Detecting Giardia: Clinical and Molecular Identification

dc.contributor.authorSaleh, Meriam Naimen
dc.contributor.committeechairZajac, Anne M.en
dc.contributor.committeememberLeib, Michael S.en
dc.contributor.committeememberLindsay, David S.en
dc.contributor.committeememberHerbein, Joel Francisen
dc.contributor.committeememberElvinger, Francois C.en
dc.contributor.departmentBiomedical and Veterinary Sciencesen
dc.date.accessioned2019-05-08T06:00:37Zen
dc.date.available2019-05-08T06:00:37Zen
dc.date.issued2017-11-13en
dc.description.abstractThe protozoan parasite Giardia duodenalis (syn. G. lamblia, G. intestinalis) can cause diarrhea in humans, cats, dogs and other animals. Giardia duodenalis consists of eight assemblages (A-H) that are morphologically identical but genetically distinct. Assemblages C-H are generally species-specific, while A and B infect people and animals and are considered potentially zoonotic. Most canine and feline isolates belong to their respective species-specific assemblages, but isolates of assemblages A and B (predominantly found in humans) have also been recovered from dogs and cats. Diagnosis of infection has historically been by morphologic techniques (observing trophozoites on direct fecal smears or cysts on centrifugal zinc sulfate fecal flotations), and it is currently recommended to use morphologic techniques in conjunction with a sensitive and specific antigen test. Diagnosis is important for management of clinical giardiasis in cats and dogs and also to identify the assemblage present to determine its zoonotic potential. In my dissertation research I evaluated diagnostic techniques in use for companion animals, including centrifugal zinc sulfate fecal flotation, antigen tests optimized for use in dogs and cats, direct immunofluorescent assay (IFA), and Polymerase Chain Reaction (PCR). I showed that when compared to the reference IFA the veterinary optimized antigen tests performed similarly and had no statistically significant differences in sensitivity or specificity when combined with a centrifugal zinc sulfate fecal flotation test. Sensitivity and specificity by comparison to IFA was ≥ 82% and ≥ 90%, respectively, for all diagnostic tests evaluated in dogs and cats. When analyzed via Bayesian analysis sensitivity and specificity for all diagnostic tests was ≥83% and ≥95%, respectively. The Bayesian analysis also showed that using the direct immunofluorescent assay (IFA) as the reference test was supported. I also evaluated PCR as a molecular diagnostic technique to detect Giardia infections in dogs with soft stool or diarrhea (mimicking clinical signs of infection). I utilized both conventional and real time PCR assays and compared the results to the recommended method of diagnosis, the zinc sulfate fecal flotation combined with an immunoassay test. I found that agreement between PCR and microscopy combined with an immunoassay was poor to fair and varied depending on the molecular parameters and size of the DNA target underscoring the complexity of test evaluation and molecular diagnostics for Giardia. I also evaluated cats from a varied population (owned, shelter, feral) in Virginia to determine to what extent (if any) they were infected with potentially zoonotic assemblages of Giardia. The species-specific assemblage F was detected in 57% of the samples and assemblage A, which is considered potentially zoonotic, was recovered from 32% of the sampleI. In 11% both assemblages F and A were detected. We showed for the first time that cats in Virginia are infected with potentially zoonotic assemblages of Giardia.en
dc.description.abstractgeneralGiardia duodenalis (syn. G. lamblia, G. intestinalis) is a parasite that can cause diarrhea in humans, cats, dogs and other animals. Giardia is divided into eight assemblages (A-H) that are identical when viewed under the microscope but when genetic analysis is performed they are actually distinct. Humans are infected with assemblages A and B. Dogs are commonly infected with the species-specific assemblages C and D, and cats are usually infected with their species-specific assemblage F. However dogs and cats can be infected with assemblages A and B and are therefore considered potentially zoonotic. Giardia exists in two stages: the feeding stage called a trophozoite and the infectious stage the cyst. Diagnosing Giardia infections has historically been diagnosed by observing trophozoites on direct fecal smears or cysts on fecal flotation tests with zinc sulfate. There are also fecal antigen tests that detect Giardia antigen in the feces. It is recommended to combine antigen testing with the fecal flotation to detect infections. Diagnosis is important for the management of clinical disease in dogs and cats and also so that the assemblage an animal is infected with can be analyzed to determine if there is any zoonotic potential. In my dissertation research we evaluated diagnostic techniques in use for dogs and cats, including centrifugal zinc sulfate fecal flotation and antigen tests optimized for use in dogs and cats. We showed that when compared to a reference test these veterinary optimized antigen tests performed very similarly to each other. We also evaluated a molecular diagnostic test to detect Giardia infections in dogs with soft stool or diarrhea (mimicking clinical signs of infection). We utilized two methods of molecular diagnosis and compared the results to the recommended method of diagnosis, the zinc sulfate fecal flotation combined with an antigen test. We found that the molecular tests did not agree well with the recommended detection method and that test evaluation and molecular diagnostics for Giardia are complex. We also evaluated cats from a varied population (owned, shelter, feral) in Virginia to determine to what extent (if any) they were infected with potentially zoonotic assemblages of Giardia. The species-specific assemblage (F) was detected in the 57% of the samples and assemblage A, which is considered potentially zoonotic, was recovered from 32% of the samples, and in 11% both assemblages F and A were detected. We showed for the first time that cats in Virginia are infected with potentially zoonotic assemblages of Giardia.en
dc.description.degreePHDen
dc.format.mediumETDen
dc.identifier.othervt_gsexam:12687en
dc.identifier.urihttp://hdl.handle.net/10919/89367en
dc.publisherVirginia Techen
dc.rightsIn Copyrighten
dc.rights.urihttp://rightsstatements.org/vocab/InC/1.0/en
dc.subjectGiardiaen
dc.subjectdiagnosisen
dc.subjectdogsen
dc.subjectcatsen
dc.subjectgenotypingen
dc.titleDetecting Giardia: Clinical and Molecular Identificationen
dc.typeDissertationen
thesis.degree.disciplineBiomedical and Veterinary Sciencesen
thesis.degree.grantorVirginia Polytechnic Institute and State Universityen
thesis.degree.leveldoctoralen
thesis.degree.namePHDen

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