History and exam

Key diagnostic factors

common

diarrhoea

Usually sudden in onset and may be initially watery with no mucus, pus, or gross blood. Patient may describe their stools as greasy and foul smelling.

frequent belching

Belching often has a sulfur smell.

Other diagnostic factors

common

abdominal bloating and discomfort

Generalised abdominal discomfort and cramps may be precipitated by eating.

malaise

Non-specific symptom.

weight loss

Due to malabsorption in chronic giardiasis.

uncommon

nausea and vomiting

Nausea and vomiting may occur.

Risk factors

strong

contaminated water/food

Transmission occurs via ingestion of cysts in contaminated water or food, or through direct faecal-oral contact.[17][18][24][42]

domestic animals living in or around the house

Children in such households are 2-5 times more likely to be infected, but animals may not be the definitive source for Giardia in these children.[43][44]​​ Zoonotic transmission is thought to be relatively uncommon.[45][46]​​ Analysis of giardiasis outbreaks in the US between 1971 and 2011 concluded that only 1.2% resulted from animal contact.[46]

weak

hypogammaglobulinaemia

Associated with a higher incidence of giardiasis, particularly in patients with immunoglobulin A deficiency.[47]

young age

Occurs in all age groups, but highest incidence rates are seen in children aged 0-4 years.[16]

male sex

In adults, exposure risks may vary between men and women, and males may be at greater risk of infection.[16][20]

day-care centre attendance

Children in day care are at increased risk of giardiasis.[19] Contact with children in nappies is a risk factor.[18]

oral-anal sexual contact

Giardia is transmitted by the faecal-oral route, and oral-anal sexual contact is a risk factor.[18][19]​​ Men who have sex with men are at increased risk of giardiasis.[18]​​

recent antibiotic use

Antibiotics may prolong alterations in the microbiota and decrease colonisation resistance, thereby increasing the risk of infection.[18]

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