Giardiasis

What is Giardiasis? the large bowel, encystation occurs in the

presence of neutral pH and secondary bile
Giardiasis is a major diarrheal disease found salts.
throughout the world. - Cysts are passed into the environment, and the
- The flagellate protozoan Giardia intestinalis-- cycle is repeated.
(previously known as G. lamblia or G. Causes:
duodenalis), its causative agent, is the most
commonly identified intestinal parasite in the Giardiasis is caused by the flagellate protozoan
United States and the most common protozoal Giardia intestinalis (formerly known as G lamblia).
intestinal parasite isolated worldwide.
- Person to person transmission. Person-to-
- Giardiasis usually represents a zoonosis with
person transmission, often associated with
cross-infectivity between animals and
poor hygiene and sanitation, is a primary
humans.
means of infection; diaper changing and
- G. intestinalis can cause asymptomatic
inadequate hand washing are risk factors for
colonization or acute or chronic diarrheal
transmission from infected children; children
illness.
attending day care centers, as well as day-
- The organism has been found in as many as
care workers, have a higher risk of infection
80% of raw water supplies from lakes,
secondary to fecal-oral transmission.
streams, and ponds and in as many as 15% of
- Water-borne transmission. Water-borne
filtered water samples.
transmission is responsible for a significant
Pathophysiology: number of epidemics in the United States,
generally following ingestion of unfiltered
Infection with Giardia intestinalis most often surface water; Giardia cysts retain viability in
results from fecal-oral transmission or ingestion cold water for as long as 2-3 months.
of contaminated water. - Venereal transmission. Venereal transmission
- Person-to-person spread is common, with 25% occurs through fecal-oral contamination;
of family members with infected children food-borne epidemics have been reported,
themselves becoming infected. most commonly secondary to contamination
- Giardia has one of the simplest life cycles of all by infected food-handlers.
human parasites; the life cycle is composed of Clinical Manifestations:
2 stages: (1) the trophozoite, which exists freely
in the human small intestine; and (2) the cyst, Clinical signs and symptoms of giardiasis include
which is passed into the environment. the following:
- Upon ingestion of the cyst (see the second
- Diarrhea. Diarrhea is the most common
image below), contained in contaminated
symptom of acute Giardia infection, occurring
water or food, excystation occurs in the
in 90% of symptomatic subjects; marked or
stomach and the duodenum in the presence of
moderate partial villous atrophy in the
acid and pancreatic enzymes.
duodenum and jejunum can be observed in
- The trophozoites pass into the small bowel
histologic sections from asymptomatic
where they multiply rapidly, with a doubling
individuals who are infected; in addition to
time of 9-12 hours; as trophozoites pass into
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 disrupting the mucosal epithelium, effects in iodine or saline wet mount or after fixation and
the intestinal lumen may contribute to staining.
malabsorption and the production of diarrhea.
Medical Management:
- Malaise, weakness. Malaise or weakness
occurs due to loss of electrolytes with Standard treatment for giardiasis consists of
diarrhea. antibiotic therapy.
- Abdominal distention. Abdominal cramping,
bloating, and flatulence occurs in 70-75% of - Fluid therapy. Appropriate fluid and electrolyte
symptomatic patients. management is critical, particularly in patients
- Malodorous, greasy stools. Stools become with large-volume diarrheal losses.
malodorous, mushy, and greasy. - Diet. No special diet is required; a significant
- Anorexia and weight loss. Anorexia, fatigue, portion of patients have symptoms of lactose
malaise, and weight loss are common; weight intolerance (cramping, bloating, diarrhea), and
loss occurs in more than 50% of patients and maintenance on a lactose-free diet for several
averages 10 pounds. months may be helpful.
- Activity. Activity restrictions are not indicated;
Assessment and Diagnostic Findings: however, infected subjects who are at risk of
spreading the infection should be isolated and
The traditional basis of diagnosis is the
treated
identification of Giardia intestinalis trophozoites or
cysts in the stool of infected patients via a stool ova Pharmacologic Management:
and parasite (O&P) examination.
Antibiotic therapy is standard in the treatment of
- Stool examination. Stool examination for giardiasis.
trophozoites or cysts is the traditional method
for diagnosing giardiasis; at least 3 stools Antibiotics. The 2 major classes of drugs that have
taken at 2-day intervals should be examined proven benefit in the treatment of giardiasis are
for ova and parasites; trophozoites may be nitroimidazole derivatives and acridine dyes;
found in fresh, watery stools but disintegrate although most experts recommend metronidazole
rapidly. and tinidazole as the drugs of choice because the
- Stool antigen detection. Several tests to detect brief treatment periods encourage good patient
Giardia antigen in the stool are commercially adherence, treatment failures occur in as many as
available; these utilize either an 20% of cases, probably because of resistance;
immunofluorescent antibody (IFA) assay or a therefore, treatment with a second-line drug (eg,
capture enzyme-linked immunosorbent assay mepacrine) may be necessary.
(ELISA) against cyst or trophozoite antigens; Nursing Management:
these tests have a sensitivity of 85-98% and a
specificity of 90-100%. Nursing Assessment:
- String test. The string test (Entero-test)
- History. The nature of the overall clinical
consists of a gelatin capsule containing a nylon
manifestations in affected patients is
string with a weight attached to it; the patient
influenced by numerous factors, including the
tapes one end of the string to his or her cheek
parasite load, virulence of the isolate, and the
and swallows the capsule; after the gelatin
host immune response.
dissolves in the stomach, the weight carries
- Physical exam. Physical examination does not
the string into the duodenum; the mucus from
contribute to the diagnosis of giardiasis;
the string is examined for trophozoites in an
weight loss may be evident, but no known
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 unique physical findings are attributable to
giardiasis.

Nursing Diagnosis:
- Diarrhea related to enteric infections.
- Fluid volume deficit related to GI losses.
- Impaired sense of comfort: pain related to
smooth muscle spasm.
- Hyperthermia related to decrease in
circulation secondary to dehydration.

Nursing Interventions:
- Restore Fluid & Electrolyte balance. Weigh
patient daily and note decreased weight;
record number and consistency of stools per
day; if desired, use a fecal incontinence
collector for accurate measurement of output;
monitor and record intake and output; note
oliguria and dark, concentrated urine; discuss
the importance of fluid replacement during
diarrheal episodes.
- Reduce pain or discomfort. Assess the extent
and characteristics of pain; give a warm
compress on the abdomen; teach the client and
caregivers about methods to distract from the
pain and set a position that can reduce the
pain.
- Improve hyperthermia. Provide tepid sponge
baths; administer antipyretics as prescribed.

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