I’ve heard that children from an orphanage setting may have Giardia. Is this an infection? A parasite? Is it communicable?
Giardia is an intestinal parasite that uses the human being as the primary host for infection. Giardia organisms also infect dogs, cats and beavers as well as other animals. These animals contaminate water with feces that contain cysts and it is these cysts that are infectious to other humans.
Persons usually become infected either directly via hand to mouth transmission of cysts from the feces of infected persons, or indirectly by drinking contaminated food or water.
Children who lived in orphanages, especially those who are not toilet trained or are mentally retarded, are more prone to these infections because of stool handling when changing soiled diapers. Close quarters, poor living conditions, poor hygiene and infection control measures amongst the caregivers are the main causes of widespread mini-epidemics within child care environments. Many times staff and family members in close contact with these children also become infected.
This disease is communicable for as long as the person excretes the cysts, which can go on for many months. The incubation period is generally about 1 – 4 weeks.
Clinical manifestations of this disease are generally localized to the intestinal system. These children tend to elicit many or all of the following symptoms:
- acute watery diarrhea with abdominal pain
- foul smelling stools with flatulence (gas and bloating)
- abdominal distention and anorexia
Sometimes with more protracted disease, malabsorption of nutrients and anorexia ensue thus causing significant weight loss, failure to thrive, and anemia in untreated individuals.
Testing for this organism is very easy to perform and it is routine testing for all internationally adopted children from any country. The actual trophozites (parasitic organisms) or cyst can be identified by a direct microscopic smear examination of the stool and by testing for the giardia antigen with a test called the Giardia EIA enzyme immunoassay. The Giardia EIA is more sensitive than the direct microscopic examination. A single stool specimen microscopic examination can detect 50% – 75% of the infections; these numbers can be increased to approximately 95% when testing 3 different stool specimens.
Treatment of this intestinal parasite is with a drug called Metronidazole and Furazolidone.
Metronidazole is 90% effective in eradicating the parasite but it not available in a liquid preparation.. It can however be compounded by special pharmacies but this usually takes time and therefore delays treatment for a couple of days.Some of my patients had luck with a pharmacy called RX-express, they compound medications on site. Furazolidone is 80% effective, but it is the only drug in the USA that comes in a liquid preparation. If therapy fails a repeated course of therapy is indicated with any of these drugs.
While children who come from an international adoption are at higher risk for a multitude of diseases, intestinal giardia infections can be easily treated. Once eradicated, these children should thrive, gain weight and any nutritional deficiencies that may have occurred because of the malnutrition syndrome should resolve.