How do children get infected and why do they get sick more often?
The parasite is excreted in the feces in the form of cysts - stable forms that persist in the external environment for weeks, tolerate cold and normal concentrations of chlorine in tap water. To get sick, it is enough to swallow a very small amount of cysts. Further in the small intestine, mobile forms emerge from them, which attach to the mucosa and interfere with absorption, primarily of fats and carbohydrates.
- Drinking water from untested sources, springs, ditches, as well as bathing water
- Unwashed or poorly washed vegetables, fruits, herbs
- Dirty hands are the main way in children's groups
- Toys, potties, shared towels in kindergarten
- Contact with pets due to poor hygiene
- Flies and cockroaches as mechanical carriers of cysts
From infection to the first complaints, it takes on average one to two weeks. This explains why the connection with a specific trip, swimming in a pond or a feast is usually not caught: by the time symptoms appear, the event has already been forgotten, and the person remembers yesterday’s dinner, and not the day before. Therefore, when analyzing a case, the doctor specifically asks about what happened one or two weeks before the onset of the disorder - and this question has practical meaning, especially when several people are sick at once.
How it manifests itself - and why it often doesn’t
A significant proportion of infected people do not have any symptoms. This is not a “hidden disease that destroys the body,” but rather an asymptomatic carrier state in which a person feels healthy. When symptoms do exist, they are associated with malabsorption in the small intestine.
- Liquid, copious, foamy stools with an unpleasant odor, sometimes greasy and difficult to flush out
- Bloating, rumbling, increased gas production
- Cramping pain around the navel and upper abdomen
- Nausea, loss of appetite, belching
- Fatigue, irritability, in children - decreased concentration
- Over a long period of time, the child experiences weight loss and growth retardation.
- Sometimes transient milk intolerance after an infection
The acute form usually lasts from several days to two to three weeks and often goes away on its own. A chronic course with wave-like exacerbations is less common and is typical for people with reduced immunity and a deficiency of certain antibodies.
In children, it is often not intestinal complaints that come to the fore, but general ones: loss of appetite, fatigue, moodiness, poor weight gain, pallor. This creates a temptation to explain any ill-being of the child as giardiasis - and this is how most unfounded courses of treatment arise. The guideline should remain simple: general complaints serve as a reason to be examined, but the diagnosis is made by detecting a parasite, and not by a set of “characteristic signs.” If the test is negative and complaints persist, the right step would be to look for another cause rather than treat giardiasis “just in case.”
Myths that cause healthy people to be treated
Not a single intestinal infection has acquired so many persistent misconceptions. It is worth examining them not for the sake of argument, but because each of them leads to specific consequences: unnecessary courses of drugs, unnecessary tests and, worst of all, untreated real diseases that are hidden behind a convenient diagnosis.
- Myth: “Everyone has Giardia.” No. The prevalence among children is really noticeable, but this is not a universal carriage, and certainly not a reason to consider parasites to be in your home by default
- Myth: “Giardia lives in the liver and gall bladder.” No. Bile is destructive for them; they live in the small intestine. The wording “giardiasis of the liver” in the conclusion is outdated
- Myth: “Giardia causes allergies and atopic dermatitis.” The connection is discussed, but attributing a chronic skin disease to parasites and stopping its treatment is a typical mistake due to which the child is left without the necessary therapy
- Myth: “the whole family needs to undergo preventive treatment once a year.” Antiparasitic drugs are not vitamins: they have side effects and are prescribed after a confirmed diagnosis
- Myth: “Positive antibodies in the blood mean giardiasis.” Antibodies persist after infection and do not allow active disease to be distinguished from past exposure.
- Myth: “it is treated with tubages, herbs and cleansing.” Such procedures do not affect the parasite, and in case of cholelithiasis they are also dangerous
All these misconceptions have one common mechanism: giardiasis is convenient as an explanation. It sounds specific, is easily “confirmed” by a blood test, does not require a long search, and suggests a simple solution in the form of a short course of pills. That is why they are often left behind questions that are behind completely different conditions - celiac disease, lactose intolerance, irritable bowel syndrome, inflammatory bowel diseases, and in children also common nutritional errors. The price of a mistake is not only in unnecessary drugs, but also in lost time.
