1. Giardiasis Giardia Enteritis Lambliasis Beaver Fever

2. Giardia Giardia lamblia is a flagellated protozoan that infects the duodenum and small intestine. range from asymptomatic colonization to acute or chronic diarrhea and malabsorption. more prevalent in children

3. Parasite Stages Two stages of the parasite: cyst and trophozoite Center for Food Security and Public Health, Iowa State University, 2013

4. EPIDEMIOLOGY usually occurs sporadically major reservoir for spread :water contaminated with Giardia cysts Giardia cysts are relatively resistant to chlorination and to ultraviolet light irradiation Boiling is effective for inactivating cysts. Person-to-person spread also occurs. Human milk contains glycoconjugates and secretory IgA antibodies that may provide protection to nursing infants.

5. Morbidity and Mortality: Humans Populations affected –Children –Travelers –Swimmers Prevalence in developed countries –2% of adults –6-8% of children Up to 15% in developing countries Center for Food Security and Public Health, Iowa State University, 2013

6. Morbidity and Mortality: Humans Naïve populations –Morbidity rate up to 20% Infections often resolve spontaneously Illness usually lasts for 1-2 weeks Center for Food Security and Public Health, Iowa State University, 2013

7. Disease in Humans Chronic infections reported –May last months to years –Immunodeficient and immunocompetent individuals –May contribute to decreased lifespan in immunodeficient individuals -May lead to malabsorption syndromes, vitamin deficiencies, severe weight loss, and debilitation Center for Food Security and Public Health, Iowa State University, 2013

8. Geographic Distribution Giardia intestinalis –Occurs worldwide –Most common in warm climates Center for Food Security and Public Health, Iowa State University, 2013

9. Transmission Cysts –Direct transmission –Fomites Contaminated water and/or food Ingested cysts release trophozoites Trophozoites multiply and encyst in intestines Excreted in feces Center for Food Security and Public Health, Iowa State University, 2013

10. CLINICAL MANIFESTATIONS incubation period :1–2 wk clinical manifestations :asymptomatic. acute infectious diarrhea, chronic diarrhea with failure to thrive and abdominal pain or cramping. Symptomatic infections occur more frequently in children than in adults. Most symptomatic patients : acute diarrhea. low-grade fever, nausea, and anorexia; intermittent or more protracted course characterized by diarrhea, abdominal distention and cramps, bloating, malaise, flatulence, nausea, anorexia, and weight loss develops

11. CLINICAL MANIFESTATIONS stools may be profuse and watery and later become greasy and foul smelling Stools do not contain blood, mucus, or fecal leukocytes Varying degrees of malabsorption may occur.

12. Abnormal stool patterns may alternate with periods of constipation and normal bowel movements. Malabsorption of sugars, fats, and fat- soluble vitamins has been well documented and may be responsible for substantial weight loss. Giardiasis has been associated with growth stunting and repeated Giardia infections with a decrease in cognitive function in children in endemic areas.

13. Giardiasis should be considered in young children in child care or in any person who has had contact with an index case or a history of recent travel to an endemic area who has persistent diarrhea, intermittent diarrhea and constipation, malabsorption, crampy abdominal pain and bloating, failure to thrive, or weight loss

14. TREATMENT should receive therapy : acute diarrhea failure to thrive exhibit malabsorption

15. Treatment Anti-protozoal drugs –Metronidazole –Tinidazole –Ornidazole Chronic cases –May be resistant –Prolonged therapy may be necessary Center for Food Security and Public Health, Iowa State University, 2013

16. PREVENTION Handwashing purify public water supplies adequately include chlorination and filtration. Travelers to endemic areas are advised to avoid uncooked foods that might have been grown, washed, or prepared with water that was potentially contaminated. Purification of drinking water can be achieved by a filter or by brisk boiling of water for at least 1 min