Giardia- one of the serious water borne diseases, from common but unknown sources
Giardia, the dreaded but easily sourced microscopic parasite is responsible for many diseases for us. The most common diarrheal illness in the name of Giardia comes from both recreational and potable waters. The parasite has different names, such as Giardia lamblia, Giardia intestinalis and Giardia duodenalis. The parasite is found in water, food, soil etc. which have been contaminated from the infected feces of animals or humans.
An outer shell protects Giardia, allowing it to survive for a long time, even though it is in the outside of the animal or human body. It can even tolerate chlorine disinfection. The spread of the parasite is not limited, however, recreational or drinking water may be the most common causes of transmission of the Giardia related problems.
Case studies of Giardia in USA.
Giardia is the most frequently diagnosed disease in the USA, due to intestinal parasites and travellers who have chronic diarrhoea.
Giardia has varying signs & symptoms. It can last minimum 1 to two weeks, but sometimes longer than that. Many people do not have any symptom. But those with the acute symptoms, may become the victim of any of the followings:
• Dehydration (loss of fluids)
• Stomach or abdominal cramps
• Greasy stools that tend to float
• Upset stomach or nausea/vomiting
• Dehydration (loss of fluids)
Some other common symptoms are swelling in the joints & eye, hives and itchy skin. In some cases, the signs of , look to be resolved, but resurface after a few days or a few weeks. Symptoms of failure to absorb Vitamin B12, Vitamin A, lactose and fats and also weightlessness are the common symptoms.
If any child is affected with giardiasis, the child’s mental & physical growth will be impaired, and the further symptoms will be malnutrition and slow development.
Giardiasis parasite feeds off other organism for its survival. Giardiasis has global presence. 6% to 8% of the children and 2% of the adults of the developed countries and 33% people of the developing countries are affected by this intestinal parasite. Giardia infection is the most commonly known water/food borne intestinal parasitic disease in USA.
Giardia cysts’ contaminated food or contaminated water are swallowed by the people Giardia cysts instantly infect the new host once it leaves the old host. Once a person is infected with Giardiasis parasite, the person might shed billions of cysts in their feces, which lasts long for months together. However, mere intake of 10 cysts may cause infection to a person. Giardiasis parasite is transmitted from animal to person or from person to person or from animal to animal. Another cause of infection is oral-anal sex. Once a person gets infected with Giardiasis parasite, the symptoms starts surfacing within one to three weeks of the infection.
Growth of the Giardiasis parasite
The late summer is the tide-time for the Giardiasis parasite. According to some confirmed data, during the months of June-October (2006-2008) the reported incidences of Giardia intestinalis were twice than they in the January-March of the same periods.
Who can be affected by the Giardiasis parasite?
Giardiasis parasite can affect any one, but the most vulnerable are:
• Travellers to those countries or places where the parasite is common
• Campers or backpackers who drink untreated water from rivers or lakes
• People, who deal with child care
• Anyone swallowing contaminated drinking or creational water
• People in close contact with someone affected by the disease
• People, who are attached with the animals, affected by the disease
• Anyone involved in anal sex
Although the risks of getting affected from the pets like cats or dogs are less, but in case the pet is already affected, there is likelihood of getting affected.
Types of Giardiasis parasites
By analysing the molecules of Giardiasis parasite, different genetic assemblages have been detected. The main assemblages are A to G, and their further subtypes are classified into A-1 to AV. These classifications are done as per the practises’ capacity to inflict some different species. A few of the assemblages are rather common type than others.
Due to the intermittent excretions of the Giardia cysts, if stools are collected three separate days, the test sensitivity increases. Simply by using trichrome staining and concentration methods are not sufficient to know about the detail of Giardia, the reason is the variability of the organism’s concentration in the stool that makes the diagnosis difficult. Better result can be obtained by using faecal immunoassays for sensitive and specific results.
The other type of diagnosis is Rapid cartridge assays (immune-chromatographic). However, this is not better than the routine parasite and ova examinations. For finding the sub types of Giardia, only molecular testing will do.
Treatments Giardia infection
There are different types of drugs for treating Giardia infection. Tinidazole, nitazoxanide and metronidazole are very effective for treating Giardia. Quinacrine, furazolidone and paromomycin are the alternative medicines.
Many factors such as medical history, patient’s immune system’s condition and nutritional status are involved for the effectiveness of the drugs. The final responsibility lies in the hand of the physician, who will discuss the treatment options available.
