[CIS PIDD] [cis-pidd] Boy with chronic giardiasis

[Church, Joseph]

I have been looking for secretory IgA deficiency for decades, perhaps this is one?  Consider salivary IgA level.

Joe Church
Children's Hospital Los Angeles

From: Leiding, Jennifer [mailto:jleiding at health.usf.edu]
Sent: Thursday, June 13, 2013 6:46 PM
To: CIS-PIDD
Subject: [cis-pidd] Boy with chronic giardiasis

Hi all:

I am following a little 6yo boy with chronic Giardia infection starting at age 4. He has intermittent symptoms of abdominal pain and diarrhea or loose stools. He has been treated with prolonged courses of metronidazole, paramomycin, and Alinia without effect. Endoscopy and colonoscopy were normal with the exception of Giardia on biopsy specimens from the colonoscopy.  He is thriving well and not losing weight.  There is no history of major infections  but does have frequent URI's. Other parasitic infections, cryptosporidium, and C. diff were ruled out. Vitamin deficiencies associated with chronic giardiasis were also ruled out.

He lives in an urban area and no one else in the family has been infected. He has an older brother who is healthy. His family had their water checked by the city and was normal with no parasites or other enteric organisms.

CMP is normal
CBC - normal with ALC 2700, ANC 3400 AEC 270
Diphtheria, tetanus, pneumococcal titers normal.
IgG 832, IgA 94, IgM 87, IgE 178
Absolute CD3 1707, CD4 1178, CD8 418, CD56 154, CD19 518
Normal endoscopy and colonoscopy other than Giardia found on biopsy slides
Vitamin C 1.62 vitamin A 30 folate 19.4

Does anybody have any ideas about further workup or management?

Thanks,
Jenny Leiding

Jennifer Leiding, MD
Assistant Professor
University of South Florida
Department of Pediatrics
Division of Allergy, Immunology, and Rheumatology
Children's Research Institute
140 - 7th Avenue South Box 9680
St. Petersburg, Florida 33701
Phone: 727.553.3519
Fax: 727.553.1295

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