Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Giardiasis (gee-ar-die-a-sis with a soft "G") is an infection of the small intestine that is caused by the parasite, Giardia intestinalis, also known as Giardia lamblia. It is the most common cause of parasitic gastrointestinal disease; it is estimated that
20,000 cases of giardiasis occur each year in the U.S., and there is a 20% to
30% prevalence in the world's population.
Giardia lamblia exists in two forms, an active form called a trophozoite, and an inactive form called a cyst. The active trophozoite attaches to the lining of the small intestine with a "sucker" and is responsible for causing the signs and symptoms of giardiasis. The trophozoite cannot live long outside of the body, therefore it cannot spread the infection to others. The inactive cyst, on the other hand, can exist for prolonged periods outside the body. When it is ingested, stomach acid activates the cyst, and the cyst develops into the disease-causing trophozoite. It takes ingestion of only ten cysts to cause infection. Trophozoites are important not only because they cause the symptoms of giardiasis, but also because they produce the cysts that exit the body in the feces and spread the infection to others.
Cysts of Giardia are present in the feces of infected persons. Thus, the infection is spread from person to person by contamination of food with feces, or by direct fecal-oral contamination. Cysts also survive in water, for example in fresh water lakes and streams. As a result, giardiasis is the most common cause of water-borne, parasitic illness in the U.S.. Domestic mammals (for example, dogs, cats, calves) and wild mammals (for example, beavers) can become infected with Giardia; however, it is not clear how often domestic or wild mammals transmit giardiasis to humans. Giardiasis also has occurred as outbreaks from recreational water sources such as swimming pools, water parks, and hot tubs, most likely because of an infected user rather than a source of water that was contaminated.
The most common manifestations of giardiasis are diarrhea
and abdominal pain,
particularly cramping; however, diarrhea is not invariable and occurs in 60% to
90% of patients. Other common manifestations include:
nausea with or
Fever is unusual. The severity of
the symptoms may vary greatly from mild or no symptoms to severe symptoms.
Stools may be foul smelling when the Giardia interferes with the absorption of
the intestine (malabsorption). The illness or the malabsorption may cause loss
Symptoms and signs of giardiasis do not begin for at least seven days
following infection, but can occur as long as three or more weeks later. In most
patients the illness is self-limiting and lasts 2-4 weeks. In many patients who
are not treated, however, infection can last for several months to years with