3. FACTS
Giardia is a microscopic parasite that
causes the diarrheal illness known as
giardiasis.
Giardia is found on surfaces or in soil,
food, or water that has been contaminated
with feces from infected humans or
animals.
https://www.cdc.gov/parasites/giardia/
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4. FACTS (CONT.)
Giardia can be spread in different ways,
water (drinking water and recreational
water) is the most common mode of
transmission.
Giardiais protected by an outer shell
that allows it to survive outside the body
for long periods of time and makes it
tolerant to chlorine disinfection
https://www.cdc.gov/parasites/giardia/
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5. FACTS (CONT.)
Giardia usually spreads when Giardia
lamblia cysts within feces contaminate food
or water which is then eaten or drunk
Giardia is one of the most common
parasitic human diseases globally
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Minetti, C; Chalmers, RM; Beeching, NJ; Probert, C; Lamden, K (27 October 2016).
"Giardiasis". BMJ (Clinical research ed.). 355: i5369.
Esch KJ, Petersen CA (January 2013). "Transmission and epidemiology of zoonotic
protozoal diseases of companion animals" Clin Microbiol Rev. 26 (1): 58–85.
6. FACTS (CONT.)
Infection is more common in children
than in adults
Infection with Giardia intestinalis most
often results from:
Fecal-oral transmission
Ingestion of contaminated water
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Huston CD. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Feldman M, Friedman LS, Brandt
LJ. Intestinal Protozoa. 8th ed. Philadelphia, PA: Saunders, An imprint of Elsevier Inc; 2006. 2: 2420-2423 / 106.
7. Contaminated food is a less common
etiology
G intestinalis is a particularly
significant pathogen for people with:
Malnutrition
Immunodeficiencies
Cystic fibrosis.
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GiardiasisProf.Dr.SaadSAlAni
FACTS (CONT.)
8. Most infections are asymptomatic
Giardia is found in healthy people in
endemic areas
Asymptomatic carriage with
excretion of high numbers of cysts in
stools is common.
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GiardiasisProf.Dr.SaadSAlAni
FACTS (CONT.)
9. Giardiasis does not have any race predilection
Giardiasis is slightly more common in males
than in females
Giardiasis affects people of all ages
Infection is rare during the first 6 months of life
in breastfed infants
infants and young children have an increased
susceptibility to giardiasis
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GiardiasisProf.Dr.SaadSAlAni
FACTS (CONT.)
1.Laupland KB, Church DL. Population-based laboratory surveillance for Giardia sp. and Cryptosporidium sp.
infections in a large Canadian health region. BMC Infect Dis. 2005 Sep 16. 5:72
2.John CC. Giardiasis and Balantidiasis. Kliegman RM, Behrman BE, Jenson HB, Stanton BF. Nelson Textbook
of Pediatrics. 279. Philadelphia, PA: Saunders, An imprint of Elsevier Inc; 2007. 18th ed: 1462-1464.
10. Cysts may survive for nearly
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Golden Age of Gaia
Minetti, C; Chalmers, RM; Beeching, NJ; Probert, C; Lamden, K (27 October 2016).
"Giardiasis". BMJ (Clinical research ed.). 355: i5369.
in cold water
11. RISK FACTORS
Include:
Travel in the developing world
Changing diapers
Eating food without cooking it
Owning a dog
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Minetti, C; Chalmers, RM; Beeching, NJ; Probert, C; Lamden, K (27 October
2016). "Giardiasis". BMJ (Clinical research ed.). 355: i5369
12. 10/06/2018GiardiasisProf.Dr.SaadSAlAni
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of raw water supplies from lakes,
streams, and ponds
Giardia has been found in as many as
Robertson LJ, Forberg T, Gjerde BK. Giardia cysts in sewage influent in Bergen, Norway 15-23
months after an extensive waterborne outbreak of giardiasis. J Appl Microbiol. 2008 Apr.
104(4):1147-52
Dreamstime.com
13. Giardia has been found in as many as
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GiardiasisProf.Dr.SaadSAlAni
Dreamstime.com
of filtered water samples
Robertson LJ, Forberg T, Gjerde BK. Giardia cysts in sewage influent in Bergen, Norway 15-23
months after an extensive waterborne outbreak of giardiasis. J Appl Microbiol. 2008 Apr.
