| GIARDIA |
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| Giardia are protozoa (one-celled organisms) that live in the small intestine
of dogs and cats. Giardia are found throughout the United States and in many
other parts of the world. Infection with Giardia is called 'giardiasis.'
There are many things we do not know about this parasite. Experts do not
agree on how many species of Giardia there are and which ones affect which
animals. Veterinarians do not even agree on how common Giardia infections
are and when they should be treated. Generally, it is believed that
infection with Giardia is common but disease is rare. There is much about
the life cycle we do not know either.
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| How do Giardia reproduce and how are they transmitted |
| A dog becomes infected by eating the
cyst form of the parasite. In the small intestine, the cyst opens and
releases an active form called a trophozoite. These have flagella, hair-like
structures that whip back and forth allowing them to move around. They
attach to the intestinal wall and reproduce by dividing in two. After an
unknown number of divisions, at some stage, in an unknown location, this
form develops a wall around itself (encysts) and is passed in the feces. The
Giardia in the feces can contaminate the environment and water and infect
other animals and people. |
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| What are the signs of a Giardia infection |
| Most infections with Giardia are
asymptomatic. In the rare cases in which disease occurs, younger animals
are usually affected, and the usual sign is diarrhea. The diarrhea may be
acute, intermittent, or
chronic. Usually the infected animals will not lose their appetite, but
they may lose weight. The feces are often abnormal, being pale, having a bad
odor, and appearing greasy. In the intestine, Giardia prevents proper
absorption of
nutrients, damages the delicate intestinal lining, and interferes with
digestion. |
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| Can Giardia of dogs infect people |
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This is another unknown. There are many species of Giardia, and experts
do not know if these species infect only specific hosts. Sources of some
human infections have possibly been linked to beavers, other wild animals,
and domestic animals. Until we know otherwise, it would be wise to consider
infected animals capable of transmitting Giardia to humans.
You may have heard about Giardia outbreaks occurring in humans due to
drinking contaminated water. Contamination of urban water supplies with
Giardia is usually attributed to (human) sewage effluents. In rural
settings, beavers most often get the blame for contaminating lakes and
streams. Giardia outbreaks have also occurred in day care centers fueled by
the less than optimal hygienic practices of children.
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| How do we diagnose giardiasis |
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Giardiasis is very difficult to diagnose because the protozoa are so
small and are not passed with every stool. Tests on serial stool samples
(one stool sample every day for three days) are often required to find the
organism. Special diagnostic procedures, beyond a routine fecal examination,
are necessary to identify Giardia. The procedures we use to identify
roundworms and hookworms kill the active form of Giardia and concentrate the
cyst form.
To see the active form, a small amount of stool may be mixed with water
on a microscope slide and examined under high magnification. Because these
forms have flagella, you can see them move around on the slide. The active
forms are more commonly found in loose stools. If you ever have the
opportunity to see the active form of Giardia under the microscope, take it!
It is an interesting-looking creature. It is pear-shaped and its anatomy
makes it look like a cartoon face, with eyes (which often look crossed),
nose, and mouth. Once you see it, you will not forget it.
Cysts are more commonly found in firm stools. Special solutions are used
to separate the cysts from the rest of the stool. The portion of the
solution that would contain the cysts is then examined microscopically.
In spring, 2004, a diagnostic test using ELISA technology became
available. This test uses a very small fecal sample, and can be performed in
8 minutes in a veterinarian's office. It is much more accurate than a fecal
examination.
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| We have done the tests, now what |
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Now we come to how to interpret the test results. It can be a dilemma for
your veterinarian. What you see (or do not see) is not always a correct
indication of what you have. A negative test may mean the animal is not
infected. However, few, if any, laboratory tests are 100% accurate. Negative
test results can also occur in some infected animals. If a negative test
occurs, your veterinarian will often suggest repeating the test.
What about a positive test? That should not be hard to interpret, right?
Wrong. Giardia can be found in many dogs with and without diarrhea. If we
find Giardia, is it the cause of the diarrhea or is it just coincidence we
found it? The animal could actually have diarrhea caused by a bacterial
infection, and we just happened to find the Giardia. Test results always
need to be interpreted in light of the signs, symptoms, and medical history.
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| how do we treat GIARDIA |
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Here we go again; treatment is controversial too. There is a question
about when to treat. If Giardia is found in a dog without symptoms should we
treat the animal? Since we should not know if G. canis can infect man, we
often err on the side of caution and treat an asymptomatic infected animal
to prevent possible transmission to people.
If we highly suspect infection with Giardia, but can not find the
organism, should we treat anyway? This is often done. Because it is often
difficult to detect Giardia in the feces of dogs with diarrhea, if there are
no other obvious causes of diarrhea (e.g.; the dog did not get into the
garbage several nights ago) we often treat the animal for giardiasis.
