Materiały źródłowe

• #1 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  Giardiasis has a global distribution and it is a common cause of diarrhea in both children and adults and is transmitted via the fecal-oral route through direct or indirect ingestion of cysts. The laboratory diagnosis of Giardia spp. is mainly based on demonstration of microscopic cyst or trophozoite in stool samples but several immunological-based assays and molecular methods are also available for giardiasis diagnosis. […] The aim of this study was to conduct a review of the applied methods in medical laboratory and to highlight pitfalls and challenges of them for diagnosis of giardiasis. […] It has been concluded that traditional microscopy combination with stool concentration method should still be held in the routine medical laboratory due to economical and high sensitivity and immunological-based assay and molecular methods which are recommended to use as a complementary test to the traditional technique.

• #2 Giardiasis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/353

  Diagnosis is by detection of cysts or trophozoites in a stool sample or by molecular-based detection of antigens or parasite-specific nucleic acids. […] Microscopy with direct fluorescent antibody testing is the gold standard for diagnosing giardiasis. […] 1st investigations to order include direct fluorescence antibody (DFA) test, enzyme-linked immunosorbent assay, nucleic acid amplification test, polymerase chain reaction of stool sample, stool microscopy, and FBC. […] Investigations to consider include lateral flow immunoassay (e.g., ImmunoCard STAT!), duodenal aspirates and biopsies, and string test (EnteroTest).

• #3 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  Giardiasis has a global distribution and it is a common cause of diarrhea in both children and adults and is transmitted via the fecal-oral route through direct or indirect ingestion of cysts. The laboratory diagnosis of Giardia spp. is mainly based on demonstration of microscopic cyst or trophozoite in stool samples but several immunological-based assays and molecular methods are also available for giardiasis diagnosis. […] The aim of this study was to conduct a review of the applied methods in medical laboratory and to highlight pitfalls and challenges of them for diagnosis of giardiasis. […] It has been concluded that traditional microscopy combination with stool concentration method should still be held in the routine medical laboratory due to economical and high sensitivity and immunological-based assay and molecular methods which are recommended to use as a complementary test to the traditional technique.

• #4 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  The traditional basis of diagnosis is identifying Giardia intestinalis trophozoites or cysts in the stool of infected patients via a stool ova and parasite (OP) examination. However, in relatively more recent years, the advent of more objective techniques (eg, immunoassays, nucleic acid amplification techniques [NAATs]) has led to an increase in their use, rather than those that rely on subjective microscopic examination of fecal specimens for Giardia cysts. […] Stool examination may be performed on fresh specimens or after preservation with polyvinyl alcohol or 10% formalin (with appropriate staining). Ideally, three specimens from different days should be examined because of potential variations in fecal excretion of cysts. G intestinalis is identified in 50-70% of patients after a single stool examination and in more than 90% after three stool examinations.

• #5 Clinical Testing and Diagnosis for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/diagnosis-testing/index.html

  Healthcare providers can order laboratory tests to identify Giardia parasites in the stool of someone who is sick. […] Diagnostic laboratories can recommend one of several tests to confirm a giardiasis diagnosis. […] CDC recommends collecting three stool samples from patients over several days for accurate test results. […] Microscopy with direct fluorescent antibody testing (DFA) is the gold standard for diagnosing giardiasis. […] Finding Giardia in a patient’s stool confirms that they have a Giardia infection. […] Healthcare providers and laboratories should report laboratory-confirmed cases to their local or state health department.

• #6 Clinical Testing and Diagnosis for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/diagnosis-testing/index.html

  Healthcare providers can order laboratory tests to identify Giardia parasites in the stool of someone who is sick. […] Diagnostic laboratories can recommend one of several tests to confirm a giardiasis diagnosis. […] CDC recommends collecting three stool samples from patients over several days for accurate test results. […] Microscopy with direct fluorescent antibody testing (DFA) is the gold standard for diagnosing giardiasis. […] Finding Giardia in a patient’s stool confirms that they have a Giardia infection. […] Healthcare providers and laboratories should report laboratory-confirmed cases to their local or state health department.

