Giardiasis

Giardiasis, an illness that affects the digestive tract, is caused by a microscopic parasite called Giardia lamblia. The parasite attaches itself to the lining of the small intestines in humans, where it sabotages the body's absorption of fats and carbohydrates from digested foods.

Giardia is one of the chief causes of diarrhea in the United States, and is transmitted through contaminated water. It can survive the normal amounts of chlorine used to purify community water supplies, and can live for more than 2 months in cold water. As few as 10 of the microscopic parasites in a glass of water can cause a severe case of giardiasis in a human being who drinks it.

Young kids are three times more likely to have giardiasis than adults, which leads some experts to believe that our bodies gradually develop some form of immunity to the parasite as we grow older. But it isn't unusual for an entire family to have giardiasis, with some family members having diarrhea, some just crampy abdominal pains, and others with few or no symptoms.

Signs and Symptoms

It's estimated that between 1% and 20% of the U.S. population has giardiasis, and this figure may be 20% or higher in developing countries, where giardiasis is a major cause of epidemic childhood diarrhea. But more than two thirds of people who are infected may have no signs or symptoms of illness, even though the parasite is living in their intestines.

When the parasite does cause symptoms, the illness usually begins with severe watery diarrhea, without blood or mucus. Giardiasis affects the body's ability to absorb fats from the diet, so the diarrhea contains unabsorbed fats. That means that the diarrhea floats, is shiny, and smells very bad.

Other symptoms include:

• abdominal cramps
• large amounts of intestinal gas
• an enlarged belly from the gas
• loss of appetite
• nausea and vomiting
• sometimes a low-grade fever

These symptoms may last for 5 to 7 days or longer. If they last longer, a child may lose weight or show other signs of poor nutrition.

Sometimes, after acute (or short-term) symptoms of giardiasis pass, the disease begins a chronic (or more prolonged) phase.

Symptoms of chronic giardiasis include:

• periods of intestinal gas
• abdominal pain in the area above the navel
• poorly formed, "mushy" bowel movements (poop)

Prevention

Here are some ways to protect your family from giardiasis:

• Drink only from water supplies that have been approved by local health authorities.
• Bring your own water when you go camping or hiking, instead of drinking from sources like mountain streams.
• Wash raw fruits and vegetables well before you eat them.
• Wash your hands well before you cook food for yourself or for your family.
• Encourage your kids to wash their hands after every trip to the bathroom and especially before eating. If someone in your family has giardiasis, wash your hands often as you care for him or her.
• Have your kids wash their hands well after handling anything in "touch tanks" in aquariums, a potential source of giardiasis.
• Have your water checked on a regular basis if it comes from a well.

Also, it's questionable whether infants and toddlers still in diapers should be sharing public pools. But certainly they should not if they're having diarrhea or loose stools (poop).

Contagiousness

People and animals (mainly dogs and beavers) who have giardiasis can pass the parasite in their stool. The stool can then contaminate public water supplies, community swimming pools, and "natural" water sources like mountain streams. Uncooked foods that have been rinsed in contaminated water may also spread the infection.

In child-care centers or any facility caring for a group of people, giardiasis can easily pass from person to person. At home, an infected family dog with diarrhea may pass the parasite to human family members who take care of the sick animal.

Diagnosis

Doctors confirm the diagnosis of giardiasis by taking stool samples and sending them to the lab to be examined for Giardia parasites. Several samples may be needed before the parasites are found.

For that reason the doctor may order a much more sensitive test called the Enzyme-Linked ImmunoSorbent Assay or ELISA test.

Less often, doctors make the diagnosis by looking at the lining of the small intestine with an instrument called an endoscope and taking samples from inside the intestine to be sent to a laboratory. This is done in more extreme cases, when a definite cause for the diarrhea hasn't been found.

Treatment

Giardiasis is treated with prescription medicines that kill the parasites. Treatment typically takes 5 to 7 days, and the medicine is usually given as a liquid that your child can drink. Some of these medicines may have side effects, so your doctor will tell you what to watch for.

