Giardiasis is a major diarrheal disease found throughout the world. The flagellate
protozoan Giardia intestinalis (also known as Giardia lamblia), its causative agent, is the
most commonly identified intestinal parasite in the United States and the most common
protozoal intestinal parasite isolated worldwide.
Giardiasis usually represents a zoonosis with cross-infectivity between animals and
humans. Giardia has been isolated from the stools of beavers, dogs, cats, rodents, sheep,
and cattle. Within Giardia intestinalis there are 7 assemblages, A, B, C, D, E, F, and the
more rarely occuring G. Of these, only assemblages A and B can infect humans, whereas,
a range of animals can be infected by assemblages A-G.
Giardiasis is caused by ingestion of Giardia cysts, which retain viability in cold water for as
long as 2-3 months. The infective dose is low in humans; 10-25 cysts are capable of
causing clinical disease in 8 of 25 subjects. Ingestion of more than 25 cysts results in a
100% infection rate. After ingestion of cysts, excystation, trophozoite multiplication, and
colonization of the upper small bowel occur.
Most infections result from fecal-oral transmission or ingestion of contaminated water.
Contaminated food is a less common etiology. Person-to-person spread is common, with
25% of family members with infected children themselves becoming infected.
Most infections are asymptomatic, and the attack rate for symptomatic infection in the
natural setting varies from 5-70%. Giardia is found in healthy people in endemic areas and
in symptomatic carrier states with high numbers of cysts excreted in stools common.
Predisposing factors to symptomatic infection include hypochlorhydria, various immune
system deficiencies, blood group A, and malnutrition. The incubation period averages 1-2
weeks, with a mean of 9 days. The average duration of symptoms in all ages ranges from
3-10 weeks.