• #7 Giardiasis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/353

  Diagnosis is by detection of cysts or trophozoites in a stool sample or by molecular-based detection of antigens or parasite-specific nucleic acids. […] Microscopy with direct fluorescent antibody testing is the gold standard for diagnosing giardiasis. […] 1st investigations to order include direct fluorescence antibody (DFA) test, enzyme-linked immunosorbent assay, nucleic acid amplification test, polymerase chain reaction of stool sample, stool microscopy, and FBC. […] Investigations to consider include lateral flow immunoassay (e.g., ImmunoCard STAT!), duodenal aspirates and biopsies, and string test (EnteroTest).

• #8 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  The traditional basis of diagnosis is identifying Giardia intestinalis trophozoites or cysts in the stool of infected patients via a stool ova and parasite (OP) examination. However, in relatively more recent years, the advent of more objective techniques (eg, immunoassays, nucleic acid amplification techniques [NAATs]) has led to an increase in their use, rather than those that rely on subjective microscopic examination of fecal specimens for Giardia cysts. […] Stool examination may be performed on fresh specimens or after preservation with polyvinyl alcohol or 10% formalin (with appropriate staining). Ideally, three specimens from different days should be examined because of potential variations in fecal excretion of cysts. G intestinalis is identified in 50-70% of patients after a single stool examination and in more than 90% after three stool examinations.

• #9 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  No imaging studies are required in the workup of giardiasis. […] Stool examination for trophozoites or cysts is the traditional method for diagnosing giardiasis. At least three stools taken at 2-day intervals should be examined for ova and parasites. […] Cysts are passed in soft and formed stools. Fresh stool can be mixed with an iodine solution or methylene blue and examined for cysts on a wet mount. […] Several tests to detect Giardia antigen in the stool are commercially available. These utilize either an immunofluorescent antibody (IFA) assay or a capture enzyme-linked immunosorbent assay (ELISA) against cyst or trophozoite antigens. […] Polymerase chain reaction (PCR) techniques may detect giardia in stool samples with parasites concentrations as low as 10 parasites/100 mcL. […] The string test (Entero-test) consists of a gelatin capsule containing a nylon string with a weight attached to it.

• #10 Testing and Diagnosis for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/testing/index.html

  Talk to a healthcare provider if you think you may be sick from Giardia. […] They may ask you for stool (poop) samples to check for Giardia. […] If you have Giardia in your poop, it means Giardia is likely making you sick. […] If you have diarrhea or other symptoms of a Giardia infection, talk to a healthcare provider about whether you should get tested. […] To see if Giardia is making you sick, a healthcare provider will ask you for one or more stool (poop) samples. […] They will send your samples to a laboratory to check if you have Giardia germs in your poop. […] If the laboratory finds Giardia in your poop, it means you have a Giardia infection. […] You may be asked to submit several stool samples collected over several days to see if you have a Giardia infection. […] The laboratory may need several samples because it can be difficult to detect Giardia in poop. […] Even if you have a Giardia infection, there may not be enough Giardia germs in every stool sample for the laboratory to find them. […] Additionally, people with Giardia infections do not pass Giardia germs every time they poop.

• #11 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  Stool OP testing aids in the diagnosis of giardiasis in 80-85% of patients. It remains the diagnostic method with which other tests are compared. […] Stool antigen enzyme-linked immunosorbent assays also are available. These tests are similar to the stool OP test in terms of cost and have a sensitivity of 88-98% and a specificity of 87-100%. […] If the results from three OP tests are negative and giardiasis is still suspected, stool antigen enzyme-linked immunosorbent assay (ELISA) may be helpful. […] Stool culture is not routinely used because of the difficulty of reproducibly isolating Giardia from patient fecal samples. […] Routine laboratory tests (eg, complete blood cell count, electrolyte levels) are often unremarkable. […] Because immunoglobulin G (IgG) levels remain elevated for long periods, they are not beneficial in making the diagnosis of acute giardiasis.

