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Giardiasis in adults

What is giardiasis?

Giardiasis is a parasitic disease caused by protozoan parasites and is characterized by lesions of the small intestine. The main symptoms of giardiasis are allergic and abnormal neurological responses.

The causative agent of giardiasis is the simplest flagellate microorganism Giardia (Giardia lamblia). Modern science knows about 40 species of Giardia, but in the human gut parasite Lamblia only interstinalis.

This protozoan microorganism exists in the form of cysts in the form of vegetati. Vegetative lamblia is pear-shaped, somewhat resembling a human face with a tight smile. Giardia in length not reaching more than 24 µm, width 12 µm, so they are only visible under a microscope.

On the ventral side of the parasite has passively drive that is used for attachment to the villi lining the intestine. Giardia eat whole surface of the body, sucking the necessary substances for life.

In the form of vegetation Giardia are actively moving. This helps them to flagella, they have a parasite there are 4 pairs. Outside of the human body vegetative forms are not capable of long-term existence and die in a few hours.

Once the parasites enter the human intestine, Giardia begin to divide, forming new vegetation and cyst. Cysts go along with the stool of the patient. Unlike vegetaci, cysts have good stability in the environment. They retain their vitality without the human body for 18 days or more in the water, and if adequate moisture live about 4 days. Cysts do not respond to treatment with chlorine, however, does not tolerate drought. Without sufficient moisture, cysts perish in a few hours.

Giardia lead an independent life, providing their needs at the expense of the host organism. Giardiasis is widespread. Most of the carriers of this protozoan infection live in countries of Latin America, Africa and Central Asia. For the first time the causative agent was discovered in human feces in 1684 Antony van Leeuwenhoek, and described the parasite of scientist D. F. Lambl in 1859. It was named after the microorganism.

Animals along with a man prone to giardiasis. This parasitic infestation is detected in rabbits, dogs, cats, rodents, cattle and other mammals. People most often become infected from another person who allocates the external environment Giardia cysts, however, do not exclude the possibility of infection from animals.

After a 9-22the day after the initial invasion, the person becomes dangerous to others, as with the feces begins to secrete into the external environment cysts of parasites, ready for infection. Only 1 g feces can contain 23 million cysts of parasites, however, the average number of cysts on 1 g feces is 1.8 million At the same time in order to happen the infection in the digestive tract of a person can get from 1 to 10 cysts. Under such conditions the risk of infestation will vary from 10-30%.

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Statistics of giardiasis

Every year in Russia recorded more than 140 thousand cases of giardiasis. The number of adults from this figure is about 30%. The disease is dangerous in the first place so that is asymptomatic and clinical signs that occur in the adult, are not specific. Often giardiasis behind the mask of the biliary dyskinesia, under chronic enteritis and other pathological conditions of the digestive tract.

The mechanism of transmission of parasitic infections – fecal-oral. The route of transmission is through the hands, through water, through food, contamination of cysts of the parasites. To transfer Giardia cysts can some insects, particularly flies.

The prevalence of giardiasis due to high contamination with cysts of parasites of most objects in the external environment:

  • 1 cubic meter of water in open reservoirs account for 4 to 30 cysts.
  • On 1 liter wastewater is not pruned, we have to 1091 cysts.
  • On 1 liter treated wastewater that will be flushed into open water account for from 10 to 35 cysts.
  • On 1 kg the soil in PEI, located in nekanalizovannyh settlements have up to 112 of cysts (in 11 to 22% of all investigated soils).
  • In 6% of cases, cysts were detected in swabs from door handles in kindergarten, 3% in swabs from the hands of children, 2% in the washings of pots with children and in 0.2% in rinse toys.

Cysts remain viable in water from 15 to 70 days in feces they live from 2 hours to days. If the cysts get into the open water, at a temperature of from 2 to 22 degrees they can live for about 3 months. In a sea of cysts retain the ability to invasion for 47 days.

However, the cysts are not resistant to heat and when boiling, they die instantly. As for food, the fruit of the cysts of the parasite are able to maintain viability for 6 hours in dairy products they can live up to 12 days, and sometimes up to 112 days.

In different countries worldwide were registered outbreaks of giardiasis because of drinking untreated water that has not passed the processing at water treatment facilities. For example, a similar situation was observed in America, in Egypt, in Sweden.

In most DOE children infected through dirty hands. Source of the spread of giardiasis are other children and staff.

One should not exclude the possibility of infection with parasites through food. The cysts can get on ready-made food from the hands of those people who stayed in contact. Or infection occurs by eating poorly processed fruit, vegetables, herbs, etc.