If your child has giardiasis and your doctor has prescribed medication, be sure to give all doses on schedule for as long as your doctor directs. This will help your child recover faster and will kill parasites that might infect others in your family. Again, encourage all family members to wash their hands frequently, especially after using the bathroom and before eating.

A child who has diarrhea from giardiasis may lose too much fluid in the stool and become dehydrated. Make sure the child drinks plenty of fluids but no caffeinated beverages, because they make the body lose water faster.

Ask the doctor before you give your child any nonprescription drugs for cramps or diarrhea because these medicines may mask symptoms and interfere with treatment.

Duration

The incubation period for giardiasis is 1 to 3 weeks after exposure to the parasite. In most cases, treatment with 5 to 7 days of antiparasitic medication will help kids recover within a week's time. Medication also shortens the time that they're contagious. If giardiasis isn't treated, symptoms can last up to 6 weeks or longer.

When to Call the Doctor

Call the doctor whenever your child has:

• large amounts of diarrhea, especially if he or she also has a fever and/or abdominal pain
• occasional, small episodes of diarrhea that continue for several days, especially if appetite is poor, and your child is either gradually losing weight or isn't gaining as much as expected

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Ascariasis

Ascariasis is an intestinal infection caused by a parasitic roundworm. While it is the most common human infection caused by worms in the world, ascariasis is not common in the United States. It occurs in varying prevalence worldwide, with far greater frequency in areas with poor sanitation or crowded living conditions.

Signs and Symptoms

Although no symptoms may occur, the greater the number of worms involved in the infestation, the more severe a child's symptoms are likely to be. Kids are more likely than adults to develop gastrointestinal symptoms because they have smaller intestines and are at greater risk of developing intestinal obstruction.

Symptoms seen with mild infestation include:

• worms in stool
• coughing up worms
• loss of appetite
• fever
• wheezing

More severe infestations can result in more serious signs and symptoms, including:

• vomiting
• shortness of breath
• abdominal distention (swelling of the abdomen)
• severe stomach or abdominal pain
• intestinal blockage
• biliary tract blockage (includes the liver and gallbladder)

Description

Ascariasis occurs when worm eggs of the parasite Ascaris lumbricoides commonly found in soil and human feces are ingested. The eggs can be transmitted from contaminated food, drink, or soil. The roundworms range in size from 5.9 to 9.8 inches for adult males and 9.8 to 13.8 inches for adult females. The worms can grow to be as thick as a pencil and can live for 1 to 2 years.

Ascariasis is frequently found in developing countries where sanitary conditions are poor or in areas where human feces are used as fertilizer. When the eggs are swallowed and passed into the intestine, they hatch into larvae. The larvae then begin to move through the body.

Once they get through the intestinal wall, the larvae travel from the liver to the lungs through the bloodstream. During this stage, pulmonary symptoms such as coughing (even coughing up worms) may occur. In the lungs, the larvae climb up through the bronchial tubes to the throat, where they are swallowed. The larvae then return to the small intestine where they grow, mature, mate, and lay eggs. The worms reach maturity about 2 months after an egg is ingested from the soil.

Adult worms live and remain in the small intestine. A female worm can produce up to 240,000 eggs in a day, which are then discharged into the feces and incubate in the soil for weeks. Children are particularly susceptible to ascariasis because they tend to put things in their mouths, including dirt, and they often have poorer hygiene habits than adults.

Ascariasis is common in warmer or tropical climates, particularly in developing nations, where it can affect large segments of the population. Ascariasis is rare in the United States, due to strict sanitation rules and regulations.

Contagiousness

Ascariasis is not spread directly from one person to another. To become infected, an individual has to consume the worm's eggs.

Prevention

The most important measure of protection against ascariasis is the safe and sanitary disposal of human waste, which can transmit eggs. Areas of the world that use human feces as fertilizer must thoroughly cook all foods or clean them with a proper iodine solution (particularly fruits and vegetables).

Children who are adopted from developing nations are frequently screened for worms as a precautionary measure. Kids who live in underdeveloped areas of the world may be prescribed a preventive deworming medication.

