Giardiasis. Issues in diagnosis and management.

Giardia lamblia is a frequent cause of diarrhea throughout the United States and the world. Advances in basic biology indicate that different strains of Giardia exist, that mammals can be infected with G. lamblia-type organisms, and that secretory IgA is important to host protection. Although water remains the most common mode of transmission of Giardia, there has been an increase in the number of person-to-person cases, especially related to children in day care, as well as an increase in food-borne cases. New antigen detection assays have improved the ability to diagnose Giardia in the stool and make it unlikely that duodenal sampling will be necessary. Metronidazole has become the drug of choice for most cases of giardiasis because of its efficacy, favorable tolerance, and availability. For pregnant women who require treatment, a non-absorbable aminoglycoside, paromomycin, may be tried first and metronidazole used if initial treatment fails.