REVIEWS IN VETERINARY AND ANIMAL SCIENCES

ISSN online: 2305-7211

13003/2013/111520 RVAS
http://www.fspublishers.org

Giardiasis
A. Raza1*, Z. Iqbal2, G. Muhammad1, K. Hanif3 and M.A. Khan4
1
Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
2
Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
3
Department of Microbiology, University of Veterinary and Animal Sciences, Lahore, Pakistan
4
Livestock and Dairy Development Department, Govt. of Punjab, Pakistan
*For correspondence: aliraza@uaf.edu.pk

Abstract
Giardiasis is one of the major gastrointestinal parasitic scourges of all the mammals. Giardia is one of the most prevalent
gastrointestinal zoonotic protozoan and millions of people are suffering from giardiasis throughout the world. Giardia lamblia
is the most prevalent species and responsible for disease production in all mammals. It is associated with poor hygienic
conditions and transmitted through fecal-oral route via contaminated food and water. A variety of drugs are reported to have
considerable efficacy against Giardia infections like metronidazole, furazolidone, albendazole, mebendazole and some
ethanobotanical agents. Good hygienic and sanitation measures are advised to reduce the contamination of the environment
that helps to control the giardiasis. The purpose of this article is to comprehensively review the epidemiology, disease
pathology and treatment of this zoonotic disease. 2013 Friends Science Publishers

Keywords: Giardiasis; Giardia lamblia; Food and water borne; Parasitic problem; Poor hygiene and sanitation

Introduction of morbidity in developing world as well as developed

Giardia was firstly reported by Dutch microbiologist
Antonie van Leeuwenhoek in 1681 who detected this
parasite in his own stool. Giardia has a characteristic
morphology; the vegetative trophozoites are 15 m in
length and tear drop shaped with two nuclei placed at
anterior side contained complete copies of the genome
(Dobell, 1920; Dupont and Sullivan, 1986; Adam, 2001; Yu
et al., 2002; Shahabi et al., 2006). There are three species of
Giardia reported in the human and domestic animals.
Giardia lamblia/duodenalis is the only recognized
species found in humans and most other mammals including
cats, dogs, cattle, pigs, sheep and horses (Filici, 1952;
Thompson, 2004). Seven different genotypes/assemblages
of Giardia lamblia have been reported with host specificity
(Monis et al., 2003; Thompson et al., 2000; Thompson and
Monis, 2004).
Assemblages A and B have been reported in human,
cattle and many other mammals (Thompson, 2004),
assemblages C and D in dogs, assemblage E in hoofed
livestock, assemblage F in cats and assemblage G has been
reported in rats (Monis et al., 2003; Read et al., 2004;
Thompson and Monis, 2004; Xiao and Fayer, 2008). G.
agilis are parasites of amphibians particularly tadpoles and
frogs, while G. muris is found in rodents and birds (Filici,
1952).
Giardia is transmitted through contaminated water and
food thus more prevalent in developing countries where
compromised hygiene infrastructure might lend itself to
increased transmission and further contamination of the
environment (Savioli et al., 2010). Giardia is a major cause
countries like USA, UK and Canada (Dupont and Sullivan,
1986). The disease spectrum varies from asymptomatic to
clinical disease commonly manifested by diarrhea,
abdominal spasm, flatulence and depression of immune
system (Gorski, 1985). The diagnosis of giardiasis can be
done by a number of modalities like direct stool examination
and antigen detection by immunofluorescence microscopy,
PCR and EILSA. Different groups of drugs are available to
treat the Giardia infections like nitromidazole, nitrofurans
and benzimidazoles (Escobedo and Cimerman, 2007).
Epidemiology
Giardia is a worldwide parasite responsible for disease
production in almost all the mammals causes enteric
problems (Ortega and Adam, 1997). The prevalence of
Giardia varies from 2-5% in developed countries and 20-
30% in developing countries (Oberhuber et al., 1997).
Giardia lamblia is the only pathogenic specie of the
protozoan parasite, which produces disease in most of the
mammals. It is most common intestinal protozoan reported
in the United States and United Kingdom (Noor et al.,
2007). Unlike other enteric pathogens (Salmonella and
Shigella), which affect females more than males; the
incidence of Giardia is equal in both sexes (Levy et al.,
1998). In homosexual males, incidence of Giardia was
higher when compared with heterosexual controls (Levine,
1991). There is also a seasonal variation in infection rate as
infection is mostly reported in summer months (Flanagan,
1992). Giardia has wide spectrum of host including human
being as well as farm, wild and domestic animals (McGlade

