Skip to main content
NCBI home page
Clinical Microbiology Reviews logoLink to Clinical Microbiology Reviews
. 1992 Jan;5(1):93–100. doi: 10.1128/cmr.5.1.93

Giardiasis.

M S Wolfe 1
PMCID: PMC358225  PMID: 1735095

Abstract

Giardiasis is one of the most common pathogenic intestinal protozoal infections worldwide. Giardia lamblia is the most frequently identified etiologic agent in outbreaks associated with the ingestion of surface water, often due to ineffective filtration or pretreatment. In addition to humans, other sources of infection include beavers, perhaps muskrats, and possibly domestic animals. A low infecting dose (10 to 25 cysts) is reported to be sufficient to produce human infection. Clinical manifestations range from asymptomatic to a transient or persistent acute stage, with steatorrhea, intermittent diarrhea, and weight loss, or to a subacute or chronic stage that can mimic gallbladder or peptic ulcer disease. Diagnosis is usually based on repeated stool examinations but examination of duodenal fluid or biopsy material may also be necessary. Enzyme immunoassay or indirect immunofluorescence methods for direct detection of antigen or whole organisms in clinical specimens have also been developed. These tests are reported to be more sensitive than routine stool examination. Demonstration of serum immunoglobulin M and G antibodies may help differentiate recent from past infection or help detect recurrence in individuals who have been treated previously. Serum immunoglobulin A levels may be a useful indicator of exposure in waterborne outbreaks of diarrhea. Drugs available for treatment within the United States include metronidazole, quinacrine hydrochloride, and furazolidone.

Full text

PDF
93

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aggarwal A., Nash T. E. Comparison of two antigenically distinct Giardia lamblia isolates in gerbils. Am J Trop Med Hyg. 1987 Mar;36(2):325–332. doi: 10.4269/ajtmh.1987.36.325. [DOI] [PubMed] [Google Scholar]
  2. Ament M. E., Rubin C. E. Relation of giardiasis to abnormal intestinal structure and function in gastrointestinal immunodeficiency syndromes. Gastroenterology. 1972 Feb;62(2):216–226. [PubMed] [Google Scholar]
  3. Barbour A. G., Nichols C. R., Fukushima T. An outbreak of giardiasis in a group of campers. Am J Trop Med Hyg. 1976 May;25(3):384–389. doi: 10.4269/ajtmh.1976.25.384. [DOI] [PubMed] [Google Scholar]
  4. Beal C. B., Viens P., Grant R. G., Hughes J. M. A new technique for sampling duodenal contents: demonstration of upper small-bowel pathogens. Am J Trop Med Hyg. 1970 Mar;19(2):349–352. doi: 10.4269/ajtmh.1970.19.349. [DOI] [PubMed] [Google Scholar]
  5. Bertram M. A., Meyer E. A., Lile J. D., Morse S. A. A comparison of isozymes of five axenic Giardia isolates. J Parasitol. 1983 Oct;69(5):793–801. [PubMed] [Google Scholar]
  6. Birkhead G., Janoff E. N., Vogt R. L., Smith P. D. Elevated levels of immunoglobulin A to Giardia lamblia during a waterborne outbreak of gastroenteritis. J Clin Microbiol. 1989 Aug;27(8):1707–1710. doi: 10.1128/jcm.27.8.1707-1710.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Blenkinsopp W. K., Gibson J. A., Haffenden G. P. Giardiasis and severe jejunal abnormality. Lancet. 1978 May 6;1(8071):994–994. doi: 10.1016/s0140-6736(78)90284-2. [DOI] [PubMed] [Google Scholar]
  8. Brandborg L. L., Tankersley C. B., Gottieb S., Barancik M., Sartor V. E. Histological demonstration of mucosal invasion by Giardia lamblia in man. Gastroenterology. 1967 Feb;52(2):143–150. [PubMed] [Google Scholar]
