Molecular Epidemiology and Assemblage Typing of Giardia duodenalis in School-Age Children Situated along the Southern Shoreline of Lake Malawi, Malawi

Author:

Archer John1,Cunningham Lucas J.1,Juhàsz Alexandra12,Jones Sam1,Doull Ffion1,LaCourse James E.1,Mainga Bright34,Makaula Peter4,Kayuni Sekeleghe A.1456,Musaya Janelisa45,Stothard J. Russell1

Affiliation:

1. Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;

2. Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary;

3. Laboratory Department, Mangochi District Hospital, Mangochi, Malawi;

4. Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi;

5. Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi;

6. MASM Medi Clinics Limited, Medical Aid Society of Malawi, Area 12 Medi Clinic and Head Office, Lilongwe, Malawi

Abstract

ABSTRACT. Almost all human giardiasis infections are caused by Giardia duodenalis assemblages A and B. Differentiation between human infections with these assemblages, as well as between single-assemblage (A or B) and mixed-assemblage (A and B) infections, is therefore needed to better understand the pathological impact of infection with either, or both, assemblages. We assessed the prevalence of G. duodenalis assemblages A and B using 305 fecal samples provided by school-age children situated along the southern shoreline of Lake Malawi. Concurrently, intestinal pathology data were also collected to test for association(s) between assemblage infection status and intestinal health. Prevalence of G. duodenalis infection was 39.3% by real-time polymerase chain reaction. Of all identified infections, 32% were single G. duodenalis assemblage A and 32% were single G. duodenalis assemblage B, whereas 33% were mixed-assemblage infections. Fifteen unique G. duodenalis assemblage A and 13 unique G. duodenalis assemblage B β-giardin haplotypes were identified. There was a positive association between single infection with G. duodenalis assemblage B and both self-reporting of abdominal pain (odds ratio [OR]: 3.05, P = 0.004) and self-reporting of diarrhea (OR: 3.1, P = 0.003). No association between single infection with assemblage A and any form of intestinal pathology was found. Additionally, there was a positive association between mixed-assemblage infections and self-reporting of abdominal pain (OR: 3.1, P = 0.002). Our study highlights the importance G. duodenalis assemblage typing and reaffirms the need for improved access to water, sanitation and hygiene infrastructure in rural areas of low- and middle-income countries.

Publisher

American Society of Tropical Medicine and Hygiene

Subject

Virology,Infectious Diseases,Parasitology

Reference74 articles.

1. Giardia and giardiasis;Thompson,1993

2. Advances in understanding Giardia: determinants and mechanisms of chronic sequelae;Bartlet,2015

3. Cryptosporidium and Giardia Infections in Children: a review;Mmbaga,2017

4. Cryptosporidium and Giardia in Africa: current and future challenges;Squire,2017

5. Molecular characterisation and taxon assemblage typing of giardiasis in primary school children living close to the shoreline of lake Albert, Uganda;Al-Shehri,2019

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