الفهرس 
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Abstract
Giardiasis is considered as a significant diarrheal disease presented throughout the world. It occurs more commonly in children. Giardia Lamblia is a common intestinal parasite that causes both acute and chronic diarrhea in human (Escobedo et al., 2016).
Giardia is a flagellated-protozoa, has two forms, cyst and trophozoite. Infection is initiated mainly by feco-oral route; the trophozoites colonize the proximal part of the small intestine however it does not invade the epithelium or deeper layers of the mucosa (Ramana, 2012 and Barry et al., 2013).
G. intestinalis may lead to asymptomatic colonization, acute or chronic diarrhea. The organism has been isolated from about 80% of raw water supplies as streams, lakes, and ponds and in about fifteen percentages of filtered water samples (Escobedo et al., 2016).
Giardiasis represents a zoonosis that is accompanied by cross-infectivity between animals and humans. Beavers, dogs, cats, and primates are the reservoirs of G.intestinalis. (Ballweber et al., 2010).
Poor sanitation causes endemic Giardia species. The infection is a main morbidity cause in developing countries. Outbreaks are commonly water-borne and food-borne.
Giardiasis occurs commonly in daycare centers in developed countries. It is commonly associated with malnutrition, immunodeficiencies. Travelers to highly endemic areas, immunodeficient persons and homosexual males are among the high-risk groups for giardiasis (Escobedo et al., 2016).
The disease is usually a self-limited among immune competent individuals or characterized by diarrhea, flatulence, epigastric pain, nausea, weight loss, and malabsorption and less commonly fever (Minetti et al., 2016).
Giardia trophozoites or cysts were identified in the stool of patients as the classic basis for diagnosis. Also, detection of stool antigen using enzyme-linked immunosorbent assay (ELISA) can be done. Treatment for giardiasis is mainly by metronidazole; but tinidazole is also approved as the first-line drug in some countries (Arbabi et al., 2015).
The nutritional interaction with giardiasis is different since the association between zinc deficiency and infection has been investigated. in addition to the undernutrition and malabsorption of micronutrients caused by the parasite, the infection has also been linked to malabsorption of vitamin A, B12, copper, and magnesium (Yones et al., 2015).
Zinc is an element that cannot be stored in the body and therefore it can be decline easily during infection (Miller et al., 2013 and Lazarte et al., 2015).
Giardia colonizes the proximal part of the small intestine where two vitamins (Vitamin B12 and folate) are absorbed. Thus, giardiasis may lead to vitamin B12 and folate deficiency; their deficiencies are related to anemia since vitamin B12 is involved in DNA synthesis (Zarebavani et al., 2012 ; Alpers et al., 2013 and Arbabi et al., 2015).
Copper is required for producing red blood cells, hemoglobin formation and iron absorption (Arbabi et al., 2015).
The current study aimed to detect the serum levels of two minerals (Copper and Zinc) and two vitamins (B12 and B9) among patients with microscopic giardiasis and to compare the serum levels of these minerals and vitamins with free microscopic individuals.
Ninety-five diarrheic patients were included, and they were subjected to:
1- A structured questionnaire was fulfilled for each patient concerning socio-demographic data, clinical manifestations and risk factors for Giardiasis.
2- Stool samples were collected from all patients in sterile clean containers labeled with each patient’s code and divided into two parts, part one to detect Giardia cyst and/or trophozoite before and after concentration technique by direct wet smear and using Lugol iodine. The second part was subjected to Iron Haematoxylin staining.
3- Blood samples were collected from all patients and subjected to serum separation to detect levels of two minerals (zinc and copper) and two vitamins (Vit B12 and Vit B9).
According to the results of the microscopic examination of diarrheic samples, patients were divided into:
• group (I): 25 microscopically positive samples for giardiasis.
• group (II): 70 microscopically negative for giardiasis.
Results revealed that:
1- The majority of the 95 patients were females. Mean age of patients was 44.60.
2- Giardiasis was detected in 25 patients (group I) with a mean age of 42.84 ± 12. Among them, female were more prevalent (72%), from urban areas (52%) and using tap water (76%).
3- Fatigue and abdominal pain were more presented among patients with giardiasis (16%, 12%, respectively).
4- The only residence of patients and water source were statistically significant (p-value≤0.05).
5-Serum levels of copper, zinc, vitamins B12 and B9 were diminished in group I (16%, 20%, 16%, 12.9%, respectively) than group II
In conclusion,
Residence and source of water may affect giardiasis infection. Serum levels of copper, zinc, vitamin B12 and B 9 should be monitored in patients with giardiasis for the deficiency.