GIARDIASIS IN SMALL ANIMALS

INTRODUCTION

Giardiasis is a major diarrheal disease found throughout the world. The flagellate protozoan
Giardia intestinalis is the most common protozoal intestinal parasite isolated worldwide. G. intestinalis
can cause asymptomatic colonization or acute or chronic diarrheal illness. The organism has been found
in as many as 80% of raw water supplies from lakes, streams, and ponds and in as many as 15% of
filtered water samples. It is a common cause of chronic diarrhea and growth retardation in children in
developing countries.

Giardia is transmitted through the fecal–oral route, frequently due to the ingestion of food and water
contaminated with the parasite’s cysts, or by host-to-host contact.

Giardia intestinalis has a direct life cycle that is composed of two morphologically different stages. On
the one hand, the infective stage, or cyst, is responsible for causing the infection. The cyst can survive in
the environment for months under optimal conditions (4 °C). On the other hand, the invasive stage, or
trophozoite, is responsible for causing the disease due to its colonization in the upper parts of the small
intestine. Previously, the cyst was considered to be a cryptobiotic form; however, it was found that its
oxygen consumption is 15% of that of trophozoites and it is capable of passing through the stomach and
excysting in the duodenum.

Giardiasis can manifest symptomatically and asymptomatically; the fact that this parasite is found to a
greater extent in asymptomatic patients, including cats, increases the risk of transmission to humans.
Although it is said that the presence of clinical signs could be linked to host factors, such as immune
response, it may also be due to virulence factors of the strain of the infecting parasite. However, the risk
factors that may trigger clinical disease are not yet known with certainty. The most common signs of
giardiasis include diarrhea, steatorrhea, abdominal pain, and weight loss.

The presence of G. intestinalis depends on variables such as geographic area, sanitary conditions, and
number of animals sharing the same space. Epidemiological studies allow us to understand the
importance of giardiasis in different regions of the world, characterizing the presence of the zoonotic
and non-zoonotic assemblages and the risk of people living with companion animals, especially cats. The
level of risk depends on the prevalence and assemblages present, and since cats are reservoirs of this
parasite, this causes public health problems, affecting the health of humans and animals.

To date, the magnitude of the risk of transmission from cats to humans is not well known.
Currently, mixed infections with assemblages belonging to humans and cats have been reported;
therefore, from an epidemiological point of view, this suggests that there is a potential environmental
reservoir for giardiasis in urban areas.
CASE 1

“Diagnostic Case Study and Treatment of Giardiasis in cats At Rvet Clinic Bogor.”

By: Niken Hardiyantia, Risa Tiuriab, Rizal Arifin Akbaric.

HISTORY AND DISCUSSION

A mixed Persian cat named Memed came to the RVet Bogor clinic. This cat is 1.5 years old, a gray mix of
white and male. Memed came with grievances of diarrhea for six days with the consistency of watery
stools, without blood, and not accompanied by vomiting. During diarrhea, Memed didn't lose appetite
and drink. The owner explained the cat was often released and drank water carelessly, including raw
water and sewage. In addition, the owner also provided information that his cat had received a complete
vaccine. The clinical examination showed Memed's weight was 3.4 kg, body temperature was 38 °C,
heart rate was 92 times/minute, and respiratory rate 32 times/minute. Memed looks limp and pale. The
clinical examination data of Memed shows that Memed has lost weight.

The anamnesis and clinical examination found that Memed was often let loose by the owner, so Memed
was diagnosed with a gastrointestinal protozoan infection. Robbie et al., (2020) supported that the
maintenance management of the owner also influences the occurrence of protozoan infection. For most
pets released outside the house by the owner, the higher the probability of a case of protozoa infection.
Most of these protozoan infections can cause diarrhea, despite sometimes being asymptomatic. In this
case, supportive examination in the form of stool examination establishes the diagnosis. A stool
examination can help to determine the type of gastrointestinal parasite that infects the cat patient.

