Giardiasis

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A protozoan infection of the upper small intestine transmitted by faecal-oral route.

Cause

• Giardia lamblia (a flagellated protozoan)

Clinical features

• Often asymptomatic
• Prolonged diarrhoea, steatorrhoea
• Abdominal cramps, bloating
• Fatigue, weight loss
• Malabsorption of fats and fat-soluble vitamins
• Severe giardiasis may cause reactive arthritis, damage to duodenal, and jejunal mucosa

Differential diagnosis

• Other causes of prolonged diarrhoea
• Other causes of malabsorption

Investigations

• Stool: For cysts and trophozoites

ManagementTreatment

• Metronidazole 2 g after food daily for 3 days
  • Child: 30 mg/kg (max: 1.2 g) per dose
• Or tinidazole 2 g single dose
  • Child: 50 mg/kg

Caution

• Metronidazole, tinidazole: Avoid in first trimester, avoid alcohol during treatment and for 48 hours after
• Metronidazole: Take after food

Prevention

• Provide health education on
• • Personal and food hygiene e.g. washing hands before handling or eating food and after using toilets
  • Proper disposal of human faeces
  • Use of safe clean drinking water