Abstract

BackgroundA waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. The aim was to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection.MethodsPatients who reported persistent fatigue, lowered functional capacity and sickness leave or delayed education after a large community outbreak of giardiasis enteritis in the city of Bergen, Norway were evaluated with the established Centers for Disease Control and Prevention criteria for CFS. Fatigue was self-rated by the Fatigue Severity Scale (FSS). Physical and mental health status and functional impairment was measured by the Medical Outcome Severity Scale-short Form-36 (SF-36). The Hospital Anxiety and Depression Scale (HADS) was used to measure co-morbid anxiety and depression. Inability to work or study because of fatigue was determined by sickness absence certified by a doctor.ResultsA total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS. In all, 1262 patients had laboratory confirmed giardiasis. At the time of referral (mean illness duration 2.7 years) 16% reported improvement, 28% reported no change, and 57% reported progressive course with gradual worsening. Mean FSS score was 6.6. A distinctive pattern of impairment was documented with the SF-36. The physical functioning, vitality (energy/fatigue) and social functioning were especially reduced. Long-term sickness absence from studies and work was noted in all patients.ConclusionAfter giardiasis enteritis at least 5% developed clinical characteristics and functional impairment comparable to previously described post-infectious fatigue syndrome.

Highlights

  • A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms

  • The present study aims to shed some light on this issue by describing the clinical picture of Chronic Fatigue Syndrome (CFS) following a common infectious agent

  • Our study show that at least 5% of the patients with confirmed Giardia enteritis reported failure to recover with unexplained fatigue and accompanying symptoms that in the broad corresponded with a clinical entity described previously [9,10]

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Summary

Introduction

A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. The aim was to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection. In a minority of the infected individuals the period of convalescence is followed by a post-infectious illness with disabling fatigue, musculoskeletal pain and neurocognitive difficulties [1]. Both viral and non-viral micro-organisms have a causative role in triggering a chronic fatigue syndrome [2]. Due to contamination of the municipal water supply in Bergen, Norway, in 2004, 1262 (764 females and 498 males) laboratory-confirmed cases of Giardia lamblia were registered [5,6].

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