• #12 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  Correct diagnosis of giardiasis is important for treatment and prevention of diseases. The laboratory diagnosis of Giardia spp. is mainly based on finding and demonstration of microscopic cyst in stool samples, but immunological-based assay and molecular methods also are available and are used for diagnostic or research proposes in developed countries. […] Some methods that are accurate, cheap and relatively easy are required to routine laboratory diagnosis and for large-scale population screening. […] The microscopic identification of Giardia spp. in fecal samples is considered as the gold standard method for the diagnosis of giardiasis. […] The diagnosis of giardiasis in most cases is mainly confirmed by stool examination. […] Fecal concentration is a recommended and routine procedure that allows the detection of a small number of Giardia cysts may be missed by using wet mounts direct smear.

• #13 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  The formalin-ether concentration technique can be adopted and used as a routine method in medical diagnostic laboratories. […] In some cases of giardiasis that routine laboratory methods are unable to confirm infection, examination of fluids obtained from duodeno-jejunal by endoscopy or using string test (entro-test) may be useful for revealing the Giardia trophozoites. […] A variety of antibody and antigen detection methods have been developed and used for immunodiagnostic of giardiasis during the last three decades. […] Immunodiagnostic test for Giardia spp. diagnostic includes immunoassay techniques such as ELISA for antibody detection and methods dependent on detection of Giardia intestinalis antigens in human fecal specimens. […] The overall conclusion of them with some exceptions is that immunoassay is more sensitive than or as sensitive as, microscopy fecal examination.

• #14 SciELO Brazil – Diagnosis of Giardia infections by PCR-based methods in children of an endemic area Diagnosis of Giardia infections by PCR-based methods in children of an endemic area

  https://www.scielo.br/j/jvatitd/a/ccFKLrTHP4k9DWS6HPbTbLH/

  The present study was designed to estimate the prevalence of Giardia infection in preschool- and school-aged children living in an endemic area. […] Centrifugal flotation presented the highest diagnostic sensitivity for Giardia infections. […] The kappa index revealed that both coproparasitological techniques closely agreed on the Giardia diagnosis (86%) versus satisfactory (72%) and poor (35%) concordances for commensal protozoan and helminth infections, respectively. […] Concerning Giardia molecular diagnosis, from the 71 microscopy-positive samples, specific amplification of gdh and tpi fragments was noted in 68 (95.7%) and 64 (90%) samples, respectively. […] The centrifuge-flotation based method was the most suitable means of Giardia diagnosis assessed in the present study by combining accuracy and low cost.

• #15 SciELO Brazil – Diagnosis of Giardia infections by PCR-based methods in children of an endemic area Diagnosis of Giardia infections by PCR-based methods in children of an endemic area

  https://www.scielo.br/j/jvatitd/a/ccFKLrTHP4k9DWS6HPbTbLH/

  Despite the wide use of microscopic examination of stool in epidemiological surveys, the actual prevalence of Giardia infection may be underestimated in the communities. […] Recently, polymerase chain reaction (PCR)-based methods that present sensitivity better than or similar to microscopy for directly detecting Giardia in stool have also been described. […] Calculations revealed that centrifugal flotation provided the highest diagnostic sensitivity only for Giardia (P 0.01). […] The kappa Index revealed that coproparasitological techniques provided an excellent level of agreement in the diagnosis of Giardia (86%) but satisfactory (72%) and poor (35%) concordances for commensal protozoan and helminth infections, respectively. […] As to Giardia molecular diagnosis, out of the 71 microscopy-positive samples, specific amplification of gdh and tpi fragments was observed in 68 (95.7%) and 64 (90.0%) samples, respectively.

• #16 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  The formalin-ether concentration technique can be adopted and used as a routine method in medical diagnostic laboratories. […] In some cases of giardiasis that routine laboratory methods are unable to confirm infection, examination of fluids obtained from duodeno-jejunal by endoscopy or using string test (entro-test) may be useful for revealing the Giardia trophozoites. […] A variety of antibody and antigen detection methods have been developed and used for immunodiagnostic of giardiasis during the last three decades. […] Immunodiagnostic test for Giardia spp. diagnostic includes immunoassay techniques such as ELISA for antibody detection and methods dependent on detection of Giardia intestinalis antigens in human fecal specimens. […] The overall conclusion of them with some exceptions is that immunoassay is more sensitive than or as sensitive as, microscopy fecal examination.

