Giardia lamblia was transmitted through a varity of sources. As it is a waterborne disease so cyst of Giardia lamblia are mixed in ponds lake and water bodies resorces as human excrement through improper sewarge system. Water contaminated and drinking of such untreaded water cause a lot of water borne disease along with the giardiasis. Gardia lamblia also cause chronic diarrhea, malabsorption and growth retardation (Baldursson S. and Karanis P. 2011). This pathogen was also transmitted from person to person contact or through contaminated food or improper cooked food and raw vegetables. This caustive agent was also transmitted and prevaled through the unwashed hands contact indivdual to individual after toilt use or diapered change. Homsexual activties also included the oral-fecal involvement cause the transmisson of this disease. At least 10 cysts are enough to this infection ( WOLFE S.M. 1992).
The poverty, improper sewage system, poor personal conditions and poor sanitation. Limited and contaminated water resources, climate changes increasing population and food handlers these are some factors that related to distribution and prevalence of giardiasis in developing countries Pakistan also include. It was also observed during survey that finger nails of primary school going children also susceptible of Giardia lamblia up to 14.28% in Lahore district (Ghani J. J. et al., 2016). Study from worldwide areas show that different factors are associated in the prevalence of this disease. In Pakistan parasitic infections become one of the biggest issues to be solved out. Giardia lamblia was mostly infected the children with less educated mothers and those children which intake raw vegetables drinking pond spring water or water from open areas and eaten meal without hand washing (Khan W., Nisa U.N. and Khan.A. 2017).
For the epidemology of those infection stool sample was collected to detect ova and parasite detection. For this different fresh sample was collected in both developing and developed countries.The 2% to 5% industrialized and 20% to 30% in under developed countries. Mostly case was asyptomatic. Mostly was manifested in children upto 40%. Asymptomatic childrens are carriar of this pathogen and transmitted this infection their family and friends. This infection show symptoms within 1 – 2 weeks and some time several weeks or even upto months if infection is left untreated. Symptomatic patients have foul smelled stool with high fat deposition and high diarrheatic condition as loose motion. Stool of such patients does not contain blood (Ortega R.Y. and Adam D.R. 1997). Immunology include both humoral and cellular immune reaction to the Giardia lamblia which was generated the patient against infective agent. Antibodies are produce in a patient body against agent to eradicate it. The immunoglobulin A(IgA) and IgM. Both antibodies fight to the caustive agent and reduce its movement and attachment to the mucosal layer of small intestine (WOLFE S.M.1992).
There are different methods to diagnose the Giardia lamblia i.e stool microscopy, digital rectal technique, ELISA, PCR etc. So to check the pathogen in vitro we have to collect stool sample, antigen, DNA intestinal fluid, tissue sample, biopsy specimens and other biological sample (Siddiqui H.M. et al., 2018). The stool of Giardia lamblia positive patient’s cyst contain an Giardia lamblia specific antigen (GSA 65). Rabbit antiserum is used against the cyst by crossed-and-line-immuno-electrophorasis and counter immune-electrophorasis (CIE). Molecular weight of GSA is 65,000 (ROSOFF D.J. and STIBSS H.H. 1986). The ELISA technique basically used for the detection of antigen in stool specimen. Formalin and polyvinyl alcohol used and stained by tricome stain technique. The tests also visually and spectro-photometrically by ELISA (ADDISS G.D et al., 1991). An enzyme The Triage parasite panel (BIOSITE Diagnostics, San Diego, Calif.) is also used for detection of antigen or antibody (GARCIA S.L., SHIMIZU Y.R. and BERNARD N.C., 2000). PCR is a multiplexreal-time assay that used for daily stool analysis. It is a time saving process and a lot number of samples obtained. It is mostly used for parasitic diarrheal infections, but used on the species specific DNA control (Verweij J.J. et al., 2004).
Water born disease caused by parasites has world wide prevalence both in developed and under developing countries. It remain a major source of morbidity and mortality in the wrold. According to previous researches between 2004-2010, diarrhea caused in 4 billion people from which 1.6 million died per year and 62.5 million were Disability adjusted Life Years (DALYs) (Baildursson S. and Karanis P. 2011). According to 2011-2016 world wide report 381 protozoan parasitic diseases due to water were reported that caused 22 million people deathes per year (Efstratiou A., Ongerth E. J. and Karanis P. 2017).
Polluted water is one of the major hazard to public health in Pakistan. Untreated water, improper sewerege system, polluted irrigated water are the major causes of Giardiasis in Pakistan (Azizullah A., et al., 2011). It has been observed that 72 species of protozoan parasites can be transmitted by water. According to recent studies 65.5% samples were collected from tap water, pinds and drain water. The Giardia spp were 14.1% observes (Kanwal K. ana Arslan M. 2016). Form workers and their families are at the risk of Giardia intestinals infection due to contact with untreated water. According to 2017 researches in district D.I Khan, KPK 3 million Pakistanies are affected in each year, of which 1.2 million die (Tayyab M. et al., 2017).
There are different medicines were used to cure the giardiasis. Like; Metronidazole, Tinidazole, Ornidazole, Quinacrine, Furazolidone, Paromomycin, Albendazole, Bacitracin zinc (HILL R.D. and GARDNER B.T. 2001).
Mostly secnidazole and metronidazole are commonly used, but secnidazole is better than metronidazole. It absorbed fastly. Secnidazole suspension 30mg/Kg body weight is used. It is called “One minute treatment” because single dose is enough for recovery %.( Khan A.I. et al., 2010).
- Keep your environment neat and clean
- Do not drink unhealthy water
- There should be proper sewerage system
- Avoid oral sex (MEYERS D.J., KUHARIC A.H., AND HOLMES K.K. 1997).
- Eat healthy food
Giardia spp is significant cause of diarrhoea and abdominal pain, especially in childrens, In whom it can be associated with long-term consequences on growth and development.In Pakistan, there is no better system for sewage disposal. The environment is very dirty, un-healthy and fowl smelling. The cyst can easily grow and survive in the environment. So there be proper disposal of waste material. There should be mechanism to supply pure water. The first effect of this disease was asymptomatic, so every person should be checked by doctor as the early symptoms appear. It is difficult to collect stool from common Pakistani because no one want to touch by other person, so give them proper guiedness and awareness. Ther should be neat and clean houses, forms, streets, toilets etc. Also government should take steps to aware every person. Every religion give stress upon cleaniness but cleaniness is the basic and major part of our religion Islam.
As Allah Subhan-o-Talla says in Holly Quran;
‘’Truly, ALLAH loves those who turn to Him constantly and He loves those who keep themselves pure and clean.’’ (Al Baqarah, 2222)
Holly Prophet (PBUH) also give strees on cleanines. Prophet (PBUH) in a Hadith said:
‘’Cleanliness is half of faith.’’
So it is duty of every person to keep neat and clean. It makes clean and healthy to our environment.