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{{Giardiasis}}
{{Giardiasis}}
 
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==Overview==
Following transmission of ''Giardia'', patients may remain asymptomatic for 1-3 weeks. Early symptoms typically include acute, watery diarrhea, bloating, and abdominal cramping, which are usually self-limited. If left untreated, giardiasis may persist in a small proprtion of patients and subsequently results in chronic giardiasis. Complications may be related to either severe dehydration (e.g. acute kidney injury), post-infectious diseases (e.g. reactive arthritis, chronic fatigue syndrome), or spread of ''Giardia'' to extraluminal sites (e.g. involvement of the gallbladder, pancreas, or eyes). The prognosis is generally excellent.
==Natural History==
*Following transmission of ''Giardia'', patients may remain asymptomatic for 1-3 weeks.
*The development of clinical manifestations is dependent on the parasite load, presence of virulence factors, and the host immune response (immunocompetent vs. immunocompromised).
*Early symptoms typically include watery diarrhea, bloating, and abdominal cramping.
*The majority of patients with giardiasis experience a self-limited acute infection.
*If left untreated, giardiasis may persist in a small proprtion of patients and subsequently results in chronic giardiasis.
*Patients with chronic giardiasis typically report chronic watery diarrhea, steatorrhea, malaise, anorexia, malabsorption, weight loss, and failure to thrive.
*Giardiasis is generally a luminal infection (i.e. does not usually spread outside the lumen of the intestine). However, extraluminal manifestations have been reported (see ''Complications'').


==Complications==
==Complications==
*[[Dehydration|Dehydration]]
Complications of giardiasis have mostly been described in case-series. Reported complications may include the following:
*[[Malabsorption|Malabsorption]] (inadequate absorption of nutrients from the intestinal tract)
*[[Chronic fatigue syndrome]]
*[[Weight loss]]
*Severe [[Dehydration|Dehydration]]
*[[Acute kidney injury]]
*[[Lactase deficiency]]
*[[Allergic reaction]] (urticaria, elevated IgE)<ref name="pmid24379622">{{cite journal| author=Halliez MC, Buret AG| title=Extra-intestinal and long term consequences of Giardia duodenalis infections. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 47 | pages= 8974-85 | pmid=24379622 | doi=10.3748/wjg.v19.i47.8974 | pmc=PMC3870550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24379622  }} </ref>
*[[Erythema multiforme]]
*[[Reactive arthritis]]<ref name="pmid17043473">{{cite journal| author=Carlson DW, Finger DR| title=Beaver fever arthritis. | journal=J Clin Rheumatol | year= 2004 | volume= 10 | issue= 2 | pages= 86-8 | pmid=17043473 | doi=10.1097/01.rhu.0000120979.11380.16 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17043473  }} </ref>
*Ocular disease (usually in children)<ref name="pmid24379622">{{cite journal| author=Halliez MC, Buret AG| title=Extra-intestinal and long term consequences of Giardia duodenalis infections. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 47 | pages= 8974-85 | pmid=24379622 | doi=10.3748/wjg.v19.i47.8974 | pmc=PMC3870550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24379622  }} </ref>
:*"Salt and pepper" retinal changes<ref name="pmid9536883">{{cite journal| author=Corsi A, Nucci C, Knafelz D, Bulgarini D, Di Iorio L, Polito A et al.| title=Ocular changes associated with Giardia lamblia infection in children. | journal=Br J Ophthalmol | year= 1998 | volume= 82 | issue= 1 | pages= 59-62 | pmid=9536883 | doi= | pmc=PMC1722351 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9536883  }} </ref>
:*[[Retinal hemorrhage]]
:*[[Iridocyclitis]]
:*[[Choroiditis]]
*Hypokalemic myopathy<ref name="pmid8856367">{{cite journal| author=Genovese A, Spadaro G, Santoro L, Gasparo Rippa P, Onorati AM, Marone G| title=Giardiasis as a cause of hypokalemic myopathy in congenital immunodeficiency. | journal=Int J Clin Lab Res | year= 1996 | volume= 26 | issue= 2 | pages= 132-5 | pmid=8856367 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8856367  }} </ref>
*[[Cognitive impairment]]
*Post-infectious irritable bowel syndrome<ref name="pmid24379622">{{cite journal| author=Halliez MC, Buret AG| title=Extra-intestinal and long term consequences of Giardia duodenalis infections. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 47 | pages= 8974-85 | pmid=24379622 | doi=10.3748/wjg.v19.i47.8974 | pmc=PMC3870550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24379622  }} </ref>
*Malignancy (unconfirmed association)
:*Pancreatic cancer<ref name="pmid20730892">{{cite journal| author=Mitchell CM, Bradford CM, Kapur U| title=Giardia lamblia trophozoites in an ultrasound-guided fine-needle aspiration of a pancreatic mucinous neoplasm. | journal=Diagn Cytopathol | year= 2011 | volume= 39 | issue= 5 | pages= 352-3 | pmid=20730892 | doi=10.1002/dc.21425 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20730892  }} </ref>
:*Gallbladder cancer<ref name="pmid21307633">{{cite journal| author=Nagasaki T, Komatsu H, Shibata Y, Yamaguchi H, Nakashima M| title=[A rare case of gallbladder cancer with giardiasis]. | journal=Nihon Shokakibyo Gakkai Zasshi | year= 2011 | volume= 108 | issue= 2 | pages= 275-9 | pmid=21307633 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21307633  }} </ref>


