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    Giardia

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    Giardia

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    waleed wains
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    Giardia

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    Intestinal, Oral,

    and Genital Flagellate

    Giardia Lamblia
    Trichomonas vaginalis
    Intestinal, Oral,
    and Genital Flagellate
    Parasitic protozoa, which possess whip-like fl agella
    as their organs of locomotion are called as flagellates
    and classified as:
    Phylum: Sarcomastigophora
    Subphylum: Mastigophora
    Class: Zoomastigophora
    Intestinal, Oral,
    and Genital Flagellate
    Depending on their habitat, they can be considered
    under:
    • Lumen-dwelling flagellates: Flagellates found in the
    alimentary tract and urogenital tract

    • Hemoflagellates: Flagellates found in blood and


    tissues
    Intestinal, Oral,
    and Genital Flagellate
    Most luminal flagellates are nonpathogenic
    commensals. Two of them cause clinical diseases
    —Giardia lamblia, which can cause diarrhea and
    Trichomonas vaginalis, which can produce vaginitis
    and urethritis
    LUMEN-DEWLLING
    FLAGELLATES
    GENUS PARASITE HABITAT
    Giardia G. lamblia Duodenum
    Chilomastix G. mesnili Caecum
    Enteromonas E. hominis Colon
    Retromonas R. intestinalis Colon
    Pentatrichomonas P. hominis Ileocaecal region
    Trichomonas T. Vaginalis Vagina &Urethra
    T. tenax Teeth & Gums
    Dientamoeba D. fragilis Colonic mucosal crypts
    Giardia
    lamblia
    ⚫ Also known as – G. intestinalis / Lamblia intestinalis.
    ⚫ HISTORY :
    First seen by Antonie Von Leeuwenhoek by examining his own stool.

    Prof. Giard of Paris Prof. Lamble of Prague


    GEOGRAPHICAL SPREAD &
    EPIDEMICS

    ⚫ GEOGRAPHICAL DISTRIBUTION : m/c protozoan pathogen,


    worldwide distributed.

    ⚫ EPIDEMIOLOGY :
    Areas with poor sanitation , especially tropics & subtropics.

    Common in younger age group.

    Traveller’s diarrhea is common among visitors caused by


    giardiasis
    through contaminated water.
    HABITA
    T
    ⚫ Duodenum & the upper part of the jejunum.

    ⚫ THE ONLY PROTOZOAN PARASITE


    FOUND IN THE LUMEN OF HUMAN
    SMALL INTESTINE.
    MORPHOLOG
    Y
    ⚫ It exists in two forms –

    1) Trophozoit (Vegetative
    form)

    2) Cyst (Infective form)


    TROPHOZOI
    TE
    ⚫ Tennis racket or heart shaped or pyriform shaped.
    ⚫ Dorsal surface – convex
    ⚫ Ventral surface – concave & having sucking disk (for attachment)
    ⚫ 14 µm x 7µm x 4µm
    ⚫ Anterior end – broad & rounded
    ⚫ Posterior end – tappers to a sharp point.
    ⚫ Bilaterally symmetrical :
    ⚫ Nuclei – 1 pair
    ⚫ Flagella with blepharoblast – 4 pair
    ⚫ Axostyle – 1 pair (along the midline)
    ⚫ Parabasal / Median body – 1 pair( transverse &
    posterior to sucking disc)
    ⚫ Falling leaf motility around its long axis.
    CYS
    TRound or oval in shape.
    ⚫
    ⚫ Surrounded by hyaline cyst wall.
    ⚫ 12µm x 7µm.
    ⚫ Axostyle – diagonally placed, form a deviding line
    within cyst.
    ⚫ 4 nuclei – clustered at one end or at opposite poles
    (each pairs).
    ⚫ Remnants of flagella and margins of the sucking disc
    may be seen inside the cytoplasm of a young cyst.
    ⚫ An acid environment often causes the parasite to
    encyst.
    CULTIVATIO
    N
    ⚫ Discovered by Karapetyan :

    ⚫ Giardia together with yeast (Candida guillermondi)

    ⚫ Medium :
    o Chick embryo extract

    o Human serum

    o Hottinger’s digest (tryptic meat digest)

    o Hank’s solution
    IMMUNITY & RISK
    FACTORS
    ⚫ Common in younger age & uncommon in adult, suggesting that an
    efficient immunity has developed.

    ⚫ Both humoral & cell mediated immunity are important.

    ⚫ RISK FACTORS :
    o IgA deficient person (hypo- or agammaglobulinaemia)
    o Blood group A
    o Achlorhydria
    o Malnutrition
    o Use of cannabis
    o Chronic pancreatitis
    o Immune defects (19A deficiency)
    MODE OF
    TRANSMISSION
    ⚫ Infection is occured by ingestion of cyst in contaminated food &
    water.

    ⚫ Direct transmission from person to person may occure in children,


    male homosexuals, mentally ill persons.
    LIFE
    CYCLE
    ⚫ Giardia passes its life cycle through one host.
    ⚫ Infective form – mature cyst (10 to 100 cysts are enough to infection).
    Ingestion of the cyst via food or drink.