To cite this paper: Raza, A., Z. Iqbal, G. Muhammad, K. Hanif and M.A. Khan, 2013. Giardiasis. Rev. Vet. Anim. Sci., 1: 1520
 Raza et al. / Rev. Vet. Anim. Sci., Vol. 1, No. 1, 2013

et al., 2003).
Giardia lamblia spreads through fecal-oral route after
the ingestion of contaminated food and water. Beavers have
been associated with the water borne outbreaks of giardiasis
(Ortega and Adam, 1997); however the contamination of
surface water supplies by human fecal material may also a
major source of the disease (Rendtroff, 1954; Brodsky et al.,
1974; Brady and Wolf, 1974; Shaw et al., 1977; Craun,
1996; Barbosa et al., 2008; Xiao and Fayer, 2008; Savioli et
al., 2010). Uncooked and foods contaminated with night
soil (Bryan, 1975; Osterholm et al., 1981; Barbosa et al.,
2008; Xiao and Fayer, 2008; Savioli et al., 2010) also serve
as major sources of Giardia transmission.
Giardia infection is more prevalent in children of both
developed and developing nations especially in those who
are visiting day care centers with an average infection rate
of 6-8% but rates as high as 20-50% has been reported in
some areas. Higher prevalence has also been reported in
persons engaged in day care centers (Flanagan, 1992).

Life Cycle

Giardia has two developmental stages i.e. cyst and

trophozoites (Rendtroff, 1954). Cysts have a hyaline wall
that acts as a protective covering and make the Giardia
Fig. 1: Life cycle of Giardia
resistant to temperature and other environmental factors like
draught and water chlorination. Cysts may survive in water
ranges from asymptomatic to severe clinical disease (Ortega
up to 3 months (Wolfe, 1992). Cysts are ingested through
and Adam, 1997; Hill and Nash, 1999). It is categorized
contaminated water or raw/ undercooked food and lodge
under low infectious agent; as few as 10 cysts may cause
into the stomach. Excystation of the cysts occur due to
infection (Rendtroff, 1954). Two trophozoites are released
contact with acidic environment in the stomach resulted into
from a cyst after excystation in the upper gut. The
the release of one or two trophozoites after some highly
trophozoites line the intestinal mucosae with resulting in
coordinated events like parasite-derived protease activation
intra-peritoneal lymphocytic infiltration and mal-absorption
(Adam, 2001). These trophozoites then moved to duodenum
(Wright and Tomkins, 1977; Farthing, 1997; MacDonald
and upper intestine where they produce clinical disease due
and Spencer, 1998). Giardia also leads to acute
to favorable alkaline pH. Encystation of the trophozoites
inflammation of the epithelium and lamina propria, atrophy
occurs in colon followed by excretion of these encysted
of the jejunal mucosa and damage to the brush border
trophozoites (cysts) in the feces (Fig. 1; Rice and Schaefer,
(Yardley et al., 1964; Blenkinnsopp et al., 1978; Hartong et
1981; Lujan et al., 1996; 1997; Ward et al., 1997; Hetsko et
al., 1979; Buret et al., 1990; 1991), patients with
al., 1998; Thurman et al., 1998; Thompson, 2000).
compromised immune system may develop extensive villous
atrophy (Ament and Rubin, 1972; Heyworth, 1992). Typical
Prevalence of Giardiasis
signs after 1-3 weeks include marked diarrhea, malaise,
flatulence, greasy stool, abdominal cramps, bloat, weight
Giardia has been reported throughout the world like Africa,
loss and anorexia (Moore et al., 1969; Wolfe, 1992; Hill,
Asia and Latin America; approximately 200 million people
1993; Thomson et al., 1993; Ferson, 1997; Ortega and
are infected with giardiasis with about 500,000 new cases
Adam, 1997; Hellard et al., 2000; Thompson, 2000).
reported each year (WHO, 1996). Water borne out breaks of
Intestinal enzymes and disaccharides are depressed along
Giardia lamblia were reported in Europe and USA during
with the defects in fat, lactose, vitamin B12 and vit. A
1960s and 1970s (Moore et al., 1969; Jokipii and Jokipii,
absorption (Notis, 1972; Duncombe et al., 1978; Solomons,
1974; Craun, 1986). A comprehensive perusal of the
1982; Farthing et al., 1986; Lengerich et al., 1994).
available literature showed that Giardia is present in both
human and animals throughout the world (Table 1).
Treatment
Disease Pathology
Although Giardia infections resolve spontaneously in
Giardiasis exhibits a wide variety of clinical presentation 85% of the patients within 6 weeks, all the patients with