==Prognosis==
==Prognosis==
It is common for the [[Infection|infection]] to go away on its own. Persistent [[Infection|infections]] have been reported and need further [[Antibiotic|antibiotic]] treatment. Some people who have had [[Giardia lamblia|''Giardia'']] [[Infection|infections]] for a long time continue having symptoms even after the [[Infection|infection]] has gone. In otherwise healthy people, symptoms of [[Giardiasis|giardiasis]] may last 2 to 6 weeks. Occasionally, symptoms last longer. Medications can help decrease the amount of time symptoms last.
*The majority of patients with giardiasis experience a self-limited acute infection.
 
*Development of chronic infection generally depends on viral infectivity and host factors.
*With adequate treatment, the prognosis of giardiasis is excellent.
*Recurrence of disease is common among children even with optimal treatment.  
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Revision as of 20:04, 8 March 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Following transmission of Giardia, patients may remain asymptomatic for 1-3 weeks. Early symptoms typically include acute, watery diarrhea, bloating, and abdominal cramping, which are usually self-limited. If left untreated, giardiasis may persist in a small proprtion of patients and subsequently results in chronic giardiasis. Complications may be related to either severe dehydration (e.g. acute kidney injury), post-infectious diseases (e.g. reactive arthritis, chronic fatigue syndrome), or spread of Giardia to extraluminal sites (e.g. involvement of the gallbladder, pancreas, or eyes). The prognosis is generally excellent.

Natural History

  • Following transmission of Giardia, patients may remain asymptomatic for 1-3 weeks.
  • The development of clinical manifestations is dependent on the parasite load, presence of virulence factors, and the host immune response (immunocompetent vs. immunocompromised).
  • Early symptoms typically include watery diarrhea, bloating, and abdominal cramping.
  • The majority of patients with giardiasis experience a self-limited acute infection.
  • If left untreated, giardiasis may persist in a small proprtion of patients and subsequently results in chronic giardiasis.
  • Patients with chronic giardiasis typically report chronic watery diarrhea, steatorrhea, malaise, anorexia, malabsorption, weight loss, and failure to thrive.
  • Giardiasis is generally a luminal infection (i.e. does not usually spread outside the lumen of the intestine). However, extraluminal manifestations have been reported (see Complications).

Complications

Complications of giardiasis have mostly been described in case-series. Reported complications may include the following:

  • Pancreatic cancer[5]
  • Gallbladder cancer[6]

Prognosis

  • The majority of patients with giardiasis experience a self-limited acute infection.
  • Development of chronic infection generally depends on viral infectivity and host factors.
  • With adequate treatment, the prognosis of giardiasis is excellent.
  • Recurrence of disease is common among children even with optimal treatment.

References

  1. ↑ 1.0 1.1 1.2 Halliez MC, Buret AG (2013). "Extra-intestinal and long term consequences of Giardia duodenalis infections". World J Gastroenterol. 19 (47): 8974–85. doi:10.3748/wjg.v19.i47.8974. PMC 3870550. PMID 24379622.
  2. ↑ Carlson DW, Finger DR (2004). "Beaver fever arthritis". J Clin Rheumatol. 10 (2): 86–8. doi:10.1097/01.rhu.0000120979.11380.16. PMID 17043473.
  3. ↑ Corsi A, Nucci C, Knafelz D, Bulgarini D, Di Iorio L, Polito A; et al. (1998). "Ocular changes associated with Giardia lamblia infection in children". Br J Ophthalmol. 82 (1): 59–62. PMC 1722351. PMID 9536883.
  4. ↑ Genovese A, Spadaro G, Santoro L, Gasparo Rippa P, Onorati AM, Marone G (1996). "Giardiasis as a cause of hypokalemic myopathy in congenital immunodeficiency". Int J Clin Lab Res. 26 (2): 132–5. PMID 8856367.
  5. ↑ Mitchell CM, Bradford CM, Kapur U (2011). "Giardia lamblia trophozoites in an ultrasound-guided fine-needle aspiration of a pancreatic mucinous neoplasm". Diagn Cytopathol. 39 (5): 352–3. doi:10.1002/dc.21425. PMID 20730892.
  6. ↑ Nagasaki T, Komatsu H, Shibata Y, Yamaguchi H, Nakashima M (2011). "[A rare case of gallbladder cancer with giardiasis]". Nihon Shokakibyo Gakkai Zasshi. 108 (2): 275–9. PMID 21307633.

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