  9. Brodsky R. E., Spencer H. C., Jr, Schultz M. G. Giardiasis in American travelers to the Soviet Union. J Infect Dis. 1974 Sep;130(3):319–323. doi: 10.1093/infdis/130.3.319. [DOI] [PubMed] [Google Scholar]
  10. Burke J. A. Giardiasis in childhood. Am J Dis Child. 1975 Nov;129(11):1304–1310. doi: 10.1001/archpedi.1975.02120480030008. [DOI] [PubMed] [Google Scholar]
  11. Burke J. A. The clinical and laboratory diagnosis of giardiasis. CRC Crit Rev Clin Lab Sci. 1977 Jun;7(4):373–391. doi: 10.3109/10408367709151690. [DOI] [PubMed] [Google Scholar]
  12. Chute C. G., Smith R. P., Baron J. A. Risk factors for endemic giardiasis. Am J Public Health. 1987 May;77(5):585–587. doi: 10.2105/ajph.77.5.585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cordingley F. T., Crawford G. P. Giardia infection causes vitamin B12 deficiency. Aust N Z J Med. 1986 Feb;16(1):78–79. doi: 10.1111/j.1445-5994.1986.tb01127.x. [DOI] [PubMed] [Google Scholar]
  14. Craft J. C. Giardia and giardiasis in childhood. Pediatr Infect Dis. 1982 May-Jun;1(3):196–211. doi: 10.1097/00006454-198205000-00015. [DOI] [PubMed] [Google Scholar]
  15. Craft J. C., Nelson J. D. Diagnosis of giardiasis by counterimmunoelectrophoresis of feces. J Infect Dis. 1982 Apr;145(4):499–504. doi: 10.1093/infdis/145.4.499. [DOI] [PubMed] [Google Scholar]
  16. Craun G. F. Waterborne giardiasis in the United States 1965-84. Lancet. 1986 Aug 30;2(8505):513–514. doi: 10.1016/s0140-6736(86)90382-x. [DOI] [PubMed] [Google Scholar]
  17. Danciger M., Lopez M. Numbers of Giardia in the feces of infected children. Am J Trop Med Hyg. 1975 Mar;24(2):237–242. doi: 10.4269/ajtmh.1975.24.237. [DOI] [PubMed] [Google Scholar]
  18. Erlandsen S. L., Sherlock L. A., Bemrick W. J. The detection of Giardia muris and Giardia lamblia cysts by immunofluorescence in animal tissues and fecal samples subjected to cycles of freezing and thawing. J Parasitol. 1990 Apr;76(2):267–271. [PubMed] [Google Scholar]
  19. Farthing M. J., Goka A. J. Immunology of giardiasis. Baillieres Clin Gastroenterol. 1987 Jul;1(3):589–603. doi: 10.1016/0950-3528(87)90049-2. [DOI] [PubMed] [Google Scholar]
  20. Giannella R. A., Broitman S. A., Zamcheck N. Influence of gastric acidity on bacterial and parasitic enteric infections. A perspective. Ann Intern Med. 1973 Feb;78(2):271–276. doi: 10.7326/0003-4819-78-2-271. [DOI] [PubMed] [Google Scholar]
  21. Gillon J. Clinical studies in adults presenting with giardiasis to a gastro-intestinal unit. Scott Med J. 1985 Apr;30(2):89–95. doi: 10.1177/003693308503000204. [DOI] [PubMed] [Google Scholar]
  22. Gillon J. Giardiasis: review of epidemiology, pathogenetic mechanisms and host responses. Q J Med. 1984 Winter;53(209):29–39. [PubMed] [Google Scholar]
  23. Goka A. K., Rolston D. D., Mathan V. I., Farthing M. J. Diagnosis of giardiasis by specific IgM antibody enzyme-linked immunosorbent assay. Lancet. 1986 Jul 26;2(8500):184–186. doi: 10.1016/s0140-6736(86)92487-6. [DOI] [PubMed] [Google Scholar]
  24. Goldman P. Metronidazole: proven benefits and potential risks. Johns Hopkins Med J. 1980 Jul;147(1):1–9. [PubMed] [Google Scholar]
  25. Green E. L., Miles M. A., Warhurst D. C. Immunodiagnostic detection of Giardia antigen in faeces by a rapid visual enzyme-linked immunosorbent assay. Lancet. 1985 Sep 28;2(8457):691–693. doi: 10.1016/s0140-6736(85)92932-0. [DOI] [PubMed] [Google Scholar]
  26. Isaac-Renton J. L., Byrne S. K., Prameya R. Isoelectric focusing of ten strains of Giardia duodenalis. J Parasitol. 1988 Dec;74(6):1054–1056. [PubMed] [Google Scholar]
