Causes of Giardiasis

Giardii - so doctors call a type of parasites, which are known to many as lamblia. They are the causative agents of the disease. The causes of giardiasis and the ways of its transmission are what most respondents are interested in.

After all, only knowing the cause and the source of infection, you can protect yourself and your loved ones, and in case of infection and fight the disease.

[1], [2], [3], [4], [5], [6]

Life cycle of Giardia

In the human body, lamblia cysts are ingested orally (through the oral cavity), then they pass through the esophagus to the duodenum, where they undergo a procedure of vegetative, asexual, division. It is here that the individual passes into its mobile phase, called trophozoite. In the area of the small intestine, parasites are fixed on villi of its mucous layer, there they feed on substances obtained during the breakdown of human food.

During the period of entering the large intestine, the life cycle of the lamblia is completed and begins again: the giardias from active organisms pass into passive, immobile forms - they again become cysts. The large intestine is an unfavorable environment for lamblia, so they "dress" in the shell, which is its protection. Hence they, together with the calves, come out of the patient's body and are ready to infect others again. The life cycle of lamblia is closed. Together with the feces, up to nine hundred million cysts are prepared, ready for infection, whereas 10 to 100 cysts are enough to lamblias have settled in the intestine of a healthy person. At the same time, their high vital activity can be preserved, in a conserved form, for a whole year, calmly transferring low (or high) temperatures, drying out. Only cysts are able to survive in such conditions, the trophozoites, released together with the calves, die in this climate.

How is Giardia transmitted?

Passing in the large intestine into the phase of cysts, Giardia together with feces are removed from the sick person. Getting into the environment, giardias are again ready to infect animals or other people. To protect yourself and your loved ones, you need to know how lamblia is transmitted to a healthy body. Doctors and epidemiologists voice three main ways of infection: contact-household, through food and through liquid.

• Giardii can enter the body of an adult and a child together with unwashed or poorly washed vegetables or fruits.
• The cause of lambliasis may be poorly purified tap water or washed fruits and vegetables.
• Bathing in the water (especially this applies to standing water): a resting person involuntarily swallows water in the process of swimming or diving.
• You can get infected and household by means of common objects: kitchen utensils, bed-clothes, bathroom accessories, children's toys.
• The cause of infection can become and bad habits, especially such as an involuntary desire: gnaw nails, pencils, other objects. In almost 100 cases of a hundred such amateurs are diagnosed with lambliasis.
• Single, but still there are cases of infection with cysts of newborns, which they received from their mothers.
• Despite the usually low temperature of the spring waters, this organism feels fine also there. Having drunk such water, a person "lets" into his organism the pathogenic flora.
• A small man can acquire these parasites during a contact game with his peers who are already carriers of giardiasis.
• It does not pass without the communication with our lesser brothers. This applies to pets, especially if they are on the street.

How do you get lamblia?

It turns out that lamblia in its active phase (in the form of trophozoite) is not contagious, because it is not able to survive in adverse conditions of the intestine of a person (or animal) and the environment. You can get infected only by cysts, inactive form of lamblia, this phase of lamblia is invasive. How do you get lamblia? Invasion occurs either directly from a sick person to a healthy, directly contact-household way, or through dirty unwashed hands, people who neglect basic rules of personal hygiene.

It should be noted that the main owners of parasites are animals: cats, dogs, mice, deer and others. The person, mainly, "catches this infection" from domestic and wild cats, which are home and mobile peddler of parasites.

That is, if we summarize the available information, the main sources and spreaders of the parasitic microflora, called lamblia, is the infected person and the sick animal.

The size of this parasite is more than modest and it is almost impossible to see it with the naked eye. Parameters of lamblia 18 per 10 microns (length and width of the parasite), this individual has four pairs of antennae.

How do you get lamblia? This question is easy to answer, in the human body, parasites get orally, that is, through the mouth. But the way this happens depends on the environment in which the parasite is found.

Microorganisms can get to a person with a liquid:

• It can be poor quality, poorly purified drinking water.
• Bathed in an open reservoir you can involuntarily take a little water. Especially the risk of catching lambliasis in standing, non-current water is particularly high. It should also be noted that giardias do not live in salt water, they are able to continue their life cycle and remain parasitically active only in fresh water.

With food:

• Unwashed or washed with low-quality water, vegetables and fruits.
• Unwashed eggshell.
• Raw meat or fish. Products have undergone insufficient heat treatment.