DIAGNOSTIC TECHNIQUES WITH STOOL EXAMINATION

Confirmation of the diagnosis in cases of a cat patient suspected of being infected by gastrointestinal
protozoa by a simple flotation test using a saturated NaCl flotation agent. This method aims to determine
the type of protozoa quickly and precisely. The flotation method is suitable for examining feces
containing a few protozoa cysts. In addition, this method also has several advantages, such as taking a
short time, economical cost, and not require complex equipment. The results of the simple flotation
method of stool examination can see be seen on the figure.
Based on the stool examination using the flotation method, Giardia sp. cysts were found in cat patient
feces samples. The Giardia cysts are oval, have a nucleus, and are fibrous. According to Levine (1995),
Giardia sp in the cyst stage has two to four nuclei and several residual fibers from trophozoite organelles.
The number of Giardia cysts found in 5 fields of view and averaged results in >1 cyst/field of view. The
findings of the Giardia cyst determined that the cat patient infects by Giardia sp. The diagnosis on the
anamnesis carries out that the cat patient liked to be released outside the house and drank raw water or
sewerage. Cats who have the habit of drinking raw water or sewerage are very susceptible to Giardiasis
because this disease is a parasitic disease that can spread through water (waterborne disease) (Tayyab et
al., 2017).

MEDICAL THERAPY RESULT AND COMAPARISON

A B

C D

The results of treatment evaluation (A) The form of feces on the 0 days of therapy, (B) Giardia cyst on the 0 days of
therapy, (C) The form of the feces on the 5th day after therapy, (D) No Giardia cyst was found on the 5th day of
therapy.

REFERENCES:

1. Akbari, R.A., Wientarsih, I., Prasetyo, B.F., Madyastuti, R. 2018. Terapi giardiasis penyebab diare
non-spesifik pada kucing. ARSHI Vet Lett. 2(1): 7–8.
2. Al-kahfaji, M.S.A., Alsaadi, Z.H. 2019. Giardia Lamblia and Giardiasis. J Univ Babylon Pure Appl
Sci. 27(5): 66–74.
3. Argüello-García, R., Leitsch, D., Skinner-Adams, T., Ortega-Pierres, M.G. 2020. Drug resistance in
Giardia: Mechanisms and alternative treatments for giardiasis. Adv Parasitol. 107: 201–282.
4. Pagati, A.L., Suwanti, L.T., Anwar, C., Yuniarti, W.M., Sarmanu., Suprihati, E. 2018. Prevalence of
gastrointestinal protozoa of cats in animal hospital and animal clinic in Surabaya. J Parasite Sci.
2(2): 61–66.
 5. Scorza, A.V., Lappin, M.R. 2003. Metronidazole for the treatment of feline giardiasis. Journal of
Feline Medicine and Surgery. 6. 157-160.

CASE 2

“Coinfection with Tritrichomonas foetus and Giardia duodenalis in Two Cats with Chronic Diarrhea”

By: Sergio A. Zanzani, Alessia L. Gazzonis, Paola Scarpa, Emanuela Olivieri, Hans-Jörg Balzer, and Maria
Teresa Manfredi

HISTORY

Two littermate Maine Coon females aged six months underwent examination by the referring
veterinarian as one of them presented a 3-month history of liquid malodorous diarrhea. A previous
diagnosis following coprological analyses in both cats had indicated an infection sustained by ascarids
and the animals had been treated by practitioners with milbemycine oxime and praziquantel (2 mg/kg
bw and 5 mg/kg bw, resp., PO, single administration).

