Giardiasis is an infectious disease of the small intestine. Giardiasis is caused by a microscopic parasite called Giardia lamblia. The disease is spread through contact with infected people. You can also become infected by drinking contaminated drinking water, not observing hand hygiene, and eating unwashed fruits and vegetables.
What are Giardia (Giardia)?
Giardia lamblia is a flagellated protozoan (unicellular). Giardiasis is transmitted through the ingestion of cysts that are in the infectious stage, which have entered the environment from the feces of a person or animal. They may be present in faecal-contaminated water, food, or fomites. Giardia cells have eight genetic varieties (named A through H), of which only A and B cause disease in humans. They also infect domestic, farm and wild animals. There is a potential risk of animal-to-animal transmissionperson.
A thriving protozoan hatches from a cyst and attaches itself to the wall of the small intestine, where it causes epithelial micro-inflammation, flattening of the mucosal villi, and diarrhea due to malabsorption (nutrient malabsorption syndrome).
In the colon, Giardia trophozoites differentiate and form new cysts that are shed into feces and pollute the environment. Cysts present in faeces can survive in a variety of environments, especially water and low temperatures. Their viability can vary from 28 to 84 days in lake or river water, but decreases in soil or cattle dung.
According to the Centers for Disease Control and Prevention, this infection is widespread throughout the world. However, it is most common in overpopulated and developing countries where conditions do not meet all sanitary and hygienic standards for water quality control.
Sources and routes of infection
G.lamblia found in animal and human feces. These parasites also live on contaminated food, water and soil. They can live outside the host organism for a long period of time. Accidental consumption of Giardia can lead to their hidden existence in the body. The most common way to get giardiasis is to drink water contaminated with giardia. Contaminated water is in swimming pools, public baths and saunas, in reservoirs.
Sourcescontamination can be animal feces, diapers and agricultural waste runoff. Alimentary giardiasis, obtained by eating food, is less common because high temperatures kill parasites. Lack of hygiene when handling food can lead to the spread of giardia.
Giardiasis is also spread through interpersonal contact. For example, unprotected anal sex can facilitate the transmission of infection from one person to another. Changing a baby's diaper or becoming infected while working in a day hospital is also a common mode of infection. Children are at high risk of contracting giardiasis because they can become soiled with feces or eat them. There is also a high probability of infection when playing on playgrounds, in sandboxes.
Clinical signs of giardiasis
Some people are carriers of giardia without experiencing any symptoms, i.e. they have an asymptomatic course (approximately 5-15% of infected people). Symptoms of giardiasis usually appear one or two weeks after infection.
And they include:
- fatigue;
- nausea;
- diarrheal cream stool;
- loss of appetite;
- vomit;
- bloating and cramps;
- weight loss;
- flatulence;
- headaches;
- abdominal pain.
In the early stages of illness, diarrhea is often continuous, especially in the morning. At the same time, the stool is viscous and difficult to wash off. Later, the diarrhea becomes more intermittent, with periods of normal bowel function alternating with diarrhea. Blood impurities in the feces are not specific for giardiasis. If they appear, then this indicates the presence of another pathology. Patients sometimes mention belching with a rotten egg smell, but the cause of this phenomenon has not been determined. Weight loss due to malabsorption occurs in more than 80% of patients with a typical adult weight loss of 5 kg over four or more weeks. Chronic infection in children can delay the normal developmental process.
Lactose deficiency occurs in 40% of patients with symptoms of giardiasis and may persist for several weeks after eradication of the parasite. Lactose deficiency manifests itself as diarrhea, which is aggravated after eating food containing lactose. More rare symptoms are vomiting and fever.
Nothing is usually found at the initial examination. Only signs of weight loss, but in chronic patients, signs of malabsorption may be identified, including pallor due to anemia.
Distribution and epidemiology of the disease
Travel to developing countries is a common risk factor for contracting this infection. Highest risk areas: South and Southeast Asia, North Africa, Caribbean, South America. Giardia is the most common enteric pathogen in travelers returning from these areas. However, studies of the disease in Russia in 2013 showed that in 75% of casesPatients did not leave the country. Approximately 4,000 cases are registered annually in all regions of our country, and about 200 million people are infected annually worldwide.
The number of detected cases of giardiasis increased 4-fold after the introduction of an enzyme-linked immunosorbent assay (ELISA) linked to an enzyme to detect parasitic antigens in stool. The highest risk of contracting giardiasis in children is at the age of 5 years, and in adults - in the period from 25 to 44 years. Most studies report that giardiasis is more common in men. As a rule, people get sick in late summer and early autumn. This mainly applies to Russian regions with a temperate continental climate.
Methods for detecting disease
To diagnose giardiasis, you will need to take several stool samples for parasitological examination. The specialist will conduct a number of successive washes from the sample to detect parasite cysts. Be prepared to donate feces during treatment.
Sampling of material for parasitological examination is performed using an endoscope. You may be referred for a duodenoscopy. This procedure involves inserting a flexible endoscope through the throat before inserting into the small intestine. This manipulation will allow the doctor to examine the small intestine and select material for a biopsy.
Diagnosis is often delayed, sometimes studies take months. This isoccurs due to the latent form and recurrent clinical course. Diagnosis is by laboratory analysis of feces or by conventional light microscopy to visualize trophozoites, cysts, and adult parasites. They also do tests to detect antigens in a stool sample.
Sensitivity between different forms of giardiasis varies. Increasingly, highly sensitive molecular methods (polymerase chain reaction - PCR) are used that detect parasitic DNA. Due to the specific lifestyle of Giardia, multiple stool examinations (ideally 2-3 consecutive days of morning and evening stools) may be required when conventional microscopy is used. If the result is negative, 3 more copies must be submitted at weekly intervals. Generally, a minimum of 6 negative microscopy results are required to rule out infection.
