Giardia Lamblia
(Giardiasis)
What is giardiasis?
Giardiasis (gee-ar-die-a-sis with a soft "G") is a contagious (infectious) form of diarrhea . This infection is caused by a parasite that is most commonly transmitted through direct contact with infected feces or by eating food or drinking water that are contaminated by feces.
What is Giardia?
Giardia lamblia is the full name of the parasite that causes giardiasis. The parasite lives in two stages: trophozoites and cysts. Trophozoites are the active form of the parasite inside the body. Cysts represent the resting stage that enables the parasite to survive outside the body.
How does the infection begin?
Infection begins from swallowing the Giardia cysts. The acid in the stomach activates the cysts, which in turn release the trophozoites. The parasites attach to the lining of the small intestine, reproduce, and are swept down the intestine in the fecal stream. Cysts form in the lower intestines and are then passed in the feces.
How is the parasite transmitted?
The parasite is spread from person to person through contact with infected feces. Contact with feces can be direct or indirect. Direct contact with infected feces can, for example, occur between children or between sexual partners through anal sex. Indirect transmission can occur by consuming food or water that have been contaminated with feces containing the cysts.
How common is giardiasis?
Giardia is one of the most common intestinal parasites in the world. The parasite infects up to 20% of the world's population. The disease is most prevalent in developing countries, where infections are associated with poor sanitary conditions, poor water quality control, and overcrowding.
Where in the United States is it most common?
In the United States, Giardia is a major cause of waterborne outbreaks of diarrhea. Giardiasis occurs primarily in mountainous areas where water supplies have become contaminated with feces from humans or possibly from animals, such as beavers. Because outbreaks have occurred from Washington State to New York State, campers and backpackers should avoid drinking any untreated water from mountain streams.
Are children at a higher risk for Giardia?
Giardiasis affects three times as many children as adults. It particularly affects diapered children and toddlers being toilet- trained. Families with young children who attend day-care centers are at greater risk of developing giardiasis than is the general population.
How long a delay is there before the onset of symptoms?
The usual interval between infection and the onset of acute (sudden) symptoms ranges from one to two weeks.
What are the symptoms of giardiasis?
In most instances, the following symptoms occur: a sudden explosive, watery, foul-smelling diarrhea; excessive gas; abdominal pain; bloating; nausea; tiredness; and loss of appetite. In some patients, vomiting is the major symptom. Fever is unusual. Many infected people, however, have very mild symptoms or no symptoms at all. Blood or mucus in the stool rarely occurs.
How is the diagnosis of giardiasis made?
Giardiasis is sometimes overlooked because the symptoms are similar to those of other gastrointestinal diseases and because many physicians are unfamiliar with parasitic diseases.
Stool specimens should be collected and examined over a period of at least three days. It is sometimes necessary to collect samples for four to five weeks. A positive diagnosis of giardiasis can be made by microscopic identification of the parasite in stool specimens. New tests that detect antigens (proteins) to Giardia in the feces are especially useful for screening children in day-care settings, and for testing adults after treatment. Because of the high accuracy of the antigen tests, it is now rarely necessary to have an intestinal biopsy of the jejunum (part of the small intestine).
How long does the disease last?
If not treated, giardiasis can last for months, or even years. The illness can cause recurrent mild or moderate symptoms such as: impaired digestion, especially lactose intolerance ; intermittent diarrhea; tiredness and weakness; and significant weight loss.
How is giardiasis treated?
Metronidazole (Flagyl) is often used to treat adults and children who are mildly affected or asymptomatic. Pregnant women are advised not to take metronidazole during the first trimester of pregnancy because of the potentially adverse effects on the fetus.
Paromomycin is an alternative and safer drug. Sometimes, a pregnant woman with mild symptoms can be treated after the first trimester or after delivery. If relapses occur, re-treatment with the same drug is usually effective.
Furazolidone (Furoxone) generally is given to infants and to children under 5 years old, since it comes in a liquid form.
Quinacrine is also sometimes used to treat giardiasis.
How can giardiasis be prevented?
To prevent the spread of giardiasis in day-care centers or other areas where there is close contact, good personal hygiene should be maintained. Day-care staff should not change diapers in food preparation areas. They should dispose of diapers in a sanitary manner, and they should wash their hands after each diaper change.
If visiting an area where Giardia may exist, the following precautions should be taken: - Drink only boiled or filtered water, or bottled carbonated drinks;
- Avoid ice and beverages made from tap water;
- Do not brush teeth with tap water; and
- Do not eat uncooked or unpeeled fruits or vegetables grown locally.
There is currently no drug available to prevent giardiasis. Prevention depends on avoiding contact with the parasite. - Giardia is a parasite that causes a common intestinal infection known as giardiasis.
- Symptoms may include diarrhea, abdominal pain , nausea, and loss of appetite and weight.
- The parasite can be acquired by direct person-to-person contact.
- Spread can also occur through food and water that are contaminated by feces.
- The disease is most common in developing countries and children everywhere.
- The diagnosis is made by identifying the parasite under a microscope in stool samples or biopsies.
- Stools can also be tested for Giardia by an antigen (protein) test.
- Oral medications such as metronidazole (Flagyl), paromomycin, furazolidone (Furoxone) or Quinacrine are used to treat giardiasis.
- Prevention is the best strategy.
This article is based in part upon information from the NIH.
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