Talk:Giardiasis

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 21 October 2019 and 15 November 2019. Further details are available on the course page. Student editor(s): Stevent99. Peer reviewers: DocWock.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 22:23, 16 January 2022 (UTC)

Anorexia?

While I'm not that familiar with the infection, it seems highly dubious to me that a parasite such as giardia could cause an eating disorder as claimed in this article. Is it possible the editor who contributed this statement actually meant "emaciation" and/or "loss of appetite"? Going to add a citation request for now. Feather Jonah (talk) 06:41, 12 September 2009 (UTC)

ANSWER: The article does not state the parasite causes anorexia; rather one of the side effects of one of the treatments can be anorexia. — Preceding unsigned comment added by 112.213.160.52 (talk) 20:44, 7 July 2011 (UTC)

Anorexia as a medical term means loss of appetite. The eating disorder is properly called Anorexia Nervosa, it might popularly be called 'anorexia', but that's not proper use of the term. So the article is correct. 94.174.108.74 (talk) 20:46, 7 April 2012 (UTC)

what are some preventions

Don't drink the water. They sell filters for it. Dave (talk) 05:06, 18 December 2005 (UTC)

Case in point, a failure of the water filtration system will render good water bad....so giardia can be gotten through this mode, as well as other modes, not merely 'drinking bad water'...

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 16:42, 11 August 2007 (UTC)

Treatment

Gardner, TB; Hill, DR (2001). "Treatment of giardiasis". Clinical microbiology reviews. 14 (1): 114–28. doi:10.1128/CMR.14.1.114-128.2001. PMC 88965. PMID 11148005. free review of treatment modalities (15 pg) JFW | T@lk 20:46, 31 October 2007 (UTC)

The dosage of Metronidazole (Flagyl)can't be right . Adult dosage: 250 mg three times a day for 5 days Pediatric dosage: 15 mg per kilogram of body weight per dose, 3 times per day, for 5 days Would mean a 17 KG child would be taking 255 mgs which is more then the adult dosage. —Preceding unsigned comment added by Kino29 (talk • contribs) 00:15, 10 May 2010 (UTC)

ANSWER - You read the dosage incorrectly – it is 5mg per kilogram for children NOT 15 mg per kg. — Preceding unsigned comment added by 112.213.160.52 (talk) 20:48, 7 July 2011 (UTC)

It looks to me that tinidazole is usually the best treatment. Drugs for treating giardiasis REVIEWER'S CONCLUSIONS: A single dose of tinidazole appears to give the highest clinical cure rate for giardiasis with relatively few adverse effects. http://www.ncbi.nlm.nih.gov/pubmed/10796511 Treatment of Giardiasis The most effective agents for therapy of giardiasis are single doses of tinidazole or ornidazole http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88965/ Bucktrack (talk) 14:11, 26 May 2013 (UTC)

Hi. the version of the review in PubMed is out dated. If you access the actual review in The Cochrane Library,(from the PubMed Link out) there will be a warning saying that it is an outdated version. Please check the new updated review. (http://www.ncbi.nlm.nih.gov/pubmed/23235648). The current authors conclusions are "Albendazole may be of similar effectiveness to metronidazole, may have fewer side effects, and has the advantage of a simplified regimen. Large, high quality trials, assessing clinical outcomes (such as diarrhoea) will help assess further alternatives."

On a related note would love your comments onWikipedia_talk:WikiProject_Medicine/Evidence_based_content_for_medical_articles_on_Wikipedia.Manu Mathew (talk) 13:47, 28 May 2013 (UTC)

Having been succesfully treated twice in the last 5 years with tinidazole, I'll continue go for a single dose of tinidazole for a prompt cure rather than metronidazol three times a day for a week - the compliance is so much easier (but don't drink for 3 days afterwards). Medscape supports this: http://emedicine.medscape.com/article/176718-medication#1 "Tinidazole is now approved in the United States and is considered a first-line agent outside the United States. " The Wiki article statement "There is very little evidence to support using any other drugs" (metronidazole albendazole) seems odd given this. Sailfish2 (talk) 03:08, 21 March 2014 (UTC)

Links

This article has very few links to different pages concerning things outlined on this page, ie: giardia lamblia, the parasitic protozoa itself (I fixed this), among others Matt.leeck (talk) 18:54, 9 March 2009 (UTC)

Resistance/Tolerance?

