Giardia Lamblia : opportunistic parasite

● Intestinal protozoa that can cause infection

● Commonly in HIV patient
● MORPHOLOGY: 2 forms:
- Trophozoites: vegetative active mobile form→ tennis racket shaped;pyriform
shaped with 2 surfaces: the dorsal is convex and the ventral is concave with the
attachment for the disk. Laterally symmetrically there're 2 nuclei, 2 axostyle and 4
pairs of flagella( 2 ant;2post;2 ventral;2 caudal;
- Cyst: infective form: resistant to adverse environment; oval, 4 nuclei, thick
cyst wall.

● Pathogenesis:
- Sucking disc: adhere to the convex surface of epithelial cells and crypts of
Intestinal mucosa;
- Doesn't invade the tissues
- May cause abnormalities of villous architecture by apoptosis
- Capable of producing harm by toxic effect, irritative effect and spoliative
action
- It is localized also in the biliary tract to avoid the high acidity to the proximal
duodenum;

● Pathology:
- Don't invade tissues;
- May localize in biliary tract
- Cause inflammation of duodenum and jejunum
- Cause malabsorption due to the damage of mucosa and epithelial brush
border
- Stool contains large amounts of mucous and fat but not blood
- Asymptomatic
- Acute: self-limiting infection, acute watery diarrhea, abdominal cramps,
bloating,flatulence,stool is profuse and watery in earlier disease, steatorrhea
- Chronic: chronic diarrhea , steatorrhea;

● Epidemiology: WORLDWIDE
- Higher incidences are likely where sanitary standards are low;
- Infants and children are more often infected
- Carriers are more important in the spread of infection than the
symptomatic patient
- Are capable to infection dogs: canines thus may be another source of
human giardiasis
- It's also transmitted through sexual activities

● Diagnosi:
● Microscopy:
Direct wet mount
Trophozoite with falling leaf motility in saline mount
Cyst in iodine mount
Because if Cyst are often shed intermittently , 3 stool specimens should be obtained at 48
hours intervals.
● Antigens detection or coproantigen
● ELISA
● Culture (not do routinely)
● Molecular Diagnosis: DNA probes and PCR for research purpose

● Treatment:
1. Nitroimidazole Derivatives like metronidazole and tinidazole
2. Drugs
3. Acridine dye- quinacrine
4. Nitrofurans-furazolidone