  27. Istre G. R., Dunlop T. S., Gaspard G. B., Hopkins R. S. Waterborne giardiasis at a mountain resort: evidence for acquired immunity. Am J Public Health. 1984 Jun;74(6):602–604. doi: 10.2105/ajph.74.6.602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Janoff E. N., Craft J. C., Pickering L. K., Novotny T., Blaser M. J., Knisley C. V., Reller L. B. Diagnosis of Giardia lamblia infections by detection of parasite-specific antigens. J Clin Microbiol. 1989 Mar;27(3):431–435. doi: 10.1128/jcm.27.3.431-435.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Jarroll E. L., Bingham A. K., Meyer E. A. Effect of chlorine on Giardia lamblia cyst viability. Appl Environ Microbiol. 1981 Feb;41(2):483–487. doi: 10.1128/aem.41.2.483-487.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Jokipii L., Jokipii A. M. Single-dose metronidazole and tinidazole as therapy for giardiasis: success rates, side effects, and drug absorption and elimination. J Infect Dis. 1979 Dec;140(6):984–988. doi: 10.1093/infdis/140.6.984. [DOI] [PubMed] [Google Scholar]
  31. Jones E. G., Brown W. R. Serum and intestinal fluid immunoglobulins in patients with giardiasis. Am J Dig Dis. 1974 Sep;19(9):791–796. doi: 10.1007/BF01071937. [DOI] [PubMed] [Google Scholar]
  32. Kamath K. R., Murugasu R. A comparative study of four methods for detecting Giardia lamblia in children with diarrheal disease and malabsorption. Gastroenterology. 1974 Jan;66(1):16–21. [PubMed] [Google Scholar]
  33. Knisley C. V., Engelkirk P. G., Pickering L. K., West M. S., Janoff E. N. Rapid detection of giardia antigen in stool with the use of enzyme immunoassays. Am J Clin Pathol. 1989 Jun;91(6):704–708. doi: 10.1093/ajcp/91.6.704. [DOI] [PubMed] [Google Scholar]
  34. Knox D. L., King J., Jr Retinal arteritis, iridocyclitis, and giardiasis. Ophthalmology. 1982 Dec;89(12):1303–1308. doi: 10.1016/s0161-6420(82)34636-9. [DOI] [PubMed] [Google Scholar]
  35. Korman S. H., Le Blancq S. M., Spira D. T., el On J., Reifen R. M., Deckelbaum R. J. Giardia lamblia: identification of different strains from man. Z Parasitenkd. 1986;72(2):173–180. doi: 10.1007/BF00931144. [DOI] [PubMed] [Google Scholar]
  36. Koszarska J., Gruszczyńska M., Pilarska K. Lamblioza jako przyczyna ostrego zapalenia trzustki. Wiad Lek. 1977 Jun 1;30(11):875–877. [PubMed] [Google Scholar]
  37. Kreutner A. K., Del Bene V. E., Amstey M. S. Giardiasis in pregnancy. Am J Obstet Gynecol. 1981 Aug 15;140(8):895–901. doi: 10.1016/0002-9378(81)90082-x. [DOI] [PubMed] [Google Scholar]
  38. Meloni B. P., Lymbery A. J., Thompson R. C. Isoenzyme electrophoresis of 30 isolates of Giardia from humans and felines. Am J Trop Med Hyg. 1988 Jan;38(1):65–73. doi: 10.4269/ajtmh.1988.38.65. [DOI] [PubMed] [Google Scholar]
  39. Meloni B. P., Thompson R. C. Comparative studies on the axenic in vitro cultivation of Giardia of human and canine origin: evidence for intraspecific variation. Trans R Soc Trop Med Hyg. 1987;81(4):637–640. doi: 10.1016/0035-9203(87)90438-x. [DOI] [PubMed] [Google Scholar]
  40. Meyer E. A., Radulescu S. Giardia and giardiasis. Adv Parasitol. 1979;17:1–47. doi: 10.1016/s0065-308x(08)60548-5. [DOI] [PubMed] [Google Scholar]
  41. Murphy T. V., Nelson J. D. Five v ten days' therapy with furazolidone for giardiasis. Am J Dis Child. 1983 Mar;137(3):267–270. doi: 10.1001/archpedi.1983.02140290053014. [DOI] [PubMed] [Google Scholar]
