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Get Informed | Giardia / Cryptosporidium

What is Giardia / Cryptosporidium?

Giardia (genus name) and Cryptosporidium (genus name) are becoming the most widespread intestinal parasites, i.e., disease causing organisms, associated with waterborne disease. They are not the same organism, but different parasitic protozoans. The protozoans (Protista Kingdom) are unicellular animals (although some have some plant or fungal features) that, like cells in general, must be in liquid to be active. There are 4 major subgroups of protozoans, two of which are often combined. The ameba-like protozoans (called the Sarcodines) and the flagella-bearing protozoans (called Mastigotes) are often linked into one inclusive group (called Sarcomastigotes) because of some shared features. The cilia-bearing protozoans (called Ciliates) are about as complicated as single cells can be. The apicomplexans (which used to be called Sporozoans) tend to be tiny parasites, often living inside other cells, but are also pretty complicated. Many can survive drying by sealing themselves in protective coverings as cysts or oocysts, but they are not really doing much in those stages. (Source) Giardia is a mastigote (flagella-bearing protozoan) and Cryptosporidium is an apicomplexan.

These organisms are not bacteria or viruses, but protozoans with complex life cycles. Outside of the host, the organisms are in a cyst stage, which is much like a seed for a plant or microscopic egg. The size of the Giardia cyst is approximately 8 to 14 um; whereas, the Cryptosporidium oocysts are usually 4 to 6 microns in diameter. (Note: 1 micron = 0.001 mm = 0.00004 inches ), which is too small to see with the naked eye. The oocysts can survive six months or more in water, and are very resistant to disinfectants; whereas, cysts have been determined to survive up to 12 weeks in water, up to 7 weeks in soil. These organisms are responsible for over 100,000 causes of reported outbreaks of waterborne illness since 1979. These are not new organisms and in fact Van Leeuwenhoek first described Giardia cysts in 1681, but these organisms had not been identified as disease-causing agents until the last two decades.

Did You Know?
- Also known as Beaver Fever, Backpacker Disease, or Travelers Diarrhea

How Does Giardia / Cryptosporidium Become a problem?

Upon ingestion, the acids in the stomach cause the cysts or oocysts to begin to ex-cyst ("like hatching an egg") and the organism begins to reproduce in the intestines. As few as 10 Giardia cysts have been shown to cause the disease giardiasis although it is not currently known what the minimum number of oocysts is to get the disease, cryptosporidiosis. This disease creates symptoms that mimic other gastrointestinal problems and the common symptoms are persistent diarrhea, weight loss, abdominal cramps, nausea, and dehydration. In general, the symptoms begin within a week after exposure and the acute symptoms can last for up to 2 weeks, but chronic symptoms can last for up to 2 months. With proper treatment and our natural immune system, the diseases are not deadly, but these diseases can be life-threatening to AIDS patients, small children, the elderly, or someone recovering from major surgery. Individuals can become exposed to these organisms through a number of routes, i.e., food-borne, waterborne, "hand to mouth transfer", and there may be an external host such as beavers, deer, dog, cats, cattle, and even rodents discharging cysts/oocysts into water supplies. With respect to a waterborne route, the exposure is typically associated with drinking from a water source that was untreated or ineffectively treated to remove the cyst or oocyst stage of the organism.

Waterborne: The drinking water supply becomes contaminated by malfunctioning on-lot wastewater disposal systems, improperly disposed sludge, improperly treated surface water, or groundwater sources under the direct influence of surface water. Groundwater is not a common route of contamination, but surface water can be a common route or wells that are improperly constructed or over-pumped can induce groundwater contamination.

Foodborne: Mother was changing the diapers of her infant and returned to canning products for the church picnic without thoroughly washing her hands and the individual purchasing the last batch of the canned items became sick. This is an example of how someone could become exposed to fecal material that contains the cysts. Similar stories could be told of exposure to cyst-contaminated soil or even pet hair.

Sexual Route:

This is a route of transmission if you engage in anal-oral sex. Overall, the most widespread route of transmission is through the consumption of contaminated or inadequately or improperly treated drinking water.

What are the Standards for Giardia / Cryptosporidium?