• #17 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  The traditional basis of diagnosis is identifying Giardia intestinalis trophozoites or cysts in the stool of infected patients via a stool ova and parasite (OP) examination. However, in relatively more recent years, the advent of more objective techniques (eg, immunoassays, nucleic acid amplification techniques [NAATs]) has led to an increase in their use, rather than those that rely on subjective microscopic examination of fecal specimens for Giardia cysts. […] Stool examination may be performed on fresh specimens or after preservation with polyvinyl alcohol or 10% formalin (with appropriate staining). Ideally, three specimens from different days should be examined because of potential variations in fecal excretion of cysts. G intestinalis is identified in 50-70% of patients after a single stool examination and in more than 90% after three stool examinations.

• #18 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  Stool OP testing aids in the diagnosis of giardiasis in 80-85% of patients. It remains the diagnostic method with which other tests are compared. […] Stool antigen enzyme-linked immunosorbent assays also are available. These tests are similar to the stool OP test in terms of cost and have a sensitivity of 88-98% and a specificity of 87-100%. […] If the results from three OP tests are negative and giardiasis is still suspected, stool antigen enzyme-linked immunosorbent assay (ELISA) may be helpful. […] Stool culture is not routinely used because of the difficulty of reproducibly isolating Giardia from patient fecal samples. […] Routine laboratory tests (eg, complete blood cell count, electrolyte levels) are often unremarkable. […] Because immunoglobulin G (IgG) levels remain elevated for long periods, they are not beneficial in making the diagnosis of acute giardiasis.

• #19 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  No imaging studies are required in the workup of giardiasis. […] Stool examination for trophozoites or cysts is the traditional method for diagnosing giardiasis. At least three stools taken at 2-day intervals should be examined for ova and parasites. […] Cysts are passed in soft and formed stools. Fresh stool can be mixed with an iodine solution or methylene blue and examined for cysts on a wet mount. […] Several tests to detect Giardia antigen in the stool are commercially available. These utilize either an immunofluorescent antibody (IFA) assay or a capture enzyme-linked immunosorbent assay (ELISA) against cyst or trophozoite antigens. […] Polymerase chain reaction (PCR) techniques may detect giardia in stool samples with parasites concentrations as low as 10 parasites/100 mcL. […] The string test (Entero-test) consists of a gelatin capsule containing a nylon string with a weight attached to it.

• #20 Rapid on-site diagnosis of canine giardiosis: time versus performance | Parasites & Vectors | Full Text

  https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04422-6

  Infections by protozoans of the genus Giardia are a common cause of diarrhea in dogs. Canine giardiosis constitutes a disease with a zoonotic potential; however, it is often underestimated due to its challenging diagnosis. The objective of the study was to assess the diagnostic performance of an immunochromatographic strip test (SpeedTM Giardia, Virbac, France) comparing it with microscopy (zinc sulfate flotation) by utilizing the combination of an enzyme immunoassay (ProSpecT Giardia EZ Microplate Assay, Oxoid Ltd., UK) and the PCR as the gold standard. A positive result in both ELISA and PCR was set as the gold standard. […] The SpeedTM Giardia test is an easy-to-perform diagnostic method for the detection of Giardia spp., which can increase laboratory efficiency by reducing time and cost and decrease underdiagnosis of Giardia spp. infections. This immunochromatographic strip test may be routinely exploited when a rapid and reliable diagnosis is required, other diagnostic techniques are unavailable and microscopy expertise is inefficient. In negative dogs with compatible clinical signs of giardiosis, it is recommended either to repeat the exam or proceed with further ELISA and PCR testing.

