To the Editor.—
We read with interest the report by Paine and Gluck on a puzzling case of giardiasis. The authors are quite right in pointing out that the diagnosis of giardiasis should be strongly considered in patients with chronic diarrhea in whom no definite cause is established. The most reliable way to establish the diagnosis of suspected giardiasis is by obtaining a mucosal smear imprint of small bowel biopsy specimens from duodenal aspiration. Histological examination of jejunal biopsy specimens also gives a high yield in identifying those trophozoites located close to the mucosal surface in the lumen.In a comparative study, Kamath and Murugasu1 reported that examination of mucosal impression smears and biopsy specimens gave the highest positive results for Giardia lamblia, followed by examination of duodenal aspirates. The least sensitive method was stool examination, which indicates that duodenal intubation and jejunal mucosal biopsy constitute valuable diagnostic procedures
Hartong WA, Arvanitakis C. Giardiasis: Manifestations and Diagnosis. JAMA. 1977;237(11):1078–1079. doi:10.1001/jama.1977.03270380022009
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