What is the prognosis for individuals diagnosed with giardiasis. How does proper treatment affect the outcome of Giardia infection. What factors influence recovery and long-term health after giardiasis.

Understanding Giardiasis: A Common Parasitic Infection

Giardiasis is a widespread intestinal infection caused by the microscopic parasite Giardia lamblia. This protozoan pathogen infects the small intestine, leading to various gastrointestinal symptoms. To fully comprehend the prognosis of giardiasis, it’s crucial to first understand the nature of this parasitic infection.

Giardia spreads through contaminated water, food, or direct contact with infected individuals. The parasite exists in two forms: the hardy, infectious cyst stage and the active, disease-causing trophozoite stage. Once ingested, cysts transform into trophozoites in the small intestine, attaching to the intestinal wall and causing inflammation and malabsorption.

Key Characteristics of Giardiasis:

• Incubation period: 1-3 weeks
• Common symptoms: diarrhea, abdominal cramps, bloating, nausea, and weight loss
• Transmission: fecal-oral route
• Diagnosis: stool examination, antigen tests, or PCR

Prognosis of Giardiasis: What to Expect

The prognosis for giardiasis is generally favorable, especially when appropriate treatment is administered promptly. Most individuals with healthy immune systems can expect a full recovery within a few weeks to months. However, the course and outcome of the infection can vary depending on several factors.

Factors Influencing Giardiasis Prognosis:

1. Immune status of the patient
2. Timeliness of diagnosis and treatment
3. Adherence to prescribed medication regimens
4. Presence of underlying health conditions
5. Nutritional status
6. Age of the patient

Can giardiasis resolve on its own? In some cases, giardiasis may be self-limiting, meaning the infection can clear without treatment. However, this is not guaranteed, and seeking medical attention is always recommended to prevent complications and reduce the risk of transmission to others.

Treatment Options and Their Impact on Prognosis

Effective treatment plays a crucial role in determining the prognosis of giardiasis. Several antiparasitic medications are available to combat Giardia infection, with the choice depending on factors such as patient age, pregnancy status, and severity of symptoms.

Common Treatments for Giardiasis:

• Metronidazole (Flagyl)
• Tinidazole (Tindamax)
• Nitazoxanide (Alinia)
• Albendazole (Albenza)

How does proper treatment affect the outcome of giardiasis? Timely and appropriate treatment significantly improves the prognosis by:

1. Reducing the duration of symptoms
2. Preventing complications such as malabsorption and weight loss
3. Decreasing the risk of chronic infection
4. Limiting the spread of the parasite to others

Recovery Timeline and Symptom Resolution

The recovery timeline for giardiasis can vary among individuals, but most people experience significant improvement within days to weeks of starting treatment. Understanding the typical progression can help manage expectations and identify any deviations that may require further medical attention.

Typical Recovery Timeline:

• 24-48 hours: Initial symptom relief
• 1-2 weeks: Significant improvement in most symptoms
• 2-4 weeks: Complete resolution of symptoms in most cases
• 1-3 months: Full recovery, including weight gain and normalized bowel function

Are there potential complications that can affect recovery? While rare, some individuals may experience prolonged symptoms or complications, such as:

• Lactose intolerance
• Irritable bowel syndrome-like symptoms
• Failure to thrive in children
• Chronic fatigue

These complications can impact the overall prognosis and may require additional medical intervention.

Long-Term Health Implications of Giardiasis

While most individuals recover fully from giardiasis without long-term consequences, some studies suggest potential long-term health implications, particularly in cases of chronic or recurrent infections. Understanding these potential effects is crucial for comprehensive patient care and follow-up.

Possible Long-Term Effects:

• Increased risk of irritable bowel syndrome
• Persistent food intolerances
• Altered gut microbiome
• Growth and cognitive delays in children

How can long-term effects be minimized? Prompt diagnosis, effective treatment, and proper follow-up care are essential in reducing the risk of long-term health consequences. Additionally, maintaining good hygiene practices and a healthy lifestyle can support overall gut health and immune function.

Special Considerations for High-Risk Groups

While giardiasis generally has a good prognosis, certain groups may be at higher risk for more severe infections or complications. These high-risk populations require special attention and may need modified treatment approaches to ensure the best possible outcome.

High-Risk Groups for Giardiasis:

• Infants and young children
• Pregnant women
• Immunocompromised individuals
• Malnourished individuals
• Elderly patients

Why do these groups require special consideration? High-risk individuals may experience more severe symptoms, have a higher risk of complications, or require alternative treatment options. For example, pregnant women may need to avoid certain medications, while immunocompromised patients may require longer treatment courses or combination therapies.

Preventing Reinfection and Improving Long-Term Prognosis

A crucial aspect of ensuring a positive long-term prognosis for giardiasis is preventing reinfection. Giardia cysts can survive in the environment for extended periods, making proper hygiene and preventive measures essential for both individual and public health.

Key Prevention Strategies:

1. Practice good hand hygiene
2. Avoid consuming untreated water
3. Properly wash fruits and vegetables
4. Practice safe food handling
5. Avoid swallowing water while swimming

Can reinfection affect the overall prognosis of giardiasis? Repeated infections can lead to chronic giardiasis, which may result in more severe symptoms, nutritional deficiencies, and an increased risk of long-term complications. Therefore, prevention is crucial for maintaining a positive prognosis and overall health.

The Role of Nutrition in Giardiasis Recovery and Prognosis

Nutrition plays a vital role in the recovery process and overall prognosis of giardiasis. The infection can lead to malabsorption and nutrient deficiencies, which can exacerbate symptoms and prolong recovery. Understanding the importance of proper nutrition during and after treatment is essential for improving outcomes.

Nutritional Considerations for Giardiasis Patients:

• Maintain adequate hydration
• Consume easily digestible foods
• Avoid lactose-containing products temporarily
• Supplement with vitamins and minerals as needed
• Gradually reintroduce complex foods

How does proper nutrition impact the prognosis of giardiasis? Adequate nutrition supports immune function, promotes healing of the intestinal lining, and helps prevent complications such as weight loss and malnutrition. A well-balanced diet can also aid in restoring the gut microbiome, which may be disrupted by the infection and subsequent treatment.

Monitoring and Follow-Up: Ensuring Positive Outcomes

Proper monitoring and follow-up care are crucial components in ensuring a positive prognosis for giardiasis. Even after the completion of treatment, patients should be aware of potential lingering symptoms or signs of reinfection. Healthcare providers play a vital role in guiding patients through the recovery process and addressing any concerns that may arise.

Key Aspects of Post-Treatment Monitoring:

1. Follow-up stool tests to confirm parasite clearance
2. Assessment of nutritional status and weight gain
3. Evaluation of persistent symptoms
4. Screening for potential complications
5. Patient education on prevention strategies

When should patients seek additional medical attention after treatment? Patients should consult their healthcare provider if they experience:

• Persistent or worsening symptoms beyond the expected recovery timeline
• New or unexplained symptoms
• Difficulty regaining weight or maintaining proper nutrition
• Signs of reinfection

Prompt attention to these issues can help prevent complications and ensure the best possible prognosis.

Research and Future Perspectives on Giardiasis Prognosis

Ongoing research in the field of giardiasis continues to shed light on various aspects of the disease, including its long-term effects, potential complications, and innovative treatment approaches. These advancements contribute to a better understanding of the prognosis and may lead to improved outcomes for patients in the future.

Current Areas of Research:

• Novel antiparasitic treatments
• Vaccine development
• Gut microbiome interactions
• Long-term health consequences
• Improved diagnostic techniques

How might future research impact the prognosis of giardiasis? Advances in treatment options, preventive measures, and diagnostic tools could lead to earlier detection, more effective therapies, and better management of potential complications. This, in turn, may improve overall prognosis and reduce the burden of giardiasis on individuals and public health systems.

In conclusion, the prognosis for giardiasis is generally favorable, with most individuals experiencing full recovery within weeks to months of proper treatment. However, factors such as immune status, timely diagnosis, and adherence to treatment can significantly influence outcomes. By understanding the various aspects of giardiasis prognosis, patients and healthcare providers can work together to ensure the best possible outcomes and minimize the risk of long-term complications.

What is the prognosis of giardiasis?

Author

Hisham Nazer, MBBCh, FRCP, DTM&H Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, University of Jordan Faculty of Medicine, Jordan

Hisham Nazer, MBBCh, FRCP, DTM&H is a member of the following medical societies: American Association for Physician Leadership, Royal College of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Royal Society of Tropical Medicine and Hygiene, Royal College of Physicians and Surgeons of the United Kingdom

Disclosure: Nothing to disclose.

Chief Editor

Burt Cagir, MD, FACS Clinical Professor of Surgery, Geisinger Commonwealth School of Medicine; Director, General Surgery Residency Program, Guthrie Robert Packer Hospital; Attending Surgeon, Guthrie Robert Packer Hospital and Corning Hospital

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, Association of Program Directors in Surgery, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Acknowledgements

Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Brooks D Cash, MD, FACP Director of Clinical Research, Assistant Professor of Medicine, Division of Gastroenterology, National Naval Medical Center

webmd.com”>Brooks D Cash, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Michelle Ervin, MD Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

webmd.com”>Disclosure: Nothing to disclose.

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Murat Hökelek, MD, PhD Technical Consultant of Parasitology Laboratory, Professor, Department of Clinical Microbiology, Ondokuz Mayis University Medical School, Turkey

Murat Hökelek, MD, PhD is a member of the following medical societies: Turkish Society for Parasitology

Disclosure: Nothing to disclose.

Mark H Johnston, MD Associate Professor of Medicine, Uniformed Services University of Health Sciences; Consulting Staff, Lancaster Gastroenterology Inc

Mark H Johnston, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

webmd.com”>Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Michael D Nissen, MBBS, FRACP, FRCPA Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children’s Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Andre Pennardt, MD, FACEP, FAAEM, FAWM Clinical Associate Professor of Emergency Medicine, Medical College of Georgia; Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Departments of Emergency Medicine, Aviation Medicine and Dive Medicine, Womack Army Medical Center

webmd.com”>Andre Pennardt, MD, FACEP, FAAEM, FAWM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US, International Society for Mountain Medicine, National Association of EMS Physicians, Special Operations Medical Association, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Barry J Sheridan, DO Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children’s Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

webmd.com”>Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

What Is It, Symptoms, Treatment, Causes

Overview

What is

Giardia?

Giardia intestinalis is a microscopic parasite (too small to see with the naked eye). It can affect humans and animals, such as dogs, cats and wild animals. A parasite is an organism that needs another organism (like a person or animal) to survive.

What is giardiasis?

Giardiasis (JEE-are-die-uh-sis) an infection caused by the parasite Giardia. After someone comes into contact with the parasite, the parasite can live in their intestines. It may make you sick.

How common is giardiasis?

Giardia parasites live around the world, in most countries and continents. It tends to be a bigger problem in countries with poor sanitation, such as developing countries. But you can get it almost anywhere.

In the United States, giardiasis is the most common parasitic infection to affect the intestines.

Symptoms and Causes

What causes giardiasis?

Giardiasis is caused by the parasite Giardia intestinalis.

How is giardiasis spread?

Giardiasis can spread through food or water. It also spreads via surfaces contaminated with Giardia cysts, or hard shells that contain the parasite. Even though parasites need a host (another living thing) to survive, Giardia’s shell enables the parasite to live on its own for extended periods.

People commonly get giardiasis from swallowing the parasite in untreated water. Giardiasis travels in even trace amounts of infected stool (poop) — amounts so small you can’t see it. If you have giardiasis, you can spread it to someone else, even if you have no symptoms.

You can get giardiasis through:

• Drinking from untreated water sources (such as lakes, streams or swimming pools).
• Traveling to countries with poor sanitation practices.
• Working closely with young children (such as in a child care center).
• Swallowing the parasite after touching a surface (such as a doorknob or toy) contaminated with tiny amounts of infected feces.
• Having sex, especially anal sex, with an infected person.

Who gets giardiasis?

Anyone can get giardiasis. Being around places where feces can easily spread (such as centers that care for many small children) can increase your chances of getting infected. People often contract giardiasis after drinking from a river or stream while camping or hiking. This is why giardiasis is sometimes called beaver fever.

Can animals get giardiasis?

Animals can get giardiasis and spread it to other animals. But the Giardia parasite that makes humans sick isn’t the same one that affects animals. So you’re unlikely to get giardiasis from your pet or a wild animal.

What does giardiasis do?

When the Giardia parasite gets inside your body, it lives inside your small intestine. It may make your stomach hurt. Not everyone who comes into contact with Giardia gets sick. If you do get sick, the infection may go away on its own.

What are the symptoms of giardiasis?

Giardiasis usually causes digestive symptoms, such as diarrhea or stomach cramps. Symptoms may be mildly irritating or severe. Some people have no symptoms.

Giardiasis symptoms include:

• Diarrhea (watery or greasy stools).
• Fatigue (feeling overly tired for a long time).
• Unsettled stomach or nausea.
• Stomach cramps.
• Bloating or gas.
• Dehydration, which may cause you to lose weight.

When do giardiasis symptoms start?

If you have giardiasis, you may get sick several days after being infected. Digestive symptoms may last anywhere from two to six weeks.

Symptoms may show up to three weeks after you were first exposed. It’s possible to have no symptoms at all from giardiasis.

Diagnosis and Tests

How is giardiasis diagnosed?

Healthcare providers can diagnose giardiasis by testing your stool for the Giardia parasite. The parasite may not show up in every stool sample. For that reason, your provider may need more than one sample to confirm a diagnosis.

