Giardia Lamblia

Dr.
Saurabh Saxena
• Giardia lamblia is also known
as....
Giardia intestinalis
Giardia duodenalis
• What is the causative agent of
Giardiasis?
Giardia lamblia
Dr. Saurabh Saxena
• One of the earliest protozoan parasite
• Most common protozoan pathogen
• Worldwide distribution.
• Endemicity is very high in areas with
low sanitation, especially tropics and
subtropics.
• Traveller's diarrhea
• .
Dr. Saurabh Saxena
Duodenum and upper jejunum
Only protozoan parasite found
in the lumen of the human
small intestine.
Dr. Saurabh Saxena

Dr. Saurabh Saxena
 Trophozoite (or vegetative form) and
Cyst (or cystic form).
 Trophozoite
• Heart shaped
• 15 μm x 9 μm wide and 4 μm thick.
• concave sucking disc
• It is bilaterally symmetrical and possess
– One pair of nuclei
– Pair of median bodies
Dr. Saurabh Saxena

– Four pairs of basal bodies .
– Four pairs of flagella—two lateral, one ventral
and one caudal pair of flagella
The trophozoite is motile, with a slow
oscillation about its long axis, often
resembling falling leaf.
Dr. Saurabh Saxena

A. Ventral view; B. Lateral view; C. Quadrinucleate Cyst
Dr. Saurabh Saxena

intracytoplasmic projections axonemes
Source: http://medlib.med.utah.edu
Dr. Saurabh Saxena
Giardia lamblia
Dr. Saurabh Saxena
 Cyst
 Infective form
 Small and oval, measuring 12 μm x 8 μm,
surrounded by cyst wall.
 2 pairs of nuclei grouped at one end. A young
cyst contains 1 pair of nuclei.
 The axostyle lies diagonally, forming a dividing
line within cyst wall.
Dr. Saurabh Saxena

Dr. Saurabh Saxena
Dr. Saurabh Saxena
Contaminated water and food.
Direct person to person
transmission may also occur in
children, male homosexuals, and
mentally ill persons.
Dr. Saurabh Saxena

Dr. Saurabh Saxena
• 1 host : humans, primates, cats,
dogs, calves or rabbits
• Infective form: Mature cyst.
Dr. Saurabh Saxena

 Within half an hour of ingestion, the cyst
hatches out into two trophozoites, which
multiply successively by binary fission and
colonize in the duodenum.
 The trophozoites live in the duodenum and

upper part of jejunum, feeding by
pinocytosis. Pinocytosis, a process by which
liquid droplets are ingested by living cells.
Dr. Saurabh Saxena

• During unfavorable conditions, encystment
occurs usually in colon.
• Cysts are passed in stool and remain viable in
soil and water for several weeks.
• ~200,000 cysts / g of feces.
• Infective dose is 10–100 cysts.
Dr. Saurabh Saxena

 Development in Man
 Excystation: Two trophozoites are released from
each cyst in the duodenum within 30 minutes of
entry.
 Multiplication: Longitudinal binary fission in
the duodenum.
 Adhesion: Trophozoites adhere to the duodenal
mucosa by the bilobed adhesive ventral disc.
 In active stage of the disease, sometimes the
trophozoites are excreted in diarrhea stool.
Dr. Saurabh Saxena

– Encystation: Gradually when the trophozoites
pass down to large intestine, encystation begins.
• Promoting factors for encystation are the conjugated
bile salts, alkaline pH and cholesterol starvation.
• Encystation specific vesicles (ESV) appear in the
cytoplasm.
• Encystation begins with retraction of the flagella
followed by condensation of the cytoplasm and
finally formation of the cyst wall.
• On maturation, nuclei divide to become four. The
mature cysts excreted in feces can survive better in
the environment and are infective to man.
Dr. Saurabh Saxena

Dr. Saurabh Saxena
Dr. Saurabh Saxena
Pass in stool cyst
Binary fission
Enter with food
trophozoite
Duodenal mucosa
Dr. Saurabh Saxena
Giardia Lamblia clinging to the wall of a duodenal villus.
Dr. Saurabh Saxena
Dr. Saurabh Saxena
 Risk factors
 Children are commonly affected.
 Other high-risk groups are elderly
debilitated persons and patients
with poor hygiene, and
immunodeficiency syndromes such
as common variable.
Dr. Saurabh Saxena

