Comparison of Giardia lamblia infection status in asymptomatic and symptomatic pediatric heart transplant patients: A parasitic infection assay

Abstract

Background: Giardiasis is one of the opportunistic infections in immunocompromised patients, especially organ transplant recipients. Regarding to the importance of this issue, the aim of this study was to investigate the Giardia lamblia infection status in children with heart transplantation.

Method: A prospective cross-sectional study was conducted on 53 cardiac transplant recipients (aged 1–17 years). Transplant patients were on oral administration of Trimethoprim / Sulfamethoxazole (TMP-SMX) from the first day of transplantation as a prophylaxis regimen. Giardia lamblia status was evaluated by phenotypic assay and Polymerase chain reaction (PCR) on stool samples.

 Results: Out of 53 patients studied, 11 (20.75%) cases had gastrointestinal and 42 (79.25%) patients had no gastrointestinal symptoms. There was no significant difference in the frequency of underlying disorder resulted in heart transplantation in two groups (p = 0.13) .The frequency of Giardia lamblia infection was 3 (27.27%) in the symptomatic group and zero in the asymptomatic group (p <0.0001). All three patients whose stool exams were phenotypically positive for Giardia were confirmed with PCR. Out of three, Two Giardia lamblia isolates were found to have genotype B while one isolate had genotype A. All of the Giardia positive patients suffered from chronic diarrhea and anorexia. Cryptosporidium spp, Isospora belli and Blastocysts spp were not found in these cases.

Conclusion:  Incidence of Giardia lamblia infection in pediatric heart transplant patients is considerable and should be noted. A comprehensive guideline for assessment of Giardia lamblia before and after transplantation is suggested.