giardiasis

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Giardiasis

 

Definition

Giardiasis is a common intestinal infection spread by eating contaminated food, drinking contaminated water, or through direct contact with the organism that causes the disease, Giardia lamblia. Giardiasis is found throughout the world and is a common cause of traveller's diarrhea. In the United States it is a growing problem, especially among children in childcare centers.

Description

Giardia is one of the most common intestinal parasites in the world, infecting as much as 20% of the entire population of the earth. It is common in overcrowded developing countries with poor sanitation and a lack of clean water. Recent tests have found Giardia in 7% of all stool samples tested nationwide, indicating that this disease is much more widespread than was originally believed. It has been found not only in humans, but also in wild and domestic animals.
Giardiasis is becoming a growing problem in the United States, where it affects three times more children than adults. In recent years, giardiasis outbreaks have been common among people in schools or daycare centers and at catered affairs and large public picnic areas. Children can easily pass on the infection by touching contaminated toys, changing tables, utensils, or their own feces, and then touching other people. For this reason, infection spreads quickly through a daycare center or institution for the developmentally disabled.
Unfiltered streams or lakes that may be contaminated by human or animal wastes are a common source of infection. Outbreaks can occur among campers and hikers who drink untreated water from mountain streams. While 20 million Americans drink unfiltered city water from streams or rivers, giardiasis outbreaks from tainted city water have been rare. Most of these problems have occurred not due to the absence of filters, but because of malfunctions in city water treatment plants, such as a temporary drop in chlorine levels. It is possible to become infected in a public swimming pool, however, since Giardia can survive in chlorinated water for about 15 minutes. During that time, it is possible for an individual to swallow contaminated pool water and become infected.

Causes and symptoms

Giardiasis is spread by food or water contaminated by the Giardia lamblia protozoan organism found in the human intestinal tract and feces. When the cysts are ingested, the stomach acid degrades the cysts and releases the active parasite into the body. Once within the body, the parasites cling to the lining of the small intestine, reproduce, and are swept into the fecal stream. As the liquid content of the bowel dries up, the parasites form cysts, which are then passed in the feces. Once excreted, the cysts can survive in water for more than three months. The parasite is spread further by direct fecal-oral contamination, such as can occur if food is prepared without adequate hand-washing, or by ingesting the cysts in water or food.
Giardiasis is not fatal, and about two-thirds of infected people exhibit no symptoms. Symptoms will not occur until between one and two weeks after infection. When present, symptoms include explosive, watery diarrhea that can last for a week or more and, in chronic cases, may persist for months. Because the
Infection with the protozoon Giardia lamblia, shown above, causes diarrhea in humans.
Infection with the protozoon Giardia lamblia, shown above, causes diarrhea in humans.
(Illustration by Electronic Illustrators Group).
infection interferes with the body's ability to absorb fats from the intestinal tract, the stool is filled with fat. Other symptoms include foul-smelling and greasy feces, stomach pains, gas and bloating, loss of appetite, nausea and vomiting. In cases in which the infection becomeschronic, lasting for months or years, symptoms might include poor digestion, problems digesting milk, intermittent diarrhea, fatigue, weakness, and significant weight loss.

Diagnosis

Diagnosis can be difficult because it can be easy to overlook the presence of the giardia cysts during a routine inspection of a stool specimen. In the past, the condition has been diagnosed by examining three stool samples for the presence of the parasites. However, because the organism is shed in some stool samples and not others, the infection may not be discovered using this method.
A newer, more accurate method of diagnosing the condition is the enzyme-linked immunosorbent assay (ELISA) that detects cysts and antigen in stool, and is approximately 90% accurate. While slightly more expensive, it only needs to be done once and is therefore less expensive overall than the earlier test.

Treatment

Acute giardiasis can usually be allowed to run its natural course and tends to clear up on its own. Antibiotics are helpful, however, in easing symptoms and preventing the spread of infection. Medications include metronidazole, furazolidone and paromomycin. Healthy carriers with no symptoms do not need antibiotic treatment. If treatment should fail, the patient should wait two weeks and repeat the drug course. Anyone with an impaired immune system (immunocompromised), such as a person with AIDS, may need to be treated with a combination of medications.

Prognosis

Giardiasis is rarely fatal, and when treated promptly, antibiotics usually cure the infection. While most people respond quickly to treatment, some have lingering symptoms and suffer with diarrhea and cramps for long periods, losing weight and not growing well. Those most at-risk for a course like this are the elderly, people with a weakened immune system, malnourished children, and anyone with low stomach acid.

Prevention

The best way to avoid giardiasis is to avoid drinking untreated surface water, especially from mountain streams. The condition also can be minimized by practicing the following preventive measures:
  • thoroughly washing hands before handling food
  • maintaining good personal cleanliness
  • boiling any untreated water for at least three minutes
  • properly disposing of fecal material
Children with severe diarrhea (and others who are unable to control their bowel habits) should be kept at home until the stool returns to normal. If an outbreak occurs in a daycare center, the director should notify the local health department. Some local health departments require a follow-up stool testing to confirm that the person is no longer contagious. People not in high-risk settings can return to their routine activities after recovery.