If you have severe symptoms, your provider may examine your intestines using a thin, flexible tube. This procedure is called an upper endoscopy. The parasites are often seen when the tiny pieces of biopsies obtained at the time of endoscopy are stained with lab. Your provider may also take a sample of the contents of your intestine to look for parasites.

Management and Treatment

How is giardiasis treated?

Many people with giardiasis have minor symptoms that go away on their own. You may not need treatment.

If you have more severe parasite symptoms, your provider may prescribe an antibiotic with antiparasitic effect to kill the parasite. Giardia medications include:

• Metronidazole (Flagyl®).
• Tinidazole (Tindamax®).
• Nitazoxanide (Alinia®).

It is important to follow your provider’s instructions and take every pill as prescribed. If not, you may not clear the infection and may need a second course of medication to get rid of the parasite completely. Rarely, some patients develop prolonged or recurrent infection that would need evaluation for disorders of immune system and the help of an infectious disease specialist to formulate the drug combination that could help clear infection.

Prevention

Can giardiasis be prevented?

Giardia parasites are microscopic (too tiny to see without a microscope). It’s hard to avoid something you can’t see. But there are several ways you can minimize your risk of getting giardiasis.

Wash your hands often.

Wash your hands often with soap and clean, running water for at least 20 seconds. Always wash your hands:

• Before and after you eat.
• After using the toilet.
• After coming in contact with your own or someone else’s germs (such as changing a diaper).

Only drink from safe water sources.

Water can contain parasites, even if it looks clean. Do not drink untreated water, such as from wells, pools, lakes or rivers. If you have any concern about water contamination, don’t drink it. When in doubt, choose bottled water if it’s available. Or boil water for five minutes to kill any parasites.

Know the basics of food safety.

Washing all fruits and vegetables under hot water can prevent giardiasis. Do not eat raw or undercooked meat. Be especially cautious in countries where the water and food may be contaminated.

Practice safe sex.

Practicing safe sex can prevent a wide range of sexually transmitted diseases. To prevent giardiasis, use protection during oral-anal sex, and wash your hands right after sex. These practices can ensure you don’t come into contact with infected feces.

Outlook / Prognosis

What is the prognosis (outlook) for people with giardiasis?

Most people with giardiasis fully recover within two months after having mild to moderate digestive symptoms. Some people continue to have gastrointestinal symptoms (such as lactose intolerance or irritable bowel syndrome) long after the infection is gone.

Living With

When should I call my healthcare provider?

Dehydration from diarrhea can be serious. It’s especially dangerous for babies and women during pregnancy. Call your healthcare provider if you notice any symptoms that concern you. For a baby, having fewer wet diapers than usual can be a sign of dehydration.

A note from Cleveland Clinic

Giardiasis can cause minor to severe digestive symptoms, such as loose, runny stools and stomach cramps. The Giardia parasite can live outside the body for a long time. It can survive in water or food and on surfaces such as doorknobs. You can get giardiasis by drinking untreated water, eating contaminated food or having contact with infected feces. Prevent giardiasis by washing your hands regularly and not drinking water that may be unsafe. If you have giardiasis, your healthcare provider may prescribe antibiotics to treat the infection.

What Is It, Symptoms, Treatment, Causes

Overview

What is

Giardia?

Giardia intestinalis is a microscopic parasite (too small to see with the naked eye). It can affect humans and animals, such as dogs, cats and wild animals. A parasite is an organism that needs another organism (like a person or animal) to survive.

What is giardiasis?

Giardiasis (JEE-are-die-uh-sis) an infection caused by the parasite Giardia. After someone comes into contact with the parasite, the parasite can live in their intestines. It may make you sick.

How common is giardiasis?

Giardia parasites live around the world, in most countries and continents. It tends to be a bigger problem in countries with poor sanitation, such as developing countries. But you can get it almost anywhere.

In the United States, giardiasis is the most common parasitic infection to affect the intestines.

Symptoms and Causes

What causes giardiasis?

Giardiasis is caused by the parasite Giardia intestinalis.

How is giardiasis spread?

Giardiasis can spread through food or water. It also spreads via surfaces contaminated with Giardia cysts, or hard shells that contain the parasite. Even though parasites need a host (another living thing) to survive, Giardia’s shell enables the parasite to live on its own for extended periods.

People commonly get giardiasis from swallowing the parasite in untreated water. Giardiasis travels in even trace amounts of infected stool (poop) — amounts so small you can’t see it. If you have giardiasis, you can spread it to someone else, even if you have no symptoms.

You can get giardiasis through:

• Drinking from untreated water sources (such as lakes, streams or swimming pools).
• Traveling to countries with poor sanitation practices.
• Working closely with young children (such as in a child care center).
• Swallowing the parasite after touching a surface (such as a doorknob or toy) contaminated with tiny amounts of infected feces.
• Having sex, especially anal sex, with an infected person.

Who gets giardiasis?

Anyone can get giardiasis. Being around places where feces can easily spread (such as centers that care for many small children) can increase your chances of getting infected. People often contract giardiasis after drinking from a river or stream while camping or hiking. This is why giardiasis is sometimes called beaver fever.

Can animals get giardiasis?

Animals can get giardiasis and spread it to other animals. But the Giardia parasite that makes humans sick isn’t the same one that affects animals. So you’re unlikely to get giardiasis from your pet or a wild animal.

What does giardiasis do?

When the Giardia parasite gets inside your body, it lives inside your small intestine. It may make your stomach hurt. Not everyone who comes into contact with Giardia gets sick. If you do get sick, the infection may go away on its own.

What are the symptoms of giardiasis?

Giardiasis usually causes digestive symptoms, such as diarrhea or stomach cramps. Symptoms may be mildly irritating or severe. Some people have no symptoms.

Giardiasis symptoms include:

• Diarrhea (watery or greasy stools).
• Fatigue (feeling overly tired for a long time).
• Unsettled stomach or nausea.
• Stomach cramps.
• Bloating or gas.
• Dehydration, which may cause you to lose weight.

When do giardiasis symptoms start?

If you have giardiasis, you may get sick several days after being infected. Digestive symptoms may last anywhere from two to six weeks.

Symptoms may show up to three weeks after you were first exposed. It’s possible to have no symptoms at all from giardiasis.

Diagnosis and Tests

How is giardiasis diagnosed?

Healthcare providers can diagnose giardiasis by testing your stool for the Giardia parasite. The parasite may not show up in every stool sample. For that reason, your provider may need more than one sample to confirm a diagnosis.

If you have severe symptoms, your provider may examine your intestines using a thin, flexible tube. This procedure is called an upper endoscopy. The parasites are often seen when the tiny pieces of biopsies obtained at the time of endoscopy are stained with lab. Your provider may also take a sample of the contents of your intestine to look for parasites.

Management and Treatment

How is giardiasis treated?

Many people with giardiasis have minor symptoms that go away on their own. You may not need treatment.

If you have more severe parasite symptoms, your provider may prescribe an antibiotic with antiparasitic effect to kill the parasite. Giardia medications include:

• Metronidazole (Flagyl®).
• Tinidazole (Tindamax®).
• Nitazoxanide (Alinia®).

It is important to follow your provider’s instructions and take every pill as prescribed. If not, you may not clear the infection and may need a second course of medication to get rid of the parasite completely. Rarely, some patients develop prolonged or recurrent infection that would need evaluation for disorders of immune system and the help of an infectious disease specialist to formulate the drug combination that could help clear infection.

Prevention

Can giardiasis be prevented?

Giardia parasites are microscopic (too tiny to see without a microscope). It’s hard to avoid something you can’t see. But there are several ways you can minimize your risk of getting giardiasis.

Wash your hands often.

Wash your hands often with soap and clean, running water for at least 20 seconds. Always wash your hands:

• Before and after you eat.
• After using the toilet.
• After coming in contact with your own or someone else’s germs (such as changing a diaper).

Only drink from safe water sources.

Water can contain parasites, even if it looks clean. Do not drink untreated water, such as from wells, pools, lakes or rivers. If you have any concern about water contamination, don’t drink it. When in doubt, choose bottled water if it’s available. Or boil water for five minutes to kill any parasites.

Know the basics of food safety.

Washing all fruits and vegetables under hot water can prevent giardiasis. Do not eat raw or undercooked meat. Be especially cautious in countries where the water and food may be contaminated.

Practice safe sex.

Practicing safe sex can prevent a wide range of sexually transmitted diseases. To prevent giardiasis, use protection during oral-anal sex, and wash your hands right after sex. These practices can ensure you don’t come into contact with infected feces.

Outlook / Prognosis

What is the prognosis (outlook) for people with giardiasis?

Most people with giardiasis fully recover within two months after having mild to moderate digestive symptoms. Some people continue to have gastrointestinal symptoms (such as lactose intolerance or irritable bowel syndrome) long after the infection is gone.

Living With

When should I call my healthcare provider?

Dehydration from diarrhea can be serious. It’s especially dangerous for babies and women during pregnancy. Call your healthcare provider if you notice any symptoms that concern you. For a baby, having fewer wet diapers than usual can be a sign of dehydration.

A note from Cleveland Clinic

Giardiasis can cause minor to severe digestive symptoms, such as loose, runny stools and stomach cramps. The Giardia parasite can live outside the body for a long time. It can survive in water or food and on surfaces such as doorknobs. You can get giardiasis by drinking untreated water, eating contaminated food or having contact with infected feces. Prevent giardiasis by washing your hands regularly and not drinking water that may be unsafe. If you have giardiasis, your healthcare provider may prescribe antibiotics to treat the infection.

What Is It, Symptoms, Treatment, Causes

Overview

What is

Giardia?

Giardia intestinalis is a microscopic parasite (too small to see with the naked eye). It can affect humans and animals, such as dogs, cats and wild animals. A parasite is an organism that needs another organism (like a person or animal) to survive.

What is giardiasis?

Giardiasis (JEE-are-die-uh-sis) an infection caused by the parasite Giardia. After someone comes into contact with the parasite, the parasite can live in their intestines. It may make you sick.

How common is giardiasis?

Giardia parasites live around the world, in most countries and continents. It tends to be a bigger problem in countries with poor sanitation, such as developing countries. But you can get it almost anywhere.

In the United States, giardiasis is the most common parasitic infection to affect the intestines.

Symptoms and Causes

What causes giardiasis?

Giardiasis is caused by the parasite Giardia intestinalis.

How is giardiasis spread?

Giardiasis can spread through food or water. It also spreads via surfaces contaminated with Giardia cysts, or hard shells that contain the parasite. Even though parasites need a host (another living thing) to survive, Giardia’s shell enables the parasite to live on its own for extended periods.

People commonly get giardiasis from swallowing the parasite in untreated water. Giardiasis travels in even trace amounts of infected stool (poop) — amounts so small you can’t see it. If you have giardiasis, you can spread it to someone else, even if you have no symptoms.

You can get giardiasis through:

• Drinking from untreated water sources (such as lakes, streams or swimming pools).
• Traveling to countries with poor sanitation practices.
• Working closely with young children (such as in a child care center).
• Swallowing the parasite after touching a surface (such as a doorknob or toy) contaminated with tiny amounts of infected feces.
• Having sex, especially anal sex, with an infected person.

Who gets giardiasis?

Anyone can get giardiasis. Being around places where feces can easily spread (such as centers that care for many small children) can increase your chances of getting infected. People often contract giardiasis after drinking from a river or stream while camping or hiking. This is why giardiasis is sometimes called beaver fever.

Can animals get giardiasis?

Animals can get giardiasis and spread it to other animals. But the Giardia parasite that makes humans sick isn’t the same one that affects animals. So you’re unlikely to get giardiasis from your pet or a wild animal.

What does giardiasis do?

When the Giardia parasite gets inside your body, it lives inside your small intestine. It may make your stomach hurt. Not everyone who comes into contact with Giardia gets sick. If you do get sick, the infection may go away on its own.

What are the symptoms of giardiasis?

Giardiasis usually causes digestive symptoms, such as diarrhea or stomach cramps. Symptoms may be mildly irritating or severe. Some people have no symptoms.

Giardiasis symptoms include:

• Diarrhea (watery or greasy stools).
• Fatigue (feeling overly tired for a long time).
• Unsettled stomach or nausea.
• Stomach cramps.
• Bloating or gas.
• Dehydration, which may cause you to lose weight.

When do giardiasis symptoms start?

If you have giardiasis, you may get sick several days after being infected. Digestive symptoms may last anywhere from two to six weeks.

Symptoms may show up to three weeks after you were first exposed. It’s possible to have no symptoms at all from giardiasis.

Diagnosis and Tests

How is giardiasis diagnosed?

Healthcare providers can diagnose giardiasis by testing your stool for the Giardia parasite. The parasite may not show up in every stool sample. For that reason, your provider may need more than one sample to confirm a diagnosis.

If you have severe symptoms, your provider may examine your intestines using a thin, flexible tube. This procedure is called an upper endoscopy. The parasites are often seen when the tiny pieces of biopsies obtained at the time of endoscopy are stained with lab. Your provider may also take a sample of the contents of your intestine to look for parasites.

Management and Treatment

How is giardiasis treated?

Many people with giardiasis have minor symptoms that go away on their own. You may not need treatment.

If you have more severe parasite symptoms, your provider may prescribe an antibiotic with antiparasitic effect to kill the parasite. Giardia medications include:

• Metronidazole (Flagyl®).
• Tinidazole (Tindamax®).
• Nitazoxanide (Alinia®).