Causes of infection with giardiasis

Causes of giardiasis infection is invasion of the intestinal parasite called Lamblia intestinalis.

Giardia multiply in the human small bowel, in those places, where they accumulate the most. Method of reproduction – continuous fresh division of the autonomic individuals. The speed of this process is very large and the average is 20 minutes, in the end, the gut is colonized by parasites fairly quickly.

Activity of Giardia, and their rate of reproduction depends on the condition of the digestive organs of man. Sharply reduced the number of individuals during fasting and in the use of sick sufficient amount of protein. When the intake of carbohydrate food, on the contrary, is an insufficient secretion of bile in the intestinal lumen, which stimulates the growth and reproduction of parasites.

The more active processes of parietal digestion in the intestine, the faster begin to divide Giardia, which explains the high prevalence of helminthiasis among children compared to the adult population. Favorable conditions for the existence of the parasite in the intestine is decreased acidity of gastric juice.

The source of infection is always sick man. And he can be a carrier of Giardia, and the symptoms of the disease to testwill not be there at all. The person becomes contagious after about 8-12 days after infestation. The incubation period in some cases can be shorter, especially when a massive infection Giardia.

The cysts are released into the environment in waves. Pause between this process can range from 1 to 17 days. If a person has been infected once, and subsequent reinfection does not occur, then he will remain contagious for 6 months.

From the point of view of maximum infectivity is the most dangerous is the patient, whose symptoms of giardiasis subsided. During this period, normal peristalsis of the intestines and create favorable conditions for the breeding of parasites.

One gram of faeces can contain about 1.8 million cysts, capable of invasion. But for infection to occur, enough to swallow only 10 cysts.

The mechanism of transmission of Giardia is fecal-oral. Path of infection: food, contact-domestic water and.

Often to mass outbreaks of infection results in the waterway distribution of giardiasis. It is not excluded infection during a visit to the pool, when swimming in open water. Giardiasis can be transmitted through the consumption of food, contamination of cysts of the parasite. Known cases of infection during sexual contact between man-gay.

High risk of transmission of giardiasis in the following conditions:

  • Lack of personal hygiene. This primarily relates to poor quality and failure to wash hands after visiting public places, using the toilet and before eating.
  • Poor processing of food that is eaten raw.
  • Drink unboiled water, especially from open natural sources. Giardia can be present in any water, including in spring.
  • Bad sanitary conditions, the presence of insects in the house. A particular danger in this regard are flies and cockroaches, which are the disseminators of infection.
  • Infection giardiasis from infected animals: dogs, Guinea pigs, cats, etc.

    • More susceptible to infestations of adults of the following professions:

    • Employees of educational institutions (kindergartens, schools).
    • Health workers (laboratory technicians).
    • Flusher.

    The risk factors of giardiasis in adults:

    • A large number of carbohydrate foodsin the diet.
    • Not drinking enough protein foods and foods with fiber (vegetables, fruits, grains).
    • Reduced stomach acidity.
    • Malfunction of the immune system.
    • Long-term treatment with antibacterial drugs, which leads to excessive bacterial growth in the intestine. This environment is favorable for the existence of Giardia.
    • Addiction.
    In the Russian Federation the disease most often recorded in spring (April and may) and summer. Fewer cases of giardiasis observed in November and October.

    For many years, the risk of giardiasis was significantly underestimated. In modern scientists there is no doubt that parasites are a threat to human health. So Giardia in adults should be promptly diagnosed and treated.

    The gateway for parasites are the upper sections of the small intestine. There Mature cysts lose their protective sheath and become vegetative individuals. One of the cyst gives 2 trafosite. With the help of flagella they move through the intestinal mucosa, and finding a comfortable environment for existence.

    After attachment to the villi of the intestine vegetative forms beginning division. Colonization of the body happens very quickly. On just one square centimeter of the intestine can be up to 1 ml individuals. The maximum number of Giardia falls on the upper portion of the small intestine. It is here that the parasites have optimal conditions for access to the spaces between the villi, from which they suck the carbohydrates, fats, proteins, minerals and other nutrients. In later periods Giardia down in the middle and the ending of the small intestine.

    Those vegetative forms of Giardia, which are not attached to the fibers descend into the small intestine, where they become cysts. Then the cysts absorb the flagella and covered by a protective sheath. This process as easy as possible for normal intestinal motility. If she hurried, there is diarrhea, vegetative forms of Giardia is not enough time to generate a cyst, and they go out into the environment inadequately protected. As mentioned, such vegetation will quickly die outside the human body.

