Amira saidin PBL13 Obj 7: Giardiasis Causative Agent

Giardiasis is a diarrheal illness caused by the parasite Giardia intestinalis (also known as Giardia lamblia or Giardia duodenalis)     Infects nearly 2% of adults 6% - 8% of children in developed countries worldwide. Nearly 33% of people in developing countries have had giardiasis. In the United States, Giardia infection is the most common intestinal parasitic disease affecting humans.

Epidemiology

People become infected with Giardia by :

a) Swallowing Giardiacysts (hard shells containing Giardia) found in contaminated food or water. Cysts are instantly infectious once they leave the host through feces (poop). b) Swallowing as few as 10 cysts might cause someone to become ill. c) Giardia may be passed person-to-person or even animal-toperson. d) Also, oral-anal contact during sex has been known to cause infection.

Risk factors

1. Travelers to countries where giardiasis is common 2. People in child care settings 3. Those who are in close contact with someone who has the
disease

4. People who swallow contaminated drinking water 5. Backpackers or campers who drink untreated water from lakes
or rivers

6. People who have contact with animals who have the disease 7. Men who have sex with men

Clinical picture

Light infection: Asymptomatic Heavy infection : Symptomatic Acute Giardiasis is manifested by: 1. Steatorrhea 2. Epigastric pain 3. Abdominal pain Chronic Giardiasis is manifested by: 1. Steatorrhea 2. Flatulence 3. Growth retardation in pre-school children

Amira saidin PBL13 Diagnosis A) Clinical diagnosis : by the presence of clinical picture of the disease B) Laboratory diagnosis: 1. Stool examination: ~Giardia cysts can be excreted intermittently, multiple
stool collections (3 stool specimens collected at interval of 2 days) increase test sensitivity.

i.

Direct stool examination (for detection of trophozoites & cysts by Saline smear, Eosin smear, Iodine smear) Concentration technique- (for concentration of cysts- zinc sulfate) Examination of duodenal contents (for detection of trophozoites by: entero- test, Duodenal test, Duodenal biopsy) Detection of Giardia copro-Ag by CIEP or ELISA

ii.

iii.

iv.

C) Indirect diagnosis (Sero-diagnosis) -for detection of antibodies in pts`s serum by IHAT, IFAT,ELISA Treatment 1. Mitronidazole (flagyl) 5 mg/kg orally for 5-6 days 2. Tinidazole (fasigen) 2 gm (single oral dose) 3. Albendazole 400 mg daily for 5 days 1. 2. 3. 4. Mass treatment of infected patients Sanitary disposal of human excreta Strict personal hygiene Pure water supply

Prevention & control