It is important to follow your provider’s instructions and take every pill as prescribed. If not, you may not clear the infection and may need a second course of medication to get rid of the parasite completely. Rarely, some patients develop prolonged or recurrent infection that would need evaluation for disorders of immune system and the help of an infectious disease specialist to formulate the drug combination that could help clear infection.

Prevention

Can giardiasis be prevented?

Giardia parasites are microscopic (too tiny to see without a microscope). It’s hard to avoid something you can’t see. But there are several ways you can minimize your risk of getting giardiasis.

Wash your hands often.

Wash your hands often with soap and clean, running water for at least 20 seconds. Always wash your hands:

• Before and after you eat.
• After using the toilet.
• After coming in contact with your own or someone else’s germs (such as changing a diaper).

Only drink from safe water sources.

Water can contain parasites, even if it looks clean. Do not drink untreated water, such as from wells, pools, lakes or rivers. If you have any concern about water contamination, don’t drink it. When in doubt, choose bottled water if it’s available. Or boil water for five minutes to kill any parasites.

Know the basics of food safety.

Washing all fruits and vegetables under hot water can prevent giardiasis. Do not eat raw or undercooked meat. Be especially cautious in countries where the water and food may be contaminated.

Practice safe sex.

Practicing safe sex can prevent a wide range of sexually transmitted diseases. To prevent giardiasis, use protection during oral-anal sex, and wash your hands right after sex. These practices can ensure you don’t come into contact with infected feces.

Outlook / Prognosis

What is the prognosis (outlook) for people with giardiasis?

Most people with giardiasis fully recover within two months after having mild to moderate digestive symptoms. Some people continue to have gastrointestinal symptoms (such as lactose intolerance or irritable bowel syndrome) long after the infection is gone.

Living With

When should I call my healthcare provider?

Dehydration from diarrhea can be serious. It’s especially dangerous for babies and women during pregnancy. Call your healthcare provider if you notice any symptoms that concern you. For a baby, having fewer wet diapers than usual can be a sign of dehydration.

A note from Cleveland Clinic

Giardiasis can cause minor to severe digestive symptoms, such as loose, runny stools and stomach cramps. The Giardia parasite can live outside the body for a long time. It can survive in water or food and on surfaces such as doorknobs. You can get giardiasis by drinking untreated water, eating contaminated food or having contact with infected feces. Prevent giardiasis by washing your hands regularly and not drinking water that may be unsafe. If you have giardiasis, your healthcare provider may prescribe antibiotics to treat the infection.

What Is It, Symptoms, Treatment, Causes

Overview

What is

Giardia?

Giardia intestinalis is a microscopic parasite (too small to see with the naked eye). It can affect humans and animals, such as dogs, cats and wild animals. A parasite is an organism that needs another organism (like a person or animal) to survive.

What is giardiasis?

Giardiasis (JEE-are-die-uh-sis) an infection caused by the parasite Giardia. After someone comes into contact with the parasite, the parasite can live in their intestines. It may make you sick.

How common is giardiasis?

Giardia parasites live around the world, in most countries and continents. It tends to be a bigger problem in countries with poor sanitation, such as developing countries. But you can get it almost anywhere.

In the United States, giardiasis is the most common parasitic infection to affect the intestines.

Symptoms and Causes

What causes giardiasis?

Giardiasis is caused by the parasite Giardia intestinalis.

How is giardiasis spread?

Giardiasis can spread through food or water. It also spreads via surfaces contaminated with Giardia cysts, or hard shells that contain the parasite. Even though parasites need a host (another living thing) to survive, Giardia’s shell enables the parasite to live on its own for extended periods.

People commonly get giardiasis from swallowing the parasite in untreated water. Giardiasis travels in even trace amounts of infected stool (poop) — amounts so small you can’t see it. If you have giardiasis, you can spread it to someone else, even if you have no symptoms.

You can get giardiasis through:

• Drinking from untreated water sources (such as lakes, streams or swimming pools).
• Traveling to countries with poor sanitation practices.
• Working closely with young children (such as in a child care center).
• Swallowing the parasite after touching a surface (such as a doorknob or toy) contaminated with tiny amounts of infected feces.
• Having sex, especially anal sex, with an infected person.

Who gets giardiasis?

Anyone can get giardiasis. Being around places where feces can easily spread (such as centers that care for many small children) can increase your chances of getting infected. People often contract giardiasis after drinking from a river or stream while camping or hiking. This is why giardiasis is sometimes called beaver fever.

Can animals get giardiasis?

Animals can get giardiasis and spread it to other animals. But the Giardia parasite that makes humans sick isn’t the same one that affects animals. So you’re unlikely to get giardiasis from your pet or a wild animal.

What does giardiasis do?

When the Giardia parasite gets inside your body, it lives inside your small intestine. It may make your stomach hurt. Not everyone who comes into contact with Giardia gets sick. If you do get sick, the infection may go away on its own.

What are the symptoms of giardiasis?

Giardiasis usually causes digestive symptoms, such as diarrhea or stomach cramps. Symptoms may be mildly irritating or severe. Some people have no symptoms.

Giardiasis symptoms include:

• Diarrhea (watery or greasy stools).
• Fatigue (feeling overly tired for a long time).
• Unsettled stomach or nausea.
• Stomach cramps.
• Bloating or gas.
• Dehydration, which may cause you to lose weight.

When do giardiasis symptoms start?

If you have giardiasis, you may get sick several days after being infected. Digestive symptoms may last anywhere from two to six weeks.

Symptoms may show up to three weeks after you were first exposed. It’s possible to have no symptoms at all from giardiasis.

Diagnosis and Tests

How is giardiasis diagnosed?

Healthcare providers can diagnose giardiasis by testing your stool for the Giardia parasite. The parasite may not show up in every stool sample. For that reason, your provider may need more than one sample to confirm a diagnosis.

If you have severe symptoms, your provider may examine your intestines using a thin, flexible tube. This procedure is called an upper endoscopy. The parasites are often seen when the tiny pieces of biopsies obtained at the time of endoscopy are stained with lab. Your provider may also take a sample of the contents of your intestine to look for parasites.

Management and Treatment

How is giardiasis treated?

Many people with giardiasis have minor symptoms that go away on their own. You may not need treatment.

If you have more severe parasite symptoms, your provider may prescribe an antibiotic with antiparasitic effect to kill the parasite. Giardia medications include:

• Metronidazole (Flagyl®).
• Tinidazole (Tindamax®).
• Nitazoxanide (Alinia®).

It is important to follow your provider’s instructions and take every pill as prescribed. If not, you may not clear the infection and may need a second course of medication to get rid of the parasite completely. Rarely, some patients develop prolonged or recurrent infection that would need evaluation for disorders of immune system and the help of an infectious disease specialist to formulate the drug combination that could help clear infection.

Prevention

Can giardiasis be prevented?

Giardia parasites are microscopic (too tiny to see without a microscope). It’s hard to avoid something you can’t see. But there are several ways you can minimize your risk of getting giardiasis.

Wash your hands often.

Wash your hands often with soap and clean, running water for at least 20 seconds. Always wash your hands:

• Before and after you eat.
• After using the toilet.
• After coming in contact with your own or someone else’s germs (such as changing a diaper).

Only drink from safe water sources.

Water can contain parasites, even if it looks clean. Do not drink untreated water, such as from wells, pools, lakes or rivers. If you have any concern about water contamination, don’t drink it. When in doubt, choose bottled water if it’s available. Or boil water for five minutes to kill any parasites.

Know the basics of food safety.

Washing all fruits and vegetables under hot water can prevent giardiasis. Do not eat raw or undercooked meat. Be especially cautious in countries where the water and food may be contaminated.

Practice safe sex.

Practicing safe sex can prevent a wide range of sexually transmitted diseases. To prevent giardiasis, use protection during oral-anal sex, and wash your hands right after sex. These practices can ensure you don’t come into contact with infected feces.

Outlook / Prognosis

What is the prognosis (outlook) for people with giardiasis?

Most people with giardiasis fully recover within two months after having mild to moderate digestive symptoms. Some people continue to have gastrointestinal symptoms (such as lactose intolerance or irritable bowel syndrome) long after the infection is gone.

Living With

When should I call my healthcare provider?

Dehydration from diarrhea can be serious. It’s especially dangerous for babies and women during pregnancy. Call your healthcare provider if you notice any symptoms that concern you. For a baby, having fewer wet diapers than usual can be a sign of dehydration.

A note from Cleveland Clinic

Giardiasis can cause minor to severe digestive symptoms, such as loose, runny stools and stomach cramps. The Giardia parasite can live outside the body for a long time. It can survive in water or food and on surfaces such as doorknobs. You can get giardiasis by drinking untreated water, eating contaminated food or having contact with infected feces. Prevent giardiasis by washing your hands regularly and not drinking water that may be unsafe. If you have giardiasis, your healthcare provider may prescribe antibiotics to treat the infection.

Giardia Lamblia Enteritis – StatPearls

Continuing Education Activity

Giardia lamblia enteritis is small-intestine gastroenteritis caused by the pathogenic protozoan Giardia lamblia, (Giardia duodenalis or Giardia intestinalis) is gastroenteritis of the small intestine caused by the protozoan Giardia lamblia. While some infected individuals may remain asymptomatic, the common presentations of symptomatic patients include foul-smelling diarrhea, greasy stools, flatulence, and bloating. This activity reviews the evaluation and treatment of Giardia lamblia enteritis and explains the role of the interprofessional team members in managing patients with this condition.

Objectives:

• Identify the pathophysiology of Giardia lambli enteritis.

• Outline the presentation of foul-smelling, greasy stools, abdominal pain, and flatulence in the typical patient history of Giardia lamblia enteritis.

• Review the use of supportive and antibiotic care for patients with Giardia lamblia enteritis.

• Describe the importance of collaboration and communication among the interprofessional team to enhance the delivery of care for patients affected by Giardia lamblia enteritis.

Access free multiple choice questions on this topic.

Introduction

Giardia lamblia enteritis is small-intestine gastroenteritis caused by the pathogenic protozoan Giardia lamblia, otherwise known as Giardia duodenalis or Giardia intestinalis.  Giardia enteritis is seen throughout the world and is one of the most common protozoan infections in the United States.[1] It usually is contracted through contact with contaminated water and is transmitted fecal-orally, presenting classically as an acute condition, which may also become chronic. While some infected individuals may remain asymptomatic, the most common symptoms include foul-smelling diarrhea, greasy stools, flatulence, and bloating.[2] This article addresses only symptomatic patients. Giardia enteritis is a disease reportable to the CDC and diagnosis is confirmed through stool sampling. The CDC recommends screening any patient with diarrhea for greater than 3 days.[3] First-line treatment is with metronidazole; however, other treatment options exist, and the disease is most often self-limiting. Complications include hypokalemia, malnutrition, growth stunting, cognitive deficits, arthritis/myopathy, irritable bowel syndrome, and chronic fatigue.[4]

Etiology

Giardia lamblia enteritis is caused by a unicellular flagellated protozoan pathogen Giardia lamblia (G. duodenalis, G. intestinalis). In addition to humans, Giardia enteritis has been reported in cats, dogs, cattle, sheep, and other livestock. It is spread via the fecal-oral route, most commonly through contaminated swimming and drinking water. [2] Giardia may be spread by ingesting as little as 10 cysts and is therefore easily transmittable between close contacts and in places where sanitation is below optimal, such as in daycare centers.[5]

Giardia has different assemblages typed A to G, with A and B types occurring in humans and animals and types C to G occurring exclusively in animals. Assemblages A and B can be spread zoonotically; however, this is not the most common route of transmission.[2]

The reproductive cycle of giardia includes nonmotile cysts and motile trophozoites. Much like other parasites, the cysts are responsible for transmission of Giardia enteritis. They are immediately infectious when released into the environment via feces and can remain infectious for up to almost 3 months, thriving and reproducing in cool, damp areas, especially river water.  The trophozoites are responsible for gastroenteritis and other symptoms of the disease. Both may be excreted in stool, but only the cysts survive long-term.[2][5]

Giardia lamblia is not considered an opportunistic pathogen, although rates in HIV-positive and immunocompromised patients are slightly higher.[2]

Epidemiology

Approximately 280 million cases of Giardia enteritis occur annually and follow a worldwide distribution,[1], with about 200 million of them occurring in Asia, Africa, and Latin America. Higher infection rates occur in developing countries and children. A review in 2007 claimed that there have been at least 134 outbreaks of giardia since the 1950s, most from contaminated drinking water.[2]

According to the CDC, approximately 17,000 and 15,000 reported cases of Giardia enteritis occurred in the U.S. in 2011 and 2012 respectively. Most cases occurred in children aged 1 to 4, possibly due to increased contact with contaminants or lack of immunity, followed by ages 5 to 9 and 45 to 49; these were generally not associated with an outbreak. [3] However, this number is under-reported, and it is estimated that 1.2 million cases occur annually in the U.S. In a study that pooled over 400,000 patients who had endoscopies performed over an 8-year span from 2008 to 2015, those who tested positive for giardiasis were 1.7 times more likely to be male. Presence of Helicobacter pylori as well as residence in the Southern U.S. were also associated with higher rates of giardiasis. Neither ethnicity, seasonal variation, nor urban versus rural setting had a significant association with the disease in this large cohort study.[1]  This differs from the CDC finding that the Northwest has the highest prevalence of giardiasis and that peak infection rates range from early summer to early fall.[3]. The discrepancy is possibly because giardiasis is not a reportable disease in six southern states, and patients in the cohort study did not mirror the demographic distribution of disease recorded by the CDC.[1]

