Pediatric emergency medicine trisk 2322 2322
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Giardia
Giardiasis is caused by Giardia intestinalis, a protozoan spread by fecal–oral
transmission. While humans are the primary reservoir, domesticated and wild
animals can also be infected. Most U.S. outbreaks have been associated with
contaminated drinking water, daycare facilities, and food handlers. One-half to
three-quarters of infections are asymptomatic. Symptoms include malodorous
watery, nonbloody diarrhea, flatulence, abdominal pain, and weight loss. Anemia
may be noted. Children with humoral immunodeficiencies can develop chronic
symptomatic infection. The diagnosis is based on EIA or direct fluorescent
antibody (DFA) assays, which have sensitivity and specificity far superior to
identification of organisms in the stool. Treatment is not needed for self-limited
infections in normal hosts, and treatment of asymptomatic carriers is not
recommended unless they live in the home with an immunocompromised person.
For patients requiring treatment, metronidazole (5 mg/kg every 8 hours
[maximum: 250 mg/dose for 5 to 7 days]), tinidazole (single dose, licensed for
children 3 years of age and older: 50 mg/kg [maximum: 2 g]), or nitazoxanide
(3-day course for children 1 year of age and older: 1 to 3 years: 100 mg twice
daily, 4 to 11 years: 200 mg twice daily, ≥12 years: 500 mg twice daily) are
options. Standard and contact precautions should be used for the incontinent
child.
Cryptosporidium
Cryptosporidiosis is caused by C. parvum and C. hominis, protozoal species
spread by fecal–oral transmission. Humans, cattle, and other animals are
reservoir species. In the United States, almost 8,000 cases occur annually, so a
travel history is not a prerequisite for infection. Risk factors include swallowing
contaminated water (including at hotel swimming pools), hiking and drinking
unfiltered water, daycare attendees, workers, and the families of children who
attend day care, and travelers. Asymptomatic infection can be seen. Most
patients will develop low-grade fever, watery, nonbloody diarrhea with crampy
abdominal pain, vomiting, and weight loss. Symptoms last 1 to 2 weeks,
although more severe and chronic symptoms can be seen in HIV-infected
patients
and
other
immunocompromised
hosts.
In
addition,
immunocompromised children can develop extraintestinal manifestations: biliary
tract and pneumonitis. DFA and EIAs are more sensitive than detection of
oocytes in stool. Self-limited illness in immunocompetent hosts usually does not
require treatment. Nitazoxanide is approved for children 1 year of age and older
(3-day course for children 1 year of age and older: 1 to 3 years: 100 mg twice