CASE DISCUSSION

Due to persistent diarrhea, in the affected cat coprological analyses were repeated to verify both
effectiveness of treatment against ascarids and a possible infection with Giardia. The cat resulted in
being positive for Giardia coproantigens (IDEXX SNAP Giardia Test, IDEXX Laboratories, Hoofddorp,
Netherlands) and was treated with fenbendazole (50 mg/kg bw, PO, SID) for 5 days, obtaining only a
moderate and transient improvement of feces consistence. As some weeks after this treatment liquid
diarrhea continued, another fecal test was performed revealing the persistence of Giardia coproantigens.
A treatment with spiramycin and metronidazole (75000 IU/kg bw 12.5 mg/kg bw, PO, SID) followed for
10 days. The feces became formed and no longer malodorous, but few days after treatment signs
recurred. No protozoan cysts or trophozoites and no ova of helminths were detected by centrifugation-
flotation technique in both cats, whereas they were positives to Giardiacoproantigens. However, in the
fecal smear stained with Lugol’s solution obtained from the refrigerated sample of the cat with chronic
liquid diarrhea, several cysts and trophozoites of G. duodenalis and unidentified elements were found.
REFERENCES:

1. C. Epe, G. Rehkter, T. Schnieder, L. Lorentzen, and L. Kreienbrock, “Giardia in symptomatic dogs

and cats in Europe— results of a European study,” Veterinary Parasitology, vol. 173, no. 1-2, pp.
32–38, 2010.
2. S. A. Zanzani, A. L. Gazzonis, P. Scarpa, F. Berrilli, and M. T. Manfredi, “Intestinal parasites of
owned dogs and cats from metropolitan and micropolitan areas: prevalence, zoonotic risks, and
pet owner awareness in northern Italy,” BioMed Research International, vol. 2014, Article ID
696508, 10 pages, 2014.
3. U. Ryan and S. M. Caccio, “Zoonotic potential of ` Giardia,” International Journal for Parasitology,
vol. 43, no. 12-13, pp. 943– 956, 2013
4. J. K. Paris, S. Wills, H.-J. Balzer, D. J. Shaw, and D. A. Gunn-Moore, “Enteropathogen co-infection
in UK cats with diarrhoea,” BMC Veterinary Research, vol. 10, article 13, 2014.
5. R. Fiechter, P. Deplazes, and M. Schnyder, “Control of Giardia infections with ronidazole and
intensive hygiene management in a dog kennel,” Veterinary Parasitology, vol. 187, no. 1-2, pp.
93–98, 2012.

CASE 3

“Giardiasis in local breed queen”

By: Hayder Al-Rammahi, Kasim H. Kashash

HISTORY

A case was a local breed queen,3 years old, with history of parturition and suffering from mild diarrhea
with steatorrhea. The cat was examined clinically, and the feces were examined by both direct and
concentrated method. The clinical examination revealed that all vital signs were within normal values.
There were no any trophozoites detected in both direct and flotation methods. Despite detecting just
one cyst in direct smear, there were numerous cysts demonstrated in centrifugal flotation method by
magnesium sulfate with 1.20 specific gravity.

CASE DISCUSSION

A three-year-old cat with history of parturition for 4 days was brought to authors suffering from mild
diarrhea. The feces were soft and pale in color. The clinical examination revealed normal vital signs with
normal appetite and body score. Direct smear of fresh feces was prepared and examined, as well as
centrifuge flotation method was performed by suspension of 2 grams of feces in saturated zinc sulfate
with specific gravity 1.290 and both techniques were carried out as described by Minami. The result of
parasitic examination by flotation method revealed present of numerous cysts of Giardia spp. while no
Giardia cysts were detected by fecal direct smear, just one cyst was observed in direct smear. No
trophozoites were detected in both examination techniques.
REFERENCES:

1. Minami, T. (2001). Technical Manual for the Examination and Control of Parasites of Domestic
Animals, Japan Livestock Technology Association.
2. Lappin MR. (2005). Enteric protozoal diseases. Vet Clin North Am Small Anim Pract; 35:81–8.
3. Kirkpatrick, C.E. and Farrell, J.P. (1984). Feline giardiasis: observations on natural and induced
infections. Am J Vet Res; 45:2182–8.

COMPARISON OF THE NORMAL INTESTINAL EPITHELIUM AND THAT OF INFECTED WITH GIARDIA SPP.