Contact path of infection with Giardiasis:

• Through unwashed hands.
• Contaminated items.
• Poorly washed kitchen utensils.
• Bed linen and bath accessories.
• Use of personal hygiene items of another person.
• The habit of gnawing nails, other objects and just taking them in your mouth. This contingent has the highest percentage of infection with Giardia, it is almost equal to one hundred percent.

Cysts of lamblia

This is an inactive, immobile phase of lamblia, but it allows the parasite to maintain its viability in difficult environmental conditions. Cysts of lamblia have an oval, slightly pear-shaped shape. Geometric parameters of the specimen can vary: along the length from 10 to 16 microns, in width from 6 to 10 microns. The vegetative form of the parasitizing microorganism is localized, mainly in the small intestine, duodenum, urinary bladder, urinary tract. But after the parasite descends into the large intestine, it is transformed into cysts - microorganisms are covered with a kind of cocoon-shell, which protects them from the difficult conditions of the colon and the environment. It is the cysts that are released from the infected organism along with the calves into the environment. When the cyst is again in the living organism, reaching the stomach, its membrane dissolves and the lamblia passes into another vegetative stage.

Cysts of the immature stage have two nuclei, which are located together with a spiraling folded flagellate apparatus in the cytoplasm, while the "matured" parasite owns four nuclei. With a visual inspection of the microorganism through the microscope, its coating is perfectly visible, it has a clear limiting contour dividing it with protoplasm, which is a distinctive feature of this type of parasite from other simple intestinal microorganisms.

The stage of cysts is endowed with distributive functions. In a humid environment, under unfavorable climatic conditions, individuals in this form are not able to lose their viability for two to two and a half months. In the waters of the lake and aqueduct, lamblia cysts can survive from a month to three if the temperature varies from 4 to 20 ° C. In the hot summer period, this parasite does not die in wastewater until three to four months. On the surface of food, these microorganisms can live for several hours, and in the case of a humid environment, then up to several days. To chlorine, which is used for cleaning and disinfection of drinking water, lamblia are absolutely unresponsive. In this case, the thermal treatment of the product can solve this problem, because the parasite is already killed at a temperature of 55 ° C.

[7]

Cysts of lamblia in feces

Diagnosis of Giardiasis includes the analysis of feces and a clinical study of blood. This is how you can find antigens or cysts of lamblia in the feces, and antibodies in the human blood plasma.

In the feces of the study to find the vegetative form of lamblia is problematic enough, here you can find only cysts. In this case, cystogenesis is represented by two periods: the maturation period, which can last up to two weeks and the time of maximum activity. It is difficult to detect giardia in a dense fecal mass, it is not easy to find them in warm feces, since the lamblias vegetative form does not survive in such an environment, passing into cysts. Diuretics, effective diuretics, can increase the chances of finding lambliasis. Their reception stimulates intestinal peristalsis, which contributes to an increase in the probability of detection of the parasite. If there is a suspicion of infection, physicians, usually for confirmation, are assigned two analyzes, especially in the case of diarrhea.

Increase the detection capabilities with a special medical device Paraser, which concentrates parasitic microorganisms. The principle of its operation is quite simple. A formalin-ether mixture is introduced into a special small container (test tube). Sterile spatula take a little feces for analysis, enough volumes with a pea. The container is screwed with a lid and the contents are well mixed. In this state, the sample can be stored at room temperature throughout the day, but no more. The tube is then placed in a medical centrifuge and scrolled at high speed (about 3000 rpm). Centrifugal forces cause the cysts to pass through the filter and accumulate at the bottom of the tube, in a conical compartment. The concentration of microorganisms is most maximal in the upper layers of fine-dispersed deposits.

[8], [9], [10], [11], [12], [13]

Whether ljamblii are dangerous?

Almost a third of the world's population are carriers of such a parasite as lamblia, and do not even know about it. This microorganism "chose" for life the small intestine of man and animal (namely animals, mainly, representatives of the family of felines are the main masters of this parasite). Getting into the human body, Giardia does not cause him any discomfort. Hence a natural question emerges: Are lamblia dangerous? Physicians answer him unequivocally. If the body of an adult human or child has a sufficiently high immune defense, then the body of a patient who has been subjected to aggression from harmful microorganisms is able to cope independently with the aggressor.

