Clinical characteristics versus human leukocyte antigen class-II DRB1 alleles profiles and fecal calprotectin level in Giardia lamblia-infected children

Abstract

Background: Giardia lamblia is a global enteric protozoan causing giardiasis, a disease characterized by different clinical presentations ranging from loss of appetite, abdominal pain, steatorrhea, nausea, vomiting to severe malabsorption syndrome, but the majority of infected children are asymptomatic, especially in developing countries. The clinical outcome may be associated with fecal calprotectin released in the bowel in case of inflammation and human leukocyte antigen (HLA) class-II DRB1 alleles that play a crucial role in the immune system. Objectives: To reveal any association between fecal calprotectin and the development of symptomatic or asymptomatic giardiasis. Also, to highlight the influence of HLA class-II DRB1 alleles on clinical manifestations of G. lamblia-infected children. Subjects and Methods:The study included 160 children: 80 healthy children (control), 40 Giardiapositive children with gastrointestinal symptoms (symptomatic group), and 40 Giardia-positive children without gastrointestinal manifestations (asymptomatic group). Fecal calprotectin was measured using ELISA, and HLA class-II was typed by PCR. Results: The commonest presentation of giardiasis was abdominal pain. Fecal calprotectin level was elevated (141.40±67.7-183±48.21 µg/gm) in children with giardiasis, mainly among asymptomatic group. HLA class-II DRB1*03:01 and *13:01 alleles were significantly associated with incidence of giardiasis (P<0.0005). A significant association of the heterozygous allotype HLA-DRB1*03:01/03:02 was recorded with giardiasis manifestations, mainly abdominal pain (P=0.026). Conclusion:Fecal calprotectin can be used as a marker of G. lamblia-induced intestinal inflammation. HLA class-II DRB1*03 and DRB1*13 alleles likely underlie clinical variability of giardiasis. This association may clarify why giardiasis does not occur in significant number of children exposed to the parasite. Calprotectin versus HLA in giardiasisElBlihy et al.

Giardia duodenalis Genotyping Not Linked to Clinical Symptomatology and Nutritional Status of School-Aged Children of Soledad and Galapa Municipality Schools, Atlántico, Colombia

“…For Giardia, the factors that determine the variability of the clinical manifestations are not completely clarified, from the clinical point of view, although attempts have been made to relate the diagnosis of some Giardia genotypes to the known clinical manifestations (Sahagun et al, 2008;Mohammed-Mahdy et al, 2009;Al-Huchaimi et al, 2020). This type of approach to the infectious problem has generated controversy among some scientists specializing in parasitic issues, since, according to their criteria, the clinical manifestations depend on many variables, among which are the nutritional and immunological status of the child, age, and factors associated with the parasite, such as the genotype (Lebbad et al, 2011;Veenemans et al, 2011;Ignatius et al, 2012;Oliveira-Arbex et al, 2016;ElBlihy et al, 2020), so it is important to implement a technique that allows infectious genotypes in hosts to be distinguished (Rodrı´guez-Gutie´rrez, 2014). In addition, protocols should include a rigorous clinical follow-up of the patient to establish an adequate treatment protocol that includes more than 1 variable, such as the molecular characteristics of the parasite, the nutritional and hygienic aspects of the patient, as well as clinical parameters (Molina, 2009).…”