Giardiasis

History and Distribution

• It is one of the earliest protozoan parasite to have been
recorded.
 The flagellate was first observed by Dutch Scientist
Antonie von Leeuweenhoek (1681) in his stools.
It is named ‘Giardia’ after professor Giard of Paris and
‘lamblia’ after Professor Lamble of Prague, who gave a
detailed description of the parasite.
 It is the most common protozoan pathogen and is
worldwide in distribution.
Endemicity is very high in areas with low sanitation,
especially tropics and subtropics. Visitors to such places
frequently develop traveler’s diarrhea caused by
giardiasis through contaminated water
Problem statement

World:
 The reported incidence of infection with giardia varies widely
from country to country
 Parasite has noted in inhabitants and travelers from all over the
world
 In US giardiasis is the most common protozoan disease and
leading infectious organism associated with waterborne
outbreaks of diarrhea
 However, in some developing countries, studies have indicates
that almost all children have been infected with G. lamblia by 3
yrs. of age
 Organism is most often found in children, especially those in
large families and in institution such as school, orphanages, and
day care centers
Global risk areas for traveler diarrhea
Nepal:
 Nepal belongs to a high risk region for travelers diarrhea
 Every yr. there are number of cases of giardiasis commonly
among children
 Incidence is more during rainy season
 Some studies show prevalence in the range of 20-30%
Epidemiological Determinants
• Agents factors:
 Agent: Giardia lamblia
 Lives in the duodenum and upper jejunum
 Parasite found only in the lumen of the intestine
and does not invade the tissue
 Exists in two forms: trophozoite (or vegetative form)
and cyst form
 Trophozoite is in the shape of tennis racket (heart
or pyriform shaped ) and is rounded anteriorly and
pointed posteriorly
 Trophozoite is motile, with a slow oscillation about
its long axis , often resembles falling leaf.
 Cyst is small and oval surrounded by a hyaline cyst
wall.
 Life cycle:

 Giardiasis passes its life cycle in 1 host.

 Infective form: mature cysts
 I.P is variable, but is usually about 2weeks
 Mode of transmission:
• Man acquires infection by ingestion of cyst in
contaminated water and food
• Direct person to person transmission may also occur in
children, male homosexuals, and mentally ill persons.
• Enhanced susceptibility to giardiasis is associated with
blood group A, achlorhydria, use of cannabis, chronic
pancreatitis , malnutrition, immune deficiency and
hyper-gammaglobulinemia
 Within half an hour of ingestion, the cyst hatches out into
two trophozoites, which multiply successively by binary
fission and colonize in the duodenum
 The trophozoites live in duodenum and upper part of
jejunum, feeding by pinocytosis
 During unfavorable conditions, encystment occurs usually in
colon
 Cysts are passed in stool and remain viable in soil and water
for several weeks.
 There may be 200,000 cysts passed per gram of feces.
 Infective dose: 10- 100 cysts
• Host factors:

Age: children >adult

No sex or racial difference in occurrence of the disease
Immunity: malnutrition, immune deficiency, and cystic
fibrosis are more susceptible
Habits of eating and drinking unhygienic food and drink,
open defecation
Travelers

• Environmental factors:
Season: more during rains, presumably cyst survive longer
and has potential for transmission
Poor sanitation
Socio-economic status: poor>rich
 use of night soils for agricultural purpose
• Pathogenesis:
colonization of trophozoite in the duodenum and
attachment to epithelial cells with the help of sucking disc

tight association with epithelial cells of duodenum

disturbance of intestinal function and abnormalities in

villous

mechanical interference to absorption of fat, fat soluble

vitamins and haematinic factors
• Clinical Features
Often asymptomatic
Giardiasis , characterized by
o Diarrhea Explosive watery stool, 5-6 times/day
o abdominal pain, nausea, vomiting
oSteatorrhoea: passage of yellowish and greasy stool
with excess of fat
oMalabsorption
oSevere flatulence
Children: develop chronic diarrhea, malabsorption, wt.
loss
Occasionally, Giardia may colonize the gall bladder,
causing biliary colic and jaundice
Laboratory Diagnosis of Giardia lamblia
1. Stool examination:
i. Macroscopic examination: specimen; offensive
odor, pale colored and fatty, and floats in water
ii. Microscopic examination :
• saline preparation for demonstration of motile
trophozoite
• Iodine preparation for demonstration of cyst in
stained state and trophozoite in killed state
• Only cysts are present in asymptomatic person
2. Serological test:
Antigen/ Antibody detection: variant specific surface
protein (VSSP) of giardia play an important role in
virulence and infectivity of the parasite
− ELISA
− Immunofluroscent test

3. Enterotest (string test)

4. Molecular test
• DNA probe
• PCR
Treatment:

Only symptomatic cases need treatment, asymptomatic

cyst carriers are not treated except in special situation like
for outbreak control or for prevention of spread from
toddler to immunocompromised family member

Metronidazole (250 mg, thrice daily for 5-7 days) and

tinidazole (2g single dose) are the drugs of choice
 Cure rate with metronidazole is more than 90%
 Tinidazole is more effective than metronidazole
 Furuzolidone and nitazoxanide are preferred in children,
as they have fewer adverse effects
 Parmomycin, an oral aminoglycoside can be given to
symptomatic pregnant females ( because of less systemic
absorption)
Prevention

Giardiasis can be prevented by following measures:

Proper disposal of waste water and feces
Avoid open defecation
Practice of personal hygiene like hand-washing before
eating and toilet and proper disposal of diapers
Prevention of food and water contamination. Community
chlorination of water is ineffective for inactivating cysts.
Boiling of water and filtration by membrane filter is required
Consumption of raw foods and vegetables only after proper
washing by non contaminated water