1221-5295, published by Mirton printing , p. 379-384, 2008.
13.5. Cumulated experience in other national/international/grants/contract programs:
4. Research regarding diagnosis , epidemiology and control of hidatidosis-echinococozis on animals, in the N-V
and center area of Romania , project CNCSIS , code 756(2004-2006).
5. Constitution of a national network regarding the study of parasitic zoonozis and it's implications in food
safety, project CEEX Module 3 , Contract 78/2006 (2006-2007)
6. Interdisciplinary evaluation and optimization of screening methods , diagnosis and treatment in trichinosis
and human/animal cyst echinococozis in the center and N-V area of Romania. Project CEEX Module 1, contract
99/2006(2006-20080)
14. Member of professional associations:
2006- Member of the Parasitology Society of Romania;
2008- Member of the Infectious Diseases Society of Romania;
15. Foreign languages:
Language
English
French
Reading
Medium
Medium
Understanding
Medium
Medium
Speech
Medium
Medium
Writing
Satisfying
Satisfying

16. Other skills: PC operating, driver's license
17. Specializations and qualifications: 5-03-2008 - specialist MD
18. Other mentions (awards, distinctions etc):
19. Presentation of anterior didactic activities:
- laboratory classes - Infectious diseases , Department of Psycho-Neurologic science and Recovery,
Faculty of Medicine and Pharmacy, University of Oradea;
20. Administrative activity:
- structuring the Infectious Diseases laboratory hours at the Infectious Diseases Clinic of Oradea,
Infectious Diseases specialty, University of Oradea;
I declare on my own responsibility that the presented data is in compliance with reality.




Date:
10-01-2012 Signature:
Assist.Prof.M.D. Jarca Adriana Gabriela