These practices are recommended for all children:

• Try as much as possible to keep kids from putting things in their mouths.
• Teach kids to wash hands thoroughly and frequently, especially after using the bathroom and before eating.

Professional Treatment

The doctor will usually prescribe antiparasitic medication to be taken orally to kill the intestinal roundworms. Sometimes the stool will be re-examined about 3 weeks after treatment to check for eggs and worms. Symptoms usually disappear within 1 week of starting treatment.

Very rarely, surgical removal of the worms may be necessary (particularly in cases of intestinal or liver-related obstruction, or abdominal infection). A child who has ascariasis should be evaluated for other intestinal parasites, such as pinworm.

Home Treatment

If your child has ascariasis, the medication prescribed should be administered accordingly. To prevent reinfection:

• Ensure that your child washes his or her hands properly, particularly after using the bathroom and before eating.
• Have your pets checked for worms regularly.
• Keep your child's fingernails short and clean.
• Sterilize any contaminated clothing, pajamas, and bedding.
• Evaluate the source of the infection. Additional sanitation measures in or around your home may be necessary.

When to Call the Doctor

If your child has any of the symptoms of ascariasis, contact your doctor right away. Stool samples will be sent to a laboratory to check for eggs and worms and confirm the diagnosis.

Call the doctor if symptoms do not improve with treatment or if new symptoms occur.

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Amebiasis

Amebiasis is an intestinal illness that's typically transmitted when someone eats or drinks something that's contaminated with a microscopic parasite called Entamoeba histolytica (E. histolytica). The parasite is an amoeba, a single-celled organism. That's how the illness got its name — amebiasis.

In many cases, the parasite lives in a person's large intestine without causing any symptoms. But sometimes, it invades the lining of the large intestine, causing bloody diarrhea, stomach pains, cramping, nausea, loss of appetite, or fever. In rare cases, it can spread into other organs such as the liver, lungs, and brain.

Amebiasis typically occurs in areas where living conditions are crowded and where there is a lack of adequate sanitation. The illness is very prevalent in parts of the developing world, including Africa, Latin America, India, and Southeast Asia. It is rare in the United States, occurring mostly in immigrants, recent travelers to high-risk countries, and people with HIV/AIDS.

Signs and Symptoms

Most kids who get amebiasis have minimal or no symptoms. When children do become ill, they experience abdominal pain that begins gradually, along with frequent loose or watery bowel movements, cramps, nausea, and a loss of appetite. In some cases they develop a fever and, possibly, bloody stools.

For some people, symptoms of amebiasis can begin within days to weeks of swallowing food or water contaminated by amoebas. For other people, symptoms of amebiasis either take months to appear or never appear at all.

Contagiousness

Amebiasis is contagious. Wherever living conditions are unsanitary and hygiene is poor, the chances are higher that the infection will pass from person to person.

Someone carrying amoebas in his or her intestines can pass the infection to others through the stool. When infected stool contaminates food or water supplies, amebiasis can spread quickly to many people at once. This is especially true in developing countries where drinking water may be contaminated.

Amebiasis can also be spread between people through inadequate hand washing, by using the same objects, and by sexual contact.

Prevention

There is no vaccine to prevent amebiasis.

Because amoebas may contaminate food and water, you can help prevent the illness by being cautious about what you eat and drink, especially in developing countries, where a good rule regarding food is to cook it, boil it, peel it, or forget it.

Treatment

If your doctor suspects that your child has amebiasis, you may be asked to collect stool samples. After diagnosis, treatment will usually require consultation with appropriate experts such as those at the Centers for Disease Control and Prevention (CDC) or other infectious disease specialists.

When to Call the Doctor

Call your doctor if your child has signs or symptoms of amebiasis, including:

• diarrhea with blood or mucus
• abdominal pain
• fever
• distended abdomen
• pain or tenderness in the area of the liver (below the ribs on the right side)

This is especially important if you have recently traveled to a part of the world where amebiasis is common. Your child should also be examined if he or she has persistent diarrhea without any other symptoms.

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