The only officially registered disease associated with lamblias, doctors diagnosed as pathological changes to which the duodenum is exposed. It is called lambliosis enteritis. In most cases, this disease passes by itself. If the immune system is weakened and unable to respond adequately to aggression, the colonization of the organism of a patient with a pathogenic flora can lead to intoxication.

In rare cases, giardiasis can cause chronic enteritis. This disease is expressed in a constant sluggish process of inflammation, which is localized in the small intestine. Ultimately, this development of the disease leads to complete or partial atrophy of the intestinal mucosa. In this case, the affected part can be subjected to such parts: duodenum (inflammatory process in this area is called duodenitis), ileum (ileitis) or small intestine (jejunitis). But nevertheless, mainly the inflammation captures the entire intestinal mucosa, therefore colitis or gastritis can also join it.

Types of lamblia

Physicians distinguish two periods of the development cycle of lamblia: immobile or cysts, and mobile or stage of vegetative existence. Active and inactive species of Giardia and form a complete life cycle of the parasite.

The first stage - motionless - is called a cyst. During this period, the individual has parameters about 12 μm in length and 9 μm in width. Due to its protective shell, the parasite is able to transfer without any consequences the complex climatic and biochemical features of the intestinal biome and the environment. Under this shell is still completely unformed trophozoite. It is in this form that lamblia stands out from the affected organism and waits for a convenient opportunity to get into the healthy organism of the "new owner". That is, it is thanks to the cysts that the microorganism is able to spread and infect all large areas.

Trophozoite is an active, vegetative phase in the development of Giardia. After hitting the cyst in the stomach, under the influence of gastric secretion, the membrane splits. The updated individual passes into the active phase. During this period it has a pear-shaped shape and dimensions are slightly larger than in the cyst period. It is in this form that giardiasis causes maximum damage to the body. Giardii move, actively eating the products of food decay, while they are able to disrupt the cellular structure of the intestinal mucosa. As a result of their activities: there is a malfunction in the intestine, signs of dysbiosis appear, the probability of penetration of pathogenic microflora increases. In this form they grow and pass a period of direct division (most of this process occurs in the duodenum). The life cycle is defined by several divisions.

Intestinal lamblia

Giardia intestinalis - this Latin name denotes lamblia intestinal - a type of flagellate protozoa, which are the causative agents of a parasitic disease affecting the human intestine, many birds and other mammals. This kind of parasites is also called Lamblia intestinalis, Giardia lamblia or Giardia duodenalis.

This simplest parasite is called a traveler's diarrhea, as it is found by about five percent of people returning from a tourist trip, especially after visiting countries in the tropical zone. Depending on the biophysical characteristics of the organism of the infected person, the disease can be asymptomatic in one case, whereas in another manifestation may be so significant that a severe form of diarrhea with malabsorption is observed.

"Accommodation" of this parasite is so extensive that it is difficult to specify a place on the Earth, where its cysts were not found. In some areas, the defeat of the population by this parasite, especially small children (up to five years), is close to one hundred percent. Giardii, under various conditions of defeat and the level of the human immune system, are able to display such symptoms:

• Refractory diarrhea or its acute form of manifestation.
• Metiorism, accompanied by rumbling sounds in the intestines.
• Malabsorption, manifested by a watery stool.
• Spasmodic pain symptoms in the abdomen.

But in the vast majority of cases the disease is completely asymptomatic. This makes it very difficult to diagnose.

Hepatic lamblia

Giardiasis is a very often diagnosed protozoal pathology. Lumblius liver, often does not show any symptoms, but in case of detection always indicates the presence of lambliasis.

Symptoms of lamblia in the liver:

• Belching.
• Bloating and unpleasant sound cacophony in the intestine.
• There is a worsening of appetite.
• Constant raid on the tongue.
• Diarrhea alternates with pinching the stool.
• When palpation, there are increased liver parameters.
• Systematic pain symptoms in the navel and lower abdomen.
• Feeling of heaviness and fullness of the stomach.
• Pain under the right rib.
• Very rarely, but there may be a sharp drop in blood pressure (hypotonic crisis).
• Prescience, fainting.
• Heart rate failure.

With the transition of the disease to the chronic stage, almost all patients are characterized by increased pallor of the skin. The skin on the soles and palms, on the contrary, acquires a red - terracotta shade. As the disease progresses, the color begins to approach pink, the epidermis loses moisture, showing the dryness of the skin. The patient begins to lose weight, there are signs of an allergic reaction (hives, itching, rashes). If chronic giardiasis affects the baby, it can have more global consequences: the child begins to lag behind in development.

