For Yolanda Torres, an experienced manager who runs the day care program at Pasadena's Huntington Memorial Hospital, it was like being a bus driver whose vehicle is broadsided by a drunk after 50 accident-free years.
On June 9, her 100-child program--where workers washed their hands twice, wore surgical gloves and used sterile paper table liners for diaper changing--was hit with an outbreak of a disease caused by a ubiquitous parasite with an unfamiliar, difficult-to-pronounce name.
The organism is giardia lamblia, and the disease it causes--characterized by diarrhea (often acute), abdominal cramps and pain, gas, bloating, loss of appetite, nausea, vomiting and low-grade fever--is called giardiasis.
Further symptomatic descriptions of it would go beyond the indelicate. It is enough to say giardia (pronounced gee-ARE-dee-uh ) does not kill. But in its most acute form, its victims may wish they were dead.
Becoming Urban Infection
Giardiasis can be treated, most of the time, with common prescription drugs. But its symptoms often can be mild and ambiguous, making it a diagnostic nightmare for doctors. Worse, the ailment, one of the most pervasive infections in human society, is increasingly being detected in urban areas and in day care centers.
About twice the size of a red blood cell and shaped like a stingray with eight tails called flagella, giardia lurks in the digestive tract, holding on to the intestinal lining with a suction-cup-like apparatus that takes up nearly all of the underside of its body.
It has looked and behaved this way probably for at least as long as human society has existed. It was first seen in 1681 by a developer of the microscope. By 1859, it had emerged as a recognized cause of diarrhea in children.
Organism in Bodies
At any one time, 1% to 3% of the people in Southern California--or any urban area--probably carry the organism in their bodies, said Dr. Jerrold Turner, a parasitic-disease expert at Harbor-UCLA Medical Center in Torrance. In high-risk populations, primarily recent immigrants from Southeast Asia and Central America, that rate may be as high as 15%.
Among children, Los Angeles County health officials estimate giardiasis develops into an acute symptomatic disease at a rate of 70 cases in every 100,000 children ages 1 to 4. For those ages 15 to 34, the acute disease develops in 10 to 15 of every 100,000 people.
But, almost as if giardia had retained an image consultant to make it seem upscale and exotic, the organism in the United States has acquired a terribly misleading reputation.
Even well-educated people believe giardia comes from contaminated mountain streams and is only a backpackers' disease. If campers will just boil, filter or iodine-treat their water, this mistaken reasoning goes, giardia will never be a problem.
Giardia is a problem for campers. Several backpackers appear weekly at Centinela Mammoth Hospital in Mammoth Lakes sick enough with giardiasis to need urgent care, said Dr. Jack Bertman, an emergency physician, who noted, "We publicize it a great deal more in Mammoth.
"In mountain communities, we're very tuned in to it (giardiasis). In the last 20 years, the organism has become very abundant."
Besides Torres at Huntington Memorial, Elyssa Nelson, co-director of the day care center serving employees of the Jet Propulsion Laboratory in Pasadena, has also been forced to handle a giardia outbreak. At JPL, it occurred in summer of 1984; a quarter of the 100 children at the center developed acute symptoms.
The JPL case served as the first serious warning to the Los Angeles County Department of Health Services that day care centers had become a giardia hot bed.
"I'm a backpacker so I had heard of it," Nelson said. "But it was relatively new to day care centers at the time."
Huntington Outbreak Minor
In contrast to what happened at JPL, the Huntington outbreak, the county's latest, has been minor. Only two children developed serious diarrhea and both recovered completely, Torres said, noting 13 other tots were found to carry the organism, though they did not have symptoms. No evidence was produced to show all the affected children acquired the organism from the same source.
But the recent Los Angeles outbreaks underscore how the tiny giardia organism can overcome safeguards in even well-run day care programs, said Dr. Stephen Waterman, chief of acute communicable disease control for the county health department.
In 1986, he said, there were two day care outbreaks; there were seven last year; the Huntington Memorial episode is the first outbreak in 1988.
Countywide, in the first four months of 1988, 339 cases of giardiasis were reported, down from 500 in the same period a year earlier when day care center outbreaks were more numerous than they have been this year.
Reported Cases Increased