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BBB - Giardia lamblia

Bad Bug Book:
Foodborne Pathogenic Microorganisms and Natural Toxins Handbook
Giardia lamblia

A new version of the Bad Bug Book was released in 2012, below is a previous version.

 1. Name of the Organism:

Giardia lamblia

Giardia lamblia (intestinalis) is a single celled animal, i.e., a protozoa, that moves with the aid of five flagella. In Europe, it is sometimes referred to as Lamblia intestinalis.

 2. Nature of Acute Disease:

Giardiasis is the most frequent cause of non-bacterial diarrhea in North America.

 3. Nature of Disease:

CDC Case Definition

What is a "Case Definition"?

Overview of Public Health Surveillance

Organisms that appear identical to those that cause human illness have been isolated from domestic animals (dogs and cats) and wild animals (beavers and bears). A related but morphologically distinct organism infects rodents, although rodents may be infected with human isolates in the laboratory. Human giardiasis may involve diarrhea within 1 week of ingestion of the cyst, which is the environmental survival form and infective stage of the organism.

Normally illness lasts for 1 to 2 weeks, but there are cases of chronic infections lasting months to years. Chronic cases, both those with defined immune deficiencies and those without, are difficult to treat.

The disease mechanism is unknown, with some investigators reporting that the organism produces a toxin while others are unable to confirm its existence. The organism has been demonstrated inside host cells in the duodenum, but most investigators think this is such an infrequent occurrence that it is not responsible for disease symptoms. Mechanical obstruction of the absorptive surface of the intestine has been proposed as a possible pathogenic mechanism, as has a synergistic relationship with some of the intestinal flora.

Giardia can be excysted, cultured and encysted in vitro; new isolates have bacterial, fungal, and viral symbionts. Classically the disease was diagnosed by demonstration of the organism in stained fecal smears.

Several strains of G. lamblia have been isolated and described through analysis of their proteins and DNA; type of strain, however, is not consistently associated with disease severity. Different individuals show various degrees of symptoms when infected with the same strain, and the symptoms of an individual may vary during the course of the disease.

Infectious Dose - Ingestion of one or more cysts may cause disease, as contrasted to most bacterial illnesses where hundreds to thousands of organisms must be consumed to produce illness.

 4. Diagnosis of Human Illness:

Giardia lamblia is frequently diagnosed by visualizing the organism, either the trophozoite (active reproducing form) or the cyst (the resting stage that is resistant to adverse environmental conditions) in stained preparations or unstained wet mounts with the aid of a microscope. A commercial fluorescent antibody kit is available to stain the organism. Organisms may be concentrated by sedimentation or flotation; however, these procedures reduce the number of recognizable organisms in the sample. Anenzyme linked immunosorbant assay (ELISA) that detects excretory secretory products of the organism is also available. So far, the increased sensitivity of indirect serological detection has not been consistently demonstrated.

 5. Associated Foods:

Giardiasis is most frequently associated with the consumption of contaminated water. Five outbreaks have been traced to food contamination by infected or infested food handlers, and the possibility of infections from contaminated vegetables that are eaten raw cannot be excluded. Cool moist conditions favor the survival of the organism.

 6. Relative Frequency of Disease:

Giardiasis is more prevalent in children than in adults, possibly because many individuals seem to have a lasting immunity after infection. This organism is implicated in 25% of the cases of gastrointestinal disease and may be present asymptomatically. The overall incidence of infection in the United States is estimated at 2% of the population. This disease afflicts many homosexual men, both HIV-positive and HIV-negative individuals. This is presumed to be due to sexual transmission. The disease is also common in child day care centers, especially those in which diapering is done.

 7. Course of Disease and Complications:

About 40% of those who are diagnosed with giardiasis demonstrate disaccharide intolerance during detectable infection and up to 6 months after the infection can no longer be detected. Lactose (i.e., milk sugar) intolerance is most frequently observed. Some individuals (less than 4%) remain symptomatic more than 2 weeks; chronic infections lead to a malabsorption syndrome and severe weight loss. Chronic cases of giardiasis in immunodeficient and normal individuals are frequently refractile to drug treatment. Flagyl is normally quite effective in terminating infections. In some immune deficient individuals, giardiasis may contribute to a shortening of the life span.

 8. Target Populations:

Giardiasis occurs throughout the population, although the prevalence is higher in children than adults. Chronic symptomatic giardiasis is more common in adults than children.

 9. Food Analysis:

Food is analyzed by thorough surface cleaning of the suspected food and sedimentation of the organisms from the cleaning water. Feeding to specific pathogen-free animals has been used to detect the organism in large outbreaks associated with municipal water systems. The precise sensitivity of these methods has not been determined, so that negative results are questionable. Seven days may be required to detect an experimental infection.

 10. Selected Outbreaks:

For more information on recent outbreaks see the Morbidity and Mortality Weekly Reports from CDC.

 11. Education and Background Resources:

Literature references can be found at the links below.

Loci index for genome Giardia lamblia

Available from the GenBank Taxonomy database, which contains the names of all organisms that are represented in the genetic databases with at least one nucleotide or protein sequence.

CDC Giardiasis FAQ'S

Frequently Asked Questions about Giardiasis.

FSIS Parasites and Foodborne Illness Resource page

Giardia duodenalis, cause of giardiasis (GEE-are-DYE-uh-sis), is a one-celled, microscopic parasite that can live in the intestines of animals and people. It is found in every region throughout the world and has become recognized as one of the most common causes of waterborne (and occasionally foodborne) illness.

 12. Molecular Structural Data:

None currently available.

 13. FDA Regulations or Activity:

Bacteriological Analytical Manual.

Current recovery methods are published in this FDA methodology reference. The FDA continues to actively develop and improve methods of recovering parasitic protozoa and helminth eggs from foods.

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