Pathophysiology

Giardiasis is multifactorial disease, with a complex interplay between the host and parasite. When a host ingests Giardia cysts, they are able to excyst into their trophozoic form due to the combination of low gastric pH and pancreatic enzyme release in the duodenum. The trophozoites then divide and adhere tightly to small intestine enterocytes but do not invade the small intestine.[2][5] Tight adhesion combined with parasitic byproducts that are not yet well-understood form the characteristic symptoms of diarrhea, foul-smelling stool, bloating, and abdominal pain. The combination of increased apoptosis of enterocytes, intestinal barrier protection dysfunction, lymphocytic and cytokinetic host response, shortening of brush border microvilli, enzyme deficiencies, anion hypersecretion, and faster gastrointestinal (GI) transit time are all thought to be part of the pathophysiological process involved in Giardia enteritis.[4] In response to alkaline pH and bile salts, new cysts form, and both trophozoites and cysts are excreted in the feces.[2][5] 

Different genotypes of Giardia have not been proven to correlate with severity of the disease. [4]

History and Physical

Acute giardia enteritis symptoms include the onset of frequent diarrhea.  One study noted maximal stools of 8.5 per day as a median when the number of maximal stools was analyzed.[6]) Symptoms also include foul-smelling, greasy stools, flatulence, abdominal cramps and bloating, nausea, and anorexia. The disease may be associated with dehydration as well. Extraintestinal symptoms, though rare, include hives, angioedema, eczema, erythema nodosum, reactive arthritides, dysuria, and ophthalmologic involvement. Most infections are self-limiting; however, a small percentage become chronic. Infections that clear usually will do so in about 13-30 days.[6] Classically, the patient’s history will include drinking, swimming, or playing in unsterilized or contaminated water.[2]

Chronic symptoms include intermittent chronic diarrhea or loose stools, bloating, abdominal pain, functional dyspepsia, secondary lactose intolerance, malnutrition, and weight loss. Interestingly, there is evidence of chronic giardia infection in approximately 5% to 10% of patients diagnosed with inflammatory bowel syndrome (IBS).[4]

Due to the possible extraintestinal manifestations of Giardia enteritis, in addition to a thorough abdominal exam, fundoscopic, musculoskeletal, and skin exams should be conducted to rule out any retinal, arthritic, myopathic, or allergic components.

Evaluation

A confirmed case of giardiasis is defined by the CDC as “the detection of Giardia organisms, antigen, or DNA in stool, intestinal fluid, tissue samples, biopsy specimens or other biological sample.”

Giardia Lamblia enteritis is diagnosed definitively through microscopic identification of the pathogen in a stool sample. Because Giardia is often shed intermittently, examining stool samples collected over a period of several days is most sensitive. [7] The traditional ova and parasite exam includes a permanent stained smear; however, because the microscopic examination takes time, resources, multiple samples, and a trained eye, immunoassays have become the main diagnostic tool.

The direct fluorescence immunoassay (DFA) detects proteins of intact organisms and is reported to have highest sensitivity and specificity (96% to 100%; 99.8% to 100%), followed by the enzyme immunoassay (EIA) which detects stool antigens at sensitivity of 94% to 97% and specificity of 96% to 100%. Results of these exams may be obtained in 1 to 2 hours.

Rapid immunoassays are the most time-efficient, with results about in 10 minutes; however, they have a low sensitivity, especially in infections with a low concentration of the Giardia parasite, and should not replace DFA or direct microscopy.[7]

PCR used to detect giardia DNA in stool samples is as specific and sensitive as antigen detection and is more sensitive than microscopy, but it has not as of yet replaced the latter as gold standard. It is the only method available to classify the assemblage of the parasite.[8]

In hard-to-diagnose cases, duodenal aspirate may also be examined in place of stool samples.[9]

Treatment / Management

Supportive Care 

In patients with mild-to-moderate dehydration, oral rehydration solution (ORS) should be initiated. In patients with moderate-to-severe dehydration or patients who do not tolerate ORS, intravenous (IV) rehydration with normal saline or lactated Ringer solution may be used. Once rehydrated, maintenance fluids should replace ongoing losses. Antimotility drugs should not be administered to patients under 18 years of age and should be avoided if inflammatory diarrhea is suspected. Antiemetics may be used as an adjunct in patients greater than 4 years old.[9]

Antimicrobial Care

Metronidazole has been the first-line treatment for Giardia enteritis; however, a recent study has concluded that treatment with tinidazole is superior and may offer a shorter treatment course and fewer side effects[10] and the IDSA recommends tinidazole as first-line in patients over 3 years of age.[9]. Metronidazole is given at doses of either 250 mg by mouth three times a day OR 500 mg by mouth two times a day for 5 to 7 days in adults and 15 mg/kg by mouth divided three times a day for 5 to 7 days in children. Tinidazole is given 2 g by mouth in 1 dose in adults and 40 to 50 mg/kg in children. Nitazoxanide is a newer anti-parasitic drug that is very efficacious but needs further study.[11]

Abstinence from alcohol during metronidazole treatment should be stressed to avoid a disulfiram-like reaction. Adverse effects include reddish-brown urine, headache, nausea, vomiting, metallic taste, and abdominal pain. Other 5-NIs (ornidazole and secnidazole) and the benzimidazoles (albendazole and mebendazole) have been studied and may offer comparable efficacy and decreased adverse effects as well, but there are conflicting results. Paromomycin and quinacrine are reserved for refractory cases.[9][11][12]

The two drugs recommended to treat women with giardiasis during pregnancy are paromomycin during the first trimester and paromomycin or metronidazole during the last two trimesters. It is reasonable to delay treatment in the first trimester as long as the woman’s symptoms are mild.[11]

If initial treatment fails, a second course of the same medication, a course of a different medication, or co-therapy with medications from two classes may be used. [11]

Differential Diagnosis

• Viral Gastroenteritis (i.e., norovirus)[13]

• Traveler Diarrhea

• Lactose intolerance

• Inflammatory bowel syndrome[4]
• Inflammatory bowel disease [15]

• Cryptosporidiosis

Performing a detailed history and physical, denoting time of onset after inciting events (e.g., after travel or food ingestion) as well as using differentiative diagnostic tools when indicated (e.g., hydrogen breath test, serum markers, stool sample, endoscopy) will help to elucidate the cause of symptoms such as diarrhea and abdominal pain.

Prognosis

Most symptomatic Giardia infections resolve spontaneously but infections can lead to chronic disease and can cause irritable bowel syndrome (IBS) and chronic fatigue syndrome. However, infections may be protective against other diarrheal diseases

Complications

Short-Term Complications

Long-Term Complications

• Salt-and-pepper retinopathy (no associated visual changes)

• HLA-B27 negative arthritides similar to reactive arthritis

• Allergies secondary to an increase in IgE, or enzyme destruction (lactose intolerance, concomitant, and post-infective urticaria) 

• Hypokalemic myopathy (related to the duration and severity of enteric symptoms)

• Nutritional consequences

  • Iron-deficiency anemia, malnutrition, growth failure, cognitive retardation, malabsorption, failure to thrive

  • More commonly seen in young children

• Chronic Fatigue

Deterrence and Patient Education

Steps to decrease transmission include:

• Hand hygiene

• Infection control in healthcare settings (universal precautions)

• Reporting cases to the CDC

• Food safety practices to avoid cross-contamination

• Avoiding swimming, water activities, and sexual contact during the disease course[9]

• Awareness of risk factors for the disease such as swimming in freshwater or shared public water sources

Enhancing Healthcare Team Outcomes

Giardiasis is a very common parasite in the tropics and for the most part, can be prevented. The key is to educate the traveler going to these areas. Besides the physician, the nurse and pharmacist play a key role in the education of the public in preventing this infection. Emphasis has to be placed on personal hand hygiene. In addition, one should avoid drinking water from the local streams, drinking only bottled or boiled water and washing all food thoroughly. Because there is a high risk of transmission of the parasite after anal/fecal contact, the importance of hand hygiene after changing diapers and defecation cannot be emphasized enough. Finally, the pharmacist should educate the public that prophylactic drug treatment while traveling is not recommended as this can lead to a build-up of drug resistance. [17][18](Level V)

Outcomes

The majority of patients who acquire giardiasis have an excellent outcome. In most people the infection is associated with mild or no symptoms. Even those who develop symptoms recover in 5-7 days. Mortality is rare but can occur in infants and the elderly. While the use of antibiotics has improved outcomes, there is evidence of drug resistance in many parts of the globe. Plus, if the environmental conditions are not altered, then reinfection is not uncommon. There are reports that chronic infection with giardia in children may lead to failure to thrive. In others, symptoms that resemble irritable bowel syndrome may persist for several years after the infection.[19][20] (Level V)

References

1.

Zylberberg HM, Green PH, Turner KO, Genta RM, Lebwohl B. Prevalence and Predictors of Giardia in the United States. Dig Dis Sci. 2017 Feb;62(2):432-440. [PubMed: 28070825]

2.

Feng Y, Xiao L. Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev. 2011 Jan;24(1):110-40. [PMC free article: PMC3021202] [PubMed: 21233509]

3.

Painter JE, Gargano JW, Collier SA, Yoder JS., Centers for Disease Control and Prevention. Giardiasis surveillance — United States, 2011-2012. MMWR Suppl. 2015 May 01;64(3):15-25. [PubMed: 25928582]

4.

Halliez MC, Buret AG. Extra-intestinal and long term consequences of Giardia duodenalis infections. World J Gastroenterol. 2013 Dec 21;19(47):8974-85. [PMC free article: PMC3870550] [PubMed: 24379622]

5.

Muhsen K, Levine MM. A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries. Clin Infect Dis. 2012 Dec;55 Suppl 4:S271-93. [PMC free article: PMC3502312] [PubMed: 23169940]

6.

Cantey PT, Roy S, Lee B, Cronquist A, Smith K, Liang J, Beach MJ. Study of nonoutbreak giardiasis: novel findings and implications for research. Am J Med. 2011 Dec;124(12):1175.e1-8. [PubMed: 22014792]

7.

Johnston SP, Ballard MM, Beach MJ, Causer L, Wilkins PP. Evaluation of three commercial assays for detection of Giardia and Cryptosporidium organisms in fecal specimens. J Clin Microbiol. 2003 Feb;41(2):623-6. [PMC free article: PMC149727] [PubMed: 12574257]

8.

Verweij JJ, Schinkel J, Laeijendecker D, van Rooyen MA, van Lieshout L, Polderman AM. Real-time PCR for the detection of Giardia lamblia. Mol Cell Probes. 2003 Oct;17(5):223-5. [PubMed: 14580396]

9.

Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. [PMC free article: PMC5850553] [PubMed: 29053792]

10.

Ordóñez-Mena JM, McCarthy ND, Fanshawe TR. Comparative efficacy of drugs for treating giardiasis: a systematic update of the literature and network meta-analysis of randomized clinical trials. J Antimicrob Chemother. 2018 Mar 01;73(3):596-606. [PMC free article: PMC5890742] [PubMed: 29186570]

11.

Escobedo AA, Cimerman S. Giardiasis: a pharmacotherapy review. Expert Opin Pharmacother. 2007 Aug;8(12):1885-902. [PubMed: 17696791]

12.

Granados CE, Reveiz L, Uribe LG, Criollo CP. Drugs for treating giardiasis. Cochrane Database Syst Rev. 2012 Dec 12;12:CD007787. [PMC free article: PMC6532677] [PubMed: 23235648]

13.

DuPont HL. Acute infectious diarrhea in immunocompetent adults. N Engl J Med. 2014 Apr 17;370(16):1532-40. [PubMed: 24738670]

14.

Robertson LJ, Hanevik K, Escobedo AA, Mørch K, Langeland N. Giardiasis–why do the symptoms sometimes never stop? Trends Parasitol. 2010 Feb;26(2):75-82. [PubMed: 20056486]

15.

Gunasekaran TS, Hassall E. Giardiasis mimicking inflammatory bowel disease. J Pediatr. 1992 Mar;120(3):424-6. [PubMed: 1538290]

16.

Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc. 2014 Oct;80(4):689-706. [PubMed: 25070906]

17.

Marsh WW. Infectious diseases of gastrointestinal tract in adolescents. Adolesc Med. 2000 Jun;11(2):263-78. [PubMed: 10916124]

18.

Forson AO, Arthur I, Ayeh-Kumi PF. The role of family size, employment and education of parents in the prevalence of intestinal parasitic infections in school children in Accra. PLoS One. 2018;13(2):e0192303. [PMC free article: PMC5802905] [PubMed: 29415040]

19.

Versloot CJ, Attia S, Bourdon C, Richardson SE, Potani I, Bandsma RHJ, Voskuijl W. Intestinal pathogen clearance in children with severe acute malnutrition is unrelated to inpatient morbidity. Clin Nutr ESPEN. 2018 Apr;24:109-113. [PubMed: 29576347]

20.