This page doesn't make clear what's so bad about having giardia — according to this website, [1], you can easily develop resistance/immunity. Can that be acknowledged in the text? --Modefier (talk) 03:54, 8 September 2009 (UTC)

The last two external links appear to have their links switched:

<a href="http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/giardia_cryptosporidium-eng.php" class="external text" rel="nofollow">Giardia: The Cosmopolitan Parasite</a>

<a href="http://www.cabi.org/bk_BookDisplay.asp?SubjectArea=&Subject=&PID=1564" class="external text" rel="nofollow">canada.gc.ca Giardia And Cryptosporidium In Drinking Water</a>

Giagdiasis vs G. lamblia

There are two articles here: Giardia lamblia should cover the organism, and Giardiasis should cover the infection caused by it. In reality, each article is a mishmash of both. I'll delineate them more clearly. - Draeco (talk) 18:31, 22 March 2010 (UTC)

Copyright problems

Unfortunately, this article contains substantial content for which we must verify license. Placed in early 2009 by User:Sparasites, there is little doubt that the material comes from this paper, as it even includes the footnote order and system (see, for example, the first edit by this user). I think there's a high likelihood that the user is the student author of the paper, but since the paper does not carry a compatible license, we have to try to verify this in order to retain the material. Given the challenges of verifying material years after the fact, it might be a good idea for interested editors to begin a rewrite. Please note that rewrites should not contain any text added by this user or built upon his or her material. This is the last "clean" version of the article before suspect material is introduced.

Sorry about this mess. :/ I'll try to reach out to the contributor and the author of the paper. --Moonriddengirl ^(talk) 13:34, 3 August 2012 (UTC)

There has been no response. In the absence of a proposed rewrite, I have restored the last clean version. Content added by other editors may be restored, as long as it does not incorporate material from that user. --Moonriddengirl ^(talk) 16:04, 17 August 2012 (UTC)

"On an immunological level, activated host T-lymphocytes attack endothelial cells that have been injured in order to remove the cell. This occurs after the disruption of the tight junctions between endothelial cells that make up the brush border. The result is heavily increased intestinal permeability." -- I think that the term intestinal epithelium better describes what you call endothelium. — Preceding unsigned comment added by 193.6.63.109 (talk) 19:59, 3 December 2012 (UTC)

Long-Term Effects ?

I just added this section, with the following content. It cites just one journal article, which is not a survey or meta-study, so I'm not sure that it's sufficiently well established to put here, and I'm also not sure whether it is of sufficiently general interest: Nealeyoung (talk) 22:26, 3 February 2013 (UTC)

Recent research suggests that long-term gastrointestinal disorders such as IBS may follow giardiasis infection, even after successful treatment.

References

Pathophysiology Section

Could we see a rewrite of the Pathophysiology section using complete sentences and fewer buzzwords? rowley (talk) 16:41, 22 October 2013 (UTC)

I cleaned up the syntax a bit, and added some explanatory links, but it's still heavily jargon-laden. rowley (talk) 16:53, 22 October 2013 (UTC)

Notice of potential COI

[[2]]32cllou (talk) 22:41, 4 May 2014 (UTC)

Have added further balance from a 2012 major medical textbook. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:33, 4 May 2014 (UTC)

Book not specific to N. AM. wilderness. CDC has been made specific. Nice to have all those bad statements and references gone. Hope the fixes aren't removed and replaced by misrepresentation.32cllou (talk) 19:02, 5 May 2014 (UTC)

Yes book actually is. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:42, 5 May 2014 (UTC)

Prevention

I would like to try to avoid an editing war in the Prevention section.

As of right now it reads:

Boiling suspect water for one minute is the surest method to make water safe to drink and kill disease-causing microorganisms such as Giardia lamblia if in doubt about whether water is infected.[15] Chemical disinfectants or filters may be used.[16][17]

According to a review of the literature from 2000, there is little evidence linking the drinking of water in the N. American wilderness and Giardia.[18]The researcher notes that treatment of drinking water for Giardia may not be as important as recommended hand-washing in wilderness regions in North America.[18] CDC surveillance data (for 2005 and 2006) reports one incident (6 cases) of waterborne giardiasis contracted from drinking wilderness river water in Colorado.[19]

Any Wikipedia article discussing giardia or giardiasis usually involves some edit wars concerning the need to treat wilderness water. As it now stands, the prevention focus is on water treatment in general and wilderness water in particular and as such is too tightly focused. The CDC has shown that there are many routes to giardiasis and as such many focuses of prevention. I think a summary of the CDC's giardiasis prevention advice is more accurate, encyclopedic and neutral and more likely to discourage editing wars. PragmaticRealist (talk) 22:34, 5 May 2014 (UTC)

