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Giardiasis. Giardiasis. Giardiasis is a diarrheal illness caused by Giardia intestinalis (also known as Giardia lamblia ) The parasite is passed in the stool of an infected person or animal (both cysts & trophozoites)
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Giardiasis • Giardiasis is a diarrheal illness caused by Giardia intestinalis (also known as Giardia lamblia) • The parasite is passed in the stool of an infected person or animal (both cysts & trophozoites) • The parasite is protected by an outer shell that allows it to survive outside the body and in the environment for long periods of time • During the past 2 decades, Giardia has become recognized as one of the most common causes of waterborne disease (drinking and recreational) in humans in the United States • Very contagious
Symptoms • Symptoms include • diarrhea • loose or watery stool • foul-smelling stool • stomach cramps • upset stomach • weight loss • dehydration • Some may be asymptomatic
Incubation Period & Duration • Incubation period • Symptoms generally begin 1-2 weeks after being infected • Duration • Healthy persons, symptoms may last 2-6 weeks
How is Giardia spread? • Swallowing recreational water contaminated with Giardia • Eating uncooked food contaminated with Giardia • Possibly found in soil, food, water, or surfaces contaminated with Giardia
Who is at risk? • Everyone • Persons at increased risk include: • child care workers • children who attend day care centers • international travelers • hikers, campers, swimmers • people drinking or accidentally swallowing untreated water
Treatment • Several prescription drugs are available • Consult with your health care provider • Giardia can infect all people • Young children & pregnant women may be more susceptible • Drink plenty of fluids while ill
Prevention • Practice good hygiene • Wash hands thoroughly with soap and water • after using the toilet • before handling or eating food • after every diaper change • Protect others by not swimming if experiencing diarrhea
Prevention • Avoid food that might be contaminated • Wash and/or peel all raw vegetables and fruits before eating • Use uncontaminated water to wash all food that is to be eaten raw • Avoid eating uncooked foods when traveling in countries with minimal water treatment and sanitation systems • Avoid fecal exposure during sex
Prevention • Avoid water that might be contaminated • Avoid swallowing recreational water • Avoid drinking untreated water from ponds and streams • Avoid using ice or drinking untreated water when traveling in countries where the water supply might be unsafe • If you are unable to avoid drinking or using water that might be contaminated, then treat the water yourself by: • Heating the water to a rolling boil for at least 1 minute • You can pass Giardia in your stool and contaminate water for several weeks after your symptoms have ended
Infectious Diarrhea in Tourists Staying in a Resort HotelEID January-February 1999, 5 (1) 168-171 • British residents ill while staying at a hotel in Greece • 6 lab confirmed cases of Giardia • All stayed in the same hotel • School sought advice about excluding a child with diarrhea • 6 patients reported that many hotel guest were ill
Resort Hotel OutbreakEID January-February 1999, 5 (1) 168-171 • British guests arrived at the hotel between May 22 and June 9 1997 • Questionnaire administered by phone • 86 booking groups • 51 groups – 239 persons interviewed • 224 ill while on holiday or within a few days of return • 95% diarrhea • Median duration of 13 days • 82% stomach cramps • 64% vomiting • Median duration of 1 day • 35 groups- 138 persons could not be contacted
Resort Hotel OutbreakEID January-February 1999, 5 (1) 168-171 • 224 ill • DEFINITE cases - lab confirmed • 70 (31%) • PROBABLE cases – no pathogen identified but had diarrhea lasting 4 or more days • 107 (48%) • POSSIBLE cases – no pathogen identified but had diarrhea lasting less than 4 days
Table 1: Pathogens identified in DEFINITE cases * Sum exceeds 70 because of co-infections
Figure 2. Interval between arrival at hotel and onset of illness (vomiting or diarrhea), by category of case
Resort Hotel OutbreakEID January-February 1999, 5 (1) 168-171 • Telephone interviews – 54 reports • 32 (59%) identified problems with food • Tasted strange • Inadequately cooked or heated • Left out uncovered • 27 (50%) identified problems with room water • Sewage smell • Discoloration (around June 4) • 7 (13%) identified problems with drinks reconstituted with tap water
Resort Hotel OutbreakEID January-February 1999, 5 (1) 168-171 • Significantly associated with illness • Consumption of reconstituted orange juice • Consumption of raw vegetables and salads • Reports of problems with water in the hotel room
Resort Hotel OutbreakEID January-February 1999, 5 (1) 168-171 • 2 Principal illnesses due to sewage contamination of the water supply • Viral gastroenteritis outbreak • Giardiasis outbreak
Resort Hotel Outbreak EID January-February 1999, 5 (1) 168-171 Outbreak • Point-source • Lab confirmation • 129 guests reported that their room water smelled of sewage or was discolored around June 4 (mostly from definite cases) • All avoided tap water a. Consumption of reconstituted orange juice • Water supply was chlorinated but not filtered at certain points within the hotel