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Giardia Lamblia

Giardia
Giardia lamblia is a flagellated protozoan that
infects the duodenum and small intestine.
range from asymptomatic colonization to acute
or chronic diarrhea and malabsorption.
more prevalent in children
life cycle of G. lamblia is composed of 2 stages:
trophozoites
cysts
EPIDEMIOLOGY
usually occurs sporadically
major reservoir for spread :water contaminated
with Giardia cysts
Giardia cysts are relatively resistant to
chlorination and to ultraviolet light irradiation
Boiling is effective for inactivating cysts.
Person-to-person spread also occurs .
Human milk contains glycoconjugates and
secretory IgA antibodies that may provide
protection to nursing infants.
CLINICAL MANIFESTATIONS
incubation period :12 wk
clinical manifestations :asymptomatic . acute infectious
diarrhea, chronic diarrhea with failure to thrive and
abdominal pain or cramping.
Symptomatic infections occur more frequently in
children than in adults.
Most symptomatic patients : acute diarrhea. low-grade
fever, nausea, and anorexia;
intermittent or more protracted course characterized by
diarrhea, abdominal distention and cramps, bloating,
malaise, flatulence, nausea, anorexia, and weight loss
develops
CLINICAL MANIFESTATIONS
stools may be profuse and watery and later
become greasy and foul smelling
Stools do not contain blood, mucus, or fecal
leukocytes
Varying degrees of malabsorption may occur.
Abnormal stool patterns may alternate with
periods of constipation and normal bowel
movements.
Malabsorption of sugars, fats, and fat-
soluble vitamins has been well documented
and may be responsible for substantial
weight loss.
Giardiasis has been associated with growth
stunting and repeated Giardia infections
with a decrease in cognitive function in
children in endemic areas.
Giardiasis should be considered in young children
in child care or in any person who has had contact
with an index case or a history of recent travel to
an endemic area who has persistent diarrhea,
intermittent diarrhea and constipation,
malabsorption, crampy abdominal pain and
bloating, failure to thrive, or weight loss
DIAGNOSIS
established by microscopy documentation of
trophozoites or cysts in stool specimens,
3 stool specimens are required to achieve a
sensitivity of >90%.
Stool enzyme immunoassay (EIA) or direct
fluorescent antibody tests are more sensitive
aspiration or biopsy of the duodenum or upper
jejunum
TREATMENT
should receive therapy :
acute diarrhea
failure to thrive
exhibit malabsorption
Asymptomatic excreters generally are not
treated except:
in specific instances such as in outbreak
control, for prevention of household
transmission by toddlers to pregnant
women and patients with
hypogammaglobulinemia or cystic fibrosis,
and in situations requiring oral antibiotic
treatment where Giardia may have produced
malabsorption of the antibiotic
Tinidazole: >3 yr: 50 mg/kg/day once daily
nitazoxanide
Metronidazole: 15 mg/kg/day in 3 divided doses
for 57 days
Second line alternatives:
furazolidone 6 mg/kg/day in 4 divided doses for
10 days
albendazole: >6 yr: 400 mg once a day for 5 days
paromomycin, and
quinacrine :6 mg/kg/day in 3 divided doses for 5
days
PREVENTION
Handwashing
purify public water supplies adequately include
chlorination and filtration.
Travelers to endemic areas are advised to avoid
uncooked foods that might have been grown,
washed, or prepared with water that was
potentially contaminated.
Purification of drinking water can be achieved by a
filter or by brisk boiling of water for at least 1 min