Giardia is the genus of a protozoan parasite infectious to both humans and pets all over the world. Giardia are flagellates, which means they move by means of several whip-like structures called flagella. They exist in two forms: trophozoites (“troph” for short) and cysts. The trophozoites live in the host’s intestine, attaching to the wall by a suction cup-like structure and causing diarrhea in some but not all hosts.
Trophozoites are passed in fresh feces but promptly round up into hard-shelled little cysts so as to withstand the conditions of the outside world. The cysts live in the environment (outside the host’s body) potentially for months until they are consumed by a host. Inside the host, the cyst’s shell is digested away, releasing two trophozoites into the intestine and the cycle begins again. Contaminated water is the classical source of a Giardia infection.
When a fecal sample is analyzed, the appearance of the Giardiaorganism depends on whether the sample is freshly obtained or if it has been outside of the host’s body for a while. Giardia organisms begin to round up into cysts in a matter of hours. The active trophozoites rather look like funny faces with the two nuclei forming the eyes and median bodies forming the mouth. Cysts look a bit more generic.
In the environment, cysts survive in water and soil as long as it is relatively cool and wet. A host animal will accidentally swallow a cyst when drinking from a puddle, toilet, or when licking fur. After the cyst has been swallowed, the cyst’s shell is digested away, freeing the two trophozoites who go forth and attach to the intestinal lining. The troph has a structure called a ventral disc, which is sort of like a suction cup and is used to attach the organism’s body to the intestine. If the troph wants to move to another spot, it lifts itself up and swims to a new spot via its flagella. Trophs tend to live in different intestinal areas in different host species but will move to other areas depending on the diet the host is eating. The troph may round itself up and form a cyst while still inside the host’s body. If the host has diarrhea, both trophs and cysts may be shed in diarrhea; either form can be found in fresh stool.
After infection, it takes 5-12 days in dogs or 5-16 days in cats for Giardia to be found in the host’s stool. Diarrhea can precede the shedding of the Giardia. Infection is more common in kennel situations where animals are housed in groups.
How Does Giardia Cause Diarrhea?
No one is completely sure, but infection seems to cause problems with normal intestinal absorption of vitamins and other nutrients. Diarrhea is generally not bloody. Immune-suppressive medications, such as corticosteroids, can re-activate an old Giardia infection. We do not know why some infected hosts get diarrhea while others never do.
Diagnosis
In the past, Giardia diagnosis was difficult. The stool sample being examined needed to be fresh, plus Giardia rarely shows up on the usual fecal flotation testing methods used to detect other parasites. Traditionally, a fecal sample is mixed in a salt or sugar solution such that any parasite eggs will float to the top over 10-15 minutes. Some tricks that have been used to facilitate finding Giardia include:
- Being sure to examine a direct smear of the fecal sample (in hope of finding swimming trophs).
- Floating the sample in zinc sulfate, a solution which has been found superior in getting Giardiacysts to float.
- Staining the sample with some sort of iodine under the microscope to make the Giardia show up easier.
What has made Giardia testing infinitely easier is the development of a commercial ELISA test kit (similar in format to home pregnancy test kits). A fecal sample is tested immunologically for Giardia proteins. This method has dramatically improved the ability to detect Giardia infections and the test can be completed in just a few minutes while the owner waits.
Giardia shed organisms intermittently and may be difficult to detect. Sometimes pets must be retested in order to find an infection and asymptomatic carrier animals are common.
Treatment
A broad-spectrum dewormer called fenbendazole (Panacur®) seems to be the most reliable treatment at this time. Metronidazole (Flagyl®) in relatively high doses has been a classical treatment for Giardia but studies show it to only be effective in 67% of cases. The high doses required to treat Giardia also have been known to occasionally result in temporary neurologic side effects or upset stomach. For some resistant cases, both medications are used concurrently. Febantel is also commonly used for Giardia as it is converted to fenbendazole in the body.
Because cysts can stick to the fur of the infected patient and be a source for re-infection, the positive animal should receive a bath at least once in the course of treatment. At the least, the patient should have a bath at the end of the treatment course.
Can Humans Be Infected?
Giardia duodenalis is classified into several subcategories called assemblages and designated A through G. Some assemblages are specific as to which host animals it can infect and other Assemblages are not so picky. Assemblage F, for example, only infects cats and Assemblages C and D only infect dogs but assemblage A will infect dogs, cats, people, rodents, wild mammals and cattle. Common testing methods do not indicate what assemblage has been detected so there is always a possibility of human transmission as long as the assemblage is unknown. To play it safe, wear gloves to dispose of animal fecal matter and always thoroughly wash your hands before eating.
Environmental Decontamination
Giardia cysts are killed in the environment by freezing temperatures and by direct sunlight. If neither of these options are practical for the area to be disinfected, a chemical disinfectant will be needed. The most readily available effective disinfectant is probably bleach diluted 1:10 in water; one study indicates that it requires less than one minute of contact to kill Giardia cysts. Organic matter such as dirt or stool is protective of the cyst, so on a concrete surface, basic cleaning should be effected before disinfection. Quaternary ammonia compounds can also be used to kill Giardia cysts.
Animals should be thoroughly bathed before being reintroduced into a clean area. A properly chlorinated swimming pool should not be able to become contaminated. As for areas with lawn or plants, decontamination will not be possible without killing the plants and allowing the area to dry out in direct sunlight.
A Footnote on Vaccination
A vaccine against Giardia was previously available not to prevent infection in the vaccinated animal but to reduce the shedding of cysts by the vaccinated patient. In other words, the vaccine was designed to reduce the contamination of a kennel where Giardia was expected to be a problem. This would be helpful during an outbreak, in a shelter or rescue situation, but is not particularly helpful to the average dog whose owner wants to simply prevent infection. Because of the limited usefulness of the vaccine, manufacturing was discontinued in 2009.
Written by: Wendy Brooks, DVM, DABVP