104(4):1147-52
14. In 2013, there were about
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GiardiasisProf.Dr.SaadSAlAni
people worldwide with symptomatic
giardiasis
Esch KJ, Petersen CA (January 2013). "Transmission and epidemiology of zoonotic
protozoal diseases of companion animals" Clin Microbiol Rev. 26 (1): 58–85.
15. GLOBAL RATES OF GIARDIASIS
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GiardiasisProf.Dr.SaadSAlAni
Hotel Can Darder Caracas Chronicles
in the developed world in the developing world
Minetti, C; Chalmers, RM; Beeching, NJ; Probert, C; Lamden, K (27 October 2016).
"Giardiasis". BMJ (Clinical research ed.). 355: i5369.
17. Person-to-person spread is common, with
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GiardiasisProf.Dr.SaadSAlAni
of family members with infected
children themselves becoming
infected
www.mychaos.co.uk
18. The rate of symptomatic infection
varies from
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GiardiasisProf.Dr.SaadSAlAni
in the natural setting
21. The infective dose
The infective dose is low in humans
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Cysts
of
are capable of causing clinical disease in
Subjects
23. Predisposing factors to symptomatic
infection
Include :
Hypochlorhydria
Various immune system deficiencies
Blood group A
Malnutrition
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GiardiasisProf.Dr.SaadSAlAni
24. GIARDIASIS (BEAVER FEVER)
Is a parasitic disease caused by Giardia
lamblia
Giardiasis is a major diarrheal disease
found throughout the world
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GiardiasisProf.Dr.SaadSAlAni
Esch KJ, Petersen CA (January 2013). "Transmission and epidemiology of zoonotic
protozoal diseases of companion animals". Clin Microbiol Rev. 26 (1): 58–85
Daly ER, Roy SJ, Blaney DD, et al. Outbreak of giardiasis associated with a
community drinking-water source. Epidemiol Infect. 2010 Apr. 138(4):491-500
25. Giardiasis usually represents a zoonosis
with cross-infectivity between animals
and humans. Giardia intestinalis has been
isolated from the stools of beavers, dogs,
cats, and primates
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GiardiasisProf.Dr.SaadSAlAni
ZONOSIS
26. Giardia life cycle
Giardia has one of the simplest life cycles
of all human parasites
The life cycle is composed of 2 stages:
(1) The trophozoite which exists freely
in the human small intestine
(2) The cyst, which is passed into the
environment.
No intermediate hosts are required.
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GiardiasisProf.Dr.SaadSAlAni
27. Giardia life cycle (Cont.)
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GiardiasisProf.Dr.SaadSAlAni
https://commons.wikimedia.org/wiki/File:Giardia_life_cycle_nl.svg
29. The trophozoite form of G lamblia
The trophozoite form of G lamblia
Teardrop-shaped
Measures 9-21 micrometers long by
5-15 micrometers wide.
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https://www.flickr.com/photos
30. The trophozoite form of G lamblia(Cont.)
Has a convex dorsal surface and a flat
ventral surface that contains the
ventral disk, a rigid cytoskeleton
composed of microtubules and
microribbons.
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https://www.flickr.com/photos
31. The trophozoite form of G lamblia (Cont.)
Contains 4 pairs of flagella, directed
posteriorly, that aid the parasite in
moving.
Two symmetric nuclei with
prominent karyosomes produce the
characteristic face like image that
appears on stained preparations
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https://www.flickr.com/photos
32. The cyst form of G lamblia
The cyst form of G lamblia
Smooth-walled and oval in shape
Measuring 8-12 micrometers long
by 7-10 micrometers wide.
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GiardiasisProf.Dr.SaadSAlAni
http://www.phsource.us
33. The cyst form of G lamblia (Cont.)
As the cyst matures, nuclear division occurs
and readies the cyst to release 2 trophozoites
upon excystation
Excystation occurs within 5 minutes of
exposure of the cysts to an environment with
a pH between 1.3 and 2.7
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GiardiasisProf.Dr.SaadSAlAni
http://www.phsource.us
35. EPIDEMIOLOGY
United States statistics
Most water-borne outbreaks in the United States
have occurred in western mountain regions (e.g.,
Rocky Mountains, Sierra Nevada, Cascades)
The incidence of giardiasis is high among
individuals who camp and backpack in
mountainous Western states
Other groups at increased risk for infection
include :
Children
Homosexual men
Individuals with immunoglobulin deficiency states
(inherited or acquired).
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GiardiasisProf.Dr.SaadSAlAni
36. Endemic infection occurs most commonly
from July through October among children
younger than 5 years and adults aged 25-39
years.
