Giardiasis Clinical Presentation

  • Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC; Chief Editor: Julian Katz, MD   more...
 
Updated: Jun 29, 2011
 

History

Clinical signs and symptoms if giardiasis include the following[5, 6, 15] :

  • Diarrhea
  • Malaise, weakness
  • Abdominal distention
  • Flatulence
  • Abdominal cramps
  • Nausea
  • Malodorous, greasy stools
  • Anorexia
  • Weight loss
  • Vomiting
  • Low-grade fever (infrequent)
  • Various neurologic symptoms (eg, irritability, sleep disorder, mental depression, neuroasthenia)
  • Urticaria

Diarrhea is the most common symptom of acute Giardia infection, occurring in 90% of symptomatic subjects. Abdominal cramping, bloating, and flatulence occur in 70-75% of symptomatic patients.

Symptoms of chronic infection include chronic diarrhea, malaise, nausea, and anorexia. Weight loss, as extensive as 10-15 pounds in an adult, occurs in approximately 66% of symptomatic patients. Chronic sporadic diarrhea may continue for months. Postinfection lactose deficiency also is a common finding, occurring in 2-40% of cases.

Extraintestinal manifestations are rare and include allergic manifestations such as urticaria, erythema multiforme, bronchospasm, reactive arthritis, and biliary tract disease. The etiology of such extraintestinal symptoms is likely a result of host immune system activation and cross-reactivity/molecular mimicry.

Gastrointestinal manifestations

A small number of persons develop abrupt onset of explosive, watery diarrhea, abdominal cramps, foul flatus, vomiting, fever, and malaise; these symptoms last 3-4 days before transition into the more common subacute syndrome. Most patients experience a more insidious onset of symptoms, which are recurrent or resistant.

Stools become malodorous, mushy, and greasy. Watery diarrhea may alternate with soft stools or even constipation. Stools do not contain blood or pus.

Upper GI symptoms, often exacerbated by eating, accompany stool changes or may be present in the absence of soft stools. These include upper and midabdominal cramping, nausea, early satiety, bloating, sulfurous belching, substernal burning, and acid indigestion.

Constitutional symptoms

Anorexia, fatigue, malaise, and weight loss are common. Weight loss occurs in more than 50% of patients and averages 10 pounds.

Chronic illness may occur. Adults may present with long-standing malabsorption syndrome and children, with failure to thrive.

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Physical Examination

Physical examination does not contribute to the diagnosis of giardiasis. Weight loss may be evident, but no known unique physical findings are attributable to giardiasis.

On abdominal examination, patients may have nonspecific tenderness without evidence of peritoneal irritation. Rectal examination should reveal heme-negative stools. In severe cases, evidence of dehydration or wasting may be present.

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Complications

Complications of giardiasis may include the following:

  • Development of chronic illness with weight loss
  • Malabsorption syndrome in adults
  • Failure to thrive in children
  • Disaccharidase deficiency
  • Zinc deficiency in schoolchildren[47]
  • Growth retardation[33]
  • Persistent gastrointestinal symptoms[48]
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Contributor Information and Disclosures
Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC  Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Coauthor(s)

Andre Pennardt, MD, FACEP, FAAEM, FAWM  Clinical Associate Professor of Emergency Medicine, Medical College of Georgia; Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Departments of Emergency Medicine, Aviation Medicine and Dive Medicine, Womack Army Medical Center

Andre Pennardt, MD, FACEP, FAAEM, FAWM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US, International Society for Mountain Medicine, National Association of EMS Physicians, Special Operations Medical Association, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Barry J Sheridan, DO  Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Murat Hökelek, MD, PhD  Technical Consultant of Parasitology Laboratory, Professor, Department of Clinical Microbiology, Ondokuz Mayis University Medical School, Turkey

Murat Hökelek, MD, PhD is a member of the following medical societies: Turkish Society for Parasitology

Disclosure: Nothing to disclose.

Glenn Fennelly, MD, MPH  Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mark H Johnston, MD  Associate Professor of Medicine, Uniformed Services University of Health Sciences; Consulting Staff, Lancaster Gastroenterology Inc

Mark H Johnston, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Manoop S Bhutani, MD  Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Brooks D Cash, MD, FACP, and Michael D Nissen, MBBS, FRACP, FRCPA,to the development and writing of the source article.

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Giardia lamblia trophozoites in culture.
A Giardia intestinalis cyst.
Giardia intestinalis trophozoites on stool examination from a patient with diarrhea.
Giardia trophozoite
Giardia cyst.
 
 
 
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