    For a long time, there was confidence that Giardia is able to parasitize the biliary tract. However, it is proved that the bile in high concentrations for these destructive parasites. Theyit lose viability in a few seconds.

    Factors that contribute to massive outbreaks of giardiasis among the population are:

    • Fecal contamination of the environment;
    • High density of people;
    • Low level of formation of hygienic skills of the population;
    • Insufficient cleaning of drinking water before it reaches the water.

    Naturally, the risks of invasion for an adult increase if the house is home to one or more children under the age of 10 years.


    Does the Giardia?

  • If Giardia is transmitted from person to person? Giardia is transmitted from person to person.
  • If Giardia is transmitted via kiss, saliva? Giardia transmission by kissing is theoretically possible, provided that in the saliva during a kiss will attend the cysts of parasites.
  • Does Giardia from cats to humans? Transmission of Giardia from cats to humans is possible.
  • Is it possible to see the Giardia in the feces? Yourself to see Giardia in the feces is impossible, since their dimensions are very small. Therefore, the parasites in the faeces can be visualized only under a microscope.

    • The symptoms of giardiasis

    The symptoms of giardiasis are very often non-existent. Asymptomatic disease occurs in 65% of patients. If the clinical picture appears bright, it is often due either to a massive invasion, or malfunction of the human immune system, or by ingestion of specific strains of infection with high virulence. For example, people with HIV disease is much harder than in healthy patients. Periods of remission are replaced by frequent periods of exacerbation.

    The most complete is considered to be the following classification of giardiasis:

    • Asymptomatic carriers of giardiasis

    • Symptoms of giardiasis. To severe symptoms of the disease include:

      1. Lose bowel enteritis, enterocolitis, duodenitis and dyskinesia of the duodenum (the intestinal form of the disease).

      2. Hepatobiliary form in which the fore symptoms of cholecystitis and biliary dyskinesia.

      3. Giardiasis as a disease and related.

    Based on the study of the symptoms of giardiasis in humans of different age groups, Zalipaev T. L. identified the following main syndromes of the disease:

    • Dyspeptic syndrome, which is a leading and is present in the clinical picture of 81.5% of all patients.
    • Pain, which is inherent in 76.9% of all infected.

    • Asthenic-neurotic syndrome with fatigue, irritability and headaches. Similar symptoms were observed in 64.8% of patients.

    • Allergodermatoses reactions. This files most often observed in patients with atopic dermatitis. This syndrome occurs in 15.7% of cases.

    Thus, it is noted that such syndromes can present in any of the following clinical forms of giardiasis. With regard to laboratory data, when giardiasis in 31.5% of patients an increase in the number of eosinophils by 5-7%.

    Symptoms of giardiasis in acute stage

    For the acute phase of giardiasis characterized by the following symptoms:

    • Nausea, lack of appetite, frequent belching.

    • Bloating, flatulence, rumbling in the intestines, excessive gas.

    • Loss of body weight.
    • In the right hypochondrium and in the umbilical area occur painful. Pain in the navel area notes every other patient, and pain in the right upper quadrant indicate about 15% of people. Pain is very often associated with food intake, so they are not associated with giardiasis.
    • In the mouth there is a bitter or sour taste.

    • May develop diarrhea. The stool is increased, it may happen 3 to 5 times a day. If at the beginning of the acute period of the character of the stools are loose and watery, then it thickens and becomes oily.

    • Increases salivation.
    • Observed fatigue and unexplained weakness.
    • Deteriorating operability.
    • Appear skin rashes.

    • Avitaminosis. Its symptoms boil down to increased brittle nails, hair loss, peeling skin, etc.

    The acute phase lasts for five days, but can sometimes last for a week. If a person has immunodeficiency, acute giardiasis is usually longer, and all of these symptoms are fully manifested.

    Sometimes in the acute phase have symptoms of biliary dyskinesia. If you have children giardiasis increases the body temperature and increasing symptoms of intoxication, for adult patients with a similar clinical picture is not typical.

    A week later, giardiasis or independently is, or becomes chronic.

    Symptoms of giardiasis in chronic stage

    Symptoms pointing to a chronic form of giardiasis in adults:

    • Disorders of the digestive organs. The stool of the patient becomes unstable, frequent constipation are replaced by the same frequent diarrhea. Appetite depressed, periodically concerned about the bloating and rumbling in the intestines.
    • Suffering overall health of the person. Often suffer from headaches, appears excessive sleepiness and irritability. This condition leads to deterioration of capacity for work.
    • Deteriorating the color of the skin may develop a weak jaundice. First icteric hue acquires a neck, face, axillary folds, abdomen.