• #21 Systematic Review of Diagnostic Approaches for Human Giardiasis: Unveiling Optimal Strategies

  https://www.mdpi.com/2075-4418/14/4/364

  While ELISAs boast commendable attributes, encompassing expeditiousness and sensitivity, they are not without noteworthy drawbacks, notably high costs and the imperative acquisition of supplementary equipment such as an ELISA reader. The immunochromatographic assays (ICAs) emerge as an alternative pathway, indicating a notable increase in their application in the field of immune methods. The realm of emerging molecular techniques, pivoting around the amplification of parasite DNA, prominently features the PCR technique. […] Reflecting on the data at hand, it becomes apparent that, concerning the diagnosis of giardiasis, the majority of published works gravitate towards microscopy, followed by PCR and subsequently ELISA. This hierarchy is intrinsically tied to the economic aspect; microscopic examination of stool samples stands out as the most cost-effective method.

• #22 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  No imaging studies are required in the workup of giardiasis. […] Stool examination for trophozoites or cysts is the traditional method for diagnosing giardiasis. At least three stools taken at 2-day intervals should be examined for ova and parasites. […] Cysts are passed in soft and formed stools. Fresh stool can be mixed with an iodine solution or methylene blue and examined for cysts on a wet mount. […] Several tests to detect Giardia antigen in the stool are commercially available. These utilize either an immunofluorescent antibody (IFA) assay or a capture enzyme-linked immunosorbent assay (ELISA) against cyst or trophozoite antigens. […] Polymerase chain reaction (PCR) techniques may detect giardia in stool samples with parasites concentrations as low as 10 parasites/100 mcL. […] The string test (Entero-test) consists of a gelatin capsule containing a nylon string with a weight attached to it.

• #23 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  The sensitivity and specificity of different kits for Giardia stool antigen detection were compared in Table1. […] Molecular diagnosis of giardiasis is not used in routine medical laboratories. […] Real-time PCR has been reported to be more sensitive and beneficial than Elisa and faecal microscopy for diagnosing G. intestinalis infection. […] Giardia spp. is one of the most common waterborne parasites that infected human. […] It is well known that no traditional or new methods can detect all cases of Giardia infection. […] Non-morphological diagnostic methods particularly immunoassay is recommended to detect coproantigen is recommended as a complementary test to the traditional technique and has been applied in larger laboratories that process a large number of stool samples daily.

• #24 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  The sensitivity and specificity of different kits for Giardia stool antigen detection were compared in Table1. […] Molecular diagnosis of giardiasis is not used in routine medical laboratories. […] Real-time PCR has been reported to be more sensitive and beneficial than Elisa and faecal microscopy for diagnosing G. intestinalis infection. […] Giardia spp. is one of the most common waterborne parasites that infected human. […] It is well known that no traditional or new methods can detect all cases of Giardia infection. […] Non-morphological diagnostic methods particularly immunoassay is recommended to detect coproantigen is recommended as a complementary test to the traditional technique and has been applied in larger laboratories that process a large number of stool samples daily.

• #25 Systematic Review of Diagnostic Approaches for Human Giardiasis: Unveiling Optimal Strategies

  https://www.mdpi.com/2075-4418/14/4/364

  While ELISAs boast commendable attributes, encompassing expeditiousness and sensitivity, they are not without noteworthy drawbacks, notably high costs and the imperative acquisition of supplementary equipment such as an ELISA reader. The immunochromatographic assays (ICAs) emerge as an alternative pathway, indicating a notable increase in their application in the field of immune methods. The realm of emerging molecular techniques, pivoting around the amplification of parasite DNA, prominently features the PCR technique. […] Reflecting on the data at hand, it becomes apparent that, concerning the diagnosis of giardiasis, the majority of published works gravitate towards microscopy, followed by PCR and subsequently ELISA. This hierarchy is intrinsically tied to the economic aspect; microscopic examination of stool samples stands out as the most cost-effective method.

• #26 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  No imaging studies are required in the workup of giardiasis. […] Stool examination for trophozoites or cysts is the traditional method for diagnosing giardiasis. At least three stools taken at 2-day intervals should be examined for ova and parasites. […] Cysts are passed in soft and formed stools. Fresh stool can be mixed with an iodine solution or methylene blue and examined for cysts on a wet mount. […] Several tests to detect Giardia antigen in the stool are commercially available. These utilize either an immunofluorescent antibody (IFA) assay or a capture enzyme-linked immunosorbent assay (ELISA) against cyst or trophozoite antigens. […] Polymerase chain reaction (PCR) techniques may detect giardia in stool samples with parasites concentrations as low as 10 parasites/100 mcL. […] The string test (Entero-test) consists of a gelatin capsule containing a nylon string with a weight attached to it.

