Giardiasis: Impact on child growth

Abstract

Chronic disorders of the gastrointestinal tract may impair physical growth during infancy and childhood. Growth retardation has been particularly well documented in children with Crohn's disease and coeliac disease in which growth retardation may occur in the absence of gastrointestinal symptoms. Recurrent and persistent infection in infancy and childhood is also associated with growth retardation, the major offenders being infections of the respiratory and gastrointestinal tracts. The pathogenic mechanisms of growth disturbance in chronic disease are poorly understood. Possible candidates include reduced dietary intake as a result of anorexia, food withholding following cultural practice or physician's advice and increased energy expenditure associated with fever and infection. Nutritional deprivation due to intestinal malabsorption is probably a less important factor in inflammatory bowel disease but may be more relevant in coeliac disease and infective disorders of the intestine. Although Giardia is now an established intestinal pathogen its relationship to child growth and development has not been clearly defined. However, giardiasis (1) frequently affects infants and children; (2) is known to cause morphological damage of the small intestine and malabsorption of a variety of nutrients 15 ; (3) is not always a self-limiting infection and may persist for many weeks or months; (4) has been shown to impair physical growth in some individuals with Giardia infection. There is, however, very little population-based data on the effect of Giardia infection on physical growth during infancy and childhood and thus the impact of this parasite at a community level is largely unknown. The parasite may be excreted by apparently asymptomatic individuals and thus before widespread strategies for the control of this infection are introduced the extent of its clinical impact must be established.