Carrier rates as high as 30-60% have been
documented among:
Children in day care centers
Institutions
On Native American reservations.
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GiardiasisProf.Dr.SaadSAlAni
EPIDEMIOLOGY (CONT.)
37. EPIDEMIOLOGY (CONT.)
International statistics
Giardia has a worldwide distribution,
occurring in both temperate and tropical
regions
Prevalence rates vary from 4-42%
In the developing world, G intestinalis infects
infants early in life and is a major cause of
epidemic childhood diarrhea.
Prevalence rates of 15-20% in children younger
than 10 years are common
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GiardiasisProf.Dr.SaadSAlAni
Caccio SM, Ryan U. Molecular epidemiology of giardiasis. Mol Biochem Parasitol. 2008
Aug. 160(2):75-80
38. Giardia has been identified as the causative
agent in a large percentage of cases among
travellers to the region of St. Petersburg, Russia,
where tap water is the primary source
The highest prevalence of G intestinalis reached
73.4% in Western Nepal
The Dhaka study performed within the urban
areas had identified G intestinalis in 11% of
diarrheal stool specimens
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GiardiasisProf.Dr.SaadSAlAni
EPIDEMIOLOGY (CONT.)
Dib HH, Lu SQ, Wen SF. Prevalence of Giardia lamblia with or without diarrhea in South
East, South East Asia and the Far East. Parasitol Res. 2008 Jul. 103(2):239-51
39. CLINICAL PRESENTATION
Clinical signs and symptoms of giardiasis include
the following:
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GiardiasisProf.Dr.SaadSAlAni
Clinical signs and symptoms
Diarrhea Nausea Low-grade fever
(infrequent)
Malaise,
weakness
Malodorou
s, greasy
stools
Various neurologic
symptoms (e.g.,
irritability, sleep
disorder, mental
depression,
neurasthenia)
Abdominal
distention
Anorexia
Flatulence Weight loss
Abdominal
cramps
Vomiting Urticaria
40. REMEMBER
Diarrhea is the most common symptom of
acute Giardia infection, occurring in
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GiardiasisProf.Dr.SaadSAlAni
of symptomatic subjects
Abdominal cramping, bloating, and
flatulence occur in
of symptomatic
patients
41. Gastrointestinal manifestations
Abrupt onset (rare)
a small number of persons develop abrupt onset
of :
these symptoms last 3-4 days
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GiardiasisProf.Dr.SaadSAlAni
• Explosive watery diarrhea • Vomiting
• Abdominal cramps • Fever
• Foul flatus • Malaise
42. Gastrointestinal manifestations (Cont.)
Subacute syndrome ( More common)
After the symptoms of abrupt onset
Most patients experience a more insidious onset
of symptoms, which are recurrent or resistant.
Stools become malodorous, mushy, and greasy
Watery diarrhea may alternate with soft stools or
even constipation
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GiardiasisProf.Dr.SaadSAlAni
43. Upper GI symptoms:
often exacerbated by eating
accompany stool changes
may be present in the absence of soft stools.
These include:
upper and midabdominal cramping
nausea
early satiety
bloating
substernal burning
acid indigestion.
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Gastrointestinal manifestations (Cont.)
44. Constitutional symptoms
Anorexia, fatigue, malaise, and weight
loss are common
Weight loss occurs in more than 50% of
patients
Chronic illness may occur
• Adults may present with long-standing
malabsorption syndrome
• children may present with failure to
thrive
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GiardiasisProf.Dr.SaadSAlAni
45. Extraintestinal manifestations
Are rare
Include allergic manifestations such as:
Urticaria
Erythema multiforme
Bronchospasm
Reactive arthritis
Biliary tract disease
The etiology is likely a result of :
Host immune system activation
Cross-reactivity/molecular mimicry.
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GiardiasisProf.Dr.SaadSAlAni
46. Symptoms of chronic infection
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Symptoms of chronic infection
• Malaise • Weight loss
(~66% of symptomatic patients)
• Nausea • Post infection lactase deficiency
(2-40% of cases)
• Anorexia • Chronic diarrhea
47. Physical Examination
Physical examination does not
contribute to the diagnosis of giardiasis
Weight loss may be evident
No known unique physical findings are
attributable to giardiasis.
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48. Physical Examination (Cont.)