There are several treatments for giardiasis; some of them have not been
FDA approved to treat giardiasis in dogs. Metronidazole is one of these, but
is the old standby. The nice thing about this drug is that it also kills
some types of bacteria that could cause diarrhea. So if the diarrhea was
caused by bacteria, and not Giardia, we still kill the cause of the diarrhea
and eliminate the symptoms. Makes us look pretty sharp! Unfortunately,
metronidazole has some drawbacks. It has been found to be only 60-70%
effective in eliminating Giardia from infected dogs. In some dogs, it can
cause vomiting, anorexia, and some neurological signs. It also can be toxic
to the liver in some animals. It is suspected of being a teratogen (an agent
that causes physical defects in the developing embryo), so it should not be
used in pregnant animals. Finally, it has a very bitter taste and many
animals resent taking it.
Quinacrine hydrochloride has been used in the past, but is not very
effective and can cause side effects such as lethargy, vomiting, anorexia,
and fever.
A newer drug, albendazole, has been shown to be 50 times more effective
than metronidazole and 10-40 times more effective than quinacrine
hydrochloride in killing Giardia in the laboratory. It has not been approved
for use in dogs. Some serious side effects of albendazole have been noted,
including injury to the bone marrow. Since it may also cause birth defects,
it should not be used in pregnant animals.
In a small study, fenbendazole, which has been approved for treatment of roundworm, hookworm,
and whipworm infections in dogs, has been shown
to be effective in treating giardiasis in dogs. It is safe to use in
puppies.
A combination of praziquantel, pyrantel pamoate, and febantel has also
been shown to decrease cyst excretion in infected dogs. |
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| This table summarizes the information above |
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Dose |
Use in pregnant animals or puppies? |
| Metronidazole
(Flagyl) |
11.5 mg/lb twice daily for 5 days |
No |
| Quinacrine hydrochloride
(Atabrine) |
3 mg/lb twice daily for 5 days |
No |
| Albendazole
(Valbazen) |
11.5 mg/lb twice daily for 2 days |
No |
| Fenbendazole
(Panacur) |
22.5 mg/lb once daily for 3 days |
Safe in puppies 6 weeks or older |
| Praziquantel/ pyrantel pamoate/ febantel
(Drontal) |
Use manufacturer's suggested dosage |
No
(puppies must be 3 weeks old and weigh more than 2 pounds) |
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| But now we come to yet another unknown. It is
possible these treatments only remove the cysts from
the feces but do not kill all the Giardia in the
intestine. This means even though the fecal exams
after treatment may be negative, the organism is
still present in the intestine. This is especially
true of the older treatments. So treated animals
could still be a source of infection for others. |
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| How can I prevent my pet from becoming infected with Giardia |
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The cysts can live several weeks to months outside the host in wet, cold
environments. So lawns, parks, kennels, and other areas that may be
contaminated with animal feces can be a source of infection for your pet.
You should keep your pet away from areas contaminated by the feces of other
animals. This is not always easy.
As with other parasites of the digestive system, prevention of the spread
of Giardia centers on testing and treating infected animals and using
sanitary measures to reduce or kill the organisms in the environment.
Solutions of Lysol, bleach, and quaternary ammonium compounds are effective
against Giardia.
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| How do I control Giardia in my kennel |
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Infection with Giardia can be a big problem in kennels. Veterinarians at
Cornell University have developed a specific protocol. They recommended a
four-pronged approach.
Treat all nonpregnant animals with
fenbendazole or albendazole for 5 days. On the last
day of treatment, move them to a holding facility
while a clean area is established. When the animals
are moved back to the clean area, treat them once
again with a 5-day course of fenbendazole or
albendazole.
Decontaminate the Environment: Establish a clean area. If possible, this
can be the whole facility. Otherwise, create a few clean runs or cages,
separate from the others. Remove all fecal material from the areas since the
organic matter in feces can greatly decrease the effectiveness of many
disinfectants. Steam clean the area and then clean it with a quaternary
ammonium disinfectant according to the manufacturer's directions. These
solutions will generally kill the cysts within one minute. Then let the area
dry for several days before reintroducing the animals.
Clean the Animals: Cysts can remain stuck to the haircoats
of infected animals. So during treatment and before moving the treated
animals to the clean area, they should be regularly shampooed and rinsed
well. Especially concentrate on the perianal area.
Prevent Reintroduction of Giardia: Giardia can be brought
into the kennel either by introducing an infected animal or on your shoes or
boots. Any new animal should be quarantined from the rest of the animals and
be treated and cleaned as described above. You should either use disposable
shoe covers or clean shoes/boots and use a footbath containing quaternary
ammonium compounds to prevent people from reintroducing Giardia.
Remember, Giardia of dogs may infect people, so good, personal hygiene
should be used by adults when cleaning kennels or picking up the yard, and
by children who may play with pets or in potentially contaminated areas. |
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