CD40LG and nutritional deficiency disease: Diarrhoeal symptoms appeared to have no relationship with the presence of infection.29 High titres of anti-Giardial IgM were associated with severe malnutrition in rural Bangladesh, despite low incidence of microscopically confirmed disease.30,31 Giardiasis can be difficult to diagnose, especially in the context of malnutrition since their clinical features have significant overlap, and laboratory diagnosis is difficult, relatively insensitive, and frequently unavailable.