The EPA developed the surface water treatment rule as an attempt to create an engineering barrier between the source and the consumer. The rule requires the regulated water supplier to determine if the source of water is a "surface water source or a groundwater source under the direct influence of surface water". The regulations require that regulated sources be filtered and disinfected to a higher standard, set Maximum Contaminant Level Goals (MCLG) for Giardia, Cryptosporidium, viruses, and other agents, and required the implementation of watershed protection programs (Source). This standard does not apply to unregulated sources and many small non-community systems.

MCLG: Giardia - "Zero" (99.9% removal/inactivation) ; Cryptosporidium - "Zero", Viruses (enteric) - "Zero" (99.99% removal/inactivation), and Legionella -"Zero".

What are the Health Risks for Giardia / Cryptosporidium?

Giardia - the symptoms of an infection by Giardia typically appear within 3 to 25 days of exposure. The most common symptoms include: diarrhea, flatulence (a lot), abdominal pain, bloating, greasy stools, belching, nausea, stomach cramps, weight loss, fatigue, headaches, and upset stomach. (Source) Also, some individuals may be asymptomatic carriers, i.e., have the disease but show no evidence of symptoms. "Giardiasis infections usually last about six to eight weeks, but problems such as lactose intolerance can persist after the infection clears up." (Source)

Cryptosporidium - the symptoms of an infection by Cryptosporidium typically appear within 1 week of exposure, but the range is 2 to 10 days, and the common symptom include: very watery diarrhea, lack of appetite, weight loss, stomach cramps, pain, fever, vomiting, nausea, and dehydration. The most likely individuals impacted by this organism include: "children under two years of age, those who travel, work with animals, or those in close personal contact with someone who has this disease. People with weakened immune systems, such as people with HIV infection or those receiving chemotherapy, are more susceptible to the disease" (Source).

Get Tested | Giardia / Cryptosporidium

Getting your water quality tested for Giardia and Cryptosporidium is getting easier, but it is still expensive. You may want to conduct this testing if you experiencing any of the following:

  • Using an unfiltered surface water source in an area with upgradient human wastewater disposal using stream discharge, agricultural lands with farm animals or using human or animal biosolids, and even pristine very-rural mountainous areas.
  • You are using a city water source that primarily comes from a surface water intake, such as a lake, stream, or reservoir, that has had problems with intermittent water quality issues such as turbid water or boil water advisories.
  • You are using a city water source that primarily comes from a surface water intake, such as a lake, stream, or reservoir, that has had problems with intermittent water quality issues such as turbid water or boil water advisories.
  • You are using an unregulated spring water source.

Level 1 | Observational Self-Testing

Observations for Giardia / Cryptosporidium

You may suspect a problem with Giardia or Cryptosporidium in the following situations:

  • You are getting your water from a spring, stream, roof cistern, or lake that is completely untreated or treated only using a standard particle filter.
  • You suspect a bacterial problem because of an odor, metallic sheen, or off-taste to the water and/or water quality tests have documented that the water contains total coliform bacteria and/or E. coli.
  • When it rains or there is a snow melt, your drinking water gets cloudy or discolored or there has been a reported break in the water distribution system.
  • Individuals using your water have been ill. You may have a problem with a waterborne pathogen if one or more of your family members has been diagnosed with a specific disease or showing symptoms associated with waterborne disease.
Try Our Level 1 Drinking Water Self-Diagnostic Tool
Have water issues? Answer our self-diagnosis questionnaire from your observations to get an initial diagnosis. Then follow our recommended steps to remediate your issue.
Self-Diagnostic Tool

Level 2 | Do-It-Yourself Water Testing

Level 2 Testing is Do-It-Yourself testing that can be done in your own home using a Testing Kit. After you’ve done Level 1 Testing, Level 2 Testing can confirm if your observations are correct. If your test results reveal the presence of a contaminant that is cause for concern, you can either proceed to determine the best treatment (see below) or continue to Level 3 Testing.

Notes on Level 2 Testing for Giardia / Cryptosporidium

There are no Level 2 Do-It-Yourself tests for waterborne pathogens, but there are low cost tests to check the potability, i.e., drinkability, of your water, that test for total coliform bacteria and E. coli If you test your water and it is negative for Total Coliform and E. coli, it is less likely the water would be a source of a pathogen; it does not mean it is NOT a source. If it is positive for Total Coliform or E. coli, it means it is MORE likely a potential source, it does not mean it is!

