Clinical Information

Giardia duodenalis (also known as Giardia lamblia, Giardia intestinalis) is a flagellated protozoan parasite found in contaminated natural streams, lakes, and surface water municipal reservoirs. Several animals may serve as a host for G duodenalis, including dogs and beavers. Humans become infected when ingesting the environmentally resistant parasite cysts in water, food, and by the fecal-oral route (eg, on hands or fomites).

Following ingestion, each cyst releases two trophozoites, which infect the small intestine by attaching to the mucosa with a ventral sucking disc. Infection may be associated with a variety of outcomes ranging from asymptomatic disease (estimated to occur in 50% of infected individuals) to acute and chronic giardiasis. When present, symptoms generally appear 7 to 14 days after infection and consist of watery diarrhea, malaise, malodorous steatorrhea, flatulence, abdominal cramping, nausea or vomiting, weight loss, and low-grade fever. Less commonly, patients experience constipation and urticaria. Symptoms will resolve in most patients after a period of several weeks. However, approximately 15% to 20% will remain chronically infected without treatment and experience ongoing loose stools, weight loss, malabsorption, steatorrhea, abdominal cramping, flatulence, and burping. Longstanding malabsorption may result in vitamin deficiencies and hypoalbuminemia. Acquired lactose intolerance may also occur and persist for months after successful parasite eradication.

Giardiasis is the most common intestinal parasitic infection in the United States reported to the Centers for Disease Control and Prevention and is a common cause of diarrhea in children (especially in daycare centers), travelers, and campers or hikers. It is also responsible for waterborne epidemics. Although Giardia parasites (cysts and trophozoites) may be seen using the microscopy-based stool parasitic exam (OPE / Ova and Parasite, Travel History or Immunocompromised, Feces), this is an insensitive method for detection and requires examination of three or more specimens. Instead, detection of parasite antigen or DNA is recommended for optimal sensitivity. The Giardia antigen test is ideal for settings in which giardiasis is specifically suspected (eg, outbreak scenarios), whereas the multiplex gastrointestinal polymerase chain reaction panel (GIP / Gastrointestinal Pathogen Panel, PCR, Feces) is better suited for evaluating multiple potential causes of diarrhea, including parasitic, viral, and bacterial pathogens.

For more information about diagnostic tests that may be of value in evaluating patients with diarrhea see the following:

-Parasitic Investigation of Stool Specimens Algorithm

-Laboratory Testing for Infectious Causes of Diarrhea