 Pathogenic mechanisms
 Trophozoites adhere to the
duodenal mucosa and cause
disruption of the intestinal
epithelial brush border that leads to
increase permeability and
malabsorption.
Dr. Saurabh Saxena

Dr. Saurabh Saxena
• Malabsorption:
– Malabsorption of fat (steatorrhea)— leads to foul
smelling profuse frothy, diarrhea.
– The stool contains excess mucus and fat but no blood.
– Disaccharidase deficiencies (lactate, xylose)—leading
to lactose intolerance
– Malabsorption of vitamin B12 vitamin A and folic acid
• Antigenic variation:
– Giardia undergoes frequent antigenic variation due to
a cysteine rich protein on its surface called variant
surface protein (VSP)
Dr. Saurabh Saxena
– Asymptomatic carrier
– Acute giardiasis:
• Incubation period varies from 1 week to 3 weeks
(average 12–20 days). Symptoms may develop
suddenly or gradually
• Common symptoms include diarrhea,
abdominal pain, bloating, belching, and
vomiting
• Diarrhea is often foul smelling with fat and mucus
but no blood
• The acute stage lasts for 1 week but usually resolves
spontaneously. Very rarely, in some children may
last for months
Dr. Saurabh Saxena

 Chronic giardiasis:
 With or without a previous acute symptomatic
episode
 Symptoms are intermittent and recurring
 Recurrent episodes of foul smelling diarrhea, foul
flatus, sulfurous belching with rotten egg taste,
and profound weight loss leading to growth
retardation
 Uncommon symptoms such as—fever, presence of
blood and/or mucus in the stools, and other signs
and symptoms of colitis
Dr. Saurabh Saxena

 Stool Examination: Giardiasis can be diagnosed by
identification of cysts of Giardia lamblia in the
formed stools and the trophozoites and cysts of the
parasite in diarrheal stools.
Macroscopic examination – offensive odor, pale

colored and fatty, and float in water.
 Microscopic examination – cysts and trophozoites can
be found in diarrheal stools by saline and iodine wet
preparations.
Dr. Saurabh Saxena

 Entero-Test (string test) is
performed when a physician
suspects a parasite infection, but no
parasites were found in a stool
sample
Dr. Saurabh Saxena

• Stool Culture--- Giardia also can
be diagnosed by examination of stool
under the microscope for cysts or
trophozoites; however, it takes three
samples of stool to diagnose 90% of
cases. Despite requiring three
samples of stool, microscopic
examination of stool identifies other
parasites in addition to Giardia that
can cause diarrheal illness.
Dr. Saurabh Saxena
• Antigen detection in stool (Coproantigen)
– ELISA and direct immunofluorescence test
• Against cyst wall protein antigens
– Immunochromatographic strip tests
• Against Giardia, Entamoeba histolytica and
Cryptosporidium with comparable sensitivity and
specificity like ELISA.
• Antibody detection
• ELISA
• Presence of antibody cannot differentiate recent and
past infection
Dr. Saurabh Saxena

• Molecular Method
– To detect the parasites in water samples or to
genotype the isolates from various mammalian
hosts.
– DNA probes
– Polymerase chain reaction (PCR)
• Radiological finding
– X-ray after barium meal
• Non specific
• It shows an increased secretion and irregular
thickening of small bowel folds
• Interferes with the stool examination
Dr. Saurabh Saxena

Which of the following is the dormant stage
of Giardia lamblia?
A. Cyst
B. Trophozoite
C. Tachyzoite
D. Oocyst
Dr. Saurabh Saxena

Each of the following statements
concerning Giardia lamblia is correct except:
a. G. lamblia has both a trophozoite and cyst

stage in its life cycle
b. G. lamblia is transmitted by the fecal oral
route from human sources
c. G. lamblia causes plague
d. G. lamblia can be diagnosed by the string test
Dr. Saurabh Saxena

Dr. Saurabh Saxena

Giardia Lamblia

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Dr.

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

 The trophozoites live in the duodenum and

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Macroscopic examination – offensive odor, pale

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

Dr. Saurabh Saxena

a. G. lamblia has both a trophozoite and cyst

Dr. Saurabh Saxena

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