How to identify lamblia?

This parasitic infectious disease is often diagnosed in both adults and children. The defeat of young children (up to the age of five) sometimes reaches a figure of more than 72%. In order to understand how to identify lamblia, it is necessary to know that the lamblia in the form of cysts are excreted from the body of a sick person mainly with caloric masses. After getting into the external environment, the parasite does not lose its ability to infect up to 70 days. This parameter depends on the climate surrounding the cyst. It is necessary to know the main symptoms of this disease. Complexity can arise in the event that the lesion passes without the appearance of special symptoms, which predominantly occurs.

But it is worthwhile still to understand what uncomfortable phenomena should make a person go to a doctor for a test for the presence of lambliasis. A person affected by giardias can experience nausea, painful spasms in the abdomen, problems with stools: diarrhea followed by fixation of fecal masses. Small patients suffer from endemic colic. This symptomatology is inherent in a fairly large range of diseases associated with pathological lesions of the gastrointestinal tract. In this case, only a certified doctor is able to make the correct diagnosis, to which one should make an appointment at the appearance of the discomfort described above.

The first thing a specialist does is send the patient to a stool test. Before the study, it is necessary to adhere strictly to the advice given by the doctor. Because of the specific features of the life cycle of lamblia, this study can not be unequivocally indicative, and in the presence of a parasite in the body, analysis of this may not show. Therefore, if there are suspicions, the doctor prescribes a second test and additional tests.

In parallel with the study of stool mass, serological testing of blood is prescribed. This requires some preliminary preparation, recommendations on which the doctor will give.

Another test for lamblia is bile testing. This technique of research is technically more complex, therefore it is prescribed less often than previous studies. If necessary, a biopsy of the intestine is also performed. All this in a complex gives an opportunity to put the correct diagnosis.

Antibodies to lamblia

In addition to feces, the patient's blood comes from the finger or vein. For this analysis, this does not matter. To find antibodies to lamblia IgA, IgM, IgG, an enzyme immunoassay is used, for which 20 microliters of serum are sufficient (for comparison, one drop of blood has a volume of approximately 50 microliters). Initially, a negative control is taken and the optical density of the diagnosis (ODP) is calculated by its value. In a situation, if the obtained value is greater than OPD, we can speak about a positive response to the presence of giardiasis. In this case, in order to avoid an error, a second analysis is carried out. The ratio of the result figure to the higher index is called the coefficient of positivity (K poses). This coefficient is a controlled parameter in the process of therapeutic therapy.

• In the case of hit K poses in a range of values from 0.85 * OPD to 1 * OPD - this answer is considered doubtful and implies a re-examination after three weeks. Such a result can be obtained if the antibodies only increase their quantitative component, they lose the previous amount, or the effect of any medications is observed.
• If the K of the poses is diagnosed less than 0.85 * OPD, then they speak of a negative result of the study.

It is worth noting that the cellular and humoral (or with the help of antibodies) immunity in the patient after recovery can still be observed for two months to six months. This indicator depends on the condition of the patient's organism and the conditions of his residence. Repeated infection can occur after the "strength" of antibodies runs out. People with a history of a shortage of gamma globulin (hypogammaglobulinemia) or a decrease in the immunoglobulin A index are at greater risk of injury. Such a contingent of patients has a high chance of acquiring a lambliasis of a chronic nature.

[14], [15], [16], [17], [18], [19]

Titer of antibodies to lamblia

An innovative study, a test used in the qualitative diagnosis of giardia in the patient's body, and, subsequently, monitoring the effectiveness of treatment - a titer of antibodies to lamblia. It is believed that this parasite is a provoking factor of more than twenty percent of acute intestinal diseases. The incubation time of Giardia from the moment of defeat can be from one to three weeks.

Most patients have the disease in a latent form, that is, without showing any symptoms. Clinically pronounced symptomatology divides the disease into two stages of percolation. The acute form of the disease has a length of five to seven days, it is able, in consequence, to go into a chronic condition. Usually such a turn of events is inherent in the case of infants of preschool age. There is a relapse of the lesion.

