The Use of Enzyme-linked immunosorbant assay in the Detection of G.Lamblia Antigens in Children with Persistent Diarrhea

Background: Persistent diarrhea is diarrhea with or without blood, which begins acutely but has long duration (at least 14 days). It may begin as watery diarrhea or as dysentery. It may lead to weight loss and if the volume of stool is great, there is risk of dehydration. Giardial infection is an important cause of persistent diarrhea. Antigen detection is a rapid and specific method for diagnosis of giardiasis. Aim: Is to evaluate the use of Enzyme- linked immunosorbant assay (ELISA) test (compared to the direct stool examination) as a diagnostic tool for G.Lamblia infection among patients with persistent diarrhea. Patients and methods: A cross sectional study done at Salahaldeen General Hospital among children aged between 6 months and 5 years of age during the period from the 1st of July 2018 to the last of February 2019. A total of 100 cases were eligible for inclusion in the study sample. Each patient was assessed by a prepared questionnaire including age, sex, residence, type of feeding and duration of diarrhea. Each patient was examined for weight and weight for height. Each patient was sent for general stool examination for 3 consecutive days. All the three stool samples of each patient was examined for the presence of giardia antigen by the use of ELISA test. Results: Only 23 cases (23%) have G.Lamblia infection. Male cases were 13 (56.5%) and Female were 10(43.5%). Most of the infected cases were from rural areas 17 cases (73.9%). The majority of cases were prevalent at the age group between 13-24 months 18 cases (78.3%). Most of the infected cases were on bottle feeding with added solid diet, 13 cases (56.5%). Most of the mothers of the giardia who infected children cases were illiterates, 20 cases (87%). There is no significant difference between the infected and non-infected cases regarding the nutritional state as most of the cases have moderate type of malnutrition for infected 18 (78.3%) and non-infected 55 (71.4%) cases. Most of the giardia cases have only cyst form of G.Lamblia 21 cases (91.3%). Regarding the use of ELISA test, only 19 cases (19%) show positive results. According to the results of first stool samples, only 8 cases (8 %) were positive for G.Lamblia infection by direct stool examination compared to 19 cases (19%) detected by stool antigens detection (ELISA test) which indicates significant highly sensitive test (82.6%) as compared to the direct stool exam( 34.8%). All the cases which were positive for G.Lamblia infection by ELISA test were confirmed to be positive by direct stool examination (100%) which indicates very high specificity (100%). Conclusions: It is concluded that antigen detection is more sensitive and specific than the direct wet stool sample in diagnosis of G.Lamblia infection and it is recommended for rapid and easy way for diagnosis of giardiasis.