Giardiasis is an infectious disease of the small intestine. The cause of giardiasis is a microscopic parasite called Giardia lamblia (giardia giardia). The disease spreads through contact with infected people. You can also get infected by drinking contaminated drinking water, not observing hand hygiene, and eating unwashed fruits and vegetables.
What are lamblia (guards)?
Giardia lamblia is a flagellum protozoa (unicellular). Giardiasis is transmitted through ingestion of cysts that are in an infectious stage, which enter the environment from feces of a person or animal. They may be present in feces-contaminated water, food or fomites. Giardia cells have eight genetic varieties (they are called the letters of the English alphabet from A to H), of which only A and B cause disease in humans. They also infect domestic, agricultural and wild animals. There is a potential risk of transmission from animal to human.
An actively propagating simple organism is hatching from the cyst and attaches to the wall of the small intestine, where it causes epithelial microinflammation, smoothing of the villi of the mucous membrane and diarrhea due to malabsorption (nutrient malabsorption syndrome).
In the colon, lamblia trophozoites differentiate and form new cysts that leak into the feces and pollute the environment. Cysts present in feces can remain viable in various environments, especially in water and at low temperatures. Their viability can vary from 28 to 84 days in lake or river water, but decreases in soil or in cattle manure.
According to the Center for the Control and Prevention of Infectious Diseases, this infection is widespread throughout the world. However, it is most often found in overpopulated and developing countries, the conditions in which do not meet all sanitary and hygienic standards for water quality control.
Sources and routes of infection
G.lamblia is found in animal and human feces. These parasites also live on contaminated foods, in water and soil. They can live outside the host for a long period of time. Accidental use of giardia can lead to their hidden existence in the body. The most common way to get giardiasis is to drink water contaminated with guards. Contaminated water happens in pools, public baths and saunas, in reservoirs.
Sources of contamination can be animal feces, diapers and agricultural waste. Alimentary giardiasis obtained by eating food is less common because high temperature kills parasites. Lack of hygiene when handling food can lead to the spread of giardia.
Giardiasis also spreads through interpersonal contacts. For example, unprotected anal sex can facilitate the transmission of infection from one person to another. Changing a baby's diaper or getting infected while working in day care is also a common way of getting infected. Children are at high risk of contracting giardiasis because they can get their feces dirty or eat them. Also, there is 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, that is, 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
- diarrhea cream stool;
- loss of appetite
- vomiting
- bloating and cramps;
- weight loss
- flatulence;
- headache;
- stomach ache.
In the early stages of the disease, diarrhea is often continuous, especially in the morning. The chair is viscous and difficult to wash. Later, diarrhea becomes more intermittent, periods of normal intestinal functioning appear, alternating with diarrhea. Impurities of blood in feces are not specific for giardiasis. If they appeared, then this indicates the presence of another pathology. Patients sometimes mention burping with the smell of a rotten egg, but the cause of this phenomenon is not determined. Weight loss due to malabsorption occurs in more than 80% of patients with a typical loss of 5 kg of weight in adults over four or more weeks. Chronic infection in children can lead to a delay in the normal development process.
Lactose deficiency occurs in 40% of patients with symptoms of giardiasis, it can persist for several weeks after the elimination of the parasite. Lactose deficiency manifests itself as diarrhea, which is aggravated after eating foods containing lactose. More rare symptoms are vomiting and fever.
At the initial examination, usually nothing is detected. Only signs of weight loss, but in patients with a chronic course, signs of malabsorption, including pallor caused by anemia, can be identified.
Disease spread and epidemiology
Traveling to developing countries is a common risk factor for this infection. High Risk Areas: South and Southeast Asia, North Africa, Caribbean, South America. Giardia is the most common intestinal pathogen in travelers returning from these areas. However, studies of the disease in Russia in 2013 showed that in 75% of cases, patients did not travel outside the country. Approximately 4,000 cases are registered annually in all regions of our country, and about 200 million people become infected annually around the world.
The number of detected cases of giardiasis increased 4 times after the introduction of enzyme-linked immunosorbent assay (ELISA) associated with the enzyme to detect parasitic antigens in the stool. The highest risk of contracting giardiasis in children is 5 years old, and in adults between 25 and 44 years old. Most studies report that giardiasis is more common in men. As a rule, people get sick in late summer and early fall. This mainly applies to Russian regions with a temperate continental climate.
Methods for identifying a disease
To diagnose giardiasis, you will need to pass several stool samples for a parasitological study. The specialist will conduct a number of sequential swabs from the sample to detect cysts of parasites. Be prepared for the fact that during treatment you will also have to take feces.
The sampling of material for parasitological examination is performed using an endoscope. You may be referred for duodenoscopy. This procedure involves the introduction of a flexible endoscope through the throat before being introduced into the small intestine. This manipulation will allow the doctor to examine the small intestine and select material for biopsy.
The diagnosis is often made late, sometimes studies take months. This is due to the latent form and relapsing clinical course. Diagnosis is carried out by laboratory analysis of feces or using conventional light microscopy to visualize trophozoites, cysts, and adult parasites. Analyzes are also done to identify antigens in the stool sample.
The 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 mode of existence of Giardia, it may be necessary to repeatedly examine the stool (ideally 2-3 days in a row morning and evening portions of feces) when using traditional microscopy. If the result is negative, another 3 copies must be returned at weekly intervals. As a rule, a minimum of 6 negative microscopy results is required to rule out infection.