It is rather difficult to diagnose giardiasis. Traditionally, they are trying to detect them by analyzing the stool or the patient's blood. The titre of antibodies to lamblia is indicated for use:

• There are suspicions of the defeat of the human body by parasitizing microorganisms, in particular, lamblia.
• If small patients suffer from frequent allergic reactions, dermatological diseases, gastroduodenitis.
• The titer is used as a control measure of the effectiveness of treatment.
• The epidemiological nature of the study.

To minimize the collateral effect of other factors on the result of the study, it is necessary to adhere to certain preparatory rules.

• Before the blood test for lamblia is better not to eat anything, you can drink only plain water.
• The day before the study it is recommended to exclude or at least reduce the amount of consumed fried and fatty foods.
• One day before the event, you can not drink alcoholic beverages.
• Exclude heavy physical activity.

The outcome of the study can be affected by such factors:

• Hemolysis of the sample, the presence in the blood of an invasive patient with chiles.
• Treatment therapy, the proposed use of immunosuppressants or cytotoxic drugs.
• Carrying out or the consequence of radiotherapy.

How to evaluate the test results?

• If the title shows a result below the figure 1/100 - the test for giardiasis is negative.
• If the title shows a result of 1/100 or higher - a test for giardiasis is positive.

If a positive test result is obtained, this indicates that the patient is infected with Giardiasis right now or was in the recent past.

If the result of the test is negative - this indicates the absence of infection or in the case of seronegative patients.

Lamblia antigen

This study is conducted to quickly test the patient's stool for the detection of Giardia lamblia (Lamblia intestinalis). The positive response of immunochromatographic and immunoenzymatic studies for the presence of lambliasis antigen, which are mainly used recently, indicates the presence of giardiasis in the body. This analysis has a fairly high level of sensitivity, which is about 96%. It is enough to have in the samples 10 - 15 individuals of the parasite, so that the test system gives a positive response.

This technique not only allows detecting lamblia cysts in the patient's blood serum, but also dividing them into specific antibodies of different classes.

• Class IgM antigen lamblia appears in the serum of the affected organism for the tenth - fourteenth day after infection and is an indicator of the disease.
• In a consequence, IgG antibodies that are present in the plasma throughout the duration of the disease begin to be diagnosed. After passing an effective course of treatment, antibodies of this class are observed in the blood for another one to two months after the end of therapy. After two to six months, IgG antibodies completely disappear.
• Antimandiblous secretory antibodies of IgA class play not the least role in suppression and elimination of giardias, intestinal sanitation. It has been confirmed that patients with cellular immunodeficiency suffer the most from a pathological lesion than those who have a history of elective insufficiency of IgA.

What do lamblia look like?

Before you become more familiar with the structure of giardia, it is necessary to remember that the life cycle of a given parasite is divided into two periods of its existence: vegetative and cysts. In each of these periods the structure of lamblia has its own peculiarities. What does lamblia look like in each of these periods?

The vegetative active period of development is represented by trophozoites, which in their outline resemble a small pear. Inside this outline, two nuclei are clearly seen present, which in combination with the parabasal body of the simplest resemble an amusing little face. The parasite is equipped with eight flagella located on its pear-shaped "head". It is with the help of them that he moves. The food occurs through the entire surface by diffusion. Reproduction obeys the laws of the simplest division of the mother cell into two daughter cells.

Now let's see what the lamblia look like, which are in the fixed stage of cysts. The form of this period is somewhat modified and approaches the oval. The parameters of the cyst are somewhat smaller than its size in the trophozoite form and, unlike the latter, they show complete immobility. A fairly thick shell is designed to protect the more vulnerable inner contents of the cyst from an unfavorable environment. "Shell" is somewhat lagging behind the content - and this is what makes it possible to distinguish lamblia from other protozoa. In contrast to the two nuclear trophozoites, the cyst has four cores and has a suction apparatus, as well as a basal body.

Whether ljamblii are treated?

Giardiasis is an unpleasant but not fatal disease. However, this does not mean that it is not necessary to quash the problem. So are lamblia treated? Medical therapy is not used immediately. Preliminary need to clean and prepare the body for anti-protozoal treatment, since antilejalic agents can provoke acute anaphylactic and toxic responses from the body. It is possible to obtain intensification of clinical manifestations of the disease.

Not the last factor in the period of antiprotozoal therapy is nutrition. Failure to do so may result in recurrence of the Giardiasis immediately after the end of the treatment course.