Dormond M, Gutierrez RL, Porter CK. Giardia lamblia infection increases risk of chronic gastrointestinal disorders. Trop Dis Travel Med Vaccines. 2016;2:17. [PMC free article: PMC5530925] [PubMed: 28883961]

Giardia Lamblia Enteritis – StatPearls

Continuing Education Activity

Giardia lamblia enteritis is small-intestine gastroenteritis caused by the pathogenic protozoan Giardia lamblia, (Giardia duodenalis or Giardia intestinalis) is gastroenteritis of the small intestine caused by the protozoan Giardia lamblia. While some infected individuals may remain asymptomatic, the common presentations of symptomatic patients include foul-smelling diarrhea, greasy stools, flatulence, and bloating. This activity reviews the evaluation and treatment of Giardia lamblia enteritis and explains the role of the interprofessional team members in managing patients with this condition.

Objectives:

• Identify the pathophysiology of Giardia lambli enteritis.

• Outline the presentation of foul-smelling, greasy stools, abdominal pain, and flatulence in the typical patient history of Giardia lamblia enteritis.

• Review the use of supportive and antibiotic care for patients with Giardia lamblia enteritis.

• Describe the importance of collaboration and communication among the interprofessional team to enhance the delivery of care for patients affected by Giardia lamblia enteritis.

Access free multiple choice questions on this topic.

Introduction

Giardia lamblia enteritis is small-intestine gastroenteritis caused by the pathogenic protozoan Giardia lamblia, otherwise known as Giardia duodenalis or Giardia intestinalis.  Giardia enteritis is seen throughout the world and is one of the most common protozoan infections in the United States.[1] It usually is contracted through contact with contaminated water and is transmitted fecal-orally, presenting classically as an acute condition, which may also become chronic. While some infected individuals may remain asymptomatic, the most common symptoms include foul-smelling diarrhea, greasy stools, flatulence, and bloating.[2] This article addresses only symptomatic patients. Giardia enteritis is a disease reportable to the CDC and diagnosis is confirmed through stool sampling. The CDC recommends screening any patient with diarrhea for greater than 3 days.[3] First-line treatment is with metronidazole; however, other treatment options exist, and the disease is most often self-limiting. Complications include hypokalemia, malnutrition, growth stunting, cognitive deficits, arthritis/myopathy, irritable bowel syndrome, and chronic fatigue.[4]

Etiology

Giardia lamblia enteritis is caused by a unicellular flagellated protozoan pathogen Giardia lamblia (G. duodenalis, G. intestinalis). In addition to humans, Giardia enteritis has been reported in cats, dogs, cattle, sheep, and other livestock. It is spread via the fecal-oral route, most commonly through contaminated swimming and drinking water. [2] Giardia may be spread by ingesting as little as 10 cysts and is therefore easily transmittable between close contacts and in places where sanitation is below optimal, such as in daycare centers.[5]

Giardia has different assemblages typed A to G, with A and B types occurring in humans and animals and types C to G occurring exclusively in animals. Assemblages A and B can be spread zoonotically; however, this is not the most common route of transmission.[2]

The reproductive cycle of giardia includes nonmotile cysts and motile trophozoites. Much like other parasites, the cysts are responsible for transmission of Giardia enteritis. They are immediately infectious when released into the environment via feces and can remain infectious for up to almost 3 months, thriving and reproducing in cool, damp areas, especially river water.  The trophozoites are responsible for gastroenteritis and other symptoms of the disease. Both may be excreted in stool, but only the cysts survive long-term.[2][5]

Giardia lamblia is not considered an opportunistic pathogen, although rates in HIV-positive and immunocompromised patients are slightly higher.[2]

Epidemiology

Approximately 280 million cases of Giardia enteritis occur annually and follow a worldwide distribution,[1], with about 200 million of them occurring in Asia, Africa, and Latin America. Higher infection rates occur in developing countries and children. A review in 2007 claimed that there have been at least 134 outbreaks of giardia since the 1950s, most from contaminated drinking water.[2]

According to the CDC, approximately 17,000 and 15,000 reported cases of Giardia enteritis occurred in the U.S. in 2011 and 2012 respectively. Most cases occurred in children aged 1 to 4, possibly due to increased contact with contaminants or lack of immunity, followed by ages 5 to 9 and 45 to 49; these were generally not associated with an outbreak. [3] However, this number is under-reported, and it is estimated that 1.2 million cases occur annually in the U.S. In a study that pooled over 400,000 patients who had endoscopies performed over an 8-year span from 2008 to 2015, those who tested positive for giardiasis were 1.7 times more likely to be male. Presence of Helicobacter pylori as well as residence in the Southern U.S. were also associated with higher rates of giardiasis. Neither ethnicity, seasonal variation, nor urban versus rural setting had a significant association with the disease in this large cohort study.[1]  This differs from the CDC finding that the Northwest has the highest prevalence of giardiasis and that peak infection rates range from early summer to early fall.[3]. The discrepancy is possibly because giardiasis is not a reportable disease in six southern states, and patients in the cohort study did not mirror the demographic distribution of disease recorded by the CDC.[1]

Pathophysiology

Giardiasis is multifactorial disease, with a complex interplay between the host and parasite. When a host ingests Giardia cysts, they are able to excyst into their trophozoic form due to the combination of low gastric pH and pancreatic enzyme release in the duodenum. The trophozoites then divide and adhere tightly to small intestine enterocytes but do not invade the small intestine.[2][5] Tight adhesion combined with parasitic byproducts that are not yet well-understood form the characteristic symptoms of diarrhea, foul-smelling stool, bloating, and abdominal pain. The combination of increased apoptosis of enterocytes, intestinal barrier protection dysfunction, lymphocytic and cytokinetic host response, shortening of brush border microvilli, enzyme deficiencies, anion hypersecretion, and faster gastrointestinal (GI) transit time are all thought to be part of the pathophysiological process involved in Giardia enteritis.[4] In response to alkaline pH and bile salts, new cysts form, and both trophozoites and cysts are excreted in the feces.[2][5] 

Different genotypes of Giardia have not been proven to correlate with severity of the disease. [4]

History and Physical

Acute giardia enteritis symptoms include the onset of frequent diarrhea.  One study noted maximal stools of 8.5 per day as a median when the number of maximal stools was analyzed.[6]) Symptoms also include foul-smelling, greasy stools, flatulence, abdominal cramps and bloating, nausea, and anorexia. The disease may be associated with dehydration as well. Extraintestinal symptoms, though rare, include hives, angioedema, eczema, erythema nodosum, reactive arthritides, dysuria, and ophthalmologic involvement. Most infections are self-limiting; however, a small percentage become chronic. Infections that clear usually will do so in about 13-30 days.[6] Classically, the patient’s history will include drinking, swimming, or playing in unsterilized or contaminated water.[2]

Chronic symptoms include intermittent chronic diarrhea or loose stools, bloating, abdominal pain, functional dyspepsia, secondary lactose intolerance, malnutrition, and weight loss. Interestingly, there is evidence of chronic giardia infection in approximately 5% to 10% of patients diagnosed with inflammatory bowel syndrome (IBS).[4]

Due to the possible extraintestinal manifestations of Giardia enteritis, in addition to a thorough abdominal exam, fundoscopic, musculoskeletal, and skin exams should be conducted to rule out any retinal, arthritic, myopathic, or allergic components.

Evaluation

A confirmed case of giardiasis is defined by the CDC as “the detection of Giardia organisms, antigen, or DNA in stool, intestinal fluid, tissue samples, biopsy specimens or other biological sample.”

Giardia Lamblia enteritis is diagnosed definitively through microscopic identification of the pathogen in a stool sample. Because Giardia is often shed intermittently, examining stool samples collected over a period of several days is most sensitive. [7] The traditional ova and parasite exam includes a permanent stained smear; however, because the microscopic examination takes time, resources, multiple samples, and a trained eye, immunoassays have become the main diagnostic tool.

The direct fluorescence immunoassay (DFA) detects proteins of intact organisms and is reported to have highest sensitivity and specificity (96% to 100%; 99.8% to 100%), followed by the enzyme immunoassay (EIA) which detects stool antigens at sensitivity of 94% to 97% and specificity of 96% to 100%. Results of these exams may be obtained in 1 to 2 hours.

Rapid immunoassays are the most time-efficient, with results about in 10 minutes; however, they have a low sensitivity, especially in infections with a low concentration of the Giardia parasite, and should not replace DFA or direct microscopy.[7]

PCR used to detect giardia DNA in stool samples is as specific and sensitive as antigen detection and is more sensitive than microscopy, but it has not as of yet replaced the latter as gold standard. It is the only method available to classify the assemblage of the parasite.[8]

In hard-to-diagnose cases, duodenal aspirate may also be examined in place of stool samples.[9]

Treatment / Management

Supportive Care 

In patients with mild-to-moderate dehydration, oral rehydration solution (ORS) should be initiated. In patients with moderate-to-severe dehydration or patients who do not tolerate ORS, intravenous (IV) rehydration with normal saline or lactated Ringer solution may be used. Once rehydrated, maintenance fluids should replace ongoing losses. Antimotility drugs should not be administered to patients under 18 years of age and should be avoided if inflammatory diarrhea is suspected. Antiemetics may be used as an adjunct in patients greater than 4 years old.[9]

Antimicrobial Care

Metronidazole has been the first-line treatment for Giardia enteritis; however, a recent study has concluded that treatment with tinidazole is superior and may offer a shorter treatment course and fewer side effects[10] and the IDSA recommends tinidazole as first-line in patients over 3 years of age.[9]. Metronidazole is given at doses of either 250 mg by mouth three times a day OR 500 mg by mouth two times a day for 5 to 7 days in adults and 15 mg/kg by mouth divided three times a day for 5 to 7 days in children. Tinidazole is given 2 g by mouth in 1 dose in adults and 40 to 50 mg/kg in children. Nitazoxanide is a newer anti-parasitic drug that is very efficacious but needs further study.[11]

Abstinence from alcohol during metronidazole treatment should be stressed to avoid a disulfiram-like reaction. Adverse effects include reddish-brown urine, headache, nausea, vomiting, metallic taste, and abdominal pain. Other 5-NIs (ornidazole and secnidazole) and the benzimidazoles (albendazole and mebendazole) have been studied and may offer comparable efficacy and decreased adverse effects as well, but there are conflicting results. Paromomycin and quinacrine are reserved for refractory cases.[9][11][12]

The two drugs recommended to treat women with giardiasis during pregnancy are paromomycin during the first trimester and paromomycin or metronidazole during the last two trimesters. It is reasonable to delay treatment in the first trimester as long as the woman’s symptoms are mild.[11]

If initial treatment fails, a second course of the same medication, a course of a different medication, or co-therapy with medications from two classes may be used. [11]

Differential Diagnosis

• Viral Gastroenteritis (i.e., norovirus)[13]

• Traveler Diarrhea

• Lactose intolerance

• Inflammatory bowel syndrome[4]
• Inflammatory bowel disease [15]

• Cryptosporidiosis

Performing a detailed history and physical, denoting time of onset after inciting events (e.g., after travel or food ingestion) as well as using differentiative diagnostic tools when indicated (e.g., hydrogen breath test, serum markers, stool sample, endoscopy) will help to elucidate the cause of symptoms such as diarrhea and abdominal pain.

Prognosis

Most symptomatic Giardia infections resolve spontaneously but infections can lead to chronic disease and can cause irritable bowel syndrome (IBS) and chronic fatigue syndrome. However, infections may be protective against other diarrheal diseases

Complications

Short-Term Complications

Long-Term Complications

• Salt-and-pepper retinopathy (no associated visual changes)

• HLA-B27 negative arthritides similar to reactive arthritis

• Allergies secondary to an increase in IgE, or enzyme destruction (lactose intolerance, concomitant, and post-infective urticaria) 

• Hypokalemic myopathy (related to the duration and severity of enteric symptoms)

• Nutritional consequences

  • Iron-deficiency anemia, malnutrition, growth failure, cognitive retardation, malabsorption, failure to thrive

  • More commonly seen in young children

• Chronic Fatigue

Deterrence and Patient Education

Steps to decrease transmission include:

• Hand hygiene

• Infection control in healthcare settings (universal precautions)

• Reporting cases to the CDC

• Food safety practices to avoid cross-contamination

• Avoiding swimming, water activities, and sexual contact during the disease course[9]

• Awareness of risk factors for the disease such as swimming in freshwater or shared public water sources

Enhancing Healthcare Team Outcomes

Giardiasis is a very common parasite in the tropics and for the most part, can be prevented. The key is to educate the traveler going to these areas. Besides the physician, the nurse and pharmacist play a key role in the education of the public in preventing this infection. Emphasis has to be placed on personal hand hygiene. In addition, one should avoid drinking water from the local streams, drinking only bottled or boiled water and washing all food thoroughly. Because there is a high risk of transmission of the parasite after anal/fecal contact, the importance of hand hygiene after changing diapers and defecation cannot be emphasized enough. Finally, the pharmacist should educate the public that prophylactic drug treatment while traveling is not recommended as this can lead to a build-up of drug resistance. [17][18](Level V)

Outcomes

The majority of patients who acquire giardiasis have an excellent outcome. In most people the infection is associated with mild or no symptoms. Even those who develop symptoms recover in 5-7 days. Mortality is rare but can occur in infants and the elderly. While the use of antibiotics has improved outcomes, there is evidence of drug resistance in many parts of the globe. Plus, if the environmental conditions are not altered, then reinfection is not uncommon. There are reports that chronic infection with giardia in children may lead to failure to thrive. In others, symptoms that resemble irritable bowel syndrome may persist for several years after the infection.[19][20] (Level V)

References

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Zylberberg HM, Green PH, Turner KO, Genta RM, Lebwohl B. Prevalence and Predictors of Giardia in the United States. Dig Dis Sci. 2017 Feb;62(2):432-440. [PubMed: 28070825]

2.

