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Giardia lamblia

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Giardia lamblia

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Uploaded by

cherineteristu
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© © All Rights Reserved
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7/20/1439

Flagellates
Possess whip-like flagella as their organs of locomotion.
Phylum: Sarcomastigophora. Subphylum: Mastigophora
Class: Zoomastigophora .
Most luminal flagellates are nonpathogenic commensals
2 cause clinical diseases:
Giardia lamblia, cause diarrhea.
Trichomonas vaginalis, produce vaginitis and urethritis.

Classification of flagellates according to their


habitats
Intestinal flagellates:
1. Giardia lamblia (duodenum, jejunum)
2.T. tenax (mouth);
3.T. hominis (caecum)
4. Chilomastix mesnili (caecum) Lumen-dwelling
5. Enteromonas hominis (colon) flagellates:
6. Retortamonas intestinalis (colon) (GI tract & UG tract)
7. Dientamoeba fragilis (colon)
Urogenital flagellates :
(a)Trichomonas vaginalis (vagina, urethra)
Blood Flagellates ( Heamoflagellates ) RBCs + Tissues
Extra cellular (outside RBCs in the plasma) Trypanosoma
Intracellular (Inside reticulo-endothelial cells) Leishmania

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Giardia Lamblia
History
*Of the earliest protozoan parasite
to have been recorded.
First observed in 1681
by Leeuwenhoek.
Distribution
• worldwide in distribution
Habitat: ( Small intestine )
Duodenum and upper jejunum.
The only parasite protozoan found
in the lumen of human SI.
Infective stage:
cyst stage

Morphology ( 2 forms ):
* Trophozoite ( vegetative or motile form).
A tennis racket (heart shaped, or pyriform shaped).
About 15x9 μ wide and 4 μ thick.
• Convex dorsally & concave ventrally
• Sucking disc.
• Bilaterally symmetrical.
• ( 1pair of nuclei, 4 pairs of flagella,
• Blepharoplast (flagella arise)
• axostyles, 1 pair along the midline.
2 transverse parabasal or median bodies.
Movement is slow oscillation.
• Reproduction : Asexual (LBF).

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Cyst
* The infective and diagnostic stage.
* Shape : Small and oval,
12x 8 μ, with a hyaline cyst wall.
* Has (2 pairs of nuclei at one end).
A young 1 pair
*Axostyle dividing line within cyst wall.
*Remnants(the flagella and the sucking
disc may be seen in the young cyst.

Mode of infection
By ingestion of G.lamblia
cyst:

1- In contaminated food or water


2- Through flies & food handlers

Heteroinfection
3- by Faeco-oral route
(hand to mouth)

Autoinfection

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Life cycle of Giardia lamblia

Development of Giardia inside human duodenum

mucosa

Cyst
Binary fission
Pass in stool Enter with
Trophozoite
food

mucosa

The cysts and trophozoites can be found in diarrhoeal stools

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Factors predisposing to symptomatic giardiasis:


* Achlorhydria
* Blood group A in children.
* Use of cannabis,
* Chronic pancreatitis,
* Malnutrition.
* Deficiency in secretory IgA in SI.
* Hypo gamma globulinaemia.
The disease may presented by one of the following :
1- A symptomatic :
Giardia does not invade tissues,
feeds on mucus.
2-Symptomatic :
Giardia attached by sucking disc to the
epithelial of duodenum and jejunum,
Leading to hyperaemia & duodenitis.

Clinical picture
* Epigastric pain, digestive disturbances.
* Diarrhea & flatulence.
* Stool is light-colored & greasy.
* The diarrhoea (may be steatorrhoeic with excess mucus
and fat but no blood ).
* Jaundice & biliary colic

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Diagnosis
1- Direct Stool Examination
* Cysts are detected in formed stool.
*Trophozoites and cysts in diarrheic stool
2- Serological Tests:
* Antibody detection (little value)
* Copro-antigen detection
3- String Test (Entero-test)
Treatment
Metronidazole and tinidazole.
Furazolidone is slower in action,
preferred in children (fewer adverse effects).
Parmomycin, an oral aminoglycoside can be given to
symptomatic pregnant females.

Laboratory diagnosis of Giardia lamblia

.
Macroscopic:An offensive odor, pale colored and fatty, and float in water.
Microscopic: cysts and trophozoites found in DS (saline and iodine wet Preparations). multiple specimens
need to examined and concentration techniques like formal ether or zinc acetate are used. In a symptomatic
carriers, only the cysts are seen

Enterotest. A coiled thread inside a small weighted gelatin capsule is swallowed by the patient,
after attaching the free end of the thread in the check. The capsule passes to the duodenum.
After 2 hours, the thread is withdrawn, placed in saline, and is mechanically shaken. The
centrifuged deposit of the saline is examined for Giardia. The use of enterotest is not
recommended because of the very high cost of the test.

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Prophylaxis

Giardiasis can be prevented by following measures:

*Proper disposal of waste water and feces.


*Practice of personal hygiene and education.
* Avoid food and water contamination.
*Chlorination of water.(inactivating cysts).
*Boiling of water.
*Filtration by membrane filters are required.

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