Level 3 | Informational Water Testing

Level 3 Testing is done through an accredited Water Testing Laboratory. With Level 3 Testing, you can order a testing kit that is used to prepare your sample and submit it to the lab. By utilizing a lab, you have the assurance that a certified water expert had analyzed your water sample. If your test results reveal the presence of a contaminant that is cause for concern, you can either proceed to determine the best treatment options (see below) or continue to Level 4 Testing - Certified Testing.

Notes on Level 3 Informational Testing for Giardia / Cryptosporidium

There are informational water testing that does include bacteria and specific waterborne pathogens. We recommend one or more of these screening tests if the available information or your personal experience suggest a problem. If the source is determined to be positive, we do not recommend immediate treatment, we suggest attempting to mitigate the source or weakness in the system, conducting a comprehensive water quality test, and then acting based on fact and not fear.

Level 4 | Certified Water Testing

A Level 4 Certified Test Test uses chain-of-custody with a water professional coming to your home to prepare the water sample and then works with an accredited laboratory in order to certify your test results. This type of testing not only gives you the highest level of assurance in the accuracy of your test results, but can also be used as a document in legal cases. For Baseline Testing, we recommend that you use Certified Testing.

Notes on Level 4 Certified Testing for Giardia / Cryptosporidium

There is certified testing for specific waterborne diseases, but this testing is expensive and typically requires laboratory or environmental professionals to collect water quality samples. If you suspect this contamination is related to a regulated activity, regulated by state or the federal government, we suggest documenting your experiences and contacting your local, state, or federal regulatory agency. When you do this testing, we strongly recommend testing for total coliform, E. coli, standard plate count, and other indicators that may be associated with the actual water source such as potential human, agricultural, or animal sources of contamination. If you need assistance, please feel free to contact the team.

Get Treatment | Giardia / Cryptosporidium

The best strategy to protect a water supply is to use a multiple barrier approach. For large water systems, this approach uses a combination of controlling land-use within a watershed to prevent degradation of the source water and the second barrier is a properly designed and well-operated filtration plant. Therefore, the physical removal, maintaining low finished water turbidity/ particle count, and effective disinfection is a combination of engineering controls that can be an effective treatment method.

For community water systems, this multiple barrier approach may include: sanitary surveys, risk assessment, water supply vulnerability analysis, land use management and control, zoning and development regulations, watershed management, wellhead and water supply protection zones, watershed and well field monitoring, water pretreatment, water filtration, disinfection, water quality monitoring, and water distribution system monitoring.

For individual water supplies, this would include a comprehensive treatment system that may include: evaluating water source, filtration, disinfection, and possibly reverse osmosis or distillation. The National Sanitation Foundation has approved several point-of-use devices. Prior to selecting a treatment option, it is advisable to have your water tested.

For workers at restaurants or daycare facilities, the multiple barrier approach is also necessary. When working with contaminated material make sure to wear gloves, properly wash hands and the more important step is to dry your hands (cysts can not survive desiccation), and properly dispose of contaminated materials.

Contact a KnowYourH2O Recommended Professional

We do not recommend a Do-It-Yourself Treatment for Giardia / Cryptosporidium. For a professional treatment, request a consultation from the KnowYourH20 Team Contact Us.

Long Term Treatment

Long-term treatment should first attempt to understand the pathway and source and mitigate any external causes for this contamination. This may mean installing a sanitary well cap, improving the well construction by extending casing, installing a new water well, and mitigating the source of contamination. After mitigation and a comprehensive water quality assessment, the treatment solution will likely require a multiple-barrier approach that will likely use a combination of filtration, disinfection, and submicron filtration. If you are looking for a treatment solution, you are looking for a system that meets NSF 43, NSF 53, and perhaps NSF 58 standards. In most cases, this will require a certified professional. If you need help finding a certified professional, please contact our team.

Contact a KnowYourH2O Recommended Professional

We do not recommend a Do-It-Yourself Treatment for Giardia / Cryptosporidium. For a professional treatment, request a consultation from the KnowYourH20 Team Contact Us.

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