  42. Naik S. R., Rau N. R., Vinayak V. K., Narayanan V. A., Zunzurwade S., Sehgal S. C., Talwar P. Presence of Candida albicans in normal and in Giardia lamblia infected human jejunum. Ann Trop Med Parasitol. 1978 Oct;72(5):493–494. doi: 10.1080/00034983.1978.11719351. [DOI] [PubMed] [Google Scholar]
  43. Naik S. R., Raue N. R., Vinayak V. K. A comparative evaluation of examinations of three stool samples, jejunal aspirate and jejunal mucosal impression smears in the diagnosis of giardiasis. Ann Trop Med Parasitol. 1978 Oct;72(5):491–492. doi: 10.1080/00034983.1978.11719350. [DOI] [PubMed] [Google Scholar]
  44. Nash T. E., Herrington D. A., Levine M. M. Usefulness of an enzyme-linked immunosorbent assay for detection of Giardia antigen in feces. J Clin Microbiol. 1987 Jul;25(7):1169–1171. doi: 10.1128/jcm.25.7.1169-1171.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Nash T. E., Herrington D. A., Losonsky G. A., Levine M. M. Experimental human infections with Giardia lamblia. J Infect Dis. 1987 Dec;156(6):974–984. doi: 10.1093/infdis/156.6.974. [DOI] [PubMed] [Google Scholar]
  46. Nash T. E., McCutchan T., Keister D., Dame J. B., Conrad J. D., Gillin F. D. Restriction-endonuclease analysis of DNA from 15 Giardia isolates obtained from humans and animals. J Infect Dis. 1985 Jul;152(1):64–73. doi: 10.1093/infdis/152.1.64. [DOI] [PubMed] [Google Scholar]
  47. Owen R. L., Nemanic P. C., Stevens D. P. Ultrastructural observations on giardiasis in a murine model. I. Intestinal distribution, attachment, and relationship to the immune system of Giardia muris. Gastroenterology. 1979 Apr;76(4):757–769. [PubMed] [Google Scholar]
  48. Petersen L. R., Cartter M. L., Hadler J. L. A food-borne outbreak of Giardia lamblia. J Infect Dis. 1988 Apr;157(4):846–848. doi: 10.1093/infdis/157.4.846. [DOI] [PubMed] [Google Scholar]
  49. Pickering L. K., Engelkirk P. G. Giardia lamblia. Pediatr Clin North Am. 1988 Jun;35(3):565–577. doi: 10.1016/s0031-3955(16)36472-0. [DOI] [PubMed] [Google Scholar]
  50. Pickering L. K., Woodward W. E., DuPont H. L., Sullivan P. Occurrence of Giardia lamblia in children in day care centers. J Pediatr. 1984 Apr;104(4):522–526. doi: 10.1016/s0022-3476(84)80540-5. [DOI] [PubMed] [Google Scholar]
  51. RENDTORFF R. C., HOLT C. J. The experimental transmission of human intestinal protozoan parasites. IV. Attempts to transmit Endamoeba coli and Giardia lamblia cysts by water. Am J Hyg. 1954 Nov;60(3):327–338. [PubMed] [Google Scholar]
  52. Roberts-Thomson I. C., Stevens D. P., Mahmoud A. A., Warren K. S. Acquired resistance to infection in an animal model of giardiasis. J Immunol. 1976 Nov;117(5 PT2):2036–2037. [PubMed] [Google Scholar]
  53. Rosoff J. D., Stibbs H. H. Isolation and identification of a Giardia lamblia-specific stool antigen (GSA 65) useful in coprodiagnosis of giardiasis. J Clin Microbiol. 1986 May;23(5):905–910. doi: 10.1128/jcm.23.5.905-910.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Rosoff J. D., Stibbs H. H. Physical and chemical characterization of a Giardia lamblia-specific antigen useful in the coprodiagnosis of giardiasis. J Clin Microbiol. 1986 Dec;24(6):1079–1083. doi: 10.1128/jcm.24.6.1079-1083.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Saha T. K., Ghosh T. K. Invasion of small intestinal mucosa by Giardia lamblia in man. Gastroenterology. 1977 Mar;72(3):402–405. [PubMed] [Google Scholar]
  56. Schmerin M. J., Jones T. C., Klein H. Giardiasis: association with homosexuality. Ann Intern Med. 1978 Jun;88(6):801–803. doi: 10.7326/0003-4819-88-6-801. [DOI] [PubMed] [Google Scholar]