Therapeutic effects
In most cases, giardiasis is cured 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 antiparasitic therapy. No one advises to leave the disease on its own. To treat the symptoms of giardiasis, like other protozoal diseases, it is necessary to comprehensively:
- 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, salty taste in the oral cavity.
- Tinidazole has the same effect as Metronidazole. These drugs can cure giardiasis even after a single dose.
- "Nitazoxanide" helps treat giardiasis in children, as this is the only drug in suspension that can be taken orally. The course of treatment is 3-4 days.
- "Paromomycin" is prescribed in three dosage options, which depends on the form of giardiasis, course for 5-10 days. This drug is more gentle compared to other antibiotics and has a lower probability of causing genetic abnormalities in the fetus when used by pregnant women.
Unlike many causes of infectious gastroenteritis, giardiasis can really be cured. Basically, drugs for giardiasis, such as Nitroimidazole, Metronidazole and Tinidazole, have similar efficacy. They help cure and alleviate symptoms in more than 90% of patients. Success in treatment is confirmed by the complete disappearance of symptoms or the lack of detection of the DNA of the guards using PCR a week after the course of therapy.
Resistance to treatment can be caused by autoimmune factors or true drug resistance of the parasite, which is becoming more common. This phenomenon is especially observed among travelers returning from South and Southeast Asia. However, Tinidazole or Metronidazole is still used as a treatment for them.
Various combination treatments are effective. These data are based on experimental studies and the diagnosis of giardiasis from individual clinicians.
Home remedies for the fight against giardiasis
The most effective folk remedies for giardiasis include the use of the following products:
- Oregon grape. There is a powerful alkaloid found in Oregon grapes that directly affects and inhibits the spread of giardiasis. It is also called berberine. This is one of the fastest means to fight infection. Although, if you suffer from other serious problems with the gastrointestinal tract, then Oregon grapes will not be the best choice.
- Long pepper. This pepper is known as Piper longum. It is very effective in eliminating the parasites of Giardia lamblia from the digestive tract. Long pepper is known to stimulate the immune system, which naturally destroys protozoan parasites.
- Beetroot juice. This is a healthy product that many people underestimate. It has certain antibacterial and antiparasitic qualities that make beets a simple home remedy for giardiasis. A few glasses of beet juice every day should overcome the infection for a week and return your condition to normal.
- Grapefruit juice. It is used to treat giardiasis, because it has rich antioxidant and immunomodulating properties. The grapefruit fruit is also a natural anthelmintic that can cleanse the digestive tract without eliminating the beneficial bacteria present in the intestines.
- Garlic (and its powerful active ingredient allicin) can help treat giardiasis, as it stimulates the body to clear parasites and helps restore digestion. Grind a few cloves and mix them with water, take inside.
- Coconut. Coconut oil and fruits contain lauric acid, which is a powerful antiparasitic compound that fights various viral and bacterial infections.
- Onions have many nutrients and have powerful antioxidant effects. Helps prevent giardiasis in humans.
- Wormwood. This is a herb that is very effective in treating and eliminating helminths and parasites of many varieties, including those that cause giardiasis. Certain terpenes found in wormwood can destroy parasitic membranes, thereby neutralizing them.
- Pumpkin seeds. Cucurbitacin is an active ingredient in pumpkin seeds, it has a laxative and anti-inflammatory effect, cleanses the intestines and helps get rid of parasites.
Complications associated with giardiasis
Giardiasis can lead to some complications, such as weight loss and dehydration (dehydration) from diarrhea. Infection can also cause an allergic and toxic reaction in some people. Children under the age of 5 who have giardiasis are at risk of switching to dietary (medical) nutrition, which may interfere with their physical and mental development.
Prevention Methods
It is not possible to 100% prevent giardiasis, infection pathways and sources of infection are everywhere. But you can reduce the risk of infection by washing your hands thoroughly. This is especially true for people working in places with a high level of spread of microbes, for example in kindergartens.
Ponds, streams, rivers and other bodies of water can become sources of invasion. Do not swallow if swimming. Carry bottled water with you when you go camping or camping. When traveling to regions with a high prevalence of this disease, do not drink tap water. Also avoid brushing your teeth using tap water.
Keep in mind that tap water may also be present in ice and other drinks. Avoid eating raw, local foods. Be careful about sex life, especially anal sex. Use a condom to reduce the likelihood of giardiasis and protect yourself from other sexually transmitted infections.
Long-term prognosis for people with giardiasis
The disease lasts an average of 6-8 weeks. But the consequences of giardiasis, such as lactose intolerance, persist even after the infection disappears. Avoid drinking milk and dairy products for 2 weeks (some clinicians advise up to 6 weeks) to assess whether persisting symptoms are the result of treatment failure or temporary lactose 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 the development of infectious gastroenteritis worldwide. The prevalence in high-income countries is 2–7% and 2–30% in low-income countries. The disease level in Russia is underestimated due to the lack of sensitive traditional coprological microscopy and the erroneous belief that giardiasis is mainly infected outside the country. Therefore, people are examined only after traveling. Only after infection are epidemiology, therapy, diagnosis and symptoms of giardiasis discussed.