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 Giardiasis / Rev. Vet. Anim. Sci., Vol. 1, No. 1, 2013

Table 1: Prevalence of giardiasis in human and animals

Specie Host Prevalence Technique Area of study Reference

reported
7% Stool examination, PCR, Light microcopy Industrialized Brodsky et al., 1974; Brady
countries and Wolf, 1974; Shaw et al.,
1977; Ortega and Adam, 1997
Giardia 5-50% Stool examination, PCR, Light microcopy Developing Brodsky et al., 1974; Brady
lamblia countries and Wolf, 1974; Shaw et al.,
Human 1977; Ortega and Adam, 1997
3.9% Gross and direct microscopic examination India Marothi and Singh, 2011
20.5% Microscopic examination (Wet-mount and formalin-ether Iran Tappe et al., 2011
sedimentation)
10.3% Microscopic examination Iran Hazrati et al., 2006
10.7% Microscopic examination (Wet mount, Lugol's iodine solution Turkey Okyay et al., 2004
and modified formalin-ethyl acetate sedimentation
6.8% Direct microscopy and ELISA Portugal Julio et al., 2012
1.3% ELISA UK Davies et al., 2009
1.5% Microscopic examination, Direct immunofluorescence assay Germany Sagebiel et al., 2009
31.8% Microscopic examination and ELISA Russia Kramar et al., 2003
2.1% Endoscopy Australia Kerlin et al., 1978
9% Endoscopy and Duodenal biopsy Pakistan Zafar et al., 1991
15.1% Endoscopy USA Carr et al., 1988
67.2% Microscopic examination (Formalin-ether sedimentation) Faisalabad, Pakistan Ensink et al., 2006
Cattle 0.16% Stool examination (Direct observation and modified Telemann Spain Diaz et al., 1996
concentration technique
15% Fluorescein isothiocynate-labeled monoclonal antibody detection Canada Ralston et al., 2003
27% PCR and DNA sequencing USA Trout et al., 2007
96% Immunofluorescence microscopy, nested-PCR and DNA Canada Dixon et al., 2011
sequencing
23.9% Zinc sulfate flotation technique and PCR USA Mark-Carew et al., 2012
17.0% Sucrose gradient immunofluorescent antibody test Canada Gow and Waldner, 2006
49% Fluorescence microscopy and PCR Canada Uehlinger et al., 2006
31.11% Direct micrscopy and DNA extraction Pakistan Ayaz et al., 2012
Cattle 100% Fluorescein isothiocynate-labeled monoclonal antibody detection
Canada Ralston et al., 2003
calf 31.5% Immunofluorescent microscopy and PCR USA Santin et al., 2009
12.5% PCR Malaysia Muhid et al., 2012
45.4% ELISA Germany, UK, France Geurden et al., 2012
and Italy
22.6% Sucrose gradient immunofluorescent antibody test Canada Gow and Waldner, 2006
40% Immunofluorescent microscopy and PCR USA Trout et al., 2005
Dog 12.09% Stool examination (Direct observation and modified Telemann Spain Diaz et al., 1996
concentration technique
13.0% ELISA Canada Olson et al., 2010
12.2% Microscopic examination (Simple flotation and Faust Brazil Oliveira-Sequeira et al.,
centrifugation-flotation) 2002
9.3% Immunofluorescence assay Belgium Claerebout et al., 2009
20.5% Direct microscopy and PCR Italy Scaramozzino et al., 2009
4.3% Telemanns sedimentation method Greece Papazahariadou et al., 2007
28% Immunofluorescent assay MeriFluor Poland Bajer et al., 2011
23% Microscopic examination (Modified Faust method) Portugal Ferreira et al., 2011
Sheep 6.26% Stool examination (Direct observation and modified Telemann Spain Diaz et al., 1996
concentration method
33% Heine method of direct examination and Fluorescent microscopy Spain Castro-Hermida et al., 2007
Goat 4.00% Stool examination (Direct observation and modified Telemann Spain Diaz et al., 1996
concentration
33% Heine method of direct examination and Fluorescent microscopy Spain Castro-Hermida et al., 2007
Alpaca 50.0% Immunofluorescent microscopy and PCR Peru Gomez-Couso et al., 2012