We do not write in this style "Practice good hygiene: Carefully wash hands before handling food, after using the bathroom or changing diapers or after contact with animal feces. Children with diarrhea should be removed from child care facilities until the diarrhea has stopped." We are not a self help guide. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:43, 5 May 2014 (UTC)

Wikipedia is not an instruction manual nor an advisory guide. Plus, your edits removed the reliable sources, which is why I continued to revert. I'd also just like to note that you're a brand new editor, so I'm not trying to be 'bitey but there are some pretty obscure policies that newcomers may not be aware of. This is one of them. Tutelary (talk) 22:53, 5 May 2014 (UTC)

Can someone clarify the purpose of the Prevention section? Why is "carefully wash hands before handling food" not allowed but "Boiling suspect water for one minute is the surest method to make water safe" appropriate? Why is most of the section about wilderness giardiasis when it comprises a tiny % of the total cases? It's very misleading to say "CDC surveillance data (for 2005 and 2006) reports one incident (6 cases) of waterborne giardiasis contracted from drinking wilderness river water..." This was an OUTBREAK. Giardiasis is primarily an endemic disease, especially in the wilderness. The CDC says "<1% of reported giardiasis cases were associated with outbreaks." Thus the actual incidence of wilderness waterborne giardiasis would be two or three orders of magnitude higher. Thanks! PragmaticRealist (talk) 03:26, 6 May 2014 (UTC)

• We write "CDC recommends the washing of hands before handling food"
• We do not write "You should was your hands before handling food"

Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:41, 6 May 2014 (UTC)

We should definitely include that less than 1% of cases in the United Staes are associated with outbreaks.Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:44, 6 May 2014 (UTC)

To avoid the edit wars inevitably involved with wilderness water treatment, wouldn't the CDC sources be considered neutral and reliable? If the point of including a "Prevention" section is presenting information on how to prevent giardiasis, would it be reasonable to add "The CDC recommends the following..." along with the brief summary of the CDCs advice as it appeared earlier? Thank you. PragmaticRealist (talk) 05:35, 6 May 2014 (UTC)

I think PragmaticRealist's additions are good, though the language could be more encyclopedic. We need to speak of hand washing, and possibly how to identify suspect water in general (see that REI editorial). That's risky though. We need to be careful to not overstate the risk, say of swimming in a pool. One pool case over two years over the whole US! Jmh's recommendation (the 1%) is good. I object to the removal of existing CDC text (stating one wilderness incident).32cllou (talk) 17:09, 6 May 2014 (UTC)

Re edit wars over the need to treat drinking water in the wilderness - the review says it's not there sufficient to contract. The CDC data (just one wilderness incident) anecdotally supports that finding. End of story. My fear is the main reason for the 180 degree shift back and forth (need or don't need to treat wilderness water) is driven by folks interested in selling water filters. Almost no other explanation for the text and especially the references used (when I first read the article recently).32cllou (talk) 17:29, 6 May 2014 (UTC)32cllou (talk) 17:36, 6 May 2014 (UTC)

The conclusions of that review are not accepted by any public health agencies to the best of my knowledge, likely for some of these reasons: http://bucktrack.blogspot.com/2012/09/backpacker-giardia-debunking-skeptical_8.html. For example, there was not "just one wilderness incident" during that time period. There was one VERIFIED WATERBORNE OUTBREAK. Standard backpacker giardiasis will rarely qualify as an outbreak so wilderness giardiasis tends to be "off the radar" for official tracking. The author of the paper concedes that backpackers are in a high risk group and blames it on poor handwashing. To the best of my knowledge not one outbreak in the wilderness has ever been shown to be from that cause. The CDC, EPA and FDA are not promoting water treatment in an effort to sell water filters. Please read through the above cited link. Thanks! PragmaticRealist (talk) 16:26, 19 June 2014 (UTC)

Happy to have CDC recommendations first. But do not think we should delete the rest. Doc James (talk · contribs · email) 14:32, 27 April 2015 (UTC)

I respectfully think it should be removed because Dr. Welch's fifteen year old conclusions are completely at odds with the current scientific consensus.

Here's how the CDC responded to Dr. TR Welch Although the advice to universally filter and disinfect backcountry drinking water to prevent disease has been debated, the health consequences of ignoring that standard water treatment advice have been documented Surveillance for Waterborne Disease and Outbreaks Associated with Drinking Water and Water not Intended for Drinking --- United States, 2005--2006

The FDC, EPA, CDC, Mayo Clinic and every state health department, as far as I know, have concluded, based on the available evidence, that people drinking drinking backcountry water untreated are in a high risk group. The EPA says [Giardia] cysts have been found all months of the year in surface waters from the Arctic to the tropics in even the most pristine of surface waters.

