Chronic fatigue syndrome after Giardia enteritis: clinical characteristics, disability and long-term sickness absence

BMC Gastroenterol. 2012 Feb 8;12:13. doi: 10.1186/1471-230X-12-13.

Abstract

Background: 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.

Methods: Patients 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.

Results: A 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.

Conclusion: After giardiasis enteritis at least 5% developed clinical characteristics and functional impairment comparable to previously described post-infectious fatigue syndrome.

Publication types

  • Case Reports

MeSH terms

  • Absenteeism*
  • Adult
  • Anxiety / epidemiology
  • Anxiety / psychology
  • Depression / epidemiology
  • Depression / psychology
  • Disability Evaluation*
  • Enteritis / complications*
  • Enteritis / parasitology*
  • Fatigue Syndrome, Chronic / epidemiology*
  • Fatigue Syndrome, Chronic / psychology
  • Female
  • Giardia / isolation & purification*
  • Giardiasis / complications*
  • Humans
  • Incidence
  • Male
  • Norway
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors