3. MORPHOLOGY
• Giardia inhabits in crypts of duodenum and upper part of jejunum in man
• Two forms:
• 1. pear shaped trophozoite : pathogenic form and feeding stage of parasite
• 2. tetra nucleated oval cysts : infective form as well as the diagnostic form of parasite
5. PATHOGENICITY
• Infective dose : 10 – 25 cysts
• Risk factors : children more commonly effected
• Other high risk group : elderly debilitated persons , poor hygiene and immune deficient individuals
• Pathogenic form : trophozoites , pathogenic form adhere to duodenal mucosa ,cause disruption of
intestinal epithelium , leads to increased permeability and malabsorption
6. • Malabsorption of fat :leads to foul smelling profuse frothy diarrhea
• Disaccharidase deficiency :leading to lactose intolerance
• Malabsorption of vitamin A , B12 and iron
• Protein loosing enteropathy
7. • Antigenic variation : Giardia undergoes frequent antigenic variation due to a cysteine rich protein on its
surface called variant surface protein [VSP].
8. CLINICAL FEATURES
• 3 Stages:
• 1. Asymptomatic carriers : most infected persons are asymptomatic , harbor the cysts in the gut and
spread the infection
• 2. Acute giardiasis
• Common symptoms include diarrhea , abdominal pain, bloating , belching ,flatus and vomiting
• Fatty diarrhea
• 3. Chronic giardiasis :
• GI symptoms : recurrent episodes of foul smelling diarrhea ,foul flatus ,sulfurous belching with rotten
egg taste, and profound weight loss leading to growth retardation
9. LABORATORY DIAGNOSIS
• STOOL EXAMINATION
• Gold standard for diagnosis ,which detects cysts and trophozoites
• Ideally 3 specimens from alternate days within 10 days should be taken
• G.intestinalis is identified in 50 to 70% of patients after a single stool examination and in more than
90% after 3 stool examination
• Pus cell or blood – alternative diagnosis
• Concentration techniques – zinc sulfate floatation or formalin ether sedimentation
• If stool examination is negative direct duodenal samples like aspirates or biopsy by endoscopy
• Should be processed
• Permanent stains – trichrome stain –demontrate cysts and trophozoites
10.
11. ENTERO TEST [ STRING TEST ]
• Uses gelatin capsule attached to a thread containing a weight
• Capsule dissolved in stomachthread carried to duodenumgets unfoldedtakes up the duodenal
samples
• 4 hrs later thread withdrawn and shaken in saline to release trophozoites which can be detected
microscopically by wet mount or permanent stained smear
17. RADIOLOGICAL FINDING
• FLUOROSCOPY May reveal hypermotility at the duodenal and jejunal levels
• XRAY AFTER BARIUM MEAL may reveal non specific irregular mucosal thickening with large dilated
loops of hypotonic bowel
18. TREATMENT
• TINIDAZOLE 2g once orally DOC
• Metronidazole for 5 days or Nitazoxanide for 3g given alternatively
• FurazolidoneChildren
• Auranofin, Paromomycin Pregnancy
• AIDS & Hypogammaglobulinemia prolonged therapy with metronidazole [21 days]
• Metronidazole resistance Auranofin
19. PREVENTION
• Impoved food and personal hygiene
• Boiling and filtering of potentially contaminated water
• Treatment of asymptomatic carriers
• No vaccine is currently available