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A Comparative Study of Four Methods for Detecting Giardia Lamblia in Children With Diarrheal Disease and Malabsorption

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      Four methods for detecting Giardia lamblia, namely examinations of stools, duodenal aspirates, intestinal biopsies, and impression smears of intestinal mucosa, were evaluated prospectively in 21 Malaysian children with acute or chronic diarrheal disease or with malabsorption. The parasites were detected by one or more of these methods in 12 patients. Although stool examinations were diagnostic in only 6 patients, duodenal aspirates were positive in 10. All 12 infections could have been detected if results of examination of stools and duodenal aspirates were combined. Mucosal impression smears and biopsies gave the highest yield of positive tests; they were diagnostic in all 12 patients in whom parasites were detected by any of the diagnostic methods. Detection of parasites in biopsies was a tedious and time-consuming process, requiring careful scrutiny of several sections before positive identifications could be made. In contrast, evaluation of mucosal impression smears for parasites was easier and quicker than examining biopsies. Examination of mucosal impression smears for G. lamblia is recommended as a useful initial step in the routine evaluation of intestinal biopsies.
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