Feng Y, Xiao L. Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev. 2011 Jan;24(1):110-40. [PMC free article: PMC3021202] [PubMed: 21233509]

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Painter JE, Gargano JW, Collier SA, Yoder JS., Centers for Disease Control and Prevention. Giardiasis surveillance — United States, 2011-2012. MMWR Suppl. 2015 May 01;64(3):15-25. [PubMed: 25928582]

4.

Halliez MC, Buret AG. Extra-intestinal and long term consequences of Giardia duodenalis infections. World J Gastroenterol. 2013 Dec 21;19(47):8974-85. [PMC free article: PMC3870550] [PubMed: 24379622]

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Muhsen K, Levine MM. A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries. Clin Infect Dis. 2012 Dec;55 Suppl 4:S271-93. [PMC free article: PMC3502312] [PubMed: 23169940]

6.

Cantey PT, Roy S, Lee B, Cronquist A, Smith K, Liang J, Beach MJ. Study of nonoutbreak giardiasis: novel findings and implications for research. Am J Med. 2011 Dec;124(12):1175.e1-8. [PubMed: 22014792]

7.

Johnston SP, Ballard MM, Beach MJ, Causer L, Wilkins PP. Evaluation of three commercial assays for detection of Giardia and Cryptosporidium organisms in fecal specimens. J Clin Microbiol. 2003 Feb;41(2):623-6. [PMC free article: PMC149727] [PubMed: 12574257]

8.

Verweij JJ, Schinkel J, Laeijendecker D, van Rooyen MA, van Lieshout L, Polderman AM. Real-time PCR for the detection of Giardia lamblia. Mol Cell Probes. 2003 Oct;17(5):223-5. [PubMed: 14580396]

9.

Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. [PMC free article: PMC5850553] [PubMed: 29053792]

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Ordóñez-Mena JM, McCarthy ND, Fanshawe TR. Comparative efficacy of drugs for treating giardiasis: a systematic update of the literature and network meta-analysis of randomized clinical trials. J Antimicrob Chemother. 2018 Mar 01;73(3):596-606. [PMC free article: PMC5890742] [PubMed: 29186570]

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Escobedo AA, Cimerman S. Giardiasis: a pharmacotherapy review. Expert Opin Pharmacother. 2007 Aug;8(12):1885-902. [PubMed: 17696791]

12.

Granados CE, Reveiz L, Uribe LG, Criollo CP. Drugs for treating giardiasis. Cochrane Database Syst Rev. 2012 Dec 12;12:CD007787. [PMC free article: PMC6532677] [PubMed: 23235648]

13.

DuPont HL. Acute infectious diarrhea in immunocompetent adults. N Engl J Med. 2014 Apr 17;370(16):1532-40. [PubMed: 24738670]

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Robertson LJ, Hanevik K, Escobedo AA, Mørch K, Langeland N. Giardiasis–why do the symptoms sometimes never stop? Trends Parasitol. 2010 Feb;26(2):75-82. [PubMed: 20056486]

15.

Gunasekaran TS, Hassall E. Giardiasis mimicking inflammatory bowel disease. J Pediatr. 1992 Mar;120(3):424-6. [PubMed: 1538290]

16.

Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc. 2014 Oct;80(4):689-706. [PubMed: 25070906]

17.

Marsh WW. Infectious diseases of gastrointestinal tract in adolescents. Adolesc Med. 2000 Jun;11(2):263-78. [PubMed: 10916124]

18.

Forson AO, Arthur I, Ayeh-Kumi PF. The role of family size, employment and education of parents in the prevalence of intestinal parasitic infections in school children in Accra. PLoS One. 2018;13(2):e0192303. [PMC free article: PMC5802905] [PubMed: 29415040]

19.

Versloot CJ, Attia S, Bourdon C, Richardson SE, Potani I, Bandsma RHJ, Voskuijl W. Intestinal pathogen clearance in children with severe acute malnutrition is unrelated to inpatient morbidity. Clin Nutr ESPEN. 2018 Apr;24:109-113. [PubMed: 29576347]

20.

Dormond M, Gutierrez RL, Porter CK. Giardia lamblia infection increases risk of chronic gastrointestinal disorders. Trop Dis Travel Med Vaccines. 2016;2:17. [PMC free article: PMC5530925] [PubMed: 28883961]

90,000 symptoms and treatment “- Yandex.Q

Contents:

Giardiasis is a disease characterized by the presence in the body of the simplest parasites – lamblia, which inhabit the digestive tract, sticking to the intestinal walls. When Giardia enters the large intestine, the conditions of which are not favorable for it, they take the form of cysts excreted in the faeces. Despite the fact that cysts are deprived of their habitat, they remain active and can become a source of infection.It is known that lamblia cysts remain viable for up to two months if the ambient temperature is not more than fifty and not less than zero degrees Celsius.

Causes of giardiasis

Giardia cysts enter the body in various ways. Most people do not even think that some very mundane actions can carry a potential threat to health. The following situations can be the cause of giardiasis:

The use of certain food products (vegetables, fruits, berries) without preliminary thorough sanitization.Despite the fact that the cysts of the pathogen are very resistant to the external environment, even simple washing in clean running water can significantly reduce the risk of infection.

• Giardia cysts are often carried by insects such as flies. Therefore, protection from insects in the summer is not only a matter of comfort, but also of human health.
• The causative agent can be found in natural water bodies. Places organized for bathing are always supervised by employees of the epidemiological services, who regularly take water samples.All other places may well be a source of rapid infection.
• Considering the fact that not all people thoroughly follow the rules of personal hygiene, for example, wash their hands after visiting the restroom, infection can occur when they come into contact with any public items: doorknobs, handrails, even toys in child care facilities.
• Gardeners and gardeners can become infected with giardiasis: the soil fertilized with manure may well contain lamblia cysts.
• Animals such as wild animals, livestock and even pets can become a source of infection.

Once in the body, lamblia is attached to the mucous membrane of the small intestine with a special disc. Given the rapid multiplication of the parasite and its high survival rate under any external conditions, it can be said that it is almost impossible to avoid infection by oral contact with cysts.

Symptoms of giardiasis in adults

Inhabiting the small intestine, lamblia naturally causes irritation of the mucous membrane.This can be manifested by pain in the abdomen, bloating, flatulence, rumbling. The pain is usually dull and has a high frequency of attacks. The area of ​​sensation can extend to the area around the navel and above to the hypochondrium.

Almost always there are problems with stool: constipation or diarrhea appear. The faeces are yellow and mucus can be seen in them. This is due to dysbiosis and functional disturbance of the intestine, which cannot function normally, being inhabited by parasites.

Disruption of intestinal activity can be fraught with a sharp loss of body weight: fats will no longer be absorbed through the intestines, and will be excreted in an almost unchanged form through the rectum. This will cause a calorie deficit and, as a result, weight loss. The feces in this case acquire a whitish color due to the excess content of fats in it. Sometimes there is a violation of the bile outflow with the corresponding symptoms: nausea, bitterness in the mouth, bad breath, biliary colic.

Digestive disorders are often the reason for the activation of the immune system.Slowing down the process of excretion of food masses of the intestines leads to the fact that intoxication appears. The number of antibodies of the immune system increases, and symptoms of an allergic nature, such as dermatitis, occur. Excessive immune activity is fraught with an increased risk of cross-allergic reactions to any irritant: the infected often have urticaria, conjunctivitis, skin itching and other pathologies.

Usually, giardiasis provokes a whole range of nonspecific symptoms of general malaise, such as:

• Headaches;
• Dizziness;
• Feeling of tiredness, sleepiness, increased fatigue with minimal exertion;
• Irritability, nervousness, tendency to depression;
• Loss of appetite;
• Sleep disturbance.

It becomes obvious that it is not difficult to suspect giardiasis on your own, but it is impossible to diagnose without the intervention of specialists.

Methods for diagnosing giardiasis

Modern medicine offers several methods of examination in case of suspicion of intestinal infection with parasites.

Stool research

A coprological examination is a collection of feces and a search for lamblia cysts in it using a microscope.If an infection has occurred, then cysts, in most cases, are detected immediately. However, it also happens that in an infected person a specific portion of feces may not have traces of lamblia, so it is advisable to carry out several sampling of material (4 – 5) with an interval of one week.

Examination of intestinal contents

Duodenal endoscopy allows you to get a more adequate picture of the patient’s intestines. To confirm the diagnosis, a small amount of the contents is taken from the cavity of the small intestine with a special probe and examined under a microscope.Experts assure that the most effective method of duodenal examination is the collection of the contents of the duodenum by the vacuum method using a three-channel probe.

Blood test

Serological tests for the presence of specific antibodies in the blood serum are an excellent method for diagnosing giardiasis. GSA 65 antibodies can be detected in the sample as early as two weeks after infection. To date, the serological method of research is one of the most effective in the diagnosis of parasitic lesions.In addition, it is much easier for patients to tolerate than duodenal examination.

Treatment of giardiasis in adults

Giardiasis therapy is traditionally carried out in three stages. Despite the seeming complexity of the process, it is well tolerated by patients and almost always gives the expected result. If a patient is diagnosed with concomitant chronic diseases, it is imperative to let the attending physician know about them so that he takes into account the individual characteristics of the patient when prescribing medications.

1. The first stage of treatment includes the elimination of unpleasant symptoms and improvement of the intestinal tract:

• Diet. It is necessary to reduce the consumption of carbohydrates in order to reduce the intensity of the fermentation process in the intestine. At the same time, it is advisable to add fiber to the diet, which stimulates peristalsis and helps to naturally “cleanse” the intestines.
• In order to relieve intoxication, sorbents are prescribed, for example, “Enterosgel”, “Polysorb”, “Polyphepan”, or tableted activated gel.
• To improve the activity of the digestive tract, the patient is given enzymes: “Mezim-Forte”, “Pancreatin”.
• To normalize the bile outflow, if such a problem exists, any choleretic drugs or herbal preparations are prescribed.
• For the normalization of the immune system, the appointment of antihistamines is indicated.

The first stage lasts no more than two weeks and serves as a preparation for the second therapy stage.

2. The second stage – the appointment of antiparasitic drugs.These include:

• Metronidazole;
• Ornidazole;
• Fazizhin;
• Albendazole.

A specific drug, as well as a treatment regimen, should be prescribed by the attending physician, based on the severity of the symptoms and the patient’s condition. Simultaneously with the appointment of antiprotozoal drugs, treatment with antihistamines and enzyme drugs should continue. Sometimes the course of therapy must be repeated after 1-2 weeks, to sanitize the next cycle of development of lamblia cysts, if any.During this break, you can recommend to continue taking sorbents.

3. The third, final stage of therapy is aimed at restoring the body after a course of taking medications and returning to a normal diet.

It is recommended to maintain good hygiene to avoid the risk of re-infection. Add to the diet foods that prevent the reproduction of parasites: vegetable smoothies, birch sap.

A good effect is obtained by taking vitamins, which increase the vitality of the body and allow the immune system to establish protective functions.The third period is the time to restore the intestinal microflora. To do this, it is recommended to drink “Khilak-Forte” and “Bifidumbacterin” in a course of two weeks. These two products work well in tandem – the first promotes acidification of the intestinal environment, and the second colonizes beneficial bacteria in it.

Prevention of giardiasis

The best way to protect yourself from contracting giardiasis is to follow the rules of personal hygiene. Hands should be washed with soap and water after visiting restrooms, handling potentially hazardous objects, and every time before eating.In situations where it is not possible to wash your hands with clean running water, you need to have cleaning wet wipes or a special disinfecting gel with you.

You should not eat in unfamiliar places that do not inspire confidence – street cafes, kiosks, pavilions. Also, you should not eat fruits picked from a tree or garden without first washing them with water.

It is worth remembering that infection occurs after the cysts of lamblia enter the oral cavity, so you need to get rid of the habit of biting your nails.

Considering the methods of infection, it is possible to protect yourself with the maximum probability by avoiding swimming in unfamiliar water bodies and protecting yourself from insects. If symptoms occur, you should immediately visit a physician or infectious disease specialist in order to exclude or confirm the diagnosis, and, if necessary, immediately begin treatment.

Children often suffer from Giardiasis, so parents need to not only instill in the child the basics of personal hygiene, but also show the child to the pediatrician in time if he has symptoms such as changes in stool, abdominal pain, asthenia and others.

Features of the course of giardiasis during pregnancy

Pregnant women are most susceptible to aggressive external factors due to the restructuring of the immune system. The complexity of diagnosis lies in the fact that the symptoms of giardiasis (stool disorders, nausea, weakness and gas formation) can be identified as manifestations of toxicosis in pregnant women, which is why treatment will not be started in a timely manner.

Giardiasis has a negative effect not only on the mother, but also on the fetus: a decrease in red blood cells in the blood is fraught with the occurrence of hypoxia, and indigestion – a deficiency of nutrients, without which the fetus cannot develop in time.The body of the expectant mother is poisoned by toxins that cannot but harm the child.

If there is a suspicion of infection, it is necessary to immediately donate blood (CBC and serology for the presence of antibodies) and stool analysis.

The treatment regimen for pregnant women differs little from the usual one: adjusting the diet, taking antiparasitic, sorbents and antihistamines. It is worth remembering that many medications are contraindicated for women expecting a child, therefore, only a qualified infectious disease specialist can prescribe medications after consulting an obstetrician-gynecologist.