Resources

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Other

Centers for Disease Control. http://www.cdc.gov/ncidod/EID/eidtext.htm.
International Society of Travel Medicine. 〈http:www.istm.org〉.

Key terms

Antibody — A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Antigen — A substance (usually a protein) identified as foreign by the body's immune system, triggering the release of antibodies as part of the body's defense mechanism.
Enzyme-linked immunosorbent assay (ELISA) — A laboratory technique used to detect specific antigens or antibodies. It can be used to diagnose giardiasis.
Giardia lamblia — A type of protozoa with a whiplike tail that infects the human intestinal tract, causing giardiasis. The protozoa will not spread to other parts of the body.
Immunocompromised — A state in which the immune system is suppressed or not functioning properly.

giardiasis

 [je″ahr-di´ah-sis]
a common infection of the lumen of the small intestine with Giardia lamblia, and spread via contaminated food and water and by direct person-to-person contact. Most of those infected are asymptomatic, but a small percentage of cases present a wide range of symptoms, including nonspecific gastrointestinal discomfort, mild to profuse diarrhea, nausea, lassitude, anorexia, and weight loss.

gi·ar·di·a·sis

(jē'ar-dī'ă-sis),
Infection with the protozoan parasite Giardia; G. lamblia may cause diarrhea, dyspepsia, and occasionally malabsorption in humans.
Synonym(s): lambliasis

giardiasis

/gi·ar·di·a·sis/ (je″ahr-di´ah-sis) infection of the small intestine with the protozoan Giardia lamblia, spread via contaminated food or water or by direct person-to-person contact; symptoms are rare and range from nonspecific gastrointestinal discomfort to mild to profuse diarrhea, nausea, lassitude, anorexia, and weight loss.

giardiasis

(jē′är-dī′ə-sĭs)
n.
Intestinal infection with giardia (especially Giardia lamblia), which can cause abdominal cramps, diarrhea, or nausea in humans.

giardiasis

[jē·ärdī′əsis]
Etymology: Alfred Giard; Gk, osis, condition
a diarrheal illness caused by infection with the protozoan Giardia lamblia. The source of infection is usually fecally contaminated water. Cases have occurred in day-care facilities with poor hygienic practices. Infection may be asymptomatic or may cause nausea; abdominal cramps; foul-smelling, greasy diarrhea; fatigue; and weight loss. Treatment is metronidazole or tinidazole, furazolidone, or paromomycin. It is treated with flagyl. Also called traveler's diarrhea.

giardiasis

A small intestinal infection by Giardia lamblia.

Pronunciation
Medspeak-UK: pronounced, ghee are DIE uh sis
Medspeak-US :pronounced, gee are DIE uh sis

giardiasis

Infectious disease Intestinal infection with Giardia lamblia Epidemiology Acquired by ingesting water or food contaminated by
G lamblia cysts or by fecal–oral; post cyst ingestion; liberated trophozoites live non-invasively in small intestine and attach to the brush border and may cause local damage with ↓ of brush-border enzymes Clinical Acute, intermittent or chronic diarrhea unresponsive to conservative management; foul smelling, greasy stools; occasionally fever and vomiting; otherwise, malaise, flatulence, bloating, nausea, abdominal pain, weight loss Lab ↓ Intestinal trophozoites are associated with ↑ G lamblia-specific secretory IgA; cysts on LM of fresh stool specimens; trophozoites in duodenal aspirates or liquid stool; G lamblia antigens in feces Treatment Rehydration, metronidazole. See Giardia lamblia.

gi·ar·di·a·sis

(jē'ahr-dī'ă-sis)
Infection with the protozoan parasite Giardia lamblia, sometimes asymptomatic but often manifested by diarrhea, dyspepsia, and malabsorption.
Synonym(s): lambliasis.

giardiasis

Intestinal infection with the single-celled protozoan organism Giardia lamblia . This is usually acquired in contaminated drinking water but may be transmitted sexually. Giardiasis causes DIARRHOEA with cramping abdominal pain, flatulence and bulky malodourous stools. Medical treatment is effective. (Vitem Dusan Lambl, 1824–95, Czechoslovakian paediatrician).

Giard,

Alfred, French biologist, 1846-1908.
Giardia lamblia - protozoa which causes diarrhea and abdominal discomfort.
giardiasis - infection with Giardia.

gi·ar·di·a·sis

(jē'ahr-dī'ă-sis)
Infection with the parasite Giardia;G. lamblia may cause diarrhea, dyspepsia, and malabsorption.

giardiasis (jēärdī´əsis),

n an inflammatory intestinal condition caused by overgrowth of the protozoan
G. lamblia. The source of infection is usually contaminated water. Also called
traveler's diarrhea.

giardiasis

infection with giardia protozoa. Infection in dogs and cats is common with subclinical to severe disease resulting. There may be profuse watery diarrhea with borborygmus. Chronic small bowel diarrhea can also result, with weight loss and signs of malabsorption. High individual and farm infection prevalence rates occur in the young of all agricultural animals but there is limited evidence for significant clinical disease. Transmission to humans can occur. Called also beaver fever.