    • Skin rashes begin to disturb the patient more often, even if people from allergies don't suffer. Possible effects of dermatitis or urticaria. Angioedema in adulthood on the background of giardiasis is extremely rare, more likely to develop asthmatic bronchitis or bronchial asthma. The main features of Allergy on the background of giardiasis are: long duration, lack of response to the intake of antihistamines, frequent relapses.

    • Especially hard on the background of giardiasis in adults occurs urticaria, disrupting the quality of life of the patient. And it arises without any background errors in the diet, without medication, and so Very often, hives are accompanied by symptoms of blepharitis.

    • Chronic giardiasis is characterized by follicular keratosis with the appearance on the skin of the point lumps. Mostly affect skin apart. Itcovered with a flaky crust or white circular plaques, are prone to excessive flaking.
    • Giardiasis is associated with xerosis in which the patient peel the heel, especially in the cold season.
    • Possible isolated lesions of the palms and feet, when the skin begins to peel at the tips of the phalanges. The fingers resemble senile. To the palms this process typically does not reach.

    • Suffering mucosa of the oral cavity. A person is often occurs aphthous stomatitis, mouth corner appear zaedy, the border of the lips become inflamed.

    • Hair become thinner, become brittle, lose their natural luster.
    • The patient continues to lose weight.

    If Giardia from adult parasites for a long time, it will show signs of immunosuppression and symptoms of intoxication. While periodically inflamed lymph nodes, tonsils increase, body temperature rises to subfebrile levels.

    Another indirect symptom of giardiasis in adults is intolerance to cow's milk, as these parasites hit the enterocytes, responsible for the hydrolysis of carbohydrate components of food. This also explains the flatulence in the intestine.

    The effects of giardiasis

    The effects of giardiasis occur with long-term course of the disease. The first to suffer the human immune system, which causes persistent viral and bacterial diseases.

    Second, increase the risks of developing chronic diseases of the digestive system, from which it will be impossible to remove even after treatment of giardiasis. The development of acute pancreatitis, cholecystitis and gastroduodenitis, ulcers of the stomach and intestines.

    Third, when parasitic infestation the patient suffers from allergic reactions that can result in bronchial asthma. The symptoms can also persist throughout life, even if cure of giardiasis.


    Diagnosis

    Diagnosis of Giardia in adults should be required to include the following indications:

    • Diarrhea, which is characterized by persistent current and finds viral, autoimmune or bacterial confirmation.

    • Allergopodobnyh allergic and respiratory diseases (bronchial asthma, obstructive bronchitis) and skin (urticaria, eczema, dermatitis , etc.).

    • The increase of eosinophils in the blood.
    • Prolonged elevation of body temperature to subfebrile level.
    • A confirmed contact with an infected person.

    Visual markers of patients with giardiasis are: dryness of the skin, soreness of mesogastric, bloating, coated tongue, a possible increase in liver size.

    Modern diagnostics of Giardia in adults includes the following set of possible events:

    • Microscopic examination of feces.
    • PCR of feces.
    • ELISA of stool using rapid tests.
    • PCR of duodenal contents duodenal.
    • ELISA blood on giardiasis.

    The basic method of diagnosis is microscopic examination of feces. It must be carried out at least 3 times, especially if there is suspicion of the presence of parasites in the human body. Most often found in the stool of Giardia cysts.

    The result was the most accurate, you must meet the following conditions:

    • On the eve of delivery of the analysis it is desirable to refuse to accept solid food, mushrooms and liver, so as not to impede visualization of parasites;
    • Do not use an enema for the collection of biological material;
    • To refuse the appointment of sorbents and antibiotics, or to wait after the last administration of the drug 2 weeks;
    • Collect stool in a sterile container;
    • Feces must be fresh, it must within hours to deliver to laboratory.

    Additional methods of diagnosis of giardiasis in adults include such studies as: General analysis of blood and urine, biochemistry of blood, coprogram and the sowing of feces on a microflora test Lactasoy failure, EGD, etc.


    Treatment of giardiasis in adults

    Treatment of Giardia in adults is an infectious diseases doctor.

    Before you decide on therapy, the doctor must consider aspects such as:

    • The severity of symptoms;
    • Durationthe presence of Giardia in the intestine;
    • The presence of concomitant diseases.

