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]
Entire Body System
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Chronic Infection
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.medscape.com]
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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 [cmaj.ca]
[…] 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]
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Pathologist
[…] and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital Michael D Nissen, MBBS is a member of the following medical societies: American Academy of Pediatrics, Royal College of Pathologists [emedicine.medscape.com]
If the laboratory is accredited by the College of American Pathologists, the permanent stain is a mandatory part of the O&P procedure. [jcm.asm.org]
Respiratoric
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Pneumonia
After absorption with Klebsiella pneumoniae and Bacteroides vulgatus, the immune rabbit serum was used for examination by the IFA assay. [ncbi.nlm.nih.gov]
After absorption with Klebsiella pneumoniae and Bacteroides vulgatus, the immune rabbit serum was used for IFA examination. A total of 155 clinical samples were tested: 42 with no parasites, 9 with D. fragilis and 104 with other parasites. [ruor.uottawa.ca]
Klebsiella pneumoniae and Clostridium perfringens are now listed as the bacterial species, although Chan et al. ( 18 ) used this strain and found the anaerobic species to be Bacteroides vulgatus. [cmr.asm.org]
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Aspiration
Blastocystis sp. in Irritable Bowel Syndrome (IBS)-Detection in Stool Aspirates during Colonoscopy. PLoS One. 2015; 10(9):e0121173. Morgan DR, Benshoff M, Cáceres M, Becker-Dreps S, Cortes L, Martin CF, Schmulson M, Peña R. [ijpa.tums.ac.ir]
Trichrome staining of mucosal aspirates revealed large numbers of D. fragilis organisms in the absence of any other known pathogens. However, more recently described pathogens such as the coccidia and microsporidia might have been overlooked. [cmr.asm.org]
Gastrointestinal
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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]
over a 1-year period. [cmaj.ca]
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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]
Skin
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Ulcer
The clinical findings in this case report suggest that D. fragilis causes colitis through an invasive ulcerating process. [ncbi.nlm.nih.gov]
There is even a paper published in 1983 that relates a case of ulcerative colitis (inflamed and ulcerated colon ie: large intestine) to an infection by Dientamoeba fragilis. Treatment of the parasite subsequently cleared up the illness ( 6 ). [fullyfunctional.com.au]
Intestinal protozoa infections among patients with ulcerative colitis: prevalence and impact on clinical disease course. Digestion. 2010;82(1):18-23. Epub 2010 Feb 9. View Abstract [4] Addadi, K., Y. Le Corroller, Y. Guy, and A. Tabet-Derraz. 1972. [clinicaleducation.org]
Petersen AM, Stensvold CR, Mirsepasi H et al (2013) Active ulcerative colitis associated with low prevalence of Blastocystis and Dientamoeba fragilis infection. Scand J Gastroenterol (in press) Google Scholar 29. [link.springer.com]
Shein and Gelb ( 111 ) reported finding multiple punctate ulcers on endoscopic examination of a female patient who had a history of chronic abdominal pain for 1 year and a sudden production of blood-streaked diarrhea. [cmr.asm.org]
Psychiatrical
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Suggestibility
The clinical findings in this case report suggest that D. fragilis causes colitis through an invasive ulcerating process. [ncbi.nlm.nih.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]
Colonoscopy
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Colitis
Clinical reports have suggested that the parasite Dientamoeba fragilis may be a cause of acute and chronic colitis in children and adults. The mechanism by which this parasite produces colitis has not been determined. [ncbi.nlm.nih.gov]
Colitis due to Dientamoeba fragilis. Am J Gastroenterol. 1983 Oct. 78(10):634-6. [Medline]. Spencer MJ, Garcia LS, Chapin MR. Dientamoeba fragilis. An intestinal pathogen in children?. Am J Dis Child. 1979 Apr. 133(4):390-3. [Medline]. [emedicine.medscape.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]
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]
Unfortunately, in vitro testing is inaccurate and cannot reliably predict treatment outcomes because Dientamoeba requires xenic media (media containing bacteria for the parasite to feed on). [cmaj.ca]
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]
Therefore, in symptomatic patients who harbor Dientamoeba and no other pathogen, Dientamoeba should be considered as the etiological agent and treated as such. [tandfonline.com]
Epidemiology
KEYWORDS: Actin; Dientamoeba; Elongation factor; Genetic diversity; Molecular epidemiology; Multilocus sequence typing [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]
Main content area Molecular epidemiology of Dientamoeba fragilis Cacciò, Simone M. [pubag.nal.usda.gov]
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]
Teach children the importance of washing hands to prevent infection. [webmd.com]
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]
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]