The definitive paper on the topic determined that the minimum infectious dose is 1 cyst [Risk assessment and control of waterborne giardiasis.]

There have been numerous peer reviewed papers concluding people contract giardiasis from backcountry water:

An outbreak of giardiasis in a group of campers: These surveys show that campers exposed to mountain stream water are at risk of acquiring giardiasis.

Giardiasis in Colorado: an epidemiologic study drinking untreated mountain water is an important cause of endemic infection.

Acute Giardiasis: An Improved Clinical Case Definition for Epidemiologic Studies: an outbreak of waterborne giardiasis occurred in a group of 93 university students and faculty participating in a geology field course in Colorado. All cases occurred in one subgroup of persons who were heavily exposed to untreated stream water.

Factors associated with acquiring giardiasis in British Columbia residents: the authors concluded that consumption of local water while participating in outdoor activities, such as camping, was associated with a higher risk of giardiasis than in controls who participated in such activities but did not ingest local waters PragmaticRealist (talk) 22:40, 27 April 2015 (UTC)

Point of View

"Those at greatest risk are travelers to countries where giardiasis is common". This passage assumes the reader is from a country where giardiasis is not common, presumably a "developed" country. I know it is a quote attributed to the CDC, but it's inclusion make the assumption nonetheless. — Preceding unsigned comment added by 103.12.161.74 (talk) 09:11, 7 May 2017 (UTC)

Fixed in May 2021. Nurg (talk) 02:56, 28 March 2022 (UTC)

Present in 3%-7% of the U.S. population?

I do not have access to the cited source for this claim (found in the very short epidemiology section), but another source cited in the article says there are 20,000 cases in the U.S. annually, significantly less than 3%. According to the article, the infection usually resolves on its own after about six weeks. Request that someone with knowledge of the topic edit the article to correct or explain this. JeffKo427 (talk) 19:14, 28 September 2014 (UTC)

As I understand it, the difference is in total estimated cases (3-7% of the population) vs cases officially reported to the CDC (~20,000.) I think the latter are all lab verified. Many giardiasis cases are treated empirically without lab tests, many sick people do not seek medical treatment, and many people who are carriers are asymptotic. Hence the reported vs estimated infection rate. PragmaticRealist (talk) 23:28, 4 October 2014 (UTC)

Cause sections Risk factors subsection - men who have sex with other men (??)

What about anal sex not between men? I get that the CDC statement is a reputable source but as it is worded awkwardly perhaps instead of an inline citation a summary would serve better. Besides the wole of the Risk factors subsection in the Cause section seems to add little to nothing contentwise to what is already understood from the lede. 89.134.199.32 (talk) 22:02, 23 August 2018 (UTC).

The anal bit was fixed in May 2021. Nurg (talk) 03:39, 28 March 2022 (UTC)

WikiProject Medicine

Hello all,

I will be editing this article over the next month as part of WikiProject Medicine. My plan is the following:

- Add Prognosis section
- Ensure article is written without bias
- Address discussion on epidemiology in this Talk page
- Ensure all information is accurately cited with reliable sources
- Ensure all source links function properly
- Incorporate a better variety of sources for information already claimed, particularly in the Lead section

I will provide a brief explanation for each edit I make.

My goal is improve the article from a C-rating and start-class rating to a Good Article (GA).

Please reach out if you have any requests and/or additional ideas. :)
Stevent99 (talk) 23:26, 22 October 2019 (UTC)

Update1: Added more sources to the lead and to the template on the right of the page. I am having difficulty changing the references within the template. The "cite" option is not active. I see the current citations are written ref name="[name generated from source]" but I am unsure how to generate that name. Does anyone have any idea how to do that?

Stevent99 (talk) 23:48, 30 October 2019 (UTC)

Update2: Going to make the following edits
- Clarify that G duodenalis, G lamblia, and G intestinalis are synonyms
- Update epidemiology statistics if the sources provide updated information
- Add to Signs and Symptoms section
- Minor edits to Cause section
- Add to Pathophysiology information with brief statement on Giardia's lifecycle
- Add sources to info that was already in pathophysiology section... I will continue to add them after this upcoming edit - Minor additions to Diagnosis section
- Add and edit Prevention, Treatment, Prognosis, Epidemiology, Research, and Other Animals sections

This will be the first of a series of edits. Let me know what you all think.