• #27 Giardiasis Symptoms, Treatment, Diagnosis & Cause

  https://www.emedicinehealth.com/giardiasis/article_em.htm

  Another method of diagnosis that is commonly used as a screening tool in outbreaks or in day care centers is antigen assay of stool. This method detects a certain protein found in the wall of Giardia lamblia. A stool sample is mixed with a solution that detects the cysts in the stool. […] The string test involves swallowing a fuzzy string enclosed in a gelatin capsule. The free end of the string is taped to the person’s cheek. Once swallowed, the string collects secretions and mucus from the small bowel. Four hours later the string is pulled back out and examined for organisms. […] This is the most invasive method of diagnosis. After the passage of a small tube (endoscope) through the person’s mouth and stomach into the small bowel, the doctor removes a small amount of tissue for examination. This method is reserved for difficult cases in which the cause of diarrhea cannot be determined using other methods. It allows for visualization of all abnormalities of the small intestine, which may cause diarrhea including giardiasis.

• #28 Giardiasis Workup: Approach Considerations, Stool Examination, Stool Antigen Detection

  https://emedicine.medscape.com/article/176718-workup

  Esophagogastroduodenoscopy (EGD) may be employed in patients in whom the diagnosis is suspected but unproven after stool microscopy and ELISA. […] Biopsy can also be used to visualize changes in histologic features. Intestinal biopsy shows flattened, mild lymphocytic infiltration and trophozoites on the surface. […] No classic universal histologic abnormalities result from infection with G intestinalis.

• #29 Giardiasis: What It Is, Symptoms, Treatments & Medications

  https://my.clevelandclinic.org/health/diseases/15238-giardiasis

  A healthcare provider can diagnose giardiasis by testing a sample of your poop for evidence of Giardia. This might take a few tries because you might pass the cysts in your poop one day but not the next. […] Healthcare providers often prescribe medications to treat giardiasis based on your symptoms alone, without needing to diagnose it first.

• #30 Testing and Diagnosis for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/testing/index.html

  Talk to a healthcare provider if you think you may be sick from Giardia. […] They may ask you for stool (poop) samples to check for Giardia. […] If you have Giardia in your poop, it means Giardia is likely making you sick. […] If you have diarrhea or other symptoms of a Giardia infection, talk to a healthcare provider about whether you should get tested. […] To see if Giardia is making you sick, a healthcare provider will ask you for one or more stool (poop) samples. […] They will send your samples to a laboratory to check if you have Giardia germs in your poop. […] If the laboratory finds Giardia in your poop, it means you have a Giardia infection. […] You may be asked to submit several stool samples collected over several days to see if you have a Giardia infection. […] The laboratory may need several samples because it can be difficult to detect Giardia in poop. […] Even if you have a Giardia infection, there may not be enough Giardia germs in every stool sample for the laboratory to find them. […] Additionally, people with Giardia infections do not pass Giardia germs every time they poop.

• #31

• #32 Understanding Giardiasis in Dogs: Diagnosis and Monitoring Guide

  https://battlab.com/giardiasis-dogs-diagnosis-monitoring/

  Giardia infection is commonly misdiagnosed or underdiagnosed because of non-specific clinical signs (common to many other infectious and non-infectious intestinal disorders), its intermittent shedding and difficulty identifying cysts/trophozoites. […] The diagnostic tests commonly performed to diagnose Giardiasis are described below and can be used alone or in combination: […] Direct faecal smear this procedure is used primarily for detection of trophozoites in diarrheic stools. […] Faecal flotation with centrifugation technique this method is used primarily for detection of cysts. […] Faecal ELISA testing this is an assay aiming to identify Giardia antigen within faeces. […] Faecal PCR testing this technique can also be used to amplify Giardia species DNA in faeces, but it is not routinely performed.