How is the diagnosis made?
The main principle: confirmation is the detection of the parasite or its antigen in the feces. Blood testing for antibodies is an auxiliary method, which in itself is not a basis for treatment.
- Исследование кала на антиген лямблий — наиболее чувствительный доступный метод, результат не зависит от того, выделяются ли цисты именно в этот день.
- Микроскопия кала на цисты и вегетативные формы — классический метод, но цисты выделяются волнообразно, поэтому однократный отрицательный результат не исключает инфекцию.
- При использовании микроскопии кал исследуют трёхкратно с интервалом 3–7 дней — это стандартный подход, а не перестраховка.
- Свежий жидкий стул желательно доставить в лабораторию быстро: подвижные формы разрушаются, и информативность падает.
- Анализ крови на антитела — только как дополнение; изолированный положительный результат не равен активной инфекции.
- Дополнительно врач оценивает общий анализ крови, а при длительной диарее — показатели питания и признаки нарушения всасывания.
- Исследование дуоденального содержимого применяется редко и только по особым показаниям.
Before donating stool, it is important not to take antiparasitic drugs, antibiotics, bismuth preparations and sorbents - they reduce the likelihood of detection. The doctor will indicate the specific dates for cancellation.
Another detail due to which tests “do not find” the infection: incorrect collection of material. The stool is collected in a clean, disposable container, free of urine and toilet water, and delivered to the laboratory on the same day, before being stored refrigerated. If the stool is loose, maximum delivery speed is important. These little things affect the result no less than the choice of method, and it is because of them that you often have to retake the test and lose a week.
Treatment and who should not be treated
Treatment is prescribed by a doctor and only if giardiasis is confirmed. The course is short, the drugs act on the parasite in the intestines; independent selection of schemes and repeated courses “to be sure” are not justified.
- For symptoms and a confirmed pathogen, a course of antiparasitic therapy prescribed by a doctor
- Simultaneous treatment of all family members when infection is detected in several of them is discussed individually to avoid re-infection in a circle
- Asymptomatic carriage in adults often does not require treatment; exceptions - food workers, contact with young children, people with reduced immunity and family members with repeated infections
- Sufficient drinking regimen and replenishment of fluid losses during diarrhea, especially in children
- Temporary restriction of dairy products in case of developed intolerance, with a gradual return
- Control stool examination usually 2–3 weeks after completion of the course
A separate question is what is considered recovery. It is wrong to focus only on well-being: some people remain carriers without experiencing any complaints. Therefore, with an initially confirmed diagnosis, a control stool test is prescribed regardless of whether the symptoms have gone away or not, and the decision to repeat the course is made based on its result, and not on sensations. And vice versa: persistent complaints with a negative control analysis are a reason to look for another cause, and not prescribe a third course of drugs.
Prevention that works
- Мыть руки с мылом после туалета, улицы, контакта с животными и перед едой — самая эффективная мера, особенно в детском коллективе.
- Пить только кипячёную или гарантированно безопасную воду; в поездках избегать воды of непроверенных источников и льда в напитках.
- Тщательно мыть овощи, фрукты и зелень проточной водой, зелень дополнительно промывать несколько раз.
- Не глотать воду при купании в открытых водоёмах и бассейнах.
- Регулярно обрабатывать горшки, игрушки и предметы общего пользования при выявлении инфекции в семье.
- При обнаружении лямблиоза у ребёнка обследовать других детей в семье, а не лечить их вслепую.
These measures look boring and obvious, but they, and not the drugs, determine whether there will be a re-infection. Giardiasis is a disease of dirty hands and unboiled water, and after successful treatment a person remains exactly as vulnerable as before: immunity to this infection is not stable. Therefore, in a family where the case has already occurred, talking about hygiene makes more sense than talking about repeat courses.
