Giardia lamblia (synonymous with Lamblia intestinalis and Giardia duodenalis) is a flagellated protozoan parasite that colonizes and

reproduces in the small intestine, causing giardiasis. The giardia parasite attaches to the epithelium by a ventral adhesive disc, and reproduces via binary fission.[1] Giardiasis does not spread via the bloodstream, nor does it spread to other parts of the gastro-intestinal tract, but remains confined to the lumen of the small intestine.[2] Giardia trophozoites absorb their nutrients from the lumen of the small intestine, and are anaerobes. If the organism is split and stained, it has a very characteristic pattern that resembles a familiar "smiley face" symbol. Chief pathways of human infection include ingestion of untreated sewage, a phenomenon particularly common in many developing countries;[3] contamination of natural waters also occurs in watersheds where intensive grazing occurs
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Life Cycle== [[File:Giardia life cycle en.svg|right|thumb|Parasite life cycle.]] The life cycle begins with a noninfective cyst being excreted with the feces of an infected individual. The cyst is hardy, providing protection from various degrees of heat and cold, [[desiccation]], and infection from other organisms. A distinguishing characteristic of the cyst is four nuclei and a retracted cytoplasm. Once ingested by a host, the trophozoite emerges to an active state of feeding and motility. After the feeding stage, the trophozoite undergoes asexual replication through longitudinal binary fission. The resulting trophozoites and cysts then pass through the digestive system in the faeces. While the trophozoites may be found in the faeces, only the cysts are capable of surviving outside of the host.

Distinguishing features of the trophozoites are large [[karyosome]]s and lack of peripheral [[chromatin]], giving the two nuclei a halo appearance. Cysts are distinguished by a retracted cytoplasm. This protozoan lacks [[mitochondria]], although the discovery of the presence of mitochodrial remnants [[organelles]] in one recent study "indicate that Giardia is not primitively amitochondrial and that it has retained a functional organelle derived from the original mitochondrial endosymbiont"<ref>{{Cite journal|author=Tovar J, Len-Avila G, Snchez LB, ''et al.'' |title=Mitochondrial remnant organelles of Giardia function in iron-sulphur protein maturation |journal=Nature |volume=426 |issue=6963 |pages=1726 |year=2003 |pmid=14614504 |doi=10.1038/nature01945}}</ref> This organelle is now termed a [[mitosome]].

=Manifestation of infection== [[Image:Giardiasis duodenum high.jpg|thumb|'''Giardiasis''' on a [[duodenum|duodenal]] [[biopsy]].]] Nomenclature for Giardia species is difficult, as humans and other animals appear to have morphologically identical parasites. Colonization of the gut results in inflammation and villous atrophy, reducing the gut's absorptive capability. In humans, infection is symptomatic only about 50% of the time, and protocol for treating asymptomatic individuals is

controversial.<ref name="Huang" /> Symptoms of infection include (in order of frequency) diarrhea, [[malaise]], excessive gas (often flatulence or a foul or sulphuric-tasting belch, which has been known to be so nauseating in taste that it can cause the infected person to vomit), [[steatorrhoea]] (pale, foul smelling, greasy stools), epigastric pain, bloating, nausea, diminished interest in food, possible (but rare) vomiting which is often violent, and weight loss.<ref name="Huang" /> Pus, mucus and blood are not commonly present in the stool. It usually causes "explosive diarrhea" and while unpleasant, is not fatal. In healthy individuals, the condition is usually self-limiting, although the infection can be prolonged in patients who are immunocompromised, or who have decreased gastric acid secretion.<ref name="Huang" /> People with recurring Giardia infections, particularly those with a lack of [[Immunoglobulin A|IgA]], may develop chronic disease.

omenclature for Giardia species is difficult, as humans and other animals appear to have morphologically identical parasites. Colonization of the gut results in inflammation and villous atrophy, reducing the gut's absorptive capability. In humans, infection is symptomatic only about 50% of the time, and protocol for treating asymptomatic individuals is controversial.[4] Symptoms of infection include (in order of frequency) diarrhea, malaise, excessive gas (often flatulence or a foul or sulphuric-tasting belch, which has been known to be so nauseating in taste that it can cause the infected person to vomit), steatorrhoea (pale, foul smelling, greasy stools), epigastric pain, bloating, nausea, diminished interest in food, possible (but rare) vomiting which is often violent, and weight loss.[4] Pus, mucus and blood are not commonly present in the stool. It usually causes "explosive diarrhea" and while unpleasant, is not fatal. In healthy individuals, the condition is usually self-limiting, although the infection can be prolonged in patients who are immunocompromised, or who have decreased gastric acid secretion.[4] People with recurring Giardia infections, particularly those with a lack of IgA, may develop chronic disease. Lactase deficiency may develop in an infection with Giardia, however this usually does not persist for more than a few weeks, and a full recovery is the norm[citation needed]. Some studies have shown that giardiasis should be considered as a cause of vitamin B12 deficiency, this a result of the problems caused within the intestinal absorption system.[9]

reatment of drinking water for Giardia is ordinarily indicated in wilderness regions in North America,[10][11] although at least four researchers disagree with this statement, including Robert W. Derlet, a professor at the University of California-Davis School of Medicine, Timothy P. Welch and Thomas R. Welsh of Tulane Medical School and the Children's Hospital of Cincinnati respectively, and Robert Rockwell, a widely quoted writer who is an engineer by training.[12][13][14][15] Boiling suspect water for one minute is the surest method to make water safe to drink and kill disease-causing microorganisms like Giardia lamblia if in doubt about whether water is infected with the Giardia parasite.[16] Giardia lamblia infection in humans is frequently misdiagnosed. Accurate diagnosis requires an antigen test or, if that is unavailable, an ova and parasite examination of stool. Multiple stool examinations are recommended, since the cysts and trophozoites are not shed consistently. Given the difficult nature of testing to find the infection, including many false negatives, some patients should be treated on the basis of empirical evidence; treating based on symptoms.[17] Human infection is conventionally treated with metronidazole, tinidazole or nitazoxanide. Although Metronidazole is the current first-line therapy, it is mutagenic in bacteria and carcinogenic in mice, so should be avoided during pregnancy.[4] It has not directly been linked to causing

cancer in humans, only in other mammals, therefore appears safe. One Drug Metronidaz ole Tinidazole Nitazoxanid e Albendazol e Treatment duration 57 days Single dose 3 days 5 days Possible Side Effects

Metallic taste; nausea; vomiting; dizziness; headache; disulfiram-like neutropenia

Metallic taste; nausea; vomiting; belching; dizziness; headache; disu

Abdominal pain; diarrhea; vomiting; headache; yellow-green discolou Dizziness; headache; fever; nausea; vomiting; temporary hair loss

of the most common alternative treatments is berberine sulfate (found in Oregon grape root, goldenseal, yellowroot, and various other plants).[citation needed] Berberine has been shown to have an antimicrobial and an antipyretic effect.[18] Berberine compounds cause uterine stimulation, and so should be avoided in pregnancy. Continuously high dosing of berberine may lead to bradycardia and hypotension in some individuals.[19] Table adapted from Huang, White.[4]