To investigate whether atopic disease influences the prevalence of irritable bowel syndrome (IBS) and chronic fatigue (CF) after giardiasis.
A questionnaire was sent to all confirmed cases of giardiasis after a Norwegian outbreak, with response rate of 65.3% (817/1252). Controls were randomly selected matched on age and sex, with response rate of 31.4% (1128/3598). Associations were evaluated by use of logistic regression analyses.
In the Giardia exposed group, 47.8% of those with asthma had IBS compared with 45.3% in those without asthma (p = 0.662). For controls, corresponding percentages were 23.9% and 12.2% (p
To document clinical characteristics of influenza-like illness, reported use of health preventive measures and attitudes towards vaccination among patients with influenza-like illness in general practice during the influenza pandemic in 2009.
Cross-sectional survey in general practice. Patients, who were identified as having influenza-like illness during the peak of the influenza pandemic activity in Norway, were eligible for inclusion in the study. A questionnaire was sent 2-4 weeks after the patients visit to the GP with influenza-like illness diagnosis during October to December 2009, from general practices in Norway. A sample of responders >18 years also had a blood test to check for serological response to the pandemic H1N1 virus.
Questionnaires were sent to 1324 patients, and 357 (27%) were returned. Fever (91% versus 49%, P
Giardia lamblia is a common cause of gastroenteritis worldwide, but there is limited knowledge about the long-term complications.
To estimate the relative risk of irritable bowel syndrome (IBS) and chronic fatigue 3 years after acute giardiasis.
Controlled historic cohort study with 3 years' follow-up. Data collected by mailed questionnaire.
Waterborne outbreak of giardiasis in the city of Bergen, Norway.
817 patients exposed to Giardia lamblia infection verified by detection of cysts in stool samples and 1128 matched controls.
IBS and chronic fatigue.
The prevalence of IBS in the exposed group was 46.1%, compared with 14.0% in the control group, and the adjusted RR=3.4 (95% CI 2.9 to 3.8). Chronic fatigue was reported by 46.1% of the exposed group and 12.0% of the controls, the adjusted RR was 4.0 (95% CI 3.5 to 4.5). IBS and chronic fatigue were associated and the RR for the exposed group of having a combination of the two outcomes was 6.8 (95% CI 5.3 to 8.5). The RR was also increased for having just one of the two syndromes, 1.8 for IBS (95% CI 1.4 to 2.3) and 2.2 for chronic fatigue (95% CI 1.7 to 2.8).
Infection with Giardia lamblia in a non-endemic area was associated with a high prevalence of IBS and chronic fatigue 3 years after acute illness, and the risk was significantly higher than in the control group. This shows that the potential consequences of giardiasis are more serious than previously known. Further studies are needed, especially in areas where giardiasis is endemic.
Functional gastrointestinal disorders and fatigue may follow acute infections. This study aimed to estimate the persistence, prevalence, and risk of irritable bowel syndrome and chronic fatigue 6 years after Giardia infection.
We performed a controlled prospective study of a cohort of 1252 individuals who had laboratory-confirmed Giardia infection during a waterborne outbreak in 2004. In total, 748 cohort cases (exposed) and 878 matched controls responded to a postal questionnaire 6 years later (in 2010). Responses were compared to data from the same cohort 3 years before (in 2007).
The prevalences of irritable bowel syndrome (39.4%) by Rome III criteria and chronic fatigue (30.8%) in the exposed group 6 years after giardiasis were significantly elevated compared with controls, with adjusted relative risks (RRs) of 3.4 (95% confidence interval [CI], 2.9-3.9) and 2.9 (95% CI, 2.3-3.4), respectively. In the exposed group, the prevalence of irritable bowel syndrome decreased by 6.7% (RR, 0.85 [95% CI, .77-.93]), whereas the prevalence of chronic fatigue decreased by 15.3% from 3 to 6 years after Giardia infection (RR, 0.69 [95% CI, .62-.77]). Giardia exposure was a significant risk factor for persistence of both conditions, and increasing age was a risk factor for persisting chronic fatigue.
Giardia infection in a nonendemic setting is associated with an increased risk for irritable bowel syndrome and chronic fatigue 6 years later. The prevalences of both conditions decrease over time, indicating that this intestinal protozoan parasite may elicit very long-term, but slowly self-limiting, complications.
Studies have shown an increased prevalence of irritable bowel syndrome (IBS) after acute gastroenteritis. Food as a precipitating and perpetuating factor in IBS has gained recent interest, but food intolerance following gastroenteritis is less investigated. The aims of this study were firstly, to compare perceived food intolerance in a group previously exposed to Giardia lamblia with a control group; secondly, to explore the relation with IBS status; and thirdly, to investigate associations with content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) in foods reported.
This is a historical cohort study with mailed questionnaire to 1252 Giardia exposed and a control cohort matched by gender and age. Differences between groups were investigated using bivariate and multivariate analyses.
The questionnaire response rate in the exposed group was 65.3 % (817/1252) and in the control group 31.4 % (1128/3598). The adjusted odds ratio (OR) for perceived food intolerance for the exposed group was 2.00 with 95 % confidence interval (CI): 1.65 to 2.42, as compared with the control group. Perceived intolerance for dairy products was the most frequently reported intolerance, with an adjusted OR for the exposed of 1.95 (95 % CI: 1.51 to 2.51). Perceived intolerance for fatty foods, vegetables, fruit, cereals and alcohol was also significantly higher in the exposed group. The groups did not differ in perceived intolerance to spicy foods, coffee or soda. The association between exposure to Giardia infection and perceived food intolerance differed between the IBS group and the no-IBS group, but IBS was not a significant effect modifier for the association. Perceived intolerance for high FODMAP foods (adjusted OR 1.91) and low FODMAP foods (adjusted OR 1.55) was significantly associated with exposure status.