• Every time & in every place
a) Clean running water must be used for washing hands with soap (minimum 20 seconds). You can make lather by rubbing your both hands together while scrubbing all parts of your palm that includes nails, fingers of both the hands.
b) Washing your hands should be BDA (before, during & after), every time you prepare food
c) Washing your hands should be before taking food
d) Before & after a wound or cut is being treated
e) Before & after an affected person is cared
f) After cleaning up a child or changing soiled diapers
g) After using toilet
h) After coming in contact with any animal or any animal waste
i) After coughing, sneezing or blowing your nose.
j) After coming in contact with any garbage
k) After attending to pet or pet food
l) Help both young & elders, you are taking care of, to hand wash as needed without fail
• Specially for the children & young ones
i) If any child is affected with the disease, the child should be kept away from child care settings till the complete relief from the diarrhea.
• Precautions at recreational water Venus
i) If you or your child is affected with diarrhea, protect others from swimming. Children must be in diapers.
ii) Take a shower bath before getting into water.
iii) Children need to be washed thoroughly with water & soap after their diapers are changed or they have used bathroom
iv) Children should be frequently taken for their bathroom breaks and also for their diaper checking
v) Never change diaper by the water, but in the bathroom only
• Proximity with animals
A) Contacts with the animal (especially the young animals) fees should be minimized
B) In case proximity with the animal is not avoidable, use gloves before touching. And after the work is finished, wash your hand without fail.
C) Never forget to wash your hands after coming in contact with any animal or its living areas.
1) Washing hands after gardening is a must, whether or not wearing your gloves
Always avoid any type of contaminated water (recreational or drinking)
If you are swimming in any of these: interactive fountains, pools, hot tubs, lakes, rivers, streams, springs, ponds etc. never swallow water
You must never drink any untreated water from springs, ponds, lakes, rivers, shallow wells, streams etc.
Poorly treated water or ice made from the water of this kind
Take care of visiting the countries and drinking the water there, if the water and ice made from the water supply is not safe or water is not properly treated.
In case water safety is in doubt (i.e. during and after an outbreak where lack of water treatment facilities or poor water treatment facility is already known), better you take any of the following steps:
1) Drink only bottled water
2) Heat it your tap water at least for 1 minute for disinfecting it
3) Use only those filters which have been tested & certified by your country’s recognised houses.
4) Even filtered tap water needs further treatment for killing the viruses and bacteria.
You must always avoid contaminated food or water
Avoid taking any raw or uncooked food if you are travelling in such a country where water treatment is very poor.
Wash fruits and vegetables with uncontaminated or fresh water. Peeling them before eating raw is always hygienic.
Avoid any type of contamination and contact with feces during sex
During oral or anal sex use a barrier
Washing hands immediately after touching the rectal or anus area or handling condom during anal sex is always the right precautions.
Cleaning up of all types of affected people and pets
It is almost impossible to completely eliminate Giardia intestinalis from the environment; however the risk of infection from a person or a pet can be decreased to a great extent, if precautions are taken correctly.
Cleaning up your home in this way:-
• Cleaning hard surfaces / trash cans / tables / pet crates / tiled or cemented floors
a) Put on your gloves
b) After removing feces, discard them in plastic bags
c) Surfaces are to be cleaned and scrubbed by using soap. Surfaces to be cleaned thoroughly, till contamination leave its last residue.
a) Put on gloves
b) Follow the below mentioned guidelines of the manufacturer for disinfections
i) QATS are found in domestic cleaning products. The ingredients are alkyl, ammonium chloride and dimethyl
ii) Bleaching (water mixed) is helpful
c) Product instructions to be followed for ensuring the product to stay on the surface, as per the guidelines
d) Use clean water for rinsing
• Upholstered furniture / carpet
a) Put on gloves
b) In case feces are or on upholstered furniture or on carpet, use absorbent material for removing them.
c) Discard the feces in a plastic bag
d) Use regular detergent or carpet cleaning detergent for cleaning the contaminated area.
e) Allow the places for fully drying
1) Put on gloves
2) Are should be stem cleaned either at 212ºF for 1 minute or 158ºF for 5 minutes
3) QATS are also other alternative for disinfecting carpets & other such items.
• Pet bed, clothing, toys etc.
1) Daily cleaning and disinfections of household items are recommended, if your pets are infected with Giardia
a) Food bowels, toys, Dishwasher-safe etc. in a dishwasher with final rinse or dry cycle, which must be exceeding one of the following
162ºF for 1 minute
122ºF for 5 minutes
113ºF for 20 minutes
In the absence of a dishwasher, dishwasher-safe items to be submerged in boiling water minimum for 60 seconds (maximum boil for 3 minutes).
• Dryer & washer
1) Linens, toys, bedding and clothing need to be washed and then get it heat dried. The heat setting should be at least for 30 minutes.