    It is equally important to try to determine the source of infection, to prevent reinfection. You should not begin treatment with receiving Antiprotozoal drugs, as this will exacerbate symptoms and could trigger a reactive response in the body.

    Therefore, the treatment of Giardia in adults is carried out in stages:

    1. The preparatory phase before treatment of giardiasis. At the preparatory stage it is necessary to try by mechanical means to remove from the bowels the maximum number of Giardia, as well as remove toxicity from the body. At this time the patient should adhere to dietary meal plans.

      For this the patient must comply with the following recommendations:

      • Completely excluded from the menu sweet and carbohydrates that are quickly absorbed;
      • Eat foods rich in fiber;
      • To use protein foods;
      • To abandon whole milk, limit fats intake;
      • Food mode, switch to smaller meals (5-6 times a day);
      • Drink more fluids, preferring acidic fruit drinks and bile broths.

      Supplement diet getting admission enterosorbents, diuretic drugs, antihistamines and digestive enzymes. Thus in the intestine will be created conditions unfavorable for reproduction of parasites and the rate of their division will be reduced significantly.

    2. The use of antiparasitic agents against Giardia. The second stage of the antiparasitic therapy is 5-10 days. All medicines are prescribed by the attending physician, as almost all drugs have contraindications and side effects.

      How to treat Giardia in adults – medication list:

    3. Metronidazole (Trihopol) – dosage in adults is equal to 0.4 g three times a day, possible vomiting, nausea, headache, sleep disturbances.
    4. Albendazole – 0.4 g once for 5 days, may develop liver failure, nausea and vomiting, hyperthermia.
    5. Fasigyn – one tablet 4 times a day for 2 days.
    6. Macmiror – 15 mg per kg of body weight, take twice a day after meals throughout the week, possible manifestations of diarrhea, gastralgia, the appearance of skin rashes, nausea and bitterness in the mouth.
    7. Furazolidone – rarely used, as the drug is ineffective against modern strains of parasites.

      8. Drugs and dosage for the treatment of children selected with great care, trying to minimize the toxic effect of drugs.

      How to treat Giardia in children drug

      • Flamin – 1/3 or 1/2 tablet three times a day, the course of treatment is for 10 days.
      • Macmiror – used with 2 years at 15 mg / kg of body weight of the child, not more than 0.4 grams in total. The course of treatment with 2-fold reception will take 7 to 10 days.
      • Interix – recommended for children year, the therapeutic dose is equal to ?-1-1? capsules three times a day.

      Along with anti-parasitic drugs and adults and children taking a course of antihistamines, enzymes and sorbents.

    8. The recovery of the body after the treatment of giardiasis. The final stage of treatment is aimed at increasing the immunity of the patient, normalization of the intestinal microflora. For this he prescribe vitamin and mineral supplements, intestinal bacteria, enzymes.

    As a rule, the prognosis for giardiasis in adults is quite favorable. In that case, if the patient strictly adheres to all appointments of the doctor, recovery is observed in 92-95% of cases. However, it is possible reinfection, therefore, the patient should remain under medical supervision for another 3-6 months. During this time, it is necessary to examine at least 2 times.


    The scheme of treatment of giardiasis

    The scheme of treatment of giardiasis are implemented with the intake of anti-parasitic drugs, including:

    • Tinidazole (Minogin, Amatin, Fasigyn). To accept the selected drug will need 1-2 days. The treatment efficiency reaches 80%.
    • Tiberal (Ornidazole). The drug can be taken in different configurations: one day, three days, five days and ten days. Effect even during a one-day admission up to 92%.
    • The drug Macmiror "Poli industria chimica". The effectiveness of this drug reaches 96.8% of the after week.

    After the treatment you will need to conduct a control study for giardiasis. Again parasitological survey carried out after 30 days.


    Prevention of Giardia in adults

    Prevention of Giardia in adults, is reduced tothe following events:

    • Timely detection of cases of infestation followed by quality treatment of giardiasis.
    • Strict hygienic conditions with regular hand washing.
    • Use to drink boiled or bottled water.
    • Preventing fecal matter in the environment.
    • Compliance with sanitary and hygienic measures in food establishments, and water.
    • Regular examination of the risk groups for giardiasis.
    • The local authorities of sanitary-educational work among the population.

    From giardiasis is no vaccine, and the immunity that is produced after the disease is very persistent. Therefore, the risk of re-infestation has persisted at a high level.


    What kind of doctor treats giardiasis?

    Treatment of giardiasis is engaged in the infectious disease physician.