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. Giardiasis is the most frequent cause of non-bacterial diarrhea in North America. 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. Major outbreaks are associated with contaminated water systems that do not use sand filtration or have a defect in the filtration system. The largest reported foodborne outbreak involved 24 of 36 persons who consumed macaroni salad at a picnic.