Exposure to Giardia infection was associated with perceived food intolerance 3 years after giardiasis. IBS status did not alter the association between exposure status and perceived food intolerance. Perceived intolerance to high FODMAP foods and low FODMAP foods were both statistically significantly associated with exposure to Giardia infection.
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To investigate in a cohort with previous gastrointestinal infection and a control group the prevalence of overactive bladder syndrome (OAB), and how it was associated with three other functional disorders; irritable bowel syndrome (IBS), functional dyspepsia (FD) and chronic fatigue (CF).
Controlled historic cohort study including 724 individuals with laboratory confirmed giardiasis six years earlier, and 847 controls matched by gender and age. Prevalence and odds ratios (OR) with 95 % confidence intervals (CI) were calculated.
The prevalence of OAB was 18.7 % (134/716) in the exposed group and 13.6 % (113/833) in the control group (p = 0.007). The association between OAB and IBS was strong in the control group (OR: 2.42; 95 % CI: 1.45 to 4.04), but insignificant in the Giardia exposed (OR: 1.29; 95 % CI: 0.88 to 1.88). The association between OAB and FD was weak in both groups. CF was strongly associated with OAB (OR: 2.73; 95 % CI: 1.85 to 4.02 in the exposed and OR: 2.79; 95 % CI: 1.69 to 4.62 in the controls), and this association remained when comorbid conditions were excluded.
Sporadic IBS was associated with increased risk of OAB, whereas post-infectious IBS was not. An apparent association between OAB and previous Giardia infection can be ascribed to comorbid functional disorders.
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BACKGROUND: A high rate of post-infectious fatigue and abdominal symptoms two years after a waterborne outbreak of giardiasis in Bergen, Norway in 2004 has previously been reported. The aim of this report was to identify risk factors associated with such manifestations. METHODS: All laboratory confirmed cases of giardiasis (n = 1262) during the outbreak in Bergen in 2004 received a postal questionnaire two years after. Degree of post-infectious abdominal symptoms and fatigue, as well as previous abdominal problems, was recorded. In the statistical analyses number of treatment courses, treatment refractory infection, delayed education and sick leave were used as indices of protracted and severe Giardia infection. Age, gender, previous abdominal problems and symptoms during infection were also analysed as possible risk factors. Simple and multiple ordinal logistic regression models were used for the analyses. RESULTS: The response rate was 81% (1017/1262), 64% were women and median age was 31 years (range 3-93), compared to 61% women and 30 years (range 2-93) among all 1262 cases. Factors in multiple regression analysis significantly associated with abdominal symptoms two years after infection were: More than one treatment course, treatment refractory infection, delayed education, bloating and female gender. Abdominal problems prior to Giardia infection were not associated with post-infectious abdominal symptoms. More than one treatment course, delayed education, sick leave more than 2 weeks, and malaise at the time of infection, were significantly associated with fatigue in the multiple regression analysis, as were increasing age and previous abdominal problems. CONCLUSION: Protracted and severe giardiasis seemed to be a risk factor for post-infectious fatigue and abdominal symptoms two years after clearing the Giardia infection.
In April 2009 the World Health Organization (WHO) declared that spreading of a new influenza A(H1N1) virus had reached epidemic proportions, and on June 11, 2009 they declared that the world was in fact facing a pandemic. In Norway the influenza pandemic was the cause of much activity from health authorities and all levels of the health services. This report concerns pandemic-related work within clinical and community medicine in a municipality in western Norway.
All contacts between the general practitioners (GPs) and patients with influenza-like disease in Austevoll municipality were recorded for the second half of 2009. The lead public health nurse recorded vaccination activity systematically. Absence from secondary school in the municipality was recorded and the Medical Health Officer recorded all pandemic-related activities.
141 patients living in the municipality (3.2 % of the population) contacted the GP for influenza-like disease. Most cases occurred during weeks 43-47. A large majority of the encounters with the GP during these weeks were with patients below 20 years of age, whereas the age distribution was much more diverse at other points in time. Absence from secondary school was also highest in weeks 43-47. 54 % of the municipality's inhabitants were vaccinated. At the end of the main wave of the epidemic, vaccination coverage had reached 28 %. The Medical Health Officer had a large workload, especially during the main wave.
The influenza epidemic in 2009 hit Austevoll municipality in weeks 43-47. Mass vaccination was started too late to have a major influence on the epidemic. Systematic mapping of the epidemic on a municipal level is a useful supplement to the national surveillance.
Comment In: Tidsskr Nor Laegeforen. 2011 Jun 17;131(12):118021694740
There was a large community outbreak of giardiasis in Bergen in the autumn of 2004 that was acknowledged about two months after the first patients became ill. The aim of this article is to describe the diagnostic approach of clinicians faced with an unexpected problem, and how they reacted when communicable disease was detected.
A focus group interview was conducted with six of the 18 doctors who had requested stool examinations from patients in October 2004 with the aim of detecting parasites. This was after the first patients became ill, but before the outbreak was widely recognized.
Discussions among doctors were instrumental, both in reaching the correct diagnosis, and in acknowledging a possible outbreak in the community. There was no uniform approach to reaching the diagnosis, but rather a common unravelling of a mutual problem. Doctors contacted or tried to make contact with public health authorities when at least one case was confirmed and this case was linked to other patients with diarrhoeal disease.
Clinicians need meeting places where they can discuss problems that arise in everyday practice. Public health authorities and clinicians need better procedures for warning, reception and follow-up when outbreaks of communicable diseases are suspected.