Giardia Lamblia

Giardia
Giardia lamblia is a flagellated protozoan

that infects the duodenum and small

intestine.
range from asymptomatic colonization
to acute or chronic diarrhea and
malabsorption.
more prevalent in children

life cycle of G. lamblia is composed of 2

stages:
trophozoites
cysts

EPIDEMIOLOGY
usually occurs sporadically
major reservoir for spread :water

contaminated with Giardia cysts

Giardia cysts are relatively resistant to
chlorination and to ultraviolet light
irradiation
Boiling is effective for inactivating cysts.
Person-to-person spread also occurs .
Human milk contains glycoconjugates and
secretory IgA antibodies that may provide
protection to nursing infants.

CLINICAL
MANIFESTATIONS

incubation period :12 wk

clinical manifestations :asymptomatic . acute
infectious diarrhea, chronic diarrhea with failure
to thrive and abdominal pain or cramping.
Symptomatic infections occur more frequently
in children than in adults.
Most symptomatic patients : acute diarrhea.
low-grade fever, nausea, and anorexia;
intermittent or more protracted course
characterized by diarrhea, abdominal distention
and cramps, bloating, malaise, flatulence,
nausea, anorexia, and weight loss develops

CLINICAL
MANIFESTATIONS
stools
may be profuse and watery and
later become greasy and foul smelling
Stools do not contain blood, mucus, or
fecal leukocytes
Varying degrees of malabsorption may
occur.

Abnormal stool patterns may alternate with

periods of constipation and normal bowel

movements.
Malabsorption of sugars, fats, and fat-soluble
vitamins has been well documented and may
be responsible for substantial weight loss.
Giardiasis has been associated with growth
stunting and repeated Giardia infections with
a decrease in cognitive function in children in
endemic areas.

Giardiasis should be considered in young

children in child care or in any person who

has had contact with an index case or a
history of recent travel to an endemic area
who has persistent diarrhea, intermittent
diarrhea and constipation, malabsorption,
crampy abdominal pain and bloating,
failure to thrive, or weight loss

DIAGNOSIS
established by microscopy documentation

of trophozoites or cysts in stool specimens,

3 stool specimens are required to achieve a
sensitivity of >90%.
Stool enzyme immunoassay (EIA) or direct
fluorescent antibody tests are more
sensitive
aspiration or biopsy of the duodenum or
upper jejunum

TREATMENT
should receive therapy :

acute diarrhea
failure to thrive
exhibit malabsorption

Asymptomatic excreters generally are not

treated except:
in specific instances such as in outbreak
control, for prevention of household
transmission by toddlers to pregnant
women and patients with
hypogammaglobulinemia or cystic fibrosis,
and in situations requiring oral antibiotic
treatment where Giardia may have
produced malabsorption of the antibiotic

Tinidazole: >3 yr: 50 mg/kg/day once

daily
nitazoxanide
Metronidazole: 15 mg/kg/day in 3
divided doses for 57 days
Second line alternatives:
furazolidone 6 mg/kg/day in 4 divided
doses for 10 days
albendazole: >6 yr: 400 mg once a day for
5 days paromomycin, and
quinacrine :6 mg/kg/day in 3 divided
doses for 5 days

PREVENTION
Handwashing
purify public water supplies adequately

include chlorination and filtration.

Travelers to endemic areas are advised
to avoid uncooked foods that might have
been grown, washed, or prepared with
water that was potentially contaminated.
Purification of drinking water can be
achieved by a filter or by brisk boiling of
water for at least 1 min