Lambliasis A07.1

Integument: Skin manifestations are rather rare. Polymorphous exanthemas have been observed, which are not very specific in appearance, mostly with urticarial, psoriasiform, bullousor pustular skin lesions. Further described are paronychia, diffuse alopecia, rectal erosions.

Of note is the occurrence of a phrynoderm associated with chronic giardiasis (Girard C et al 2006).

Extracutaneous manifestations: Acute and chronic enteritis, occasionally with malabsorption syndrome.

• Metronidazole (e.g. Clont) daily ED of 2 g with breakfast on 3 consecutive days (children: 30 mg/kg bw/day for 3 days).
• Alternatively: Tinidazole (e.g. Simplotan) 2 g/day as a single dose or Nimorazole (Esclama) 4 times/day 500 mg p.o. for 7 days.
• Alternatively ( Off-Label-Use): Nitazoxanid (e.g. Alinia): 2 times/day 500 mg p.o. for 3 days.
• Compensation of the malabsorption syndrome with vitamin-rich nutrition.

Remember! Do not consume alcohol when taking metronidazole and tinidazole!

Girard C et al (2006) reported a 6-year-old boy with an unusual form of phrynoderma characterized by multiple tiny digital hyperkeratoses due to severe vitamin A and C deficiency as a complication of chronic intestinal giardiasis. The lesions responded well to oral vitamin A and C in combination with albendazole treatment.

1. Dobell C (1932) Antony van Leeuwenhoek and his "little animals." John Bale Sons and Danielsson, London.
2. Lambl V (1859) Microscopic studies of the intestinal excreta. Contribution to the pathology of the intestine and to diagnosis at the bedside. Viert Prakt Heilkd (Prague) 61: 1-57
3. Girard C et al (2006) Vitamin a deficiency phrynoderma associated with chronic giardiasis. Pediatr Dermatol 23:346-349.
4. Stiles CW (1902) Parasitological observations made in Orange county, Florida. Helminth Soc Wash 19: 90