  57. Sealy D. P., Schuman S. H. Giardiasis: a common and underrecognized enteric pathogen. J Fam Pract. 1981 Jan;12(1):47–54. [PubMed] [Google Scholar]
  58. Shaw R. A., Stevens M. B. The reactive arthritis of giardiasis. A case report. JAMA. 1987 Nov 20;258(19):2734–2735. [PubMed] [Google Scholar]
  59. Smith J. W., Wolfe M. S. Giardiasis. Annu Rev Med. 1980;31:373–383. doi: 10.1146/annurev.me.31.020180.002105. [DOI] [PubMed] [Google Scholar]
  60. Smith P. D., Gillin F. D., Brown W. R., Nash T. E. IgG antibody to Giardia lamblia detected by enzyme-linked immunosorbent assay. Gastroenterology. 1981 Jun;80(6):1476–1480. [PubMed] [Google Scholar]
  61. Soto J. M., Dreiling D. A. Giardia lamblia. A case presentation of chronic cholecystitis and duodenitis. Am J Gastroenterol. 1977 Mar;67(3):265–269. [PubMed] [Google Scholar]
  62. Stevens D. P., Frank D. M., Mahmoud A. A. Thymus dependency of host resistance to Giardia muris infection: studies in nude mice. J Immunol. 1978 Feb;120(2):680–682. [PubMed] [Google Scholar]
  63. Stevens D. P. Giardiasis: host-pathogen biology. Rev Infect Dis. 1982 Jul-Aug;4(4):851–858. doi: 10.1093/4.4.851. [DOI] [PubMed] [Google Scholar]
  64. Stibbs H. H., Samadpour M., Manning J. F. Enzyme immunoassay for detection of Giardia lamblia cyst antigens in formalin-fixed and unfixed human stool. J Clin Microbiol. 1988 Sep;26(9):1665–1669. doi: 10.1128/jcm.26.9.1665-1669.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Tandon B. N., Tandon R. K., Satpathy B. K., Shriniwas Mechanism of malabsorption in giardiasis: a study of bacterial flora and bile salt deconjugation in upper jejunum. Gut. 1977 Mar;18(3):176–181. doi: 10.1136/gut.18.3.176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Thornton S. A., West A. H., DuPont H. L., Pickering L. K. Comparison of methods for identification of Giardia lamblia. Am J Clin Pathol. 1983 Dec;80(6):858–860. doi: 10.1093/ajcp/80.6.858. [DOI] [PubMed] [Google Scholar]
  67. Ungar B. L., Yolken R. H., Nash T. E., Quinn T. C. Enzyme-linked immunosorbent assay for the detection of Giardia lamblia in fecal specimens. J Infect Dis. 1984 Jan;149(1):90–97. doi: 10.1093/infdis/149.1.90. [DOI] [PubMed] [Google Scholar]
  68. Vinayak V. K., Kum K., Chandna R., Venkateswarlu K., Mehta S. Detection of Giardia lamblia antigen in the feces by counterimmunoelectrophoresis. Pediatr Infect Dis. 1985 Jul-Aug;4(4):383–386. doi: 10.1097/00006454-198507000-00010. [DOI] [PubMed] [Google Scholar]
  69. Visvesvara G. S., Smith P. D., Healy G. R., Brown W. R. An immunofluorescence test to detect serum antibodies to Giardia lamblia. Ann Intern Med. 1980 Dec;93(6):802–805. doi: 10.7326/0003-4819-93-6-802. [DOI] [PubMed] [Google Scholar]
  70. WEBSTER B. H. Human infection with Giardia lamblia; an analysis of 32 cases. Am J Dig Dis. 1958 Jan;3(1):64–71. doi: 10.1007/BF02231310. [DOI] [PubMed] [Google Scholar]
  71. Walzer P. D., Wolfe M. S., Schultz M. G. Giardiasis in travelers. J Infect Dis. 1971 Aug;124(2):235–237. doi: 10.1093/infdis/124.2.235. [DOI] [PubMed] [Google Scholar]
  72. Wolfe M. S. Giardiasis. Pediatr Clin North Am. 1979 May;26(2):295–303. doi: 10.1016/s0031-3955(16)33706-3. [DOI] [PubMed] [Google Scholar]
  73. Wolfe M. S. Giardiasis. N Engl J Med. 1978 Feb 9;298(6):319–321. doi: 10.1056/NEJM197802092980606. [DOI] [PubMed] [Google Scholar]
  74. Wright R. A., Vernon T. M. Epidemic giardiasis at a resort lodge. Rocky Mt Med J. 1976 Jul-Aug;73(4):208–211. [PubMed] [Google Scholar]

Articles from Clinical Microbiology Reviews are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES