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Dientamoeba Fragilis


Presentation

  • Gastrointestinal symptoms were present in 40/41 (98%) of these children with dientamoebiasis, with diarrhoea (71%) and abdominal pain (29%) the most common clinical signs. Chronic gastrointestinal symptoms were present in 2% of cases.[ncbi.nlm.nih.gov]
  • Peripheral eosinophilia was present in half of the children examined and was statistically more significant in patients with D fragilis than in a control group of children admitted for elective surgery.[ncbi.nlm.nih.gov]
  • A case report is presented that details a patient with a 1-month history of vague abdominal complaints who presented to the Emergency Department with an apparent episode of acute appendicitis.[ncbi.nlm.nih.gov]
  • Peripheral eosinophilia was present in seven patients. One patient with well-documented bovine protein allergy had intermittent episodes of diarrhea and abdominal pain, despite an appropriate elimination diet.[ncbi.nlm.nih.gov]
  • Gastrointestinal symptoms were present in all patients, with diarrhea and abdominal pain the most common symptoms. Thirty-two percent of patients presented with chronic symptoms. The average age of infected patients was 39.8 years.[ncbi.nlm.nih.gov]
Chronic Infection
  • Acute and recurrent diarrhoea have been found to be the most common symptoms, whereas abdominal pain was most common in children with chronic infections. Peripheral blood eosinophilia was seen in a third of the children with dientamoebiasis.[ncbi.nlm.nih.gov]
  • Dientamoeba fragilis is a protozoan parasite emerging as a cause of diarrhoea and "irritable-bowel-like" gastrointestinal disease in humans with a propensity for establishing long-term, chronic infections in humans.[ncbi.nlm.nih.gov]
  • Chronic infection occurs after 1-2 months of illness and is manifested by abdominal pain. Age Infection may occur at any age. The most common age at which infection has been reported in children is 5-10 years.[emedicine.com]
  • infection often reported. 4 , 11 , 12 Numerous studies have shown antimicrobial therapy targeting and eliminating D. fragilis will result in marked clinical improvement for patients suffering from dientamoebiasis. 3 , 12 , 13 All patients from both families[ncbi.nlm.nih.gov]
Plethora
  • […] the nonpathogenicity of this protozoan have emerged, however, and there can now be little doubt of its role in gastrointestinal disease. 1 – 3 Only recently has the evidence supporting D. fragilis as a cause of diarrhea, abdominal pain, cramping and a plethora[doi.org]
  • […] the nonpathogenicity of this protozoan have emerged, however, and there can now be little doubt of its role in gastrointestinal disease. 1–3 Only recently has the evidence supporting D. fragilis as a cause of diarrhea, abdominal pain, cramping and a plethora[ncbi.nlm.nih.gov]
Overeating
  • Patients presented with diarrhea lasting from 5 days to over 4 weeks. Dientamoeba fragilis should be considered as a cause of diarrhea in returning travelers.[ncbi.nlm.nih.gov]
  • This review encompasses a large body of knowledge generated on various aspects of D. fragilis over the last century, together with an update on the most recent developments.[ncbi.nlm.nih.gov]
  • Abstract Over a six-month period, 857 faecal samples were submitted to the Department of Microbiology and Immunology at Sultan Qaboos University Hospital in Oman, for routine microbiological examination.[ncbi.nlm.nih.gov]
  • A prospective study was conducted over a 30-month period, in which fecal specimens from 6,750 patients were submitted to the Department of Microbiology at St. Vincent's Hospital, Sydney, Australia.[ncbi.nlm.nih.gov]