On abdominal examination, patients may
have nonspecific tenderness without
evidence of peritoneal irritation
Rectal examination should reveal heme-
negative stools
In severe cases, evidence of dehydration
or wasting may be present.
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49. Complications of giardiasis
May include the following:
Development of chronic illness with weight loss
Malabsorption syndrome in adults
Failure to thrive in children
Disaccharidase deficiency
Zinc deficiency in schoolchildren 1
Growth retardation 2
Persistent gastrointestinal symptoms 3
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GiardiasisProf.Dr.SaadSAlAni
1.Quihui L, Morales GG, Mendez RO, Leyva JG, Esparza J, Valencia ME. Could giardiasis be a risk factor for low zinc status in
schoolchildren from northwestern Mexico? A cross-sectional study with longitudinal follow-up. BMC Public Health. 2010 Feb 20.
10(1):85.
2.Pickering LK. Giardia lamblia (Giardiasis). Long SS. Principles and Practice of Pediatric Infectious Diseases. 3rd ed.
Philadelphia, PA: Churchill Livingstone An imprint of Elsevier Inc; 2008. 265: 1241-1245.
3.Ouattara M, N'guessan NA, Yapi A, N'goran EK. Prevalence and spatial distribution of Entamoeba histolytica/dispar and Giardia lamblia
among schoolchildren in Agboville area (Côte d'Ivoire). PLoS Negl Trop Dis. 2010 Jan 19. 4(1):e574.
50. The diagnosis
Stool examination
• Ideally, 3 specimens from different days
should be examined because of potential
variations in fecal excretion of cysts.
• G intestinalis is identified in 50-70% of
patients after a single stool examination and
in more than 90% after 3 stool examinations.
Stool ova and parasite (O&P) examination
aids in the diagnosis of giardiasis in 80-85% of
patients
Nagaty IM, Hegazi MM. Dot-ELISA copro-antigen and direct stool examination in diagnosis of giardiasis patients. J Egypt Soc Parasitol.
2007 Aug. 37(2):641-8.
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51. The diagnosis (Cont.)
Stool antigen enzyme-linked immunosorbent assays
These tests are best used as a screening test in
high-incidence settings such as:
• Day-care centers
• For identification of subjects during an
epidemic,
They should not take the place of stool
microscopy.
Nagaty IM, Hegazi MM. Dot-ELISA copro-antigen and direct stool examination in diagnosis of
giardiasis patients. J Egypt Soc Parasitol. 2007 Aug. 37(2):641-8.
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52. The diagnosis (Cont.)
Stool antigen enzyme-linked immunosorbent assay
(ELISA) may be helpful , If the results from 3 O&P
tests are negative and giardiasis is still suspected
Upper endoscopy with biopsies and duodenal
aspirate is a reasonable alternative
Nagaty IM, Hegazi MM. Dot-ELISA copro-antigen and direct stool examination in diagnosis of
giardiasis patients. J Egypt Soc Parasitol. 2007 Aug. 37(2):641-8.
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54. Treatment
Generally, do not treat asymptomatic persons
who excrete the organism, except to :
Prevent household transmission( e.g., from
toddlers to pregnant women or to patients
with hypogammaglobulinemia or cystic
fibrosis)
Permit adequate treatment in individuals
with possible Giardia intestinalis –associated
antibiotic malabsorption who require oral
antibiotic treatment for other infections
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GiardiasisProf.Dr.SaadSAlAni
Kiser JD, Paulson CP, Brown C. Clinical inquiries. What's the most effective
treatment for giardiasis?. J Fam Pract. 2008 Apr. 57(4):270-2
55. Treatment
Metronidazole is the most commonly
prescribed antibiotic for this condition
Appropriate fluid and electrolyte
management is critical, particularly in
patients with large-volume diarrheal
losses
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GiardiasisProf.Dr.SaadSAlAni
Abdul-Wahid A, Faubert G. Characterization of the local immune response to cyst
antigens during the acute and elimination phases of primary murine giardiasis. Int J
Parasitol. 2008 May. 38(6):691-703.
56. Prognosis
The prognosis for patients with giardiasis is
generally excellent.
Most patients are asymptomatic
Most infections are self-limited.
Giardiasis is not associated with mortality
except in rare cases of extreme dehydration,
primarily in infants or malnourished
children.
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57. Prevention
Careful hand washing
Infected persons and persons at risk
should carefully wash their hands after
they have any contact with feces
Careful hand washing is important,
especially for caregivers of diapered
infants in day-care centers
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