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Clin Infect Dis. 2014 Nov 15;59(10):1394-400. doi: 10.1093/cid/ciu629. Epub 2014 Aug 12.

Irritable bowel syndrome and chronic fatigue 6 years after giardia infection: a controlled prospective cohort study.

Author information

  • 1Department of Clinical Science, University of Bergen.
  • 2Research Unit for General Practice, Uni Research Health.
  • 3Research Unit for General Practice, Uni Research Health Department of Global Public Health and Primary Care, University of Bergen.
  • 4Department of Global Public Health and Primary Care, University of Bergen Centre for Clinical Research.
  • 5National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.

Abstract

BACKGROUND:

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.

METHODS:

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).

RESULTS:

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.

CONCLUSIONS:

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.

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

KEYWORDS:

Giardia; chronic fatigue; irritable bowel syndrome; postinfectious

PMID:
25115874
[PubMed - indexed for MEDLINE]
PMCID:
PMC4207419
Free PMC Article
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