Stevent99 (talk) 18:21, 6 November 2019 (UTC)

Update3: On to a second-round of edits
- Continue to add citations for previously uncited info in the Pathophys section
- Minor editing to the diagnosis section to increase clarity
- Minor additions to Treatment, Prognosis, and Research

Stevent99 (talk) 17:09, 9 November 2019 (UTC)

WikiProject Medicine Fall 2019 - Peer Review

Overall, the article is well done and you've accomplished most of what you set out to do. I have no recommendations for the content or flow of the article. I have seen a large amount of discussion on your talk page and it seems you handled it well.

The following is non exhaustive list of details from top to bottom to consider correcting.

- The first citation in the article is labeled #3 and number #1 comes a sentence or two later.

- You discussed adding additional citations for the introduction and I'm seeing just one main one for most of the statements.

- The differential diagnosis section in the summary by the introduction is pretty minimal.

- In the signs and symptoms section, second paragraph, first line, there is a citation in the middle of sentence. It may be a stylistic choice but I haven't seen that elsewhere before now.

- Under risk factors, the quote by the CDC could likely be summarized and supported by other sources rather than just quoting the whole long statement directly.

- The pathophysio section is excellent. There are two lines at the end of the 3rd paragraph where the statements have no citation. The section might also be improved with an image if possible. For example, the life cycle of giardia if available.

- The prevention section is excellent as well. There are a few missing citations for statements in the 3rd paragraph.

- The epidemiology section is thorough. I see you are citing the last statement of the paragraph only. Other sections used the same citation for every line. It may a stylistic choice but it might be worthwhile to look around at other articles and see what they do with this type of citation.

- The "other animals" section is a little unorthodox title in terms of the manual style and may find itself better in a different section like "causes".

DocWock (talk) 20:10, 9 November 2019 (UTC)

Response to Peer Review

Thank you for your review, DocWock. Here, I will address your suggestions.

- The first citation in the article is labeled #3 and number #1 comes a sentence or two later.

I was confused by this as well but I discovered that Wikipedia uses the box on the right as the start of the article and starts numbering from there. The first citation in the lead is the third one after the citations within that box. For a reader that glances at the overview in the box first, the numbering would make sense. I could not find anything in the manual of style but I will check out other pages. I will try to find a workaround for this if it appears the citations in the lead should be numbered before the ones in the block.

- You discussed adding additional citations for the introduction and I'm seeing just one main one for most of the statements.

My first edit involved adding additional citations to this but they were changed back by DocJames who stated that it did not need additional citations. I decided to leave the citations as they were since the review article that is cited is one of the most up-to-date reviews on giardiasis. The source appears to be unbiased and reliable; I personally think it is okay for this page. I have rechecked the manual of style and I could not find anything that discusses repeat use of the same source. If anyone else has input on this, please write here on the talk page.

- The differential diagnosis section in the summary by the introduction is pretty minimal.

I agree that the differential diagnoses talked about in the article is limited. I think that a full differential diagnosis would provide the reader more information, but I have chosen to leave it out so that the article is focused more on the disease itself. I also preferred to not include it since my target audience is not a medical professional. I think that if a reader would like to find a differential diagnosis, they can click a link of a symptom (eg, diarrhea) which brings them to a page with an extensive list of causes.

- In the signs and symptoms section, second paragraph, first line, there is a citation in the middle of sentence. It may be a stylistic choice but I haven't seen that elsewhere before now.

I have rechecked the manual of style and they prefer citations to be as close to the information as possible so I will keep this as is.

- Under risk factors, the quote by the CDC could likely be summarized and supported by other sources rather than just quoting the whole long statement directly.

I will consider changing it for style.

- The pathophysio section is excellent. There are two lines at the end of the 3rd paragraph where the statements have no citation. The section might also be improved with an image if possible. For example, the life cycle of giardia if available.

I have been adding citations to this section as it was entirely uncited prior to editing. I have yet to find a source for this information. If I still cannot find it by the end of editing I think it would be reasonable to delete this information. I will look into adding an image.

- The prevention section is excellent as well. There are a few missing citations for statements in the 3rd paragraph.

I will try to find citations for this info.

- The epidemiology section is thorough. I see you are citing the last statement of the paragraph only. Other sections used the same citation for every line. It may a stylistic choice but it might be worthwhile to look around at other articles and see what they do with this type of citation.

This does appear to be a stylistic choice. To continue with the style of the article, I will change this.

- The "other animals" section is a little unorthodox title in terms of the manual style and may find itself better in a different section like "causes".

"Other Animals" is a section recommended in the manual of style. I will keep this since giardiasis can occur in other animals.

Thank you again, DocWock. I appreciate the review. Stevent99 (talk) 01:22, 13 November 2019 (UTC)