• #33 Giardiasis: a diagnosis that should be considered regardless of the setting | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/giardiasis-a-diagnosis-that-should-be-considered-regardless-of-the-setting/DAF07AA78BBF889F98747918F5E10C2F

  These scattered reports underline the need to enhance efforts to provide education among general practitioners and pediatricians to be aware of Giardia as a cause of indigenous cases of diarrhoea and on how best to diagnose and effectively treat them. […] If Giardia is suspected, the right specimen and specific tests must be ordered and sent to a laboratory where adequate diagnostic tools and skills are available. […] For laboratory diagnosis, a morphological determination by microscopy is the most commonly used method, which is simple and fast. […] Unfortunately, it is less sensitive, requires multiple sample examinations and concentration procedures and needs to be performed by well-trained technicians. […] The discovery of Giardia as the cause of a large waterborne outbreak in Bergen, Norway was delayed due to no history of travel abroad among the many patients seeking medical care for diarrhoeal disease.

• #34 Giardiasis: a diagnosis that should be considered regardless of the setting | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/giardiasis-a-diagnosis-that-should-be-considered-regardless-of-the-setting/DAF07AA78BBF889F98747918F5E10C2F

  There are important reasons to pay attention to under-diagnosis of Giardia infection. […] This infection may also be accompanied with or without malabsorption, abdominal cramps, nausea, vomiting, increased flatulence and weight loss. […] The changing perspectives of the incidence and prevalence of giardiasis in industrialised countries, where it is still relatively neglected and underappreciated by practicing clinicians and maybe by caregivers, need to be taken into account. […] Giardiasis may exceed the current prevalence estimates. […] This protozoan disease, as well as other enteric parasites, should be considered more often in the differential diagnosis.

• #35 Giardiasis (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/giardiasis.html

  Doctors confirm the diagnosis of giardiasis by having stool samples checked for Giardia parasites. […] Sometimes it is hard to find the giardia in one sample, so doctors may send more than one to the lab.

• #36

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Giardia-Lamblia-Infections.aspx

  A stool sample from your child will be examined for the presence of Giardia Intestinalis. […] If your child has Giardia organisms in the stool but does not have symptoms, no treatment is needed.

• #37 Giardia lamblia infection: review of current diagnostic strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6441489/

  The formalin-ether concentration technique can be adopted and used as a routine method in medical diagnostic laboratories. […] In some cases of giardiasis that routine laboratory methods are unable to confirm infection, examination of fluids obtained from duodeno-jejunal by endoscopy or using string test (entro-test) may be useful for revealing the Giardia trophozoites. […] A variety of antibody and antigen detection methods have been developed and used for immunodiagnostic of giardiasis during the last three decades. […] Immunodiagnostic test for Giardia spp. diagnostic includes immunoassay techniques such as ELISA for antibody detection and methods dependent on detection of Giardia intestinalis antigens in human fecal specimens. […] The overall conclusion of them with some exceptions is that immunoassay is more sensitive than or as sensitive as, microscopy fecal examination.

• #38 Understanding Giardiasis in Dogs: Diagnosis and Monitoring Guide

  https://battlab.com/giardiasis-dogs-diagnosis-monitoring/

  According to the European Scientific Counsel Companion Animal Parasites, follow up testing should be carried out preferably with direct smear or faecal flotation test, approximately 5 days after treatment ends. […] ELISA tests may remain positive even after treatment for variable periods of time and should not be used as a guide to determine reinfection or failure of treatment. […] Treatment of asymptomatic dogs that shed Giardia cysts and of cats in general has been controversial and may not be recommended in most cases. […] Exceptions, where treatment of asymptomatic infected dogs may be considered include high risk environments like kennels, catteries or with breeders, particularly with a high incidence of diarrhoea in puppies, or where there are small children or immunocompromised humans.

• #39 Giardia infection (giardiasis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giardia-infection/diagnosis-treatment/drc-20372790

  To help diagnose giardia infection (giardiasis), your doctor is likely to test a sample of your stool. For accuracy, you may be asked to submit several stool samples collected over a period of days. The samples are then examined in a lab for the presence of parasites. Stool tests may also be used to monitor the effectiveness of any treatment you receive.

