Missionary
Medical
Moment
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MISSIONARY MEDICAL MOMENT
Giardiasis
"...and this water that brings a curse shall go into your
stomach..."
Numbers 5:22a NASB
Missionaries travelling to different parts of the world are often faced with health
challenges, including the absence of a predictably safe water supply. There are a
number of illnesses that can be contracted by drinking contaminated water, but a
most common form is known as giardiasis, caused by drinking water containing the
microscopic parasite Giardia lamblia. Not a bacterium, Giardia is a single celled
animal (protozoan) that is the most frequent cause of non-bacterial diarrhea in
North America, and is present in many countries throughout the world.
Giardia can contaminate uncooked food, but the most common means of acquiring an
infection with giardia is by drinking contaminated water. Water can become
contaminated by contacted with sewage or feces from humans or animals. Often,
even though adequate water treatment at the source is free of contamination,
antiquated water pipes allow leakage and contamination, so that the drinking
water contains giardia. Giardia passes through several stages and forms, and
exists primarily in a cyst form when ingested. In contrast to bacterial infections
where it may take exposure to thousands of bacteria to cause disease, it only takes
ingestion of one giardia cyst to become infected, so even minimal exposure to contaminated
water can lead to infection.
Symptoms of infection may occur within one to two weeks of ingestion of contaminated
food or water; the usual symptoms are diarrhea, abdominal cramping, and nausea.
Particularly foul smelling stools, and much bloating, are common. There is usually
no fever, and the diarrhea is often episodic rather than acutely severe. The symptoms
may last for weeks, and weight loss can occur in many people infected with the parasite.
Loss of appetite is common. Since there is usually a delay between exposure and first
symptoms, and the symptoms are gradual in onset, the infected person often thinks they
have "the flu", and do not seek treatment. Even after effective treatment, a person who
has had giardiasis may continue to experience abnormal bowel movements and intestinal
discomfort; about 40% of infected individuals will have problems with absorption of
certain foods, particularly those containing lactose (milk sugar).
Anyone can get giardiasis, although there is an increased risk of infection in children
and those who may have a compromised immune system. Even though children may be more likely
to acquire the acute infection, chronic infection is more common in adults. The diagnosis
of a giardia infection is usually made by recognition of the typical symptoms and awareness
of a possible source of contamination (for instance, certain areas of the world are renown
for giardia infection, Russia being one). Definite diagnosis can be made by a laboratory
test in which the microscopic forms of the parasite are seen in stool samples. More exotic
tests are available but are expensive.
Treatment of giardia is relatively simple; the most common effective antibiotic is
metronidazole, which is sold in many countries under the trade name Flagyl. The usual
adult dose is 250 mg tablets three times daily for 7-10 days. Chronic cases may
require larger doses or treatment for a longer period of time. Metronidazole is
available in most countries, and is relatively inexpensive. Prevention of infection
is primarily that of avoiding contaminated water and food. All vegetables and fruits
that are to be eaten with cooking should be washed with safe water. All drinking
water should either be boiled or filtered. Since even a small amount of contact
with contaminated water can result in infection, one should take care to not even
wash a toothbrush in water that might be contaminated. Using mouthwash for tooth
brushing and cleaning can prevent contamination.
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