  • Although Dientamoeba was discovered over a century ago its life cycle and mode of transmission is not known. No cyst stage has been described and no animal models are presently available for the study of this parasite.[ncbi.nlm.nih.gov]
Chronic Abdominal Pain
  • AIM: The aim of this retrospective case-control study is to clarify the clinical relevance of D. fragilis in children with chronic abdominal pain.[ncbi.nlm.nih.gov]
  • Aim The aim of this retrospective case–control study is to clarify the clinical relevance of D. fragilis in children with chronic abdominal pain.[adc.bmj.com]
  • Abstract Chronic abdominal pain, constipation, diarrhea, and anorexia are often difficult symptoms for a pediatrician to evaluate. These children are often thought to have psychosomatic complaints.[nature.com]
  • ", keywords "Dientamoeba fragilis, gastrointestinal symptoms, paediatrics, primary care, IRRITABLE-BOWEL-SYNDROME, CHRONIC ABDOMINAL-PAIN, REAL-TIME PCR, INTESTINAL PARASITES, PREVALENCE, SAMPLES", author "Holtman, {Gea A.} and Kranenberg, {Justin J.}[rug.nl]
  • Dientamoeba fragilis and chronic abdominal pain in children: a case-control study . Archives of Disease in Childhood, Vol. 99, Issue. 12, p. 1109. CrossRef Google Scholar Verweij, J. J. and Stensvold, C. R. 2014.[cambridge.org]
Recurrent Abdominal Pain
  • Recurrent abdominal pain in children Irritable Bowel Syndrome in adults ( 5 ). Diarrhea severe abdominal pain Cramps Nausea Vomiting mild fever general fatigue ( 4 ).[fullyfunctional.com.au]
  • Gijsbers , CFM , Benninga , M and Büller , H ( 2011 ) Clinical and laboratory findings in 220 children with recurrent abdominal pain . Acta paediatrica 100 , 1028 –32.[cambridge.org]
Failure to Thrive
  • It is an important cause of travellers diarhoea, chronic diarhoea, fatigue and in children, failure to thrive. Etymology of the name Dientamoeba fragilis:Di refers to the two nuclei in the trophozoites (feeding stage of the organism).[amazon.es]
  • It is an important cause of travellers diarrhoea, chronic diarrhoea, fatigue and, in children, failure to thrive. Despite this, its role as a "commensal, pathobiont, or pathogen" is still debated.[en.wikipedia.org]
Acute Diarrhea
  • All of the patients having profile 2 had acute diarrhea while all of the patients having profile 3 had diarrhea alternating with constipation.[ncbi.nlm.nih.gov]
Neglect
  • Dientamoeba remains neglected, probably due to the misconceptions that it is uncommon and non-pathogenic. Usually, carriage of Dientamoeba is associated with symptoms such as abdominal pain and diarrhea.[ncbi.nlm.nih.gov]
  • There is little justification for this neglect, however, since there exists a growing body of case reports from numerous countries around the world that have linked this protozoal parasite to clinical manifestations such as diarrhea, abdominal pain, flatulence[ncbi.nlm.nih.gov]
  • This study therefore provides extensive and novel details of the ultrastructure of a neglected protozoan parasite that is an emerging cause of human disease. Copyright 2011 Australian Society for Parasitology Inc. Published by Elsevier Ltd.[ncbi.nlm.nih.gov]
  • Windsor, Damien Stark Dientamoeba fragilis is a neglected trichomonad parasite that was discovered over a century ago. It has a world-wide distribution and is one of the most common enteric protozoans of humans.[journals.elsevier.com]
  • Dientamoeba fragilis, a neglected cause of diarrhea, successfully treated with secnidazole. Clin Microbiol Infect 2003;9:110–3. Norberg A, Nord CE, Evengard B. Dientamoeba fragilis —a protozoal infection which may cause severe bowel distress.[cdc.gov]