symptoms of giardiasis should be treated promptly Control

(Flanagan, 1992; Hill, 1993). Treatment of asymptomatic
active carriers is controversial in developed countries but
some people suggest treatment for the following reasons; to
prevent the development of acute infection, to prevent the
consequences of chronic infections and to prevent the
transmission of Giardia to other individuals (Hill, 1993). A
number of treatment options exist for the patients suffering
from giardiasis (Table 2).
Giardiasis is transmitted through contaminated water or
fecal-oral route so good sanitation and hygiene practices are
necessary to control and prevent the Giardia infections
(Bowman and Lucio-Forster, 2010). Filtration or boiling is
quite effective to remove the Giardia cysts while
chlorination is relatively ineffective at rendering the cyst
non-viable and cannot be recommended as the only water

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 Raza et al. / Rev. Vet. Anim. Sci., Vol. 1, No. 1, 2013

Specie of Parasite Drug Technique Country Reference

Giardia lamblia Metronidazole In-vitro and in-vivo World wide Bassily, et al., 1970; Jokipii and Jokipii,
1980; Paget et al., 1989; Gillis and
Wiseman, 1996; Tracy and Webster,
1996; Escobedo and Cimerman, 2007
Furazolidone In-vivo World wide Bassily, et al., 1970; Garg, 1972;
Wolfe, 1975; Craft et al., 1981; Lerman
and Walker, 1982; Murphy and Nelson,
1983; Dupont and Sullivan, 1986;
Quiros-Buelna, 1989; Escobedo and
Cimerman, 2007;
Albendazole In-vivo Bangladesh, Cuba Hall and Nahar, 1993: Canete et al.,
2012
Mebendazole In-vivo Cuba Almirall et al., 2011
Fenbendazole In-vivo Belgium Geurden et al., 2010
Secnidazole In-vivo Cuba Almirall et al., 2011
Paromomycin In-vivo, in-vivo Australia, Egypt, Belgium, USA Boreham et al., 1985; Gordts et al.,
1985; Hill, 1993); Awadalla et al., 1995
Ethanobotanical agents In-vivo, in-vivo India, USA Agarwal et al., 1994; Calzada et al.,
(Geranium nivem, Pippali 1999; Tripathi et al., 1999
rasayana and Piper longum)
Proposlina In-vivo Cuba Miotti et al., 1986; Zaat et al., 1997

treatment (Ortega and Adam, 1997). Breast milk may
protect against giardiasis as it contained free fatty acids
generated from milk triglycerides by the action of a bile salt-
stimulated lipase (Reiner et al., 1986). Immune response
also counters the Giardia infection as successful treatment
of Giardia infections was done by using vaccine against
Giardia and it was suggested that vaccination seems to be a
potential method of treating giardiosis in dogs (Olson et al.,
2001).
Acknowledgement
We would like to thank Center for Diseases Prevention
and Control (CDC), USA on granting permission to print
the life cycle diagram of Giradia.
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(Received 05 March 2013; Accepted 10 April 2013)