• #40 Understanding Giardiasis in Dogs: Diagnosis and Monitoring Guide

  https://battlab.com/giardiasis-dogs-diagnosis-monitoring/

  According to the European Scientific Counsel Companion Animal Parasites, follow up testing should be carried out preferably with direct smear or faecal flotation test, approximately 5 days after treatment ends. […] ELISA tests may remain positive even after treatment for variable periods of time and should not be used as a guide to determine reinfection or failure of treatment. […] Treatment of asymptomatic dogs that shed Giardia cysts and of cats in general has been controversial and may not be recommended in most cases. […] Exceptions, where treatment of asymptomatic infected dogs may be considered include high risk environments like kennels, catteries or with breeders, particularly with a high incidence of diarrhoea in puppies, or where there are small children or immunocompromised humans.

• #41 Understanding Giardiasis in Dogs: Diagnosis and Monitoring Guide

  https://battlab.com/giardiasis-dogs-diagnosis-monitoring/

  According to the European Scientific Counsel Companion Animal Parasites, follow up testing should be carried out preferably with direct smear or faecal flotation test, approximately 5 days after treatment ends. […] ELISA tests may remain positive even after treatment for variable periods of time and should not be used as a guide to determine reinfection or failure of treatment. […] Treatment of asymptomatic dogs that shed Giardia cysts and of cats in general has been controversial and may not be recommended in most cases. […] Exceptions, where treatment of asymptomatic infected dogs may be considered include high risk environments like kennels, catteries or with breeders, particularly with a high incidence of diarrhoea in puppies, or where there are small children or immunocompromised humans.

• #42 Clinical Testing and Diagnosis for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/diagnosis-testing/index.html

  Healthcare providers can order laboratory tests to identify Giardia parasites in the stool of someone who is sick. […] Diagnostic laboratories can recommend one of several tests to confirm a giardiasis diagnosis. […] CDC recommends collecting three stool samples from patients over several days for accurate test results. […] Microscopy with direct fluorescent antibody testing (DFA) is the gold standard for diagnosing giardiasis. […] Finding Giardia in a patient’s stool confirms that they have a Giardia infection. […] Healthcare providers and laboratories should report laboratory-confirmed cases to their local or state health department.

• #43 Giardiasis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/353

  Diagnosis is by detection of cysts or trophozoites in a stool sample or by molecular-based detection of antigens or parasite-specific nucleic acids. […] Microscopy with direct fluorescent antibody testing is the gold standard for diagnosing giardiasis. […] 1st investigations to order include direct fluorescence antibody (DFA) test, enzyme-linked immunosorbent assay, nucleic acid amplification test, polymerase chain reaction of stool sample, stool microscopy, and FBC. […] Investigations to consider include lateral flow immunoassay (e.g., ImmunoCard STAT!), duodenal aspirates and biopsies, and string test (EnteroTest).

• #44 Systematic Review of Diagnostic Approaches for Human Giardiasis: Unveiling Optimal Strategies

  https://www.mdpi.com/2075-4418/14/4/364

  Hence, derived from the outcomes delineated in this study, the adoption of microscopic concentration methods is recommended as the primary modality within clinical settings, given its manifold advantages. In instances where a negative result persists amid indicative symptoms, the implementation of the ELISA method is warranted, given its heightened sensitivity. Notably, the utilization of PCR would be more judicious in characterizing resilient species and strains, albeit hindered by its elevated cost.

• #45 Systematic Review of Diagnostic Approaches for Human Giardiasis: Unveiling Optimal Strategies

  https://www.mdpi.com/2075-4418/14/4/364

  Hence, derived from the outcomes delineated in this study, the adoption of microscopic concentration methods is recommended as the primary modality within clinical settings, given its manifold advantages. In instances where a negative result persists amid indicative symptoms, the implementation of the ELISA method is warranted, given its heightened sensitivity. Notably, the utilization of PCR would be more judicious in characterizing resilient species and strains, albeit hindered by its elevated cost.

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