Methods of therapeutic effect
In most cases, giardiasis heals on its own. But if an infected person has a severe and prolonged chronic course of the disease, special treatment is prescribed. Most doctors recommend therapy with antiparasitic drugs. No one advises to leave the disease to chance. It is necessary to treat the symptoms of giardiasis, like other protozoal diseases, in a complex way:
- As a rule, the antiprotozoal antimicrobial drug "Metronidazole" is used. The course of treatment usually lasts about a week. Side effects include nausea and an unpleasant s alty taste in the mouth.
- "Tinidazole" has the same effect as "Metronidazole". These drugs can cure giardiasis even after a single dose.
- "Nitazoxanide" helps treat giardiasis in children, as it is the only drug in suspension form that can be taken orally. The course of treatment is 3-4 days.
- "Paromomycin" is prescribed in three dosage options, depending on the form of giardiasis, a course of 5-10 days. This drug is more gentle than other antibiotics and has a low chance of causing genetic abnormalities in fetuses when used by pregnant women.
Unlike many causes of infectious gastroenteritis, giardiasis can be cured. Basically, drugs for giardiasis, such as Nitroimidazole, Metronidazole and Tinidazole, have similar effectiveness. They help to heal and relieve symptoms in more than 90% of patients. Success in treatment is confirmed by the complete disappearance of symptoms or the absence of PCR DNA detection of giardiae one week after the course of therapy.
Treatment resistance may be due to autoimmune factors or true parasite drug resistance, which is becoming more common. In particular, this phenomenon is observed among travelers returning from South and Southeast Asia. However, "Tinidazole" or "Metronidazole" is still being used as a treatment for them.
Various combined therapies are effective. These data are based on experimental studies and diagnosis of giardiasis from individual clinicians.
Home remedies for giardiasis
The most effective folk remedies for giardiasis include the use of the following products:
- Oregon grapes. There is a powerful alkaloid found in Oregon grapes that directly affects and inhibits the spread of giardiasis. It is also called berberine. It is one of the fastest means to fight infection. Although, if you suffer from other serious gastrointestinal problems, Oregon grapes may not be the best choice.
- Long Pepper. This pepper is known as Piper longum. It is very effective in eliminating Giardia lamblia parasites from the digestive tract. Long peppers are known to stimulate the immune system, which naturally destroys protozoan parasites.
- Beet juice. This is a useful product that many people underestimate. It has certain antibacterial and antiparasitic qualities that make beets an easy home remedy for giardiasis. A few glasses of beetroot juice every day should clear up the infection within a week and get you back to normal.
- Grapefruit juice. It is used to treat giardiasis as it has rich antioxidant and immunomodulatory properties. The grapefruit fruit is also a natural anthelmintic that can cleansedigestive tract without eliminating the beneficial bacteria present in the gut.
- Garlic (and its powerful active ingredient allicin) can help treat giardiasis as it stimulates the body to rid itself of parasites and helps to get digestion back on track. Grind a few cloves and mix them with water and take them internally.
- Coconut. Coconut oil and fruits contain lauric acid, which is a powerful antiparasitic compound that fights various viral and bacterial infections.
- Onions are high in nutrients and have powerful antioxidant effects. Helps prevent giardiasis in humans.
- Bitter wormwood. It is an herb that is very effective in treating and eliminating helminths and parasites of many varieties, including those that cause giardiasis. Certain terpenes found in mugwort can break down parasitic membranes, thereby neutralizing them.
- Pumpkin seeds. Cucurbitacin is the active ingredient in pumpkin seeds, it has laxative and anti-inflammatory effects, cleanses the intestines and helps to get rid of parasites.
Complications associated with giardiasis
Giardiasis can lead to some complications such as weight loss and dehydration (dehydration) from diarrhea. The infection can also cause an allergic and toxic reaction in some people. Children under the age of 5 who are diagnosed with giardiasis are at risk of switching to a dietary(healing) food, which may interfere with their physical and mental development.
Methods to prevent infection
It is impossible to 100% prevent giardiasis, the routes of infection and sources of infection are everywhere. But you can reduce your risk of infection by washing your hands thoroughly. This is especially true for people who work in areas with high levels of germs, such as kindergartens.
Ponds, streams, rivers and other bodies of water can become sources of invasion. Do not swallow water if you are swimming. Carry bottled water with you when you go hiking or camping. When traveling to areas with a high prevalence of this disease, do not drink tap water. Also avoid brushing your teeth with tap water.
Be aware that tap water can also be present in ice and other drinks. Avoid eating raw local foods. Be careful about your sex life, especially anal sex. Use a condom to reduce your chance of getting giardiasis and protect yourself from other sexually transmitted infections.
Long-term prognosis for people with giardiasis
The illness lasts 6-8 weeks on average. But the effects of giardiasis, such as lactose intolerance, persist even after the infection clears up. Avoid milk and dairy products for 2 weeks (some clinicians advise up to 6 weeks) to assess whether persistent symptoms are the result of failed treatment or temporarylactose intolerance. Signs of giardiasis are associated with prolonged symptoms that can have a detrimental effect on quality of life.
Giardiasis is the leading cause of infectious gastroenteritis worldwide. The prevalence rate in high-income countries is 2-7% and 2-30% in low-income countries. The level of the disease in Russia is underestimated due to the lack of sensitive traditional scatological microscopy and the erroneous belief that giardiasis is mainly infected outside the country. Therefore, people are examined only after traveling. Only after infection, the epidemiology, therapy, diagnosis and symptoms of giardiasis are discussed.