Workup

  • We report a patient with symptomatic D. fragilis infection and negative extensive laboratory and radiological workup, with resolution of symptoms after diiodohydroxyquin therapy. No parasites were detected in three follow-up stool examinations.[ncbi.nlm.nih.gov]
  • Other causes of eosinophilia were considered but were excluded given the negative serological workup, negative Harada-Mori and agar plate cultures for Strongyloides , and the completion of 43 fixed stool specimens (range, 6–11 per family member).[academic.oup.com]

Treatment

  • The most common anti-microbial used for treatment was metronidazole (n 41), with complete resolution of symptoms and clearance of parasite occurring in 85% of cases. A treatment failure rate occurred in 15% of those treated with metronidazole.[ncbi.nlm.nih.gov]
  • RESULTS: Metronidazole treatment failure was significantly more frequent in patients with E. vermicularis co-infection and in patients with children in the family.[ncbi.nlm.nih.gov]
  • Treatment Examples of several of the most commonly used treatments are provided in the table below. As always, treatment decisions should be individualized.[cdc.gov]
  • If the patient is a child, a temporary treatment would be offered to test if symptoms can be alleviated, otherwise, another diagnosis and treatment are required. If the child is asymptomatic, then treatment is not necessary.[en.wikipedia.org]
  • To our knowledge, this is the first report of secnidazole being used in the treatment of dientamoebiasis.[ncbi.nlm.nih.gov]

Etiology

  • It is a flagellate protozoan that is an uncommon etiology of gastrointestinal disease. Primarily characterized by diarrhea and abdominal pain, other symptoms such as flatulence, nausea, vomiting, fatigue, malaise, and weight loss occur.[ncbi.nlm.nih.gov]
  • Rarely, D. fragilis infestation is the etiology of acute abdominal pain, mimicking a surgical abdomen.[ncbi.nlm.nih.gov]
  • Therefore, in symptomatic patients who harbor Dientamoeba and no other pathogen, Dientamoeba should be considered as the etiological agent and treated as such. 2011 Landes Bioscience[ncbi.nlm.nih.gov]
  • Author information 1 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. yakoobjaved@hotmail.com Abstract Studies have suggested a possible role for Blastocystis hominis and Dientamoeba fragilis in the etiology of irritable bowel[ncbi.nlm.nih.gov]
  • Abstract Studies have suggested a possible role for Blastocystis hominis and Dientamoeba fragilis in the etiology of irritable bowel syndrome (IBS). We studied the prevalence of B. hominis and D. fragilis in patients with IBS-diarrhea (IBS-D).[ecommons.aku.edu]

Epidemiology

  • KEYWORDS: Actin; Dientamoeba; Elongation factor; Genetic diversity; Molecular epidemiology; Multilocus sequence typing [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • KEYWORDS: Clonality; Dientamoeba fragilis; Epidemiology: transmission; Molecular typing[ncbi.nlm.nih.gov]
  • In conclusion, the ITS-1 region can serve as a molecular epidemiological tool for the subtyping of D. fragilis directly from feces.[ncbi.nlm.nih.gov]
  • Little is known about its epidemiology. We evaluated the prevalence of D. fragilis by conducting a cross sectional study of an Orang Asli population in rural Malaysia.[ncbi.nlm.nih.gov]
  • The identification of this pathogen requires clinical awareness of epidemiologic risk factors and presenting complaints, as well as the laboratory staining procedures essential to its proper identification.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Organisms infect mucosal crypts of the large intestine that are located close to the mucosal epithelium, from the cecum to the rectum; however, the cecum and proximal colon are usually affected.[emedicine.medscape.com]

Prevention

  • How can I prevent Dientamoeba fragilis infection? Wash your hands with soap and warm water after using the toilet, after changing diapers, and before preparing or eating food. Teach children the importance of washing hands to prevent infection.[cdc.gov]
  • CONCLUSIONS: Co-infection with E. vermicularis may act as a factor favoring D. fragilis infection by preventing eradication measures. This suggests that both parasites should be treated simultaneously. Copyright 2016 The Authors.[ncbi.nlm.nih.gov]
  • Teach children the importance of washing hands to prevent infection.[webmd.com]
  • Prevention People with confirmed D. fragilis without symptoms do not need to be excluded. Exclude people with diarrhoea from childcare, preschool, school and work until there has been no diarrhoea for 24 hours.[sahealth.sa.gov.au]

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