    Within 30 min of ingestion, the cyst hatches out into two trophozoites.
    They multiply in enormous numbers by binary fission & colonise in duodenum.

    They live in the duodenum & upper part of the jejunum, feeding by pinocytosis.

    During unfavourable condition, encystment occurs usually in the colon. A thick resistant wall
    is secreted by the parasite.
    The cystic cell is then divided into two within the cyst wall.

    Cysts are passed in stool (may be 200,000) & remain viable in soil & water for several weeks.
    PATHOGENES
    IS
    ⚫ With the help of sucking disc they adhere to the convex surface of
    epithelial cells & crypts of intestinal mucosa.

    ⚫ It doesn’t invade the tissues.

    ⚫ May cause abnormalities of villous architecture by apoptosis.

    ⚫ Capable of producing harm by the toxic effect (VSSP- Variant Specific


    Surface Proteins), irritative effect & spoliative action (by diverting the
    nutriments).

    ⚫ To avoid the high acidity of proximal duodenum, Giardia


    often localizes in the biliary tract (gall bladder).
    CLINICAL
    FEATURES
    1. Silent cases without any symptoms.
    2. Intestinal :
    1. Malabsorption syndrome (Steatorrhoea)
    2. Mucus diarrhea
    3. Dull epigastric pain
    4. Flatulence
    5. Chronic enteritis
    6. Acute enterocolitis
    3. General :
    1. Fever
    2. Anaemia
    3. Weight loss
    4. Allergic manifestations.
    4. Chronic cholecystopathy.
    LABORATORY DIAGNOSIS

    Enterotest
    Stool Serological Molecular
    examination (String test) test diagnosis

    Macroscopic DNA
    Antigen Antibody
    Microscopic detection detection probe
    PCR
    STOOL
    EXAMINATION
    ⚫ Identification of cysts in formed stool and trophozoites & cysts in
    diarrhoeic stool or after a purgative.

    ⚫ In asymptomatic carriers only cysts are seen.

    ⚫ Macroscopy : offensive odour, pale coloured & fatty stool.

    ⚫ Microscopy : salaine & iodine wet preparations.

    ⚫ Multiple specimens need to be examined.

    ⚫ Concentration techniques like formal ether or zinc acetate are used.


    ENTEROTEST (STRING
    TEST)
    ⚫ Method for obtaining duodenal specimen (upper part of small intestine)
    ⚫ Procedure :
    ⚫ A coiled string with a small weighted gelatin capsule is swallowed by
    the patient & the free end of the string is attached to the side of the
    patient’s face.
    ⚫ The capsule dissolves in the stomach & the string which is weighted at its
    distal end, passes into the duodenum.
    ⚫ After 2-4 hrs the string is withdrawn & placed in a saline with mechanical
    shaking.
    ⚫ The centrifuged deposit of saline is examined by wet mount technique to
    detect the presence of motility of the organism or specific morphological
    forms of trophozoites of Giardia (and larvae of Strongyloides stercoralis).
    When the test should performed
    ⚫ Entero-test is performed when a physician suspects a parasitic
    infection, but no parasites were found in stool sample.

    ⚫ As its sensitivity is comparable to duodenal aspirate, it eliminates the


    need of duodenal intubation.
    SERODIAGNOS
    IS
    ⚫ Antigen detection in feces –
    ▪ ELISA
    ▪ IIF (Indirect immunofluroscent tests)
    ▪ Immuno-chromatographic strip test

    ✔ Antigen present – active infection.


    ✔ Giardia specific Ag 65 (GSA 65) detection by ELISA
    kits.
    o Sensitivity - 95%
    o Specificity – 100% compared to microscopy.
    o Tests are not for routine purpose.
    o It is for epidemiological & control purposes.
    ⚫ Antibody detection –
    ▪ IIF
    ▪ ELISA

    ✔ Tests can’t differentiates between recent & past infection.


    ✔ Lack sensitivity & specificity.
    o Antibody detection (anti Giardia IgG Ab) is useful for epidemiological &
    pathophysiological studies.
    o The presence of anti Giardia secretory IgA Ab in breast milk protects
    breast fed infants from giardiasis.
    MOLECULAR
    METHOD
    ⚫ DNA based techniques are available now.

    ⚫ They are used to demonstrate the genome of the parasite.

    ▪ PCR

    ▪ DNA probe
    TREATMENT

    ⚫ Metronidazole – 250mg x 3 times daily x 5 days. (Cure rate -95%)

    ⚫ Tinidazole – 2 gm single dose. (More effective)

    ⚫ Furazolidone
    Children (less adverse effects)
    ⚫ Nitazoxamide

    ⚫ Parmomycin Pregnant female


    PROPHYLAXIS

    ⚫ Proper disposal of the waste water & feces.

    ⚫ Maintain personal hygiene like hand washing before eating & proper
    disposal of diapers.

    ⚫ Prevention of food & water contamination.

    ⚫ Boiling of water and filtration by membrane filters are required.

    ⚫ Chlorination of water is not effective against cysts.

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