Primarily it is necessary to determine the products that are not recommended for use during treatment:

• Foods with a high content of easily assimilated carbohydrates.
• Oily, peppery, smoked and fried food.
• Production of fast food.
• Sausages.
• Pasta.
• Canned food.
• Baking and confectionery.
• Whole milk, semolina porridge.

The diet should include:

• Porridges cooked on the water. Rice and buckwheat groats are best.
• Fermented milk products: curdled milk, fermented baked milk, kefir.
• Any vegetable oil that has not undergone the refining process.
• Dried fruits.
• Berry - fruit compotes, kissels and fruit drinks.
• Vegetables with a low content of starch.
• Baked apples.

The first stage of therapy can be called preparation for treatment. In this period, diuretics (cholagogue) are prescribed. They stop the inflammation, promote increased elimination of the liquid, and with it toxins from the body of the patient. There is an active outflow of bile, along the way clearing the bile ducts. Appointed and cholekinetics, which contribute to increased activity of the gallbladder. This division is rather conditional, since modern preparations of this orientation are usually provided with both characteristics. For example, closton, oxaphenamide, choleritin, barberry preparations, pituitrin, cholecystokinin, mannitol, sorbitol, xylitol.

Oxafenamide. The drug is administered orally after eating. The dose of the drug is 0.25-0.5 g, taken three times throughout the day. The duration of the course is determined by the attending physician, but on the average it is 15-20 days. If necessary, after a short break, the drug can be resumed.

It is not recommended to take Oksafenamide for patients who suffer from hypersensitivity to the chemical compounds of this group, if there is a history of an invasive patient with cirrhosis of the liver, ulcerative manifestation in the digestive system, in case of acute form of hepatitis, obstructive jaundice.

Spasmolytic drugs are prescribed, which relax the muscle spasms, for example, drotaverin, besalol, datiscan.

Besalol. The drug is administered orally one tablet two to three times a day. Do not prescribe the drug to patients whose history is burdened by hypersensitivity to the components of the drug, hypertrophic changes in the prostate gland, flowing with a violation of the outflow of urine, gastrointestinal bleeding.

Introduced enterosorbents that clean the body, for example, activated charcoal, which take 0.25-0.75 g three to four times a day. Sometimes the dose is calculated - one tablet per 10 kg of the patient's weight.

Enzymes are also used to normalize the fermental component of the intestine (it is appointed according to the results of the coprogram).

The basic stage of therapy includes the introduction of strong antiparasitic drugs and antibiotics. Such are the medicines: metronidazole, chloroquine, tinidazole, furazolidone, paromomycin, tiberal, makmiror and others.

Tinidazole is prescribed once a day in an amount of 2 g, which corresponds to four tablets. The reception takes place forty to fifty minutes after a meal. Or 0.3 g daily for seven days. With a persistent course of the disease and resistance manifestations, such courses need six to seven.

Contra-indications of the drug include the pathology of blood, changes in the central nervous system, the first trimester of pregnancy, lactation.

The general protocol of treatment is signed by the attending physician, based on the results of the examination. The use of drugs makes it possible to obtain an improvement in the patient's condition already during the first week of the treatment course. After seven to ten days the course should be repeated regardless of the preliminary positive result. This will reduce the risk of relapse. If necessary, several such courses are conducted, with the greatest effect is the use of different drugs for each stage of treatment.

To fix the effect obtained, they practice:

• Eating the foods recommended above.
• Application of phytotherapeutic agents: decoctions of birch buds, bearberry seeds and others.
• Taking medications that normalize the intestinal microflora.

In this situation, prescriptions of alternative medicine will also help:

• Effective work mixture blended in the blender of fresh leaves of plantain and, taken in equal proportions, honey. The finished composition is kept in the refrigerator and one tablespoon is consumed 30 minutes before breakfast for a month. This composition not only perfectly copes with the parasitic microflora, but also activates the defenses of the organism. •
• The coconut also proved to be very good. It must be split and let down the milk. Then grate the flesh and take it on an empty stomach for three days. •
• Effective tincture from a hundred unripe walnuts, placed in a liter of vodka. This composition for 14 days to keep in a cool dark place, periodically shaking. The liquid is filtered and drunk on a teaspoon before each meal.

Giardiasis is a complex and veiled disease. The causes of giardiasis are extensive, but they need to be known to effectively deal with the problem and be able to reduce the risk of human body damage by parasitic microorganisms.