eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Giardiasis: Follow-up

Author: Murat Hökelek, MD, PhD, Technical Consultant of Parasitology Laboratory, Associate Professor, Department of Clinical Microbiology, Ondokuz Mayis University Medical School, Turkey
Contributor Information and Disclosures

Updated: Dec 17, 2008

Follow-up

Further Inpatient Care

  • Monitor patients with giardiasis who have severe malnutrition or dehydration. Rare associations with giardiasis include cholecystitis, arthritis, pancreatitis, retinal arteritis, and iridocyclitis.7

Further Outpatient Care

  • Recommended consultations include those with a parasitologist, an infectious disease specialist, and a gastroenterologist.

Deterrence/Prevention

  • Infected persons and persons at risk should carefully wash their hands after they have any contact with feces. Careful handwashing is important, especially for caregivers of diapered infants in daycare centers, where diarrhea is common and carriers of Giardia organisms are numerous.
    • Chlorination, sedimentation, and filtration methods should be implemented to adequately purify public water supplies.
    • Effective chlorine inactivation of Giardia cysts in water requires an optimal chlorine concentration, water pH, turbidity, temperature, and contact time. These variables cannot be appropriately controlled in all municipalities, and they are particularly difficult to control in swimming pools.
  • Advise travelers to endemic areas to avoid eating uncooked foods that may have been grown, washed, or prepared with contaminated water.
  • Drinking water can be purified by using filtration (pore size, <1 µm) or by briskly boiling water for at least 5 minutes.
  • Chlorine or iodine water treatments are less effective than boiling or filtration, but they may be used as alternatives when other methods are not available.
  • Breastfeeding appears to protect infants from Giardia intestinalis infections.6,11,14

Complications

  • Chronic illness and weight loss
    • Malabsorption syndrome in children
    • Disaccharidase deficiency
  • Growth retardation20

Prognosis

  • The prognosis is usually good.
  • Reinfection is possible.
  • Drug resistance has been observed in clinical experience.
  • The parasite persists in the stool, and the symptoms continue for weeks if giardiasis is untreated.1,17

Patient Education

  • Personal hygiene education should emphasize methods to minimize person-to-person transmission, particularly in high-risk settings such as daycare centers and residential institutions.
  • Avoiding oral-anal and oral-genital sex can decrease venereal transmission of giardiasis.
  • For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article, Giardiasis.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnosis giardiasis or to differentiate it from other possible diarrheal agents

Special Concerns

  • Giardiasis is a common cause of chronic diarrhea and associated with significant morbidity, especially in children.
  • If medical treatment is restricted, as in the first trimester of pregnancy, effective supportive treatment should be administered.
  • Reinfection or treatment failure can be treated with a second course of the same drug or with an alternative drug.
  • The potential development of later clinical infection or chronic disease is not rare in giardiasis.25,11
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Michael D Nissen, MBBS, FRACP, FRCPA, to the original writing and development of this article.



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References
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Further Reading

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Keywords

giardiasis, Giardia, Giardia lamblia, Giardia duodenalis, Giardia intestinalis, protozoal diarrhea, steatorrhea, malabsorption, lambliasis, chronic diarrhea, vomiting, nausea, irritability, sleep disorder, mental depression, neuroasthenia, urticaria, abdominal cramps, contaminated food, food poisoning

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Contributor Information and Disclosures

Author

Murat Hökelek, MD, PhD, Technical Consultant of Parasitology Laboratory, Associate 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.

Medical Editor

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

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: None None None

 
 
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