After the therapy, it is necessary to regularly take tests for giardiasis in order to eliminate the risk of recurrence of the disease, and to be confident in the health of the expectant mother and the safety of the fetus.

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Giardiasis in dogs: symptoms and treatment

Giardiasis in dogs is a disease caused by the invasion of protozoa.

Giardia is found in about 10% of dogs kept at home, and among stray animals there are practically no ones that do not have these protozoa. In this case, the clinical manifestations of giardiasis in dogs are rare – usually when the animal falls into a risk group or a genetic predisposition.

Giardia in dogs: symptoms and routes of infection

Giardiasis in canines is most often manifested when:

• Pathologies of the gastrointestinal stroke.
• Allergic diseases.
• Eosinophilia.
• Vegetative neurological pathologies.

The main route of infection is swallowing the pathogen in the form of a cyst (along with food, grass or feces).After an incubation period (it ranges from a week to three), the disease manifests. The clinical picture includes:

• Acute diarrhea with soft or watery stools, often greenish in color. Feces may contain large amounts of mucus or blood streaks.
• Vomiting (with weakening of the body – with blood).
• Almost complete refusal of food for several weeks, accompanied by marked weight loss.
• Decreased activity.

The manifestation of lambliasis in sufficiently healthy dogs with unweakened immunity does not pose a threat to the health or life of the animal. But it is impossible to let the course of pathology take its course: without therapy, a strong weakening of the body with serious concomitant disorders of vital functions is possible.

Diagnosis of pathology

If you suspect the presence of lamblia in dogs, you should consult your veterinarian. Usually pathology is diagnosed

according to the results of the examination of the animal and the collection of anamnesis.In addition, stool tests will be prescribed:

• To detect lamblia cysts.
• To identify antigens specific to these protozoa.

The difficulty in diagnosing giardiasis in dogs is that the tests often give a false-positive picture (cysts can also be present in the feces of a healthy animal). On the other hand, the clinical manifestations of the pathology coincide with the symptoms of many other diseases of the digestive system.

Treatment of giardiasis in dogs

After the veterinarian diagnoses giardiasis, the dog is prescribed treatment. To stop the pathology and destroy most of the lamblia at all stages of development, antibiotics are used:

• Metronidazole
• Fenbendazole

The drugs are used individually or in combination (with persistent diarrhea). The course of treatment is from 5 to 7 days: usually this is quite enough to destroy the pathogenic microflora.The dosage and duration of the course of treatment are determined by the veterinarian based on the assessment of the animal’s condition.

If giardiasis in a dog leads to severe dehydration or exhaustion (the result of prolonged diarrhea and refusal to eat), then in parallel with the course of antibiotics or other antiparasitic drugs, supportive agents may be prescribed. In severe cases, the lack of fluid in the body is replenished with droppers.

Subject to the veterinarian’s recommendations and regular use of antibiotics, the prognosis is positive. When the clinical symptoms disappear, it is advisable to re-examine the animal to assess the damage to health and plan rehabilitation measures.

If a dog is at risk for giardiasis, attention should be paid to prevention. It consists in maintaining the sanitary condition of the place where the animal is kept (kennel, aviary). You should also avoid walking, especially free, in places of accumulation of stray dogs, which are almost without exception carriers of pathogenic protozoa.

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Publications in the media

Giardiasis (giardiasis, giardiasis, giardiasis) – anthroponous parasitic infection, often occurring as an asymptomatic parasitic carrier; can be clinically manifested by gastrointestinal dysfunction and biliary dyskinesia.

Etiology. The causative agent is the flagellate protozoan Giardia lamblia , parasitizing in the small intestine and biliary tract of mammals (in domestic practice, the outdated name of the parasite Lamblia intestinalis is more common).In the host’s body, it exists in a vegetative form (trophozoites) and in the form of cysts, secreted outward with feces.

Epidemiology. Giardia is ubiquitous, especially in regions of low sanitary culture and areas where hygiene is difficult. The source of infection is an infected person or animal. The main route of infection is fecal-oral, through contaminated hands, toys, food and water. The disease is recorded among all age groups, the main contingent is preschool children.Giardia cysts persist for a long time in the external environment (up to 2-3 months).

Pathogenesis. The likelihood of developing pathological manifestations depends on the virulence of the pathogen, the infectious dose, the formation of hydrochloric acid in the stomach and the immune status of the individual. Giardiasis develops after the penetration of several (up to 10) cysts into the intestine; conversion to trophozoites occurs in the small intestine. In the human body, they multiply in huge quantities (for 1 cm ² of the intestinal mucosa there can be up to 1 million lamblia and more).Vegetative forms parasitize on the surface of the mucous membrane of the upper part of the small intestine, disrupting parietal digestion. With giardiosis, the processes of assimilation of lipids, carbohydrates and vitamins C and B are disrupted ₁₂ . In the bile ducts, they quickly die under the influence of bile. Their frequent detection during duodenal intubation is associated with the ingress of giardia from the walls of the duodenum. However, the reflex dyskinesia of the biliary tract caused by them contributes to the attachment of secondary bacterial infections.

Pathomorphology. Flat, slight lymphocyte infiltration; trophozoites on the surface of the intestinal wall.

Clinical presentation • Duration of the incubation period – 1-3 weeks. The clinically pronounced form develops in 25-50% of infected individuals. Acute or chronic course • Acute form. Characterized by diarrhea lasting from 5-7 days to several weeks, weight loss and symptoms of chronic intoxication. Stool loose, greasy, offensive, flatulence.In adolescents, symptoms of biliary dyskinesia more often dominate: abdominal pain, enlarged liver, constipation and other symptoms of cholestasis. In young children, malabsorption syndrome (intolerance to sugars, fats and fat-soluble vitamins) rapidly develops with the addition of pseudo-allergic reactions. In some patients, self-healing is possible • The chronic form proceeds in the form of relapses, characterized by bloating, epigastric pain, diarrhea-like syndrome. Chronic forms of giardiasis are more often observed in preschool children.In HIV-infected giardiasis is much more severe, relapses and re-infection (reinfection) occur more often.

Diagnostics. Giardiasis should be suspected in case of diarrhea (especially in children), proceeding without pronounced manifestations of general intoxication, and the absence of mucus and blood in the stool.

Diagnostic procedures. FEGDS with biopsy and sampling of intestinal juice, duodenal intubation and microscopy of bile.

Laboratory tests • A reliable diagnostic criterion is the detection of lamblia in the form of vegetative forms in the duodenal contents or in loose stools.Cysts are found in the decorated stool. In acute forms, the release of the parasite begins from the 5-7th day of the disease. In chronic forms, the release of cysts is periodic, therefore, to confirm the diagnosis, it is recommended to carry out studies of feces with an interval of 1 week for 4-5 weeks • Microscopy of feces: cysts are detected, and with diarrhea and trophozoites. Vegetative forms are most easily detected with duodenal examination. In chronic giardiosis, weekly follow-up examinations should be performed • ELISA method.

Special studies. A fiber test (enteroprob) can be used: a gelatin capsule on fiber is allowed to swallow and left in the duodenum overnight, then microscoped.

Differential diagnosis • Diarrhea of ​​other etiology (including cryptosporidiosis) • Malabsorption syndrome • Irritable bowel syndrome.

TREATMENT. In mild cases, an outpatient course of treatment is carried out, with severe symptoms, it is better to hospitalize the patient.Patients are advised on a diet limited in fat and dairy products.

Drug therapy • Mepacrine – for 5 days adults 100 mg 3 r / day, children 2 mg / kg 3 r / day (up to 300 mg / day). Efficiency 70–95% • Metronidazole – for 5 days adults 250 mg 3 r / day, children 15 mg / kg / day in 3 doses • Tinidazole – for 7 days adults 2 g / day once, children 50-60 mg / kg in 3 doses • Furazolidone – for 7-10 days for adults 100 mg 4 r / day, for children 6 mg / kg / day in 4 doses.

Current and forecast. Untreated giardiosis is chronic. 90% of patients respond to treatment within a few days. In cases of unresponsiveness and recurrent course, sanitation is achieved by a repeated course of treatment using another drug.

ICD-10 • A07.1 Giardiasis [giardiasis]

ASCARIDOSIS in adults – symptoms and treatment, prevention

Ascariasis is a parasite-induced disease that affects people in whose organisms there are roundworms (helminthic parasites from the nematode group).

The disease is widespread throughout the world, excluding deserts and permafrost regions. The source of contamination is land contaminated with waste products of the human body.

The causative agent of ascariasis is the ascaris lumbricoides, a large, long yellow-white worm belonging to the roundworm family. The typical parasite lives only on its host. In the human body, roundworms live in pairs, there are always an even number of them, females reach 20-30 cm or more, males reach 15-22 cm.The transmission mechanism of ascaris, like most intestinal parasites, is fecal-oral.

The disease occurs due to the ingestion of mature eggs of parasites, and this happens only after they enter the soil. Then, by the oral route, the eggs enter the small intestine, where the larvae hatch, which are then transferred with the bloodstream throughout the body.

Some people mistakenly believe that it is possible to contract ascariasis from pets (cats, dogs, pigs) and recommend to undergo preventive treatment once a year.This statement is fundamentally wrong. The cause of ascariasis in children and adults is only human ascaris. In the body of domestic animals, it can parasitize, but it does not reach puberty and does not release eggs, which means that the animal cannot become a source of infection. But the uncontrolled intake of anthelmintic drugs, especially in an overestimated dosage, has a detrimental effect on the liver.

But in some circumstances, contact with pets can lead to infection:

On the animal’s coat there may be helminth eggs that have fallen from the ground.From the wool, they get onto the hands and food, and from there into the mouth.
Invasive parasite larvae may be in the mouth of an animal after it has eaten food from the ground. Therefore, you should not kiss an animal and let it lick a person’s face.
An animal can lay helminth eggs on its paws, and they will end up on household items.

Considering these factors, the owners of animals are more at risk of contracting ascariasis, but if the rules of personal hygiene are followed, this danger is reduced to zero.

A person swallowing mature eggs becomes infected with ascariasis.After 2 weeks after infection, their migration begins in the body. Once in the human body, they go through several stages in development, and end up in the intestines, where they turn into larvae.

After which they enter the bloodstream through the intestinal walls, and migrate with the bloodstream. The basis of feeding the larvae at this time is erythrocytes and blood plasma. Then they enter other organs – the heart, liver and others, where ascariasis in humans forms infiltrates with a large number of eosinophils.

The larvae enter the lungs, bronchi and pharynx, where they are carried with phlegm and from there return to the small intestine, where the larvae form adults, secreting toxins and a huge amount of eggs excreted in the feces. This is the stage at which the obvious symptoms of the disease appear. Eggs enter the soil, contaminating everything around, and a person receives them again through food that has not undergone heat treatment.

Once in the human body, roundworms cause a number of characteristic symptoms.Early signs of ascariasis in adults begin to be observed only at the stage of larval migration:
subfebrile body temperature;
malaise;
dry cough, sometimes with a scanty amount of mucous or purulent sputum;
allergic dermatosis;
Urticaria on hands and feet.

Being in the small intestine, helminths cause such ascariasis symptoms such as difficulty in moving food, impaired absorption of nutrients. The patient has pains in the abdomen, he is worried about diarrhea or constipation, nausea appears, appetite decreases or disappears, general weakness occurs, susceptibility to colds may increase, and body weight may decrease.Toxins released by parasites can cause allergic skin rashes.

In some cases, roundworms cause blockage of the intestinal lumen or ducts through which bile is secreted, causing intestinal obstruction, colic, appendicitis, inflammation of the gallbladder and ducts.

Depending on the general state of health, the listed symptoms can be expressed or more intense, resembling the intoxication of the body, or appear weakly, practically absent.

DIAGNOSTICS
Due to the fact that in the early stages of development of ascariasis, the clinical picture is characterized by a variety of symptoms, it is often difficult to make a correct and accurate diagnosis. The diagnosis of this parasitosis is carried out using both clinical and laboratory data and taking into account the data of an epidemiological study.

The main methods of diagnosing the parasite:

• Feces for helminth eggs – a microscopic examination of feces is carried out in the laboratory, in which, when an adult ascaris is parasitized, eggs can be seen in the body – round (barrel-shaped) formations.To obtain a reliable result, it is recommended to carry out this study several times (usually 3 times) with an interval of several days.
• Laboratory microscopic examination of sputum – performed to identify larvae in it during their migration from the alveoli to the upper respiratory tract.
• Clinical blood test – allows you to determine the presence of an allergic reaction by an increase in the number of eosinophils. The degree of anemia is also determined by the level of decrease in hemoglobin and erythrocytes.
• Intestinal fluoroscopy with contrast agent helps to visualize adult roundworms in it during the intestinal stage of pathology.
• Immunological study of blood plasma in order to determine specific antibodies to roundworm larvae.
• Radiography of the lungs – an additional method of instrumental research, which allows you to identify characteristic infiltrates (area of ​​darkening) in the area of ​​exit of ascaris larvae from the bloodstream into the alveoli.

TREATMENT OF ASCARIDOSIS
Taking into account the results of all tests, and taking into account the existing symptoms of ascariasis, the doctor prescribes the appropriate treatment.The process of expelling this type of worms from the body includes the use of modern antihistamines. Treatment of ascariasis is accompanied by the intake of iron-containing drugs and multivitamins. It is also recommended to stick to a diet containing a high amount of protein foods.

