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General issues of Tropical med.
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Trematode (fluke, distoma)
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Giardia intestinalis
- a.k.a. G. lamblia or G. duodenalis
- 「ランブル鞭毛虫」is named after G. lamblia
epidemiology
- worldwide
- human is main reservior
- water-borne
- food-borne thru uncooked vegetable or fruit washed with contaminated water
- feco-oral
life cycle
- ingestion of cyst
- hutch in intestinal wall into trophozoite
- trophozoite propagets in binary fission
- trophozoite does not invade human cells, just adhere to intestinal mucosa (villi)
- produces no bloody diarrhea
- trophozoite transforms into cyst under dry environment
- cyst is resistant to chlorinated water
morphology
- 2 nuclei in trophozoite
- 4 nuclei in cyst
clinical features
- incubation 3 days to months
- 10 cysts are enough to develop symptoms
- most asymptomatic
- repeated infections induce immunity
- abrupt onset of diarrhea
- abd cramps
- no fatality case
diagnosis
- fecal microscopy
- duodenal fluid aspiration
- "String test"
- "Crosby capsule"
- antigen detection in feces
- ELISA
- EIA - rapid diagnostic test
- fluorescence microscopy of feces
treatment