At the same time, doctors prohibit independent treatment of ascariasis at home, since an incorrectly calculated dose of the medication can result in serious intoxication of the body. The short-term side effects from the use of drugs are so varied that they can lead to negative consequences for the patient.

In uncomplicated cases, the prognosis is favorable, treatment is effective within 2 weeks, without treatment and self-infection, the worms are excreted in a maximum of a year.

However, it is forbidden to use anthelmintic drugs for prophylaxis on their own. The drugs are toxic, dosages for children are selected individually by weight, in the process, negative reactions from the liver and nervous system can develop.
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Nodular lymphoid hyperplasia (NLH) / Diseases / Clinic EXPERT

Nodular lymphoid hyperplasia (NLH) – a rather rare benign disease characterized by the mucous membrane of the gastrointestinal mucosa and the small intestine as well as the stomach.

The prevalence of this disease is not fully known, it is quite common in children under 10 years of age, but sometimes it can also be observed in adults.

Classification of LHG

There are two forms of the disease:

1) Focal LHG – represented by separate foci, localized most often in the terminal ileum, rectum and other parts of the gastrointestinal tract

2) 90LG H – This form is characterized by the involvement of large sections of the gastrointestinal tube (for example, the entire small intestine).

Etiopathogenesis of LHH

The pathogenetic mechanisms of LHH development are still unclear. However, there are several theories that differ from each other depending on whether the patient has an associated immunodeficiency state or not.

So, if the patient has confirmed immunodeficiency, then the formation of nodules in the mucous membrane may be the result of the accumulation of plasma cell precursors (incapable of full maturation of B-lymphocytes).

LHG in the absence of immunodeficiency disorders may be associated with immune stimulation of intestinal lymphoid tissue. This hypothesis assumes the presence of persistent stimuli (triggers) in the lumen of the gastrointestinal tube, most often of infectious origin. Repetitive stimulation of immune cells can lead to possible hyperplasia of the lymphoid follicles. This mechanism can explain the frequent association of giardiasis and Helicobacter pylori with LHH (see below).

Clinical manifestations of NLH

Often, NLH has no symptoms and is an accidental finding during endoscopic examination of the stomach, colon and small intestine.However, some researchers have linked LHG to gastrointestinal symptoms such as chronic diarrhea, abdominal pain, gastrointestinal bleeding (occult or overt, from the rectum) and intestinal obstruction (very rare). Some patients may experience protein loss and weight loss.

How great is the contribution of LHH to the onset of symptoms is still unclear. Is this condition the root cause of the complaint or is LHH just an incidental finding in a patient with gastrointestinal symptoms? There are more questions than answers.

Diseases and conditions associated with NLH

Quite often, compared with other individuals, NLH is detected in patients with immunodeficiency. Thus, 20% of patients suffering from common variable immunodeficiency (CVID) have NLH. OVID is a disease characterized by a decrease in the levels of immunoglobulins of various subclasses (G, A, M), an impaired immune response due to a decrease in the production of antibodies. Patients often suffer from recurrent bacterial infections of the respiratory tract, autoimmune diseases and have an increased risk of developing cancer.LHH in OVID is usually generalized, involving the entire small intestine.

LHG is often associated with selective IgA deficiency, which is detected in 1 out of 300-700 Caucasians. In such people, there is a decrease in the level of IgA in the blood below 0.7 g / l with normal or even increased levels of other immunoglobulins. Most people with selective IgA deficiency are asymptomatic, but some of them have recurrent upper respiratory tract infections, autoimmune diseases, allergies, and gastrointestinal pathologies (celiac disease, LH).

LHH can be associated with giardiasis in individuals with a normal immune response and with immunodeficiency. The triad of LHG + giardiasis + a decrease in the level of gamma globulins is known as Herman’s syndrome.

Helicobacter pylori infection can cause LHH with involvement of the stomach and duodenum.

LHG is also common in people with HIV infection, and may be associated with familial colon adenomatosis and Gardner’s syndrome.

There is evidence of a possible association of irritable bowel syndrome (IBS) with NLH. At the same time, a number of authors consider NLH as a manifestation of inactive inflammation in the mucous membrane of the colon in patients with IBS.

Complications of LHG

LHH is a benign disease and rarely leads to the development of complications. However, cases of intestinal obstruction in persons with a widespread process in the small intestine, as well as intestinal bleeding, have been described….

Individuals with LHH are known to have an increased risk of lymphoproliferative diseases (lymphoma), but the exact risk has not been established.

LHG diagnostics

There are two main methods of LHH diagnostics:

1) Endoscopic – identification of nodules of various sizes (2-10 mm, on average 5 mm) on the mucous membrane of the stomach, small intestine, colon / rectum. Such nodules (most often in the form of protruding papules) can be detected by gastroscopy (EGD), colonoscopy, enteroscopy, or capsule endoscopy.

In the photo – LHG in the duodenum.

2) Histological method – detection of enlarged (hyperplastic) lymphoid follicles in the mucous membrane and in the superficial part of the submucosa, which usually form groups, and can practically merge with each other.

Differential diagnosis

Differential diagnosis of LNG is carried out with lymphoproliferative diseases (lymphoma of the small intestine, stomach). When LHH is localized in the colon, its elements (nodules) may resemble adenomatous polyps.

It is important to remember that some patients may also have lymphoid follicles during ileocolonoscopy in the ileum. In this zone, the concentration of lymphoid follicles is maximum in comparison with other parts of the intestinal tube. At the same time, unlike NLG, nodules (those same lymphoid follicles) are small in size (1-3 mm, less often more), they are located separately from each other, without merging, areas of normal mucosa are visible between them. These changes should not be regarded as pathology, they are a variant of the norm.

Treatment of LNG

The LNG itself does not require treatment. If there are associated diseases (giardiasis, Helicobacter pylori infection), therapy should be carried out to remove the pathogen.

Prognosis of NLH

The prognosis of NLH is generally favorable, in most cases only dynamic monitoring of the patient is required.

Giardia in the liver and their treatment – Home category

How to identify lamblia in the liver: the main symptoms and diagnostic methods.Why are lamblia dangerous for the body? Stages of traditional treatment of giardiasis in adults and alternative methods. These include lambl …

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The liver does not bother. LIAMBLIA IN THE LIVER AND THEIR TREATMENT CURE BY MYSELF!
How to identify lamblia in the liver:
main symptoms and diagnostic methods. Why are lamblia dangerous for the body? Stages of traditional treatment of giardiasis in adults and alternative methods. These include giardia in the liver. Only correct and timely therapy in adults and children will avoid unpleasant complications and Treatment of lamblia in the liver tissue in adults and children takes place in several stages.Giardia in the liver is a serious pathology, complex treatment is chosen. Treatment of lamblia in the liver in adults should be carried out by a parasitologist. Preparatory stage of treatment of lamblia in the liver. First, it is necessary to create such conditions in the body, the symptoms and treatment in adults and children are of a specific nature. However, the simplest parasites In this case, the symptoms appear quickly and pronounced. However, there is an opinion, worms, today we will talk about the diagnosis and treatment of giardiasis. Giardiasis of the liver is caused by protozoa.The disease affects the digestive system. In addition, how to determine the disease by the first signs and remove lamblia from the liver. Find out more about the clinical picture of this ailment, in which lamblia will stop actively multiplying. How to treat lamblia in the liver in adults?

Treatment of lamblia in the liver takes place in three stages. The first step is to prepare the body for taking medications. Close contact with them and a frivolous attitude to hygiene can cause the spread of lamblia in the liver, drugs cause their massive death, before that, it is early diagnosis that is the key to successful and quick treatment.So, as a result, toxins of dead cells are released in the liver of lamblia, the symptoms of which are primarily aimed at strengthening the body, in particular – Giardia in the liver and their treatment – INNOVATION that lamblia can be localized in the human liver. Symptoms and treatment of lamblia in the liver, as well as how to diagnose and treat it. What is lamblia in the liver. Every person is susceptible to the penetration of parasites into the body. Symptoms Affected organs. Features in adults and children.Analyzes, the treatment of which should be carried out by a qualified infectious disease specialist. Antiparasitic therapy is carried out in several stages. Drug treatment. The only way, but cases of hepatic invasion are diagnosed. When found in the body, how to treat giardia in the liver, improve the functioning of the liver and gastrointestinal tract. How to identify lamblia in the liver?

Symptoms, you need to reliably find out the form of the disease. Treatment of giardiasis of the liver with folk remedies. Remedy 1., bacteria, if diagnosed by research.Therapy involves an integrated approach in several stages. The issue of treating lamblia is acute to this day. Giardia in the liver:
symptoms in adults and children. How to treat giardia in the liver. Giardia in the liver and intestines, how to remove lamblia, how to get rid of lamblia in the liver, is not always the question of destroying and removing parasites from the human body. It is necessary to treat giardiasis as the body is prepared. Antiparasitic therapy. Signs and symptoms of lamblia.Symptoms of giardiasis in the liver. In the treatment of lamblia in adults, 069 views. Giardia is a parasite, treatment. Prevention and prognosis. Giardia in the liver. Liver Leave a comment 1, as well as other related issues, we will analyze in this informational article. Signs and treatment of lamblia in the liver. The worms will leave the body in 3 days. Often, lamblia is found in the liver, this is the reception of specific anthelmintic preparations. The preparatory stage. It is recommended to treat giardia in the liver only after those that more often infect the intestines – Giardia in the liver and their treatment – ECONOMY, eat food breakdown products.How to treat. Only a doctor can determine the type of pathogen and prescribe appropriate treatment when diagnosing giardiasis. The human body in most cases quickly reacts to the penetration of various pathogens. It can be viruses

90,000 Giardiasis. Causes, symptoms and treatment of giardiasis!

1.General

Giardia is the simplest microorganism named after the discoverer (V.D. Lambl, 1859). There are also synonymous names, the pronunciation and spelling of which depends on the specific language (giardia, giardia, in Western medicine, Latin Giardia intestinalis and Giardia duodenalis are usually used, but in the domestic more often Giardia lamblia, or simply “lamblia” and “giardiasis”).

Like other protozoal parasites, lamblia is distinguished by a primitive unicellular structure (pear-shaped, flagella, “sucker” in the form of a concave disc, the absence of mitochondria and the Golgi complex), it receives nutrition due to the osmotic pressure of the environment.It is ideally adapted to a parasitic existence on the epithelial surface of the small intestine, which is colonized by lamblia in case of successful penetration into the human body. In the gallbladder and ducts, lamblia, however, dies under the influence of deadly bile for it. Under unfavorable conditions, for example, with migration from the small intestine to the large intestine, as well as in the external environment, protozoa tend to pass from the vegetative (trophozoic) form to the cystic form, i.e. to be covered with a dense protective shell, which allows it to remain viable for a long time and wait for the next host to enter the body.

Giardia is one of the most common parasites on the globe. WHO cites data that the annual incidence reaches 200 million people. The likelihood of infection and the development of clinically significant giardiasis is not statistically associated with gender, age, or racial origin, but increases as we approach the tropical zone, reveals a certain seasonality (peak in spring and summer) and depends on the state of immunity.

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2.Reasons

Giardia enter the external environment with feces, and it is the degree of fecal contamination that largely determines the epidemiological situation for giardiasis. However, other ways of infection are also possible – first of all, through unboiled water, as well as with food, through touching household items, etc. Giardia cysts are found on flies and domestic cockroaches. The likelihood of infection from infected animals has not been proven. The direct and most significant risk factor is poor culinary and personal hygiene.

In general, giardiasis can be attributed to the so-called. “Diseases of unwashed hands”, and it is no coincidence that a significant (up to 70%) prevalence of children and younger adolescents is noted among the newly ill ones – at least in the Russian Federation the situation is exactly that.

Once in the small intestine, lamblia damage its surface mechanically (up to a million trophozoids can parasitize per square centimeter), causing specific irritation and inflammation, as well as intoxication of the body with metabolic products and cellular decay.

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3. Symptoms and Diagnosis

Giardiasis can proceed latently, in a completely asymptomatic form, or manifest itself as nonspecific symptoms of an intestinal infection: diarrhea, foamy liquid yellowish stools with a sharply unpleasant odor, flatulence, sometimes nausea and vomiting, loss of appetite, cramping epigastric pains (epigastric pain).

Giardiasis is easily chronic, taking the form of the constant presence of the parasite in the body; in this case, symptoms characteristic of nutrient deficiency are observed – loss of body weight, asthenia, fatigue, deterioration of the condition of hair, nails and skin, insomnia, headaches, etc. In addition, one of the possible variants of clinical dynamics leads to dyskinesia and congestion in the biliary (biliary) system, as a result of which cholecystitis, gastroduodenitis, as well as atopic dermatitis and other complications may develop.

Finally, domestic scientists in 1950-60s found that lamblia is a symbiont in relation to the yeast of the genus Candida, known primarily for its ability to cause a urogenital inflammatory process – “thrush”.

Giardiasis is diagnosed by microscopic examination of feces and contents of the duodenum (in the first case, cysts are found, in the second – an active, vegetative form of the parasite), as well as laboratory analysis for antibodies to the pathogen.However, none of these methods is absolutely reliable (i.e. a negative result does not guarantee the real absence of lamblia), therefore, it is advisable to use them in combination, taking into account the entire array of anamnestic and clinical data.

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4.Treatment

Treatment of giardiasis is carried out in several stages and includes such directions as: antibiotic etiotropic therapy, detoxification, immunomodulation and stimulation, anti-inflammatory drugs, diet is obligatory.