A clinical guideline onDientamoeba fragilisinfections

Gestel, Rosanne Sfe van; Kusters, Johannes G.; Monkelbaan, Jan F

doi:10.1017/s0031182018001385

Cited by 31 publications

(37 citation statements)

References 67 publications

(150 reference statements)

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“…Data on family members were not collected, since they are rarely found in patient charts. Variation in failure rates has been shown between various regimens [36], demonstrating that a substantial part of treatment failures are not reinfections.…”

Section: Discussionmentioning

confidence: 99%

Dientamoeba fragilis – the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017

et al. 2019

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Background Despite the global distribution of the intestinal protozoan Dientamoeba fragilis, its clinical picture remains unclear. This results from underdiagnosis: microscopic screening methods either lack sensitivity (wet preparation) or fail to reveal Dientamoeba (formalin-fixed sample). Aim In a retrospective study setting, we characterised the clinical picture of dientamoebiasis and compared it with giardiasis. In addition, we evaluated an improved approach to formalin-fixed samples for suitability in Dientamoeba diagnostics. Methods This study comprised four parts: (i) a descriptive part scrutinising rates of Dientamoeba findings; (ii) a methodological part analysing an approach to detect Dientamoeba -like structures in formalin samples; (iii) a clinical part comparing demographics and symptoms between patients with dientamoebiasis (n = 352) and giardiasis (n = 272), and (iv) a therapeutic part (n = 89 patients) investigating correlation between faecal eradication and clinical improvement. Results The rate of Dientamoeba findings increased 20-fold after introducing criteria for Dientamoeba -like structures in formalin-fixed samples (88.9% sensitivity and 83.3% specificity). A further increase was seen after implementing faecal PCR. Compared with patients with giardiasis, the symptoms in the Dientamoeba group lasted longer and more often included abdominal pain, cramping, faecal urgency and loose rather than watery stools. Resolved symptoms correlated with successful faecal eradication (p < 0.001). Conclusions Previously underdiagnosed, Dientamoeba has become the most frequently recorded pathogenic enteroparasite in Finland. This presumably results from improved diagnostics with either PCR or detection of Dientamoeba -like structures in formalin-fixed samples, an approach applicable also in resource-poor settings. Symptoms of dientamoebiasis differ slightly from those of giardiasis; patients with distressing symptoms require treatment.

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Section: Discussionmentioning

confidence: 99%

Dientamoeba fragilis – the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017

et al. 2019

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“…Dientamoeba fragilis is a non-flagellated trichomonad protozoan parasite which inhabits the human intestine and is found worldwide (Barratt et al, 2011). The prevalence of D. fragilis is very heterogeneous, depending on the geographical region and the diagnostic method used (Barratt et al, 2011; van Gestel et al, 2018), with highest levels of prevalence observed in high-income countries (Stark et al, 2016). In Europe, prevalence varies from 1.6% to 83% (González-Moreno et al, 2011; Preiss et al, 1990); in Spain, from 0.4% to 24% in children (Belda Rustarazo et al, 2008) and from 2% to 9% in adults (González-Moreno et al, 2011; Fernández-Suarez et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…The principal diagnostic techniques used for the diagnosis of D. fragilis are light microscopy and polymerase chain reaction (PCR) amplification of DNA from stools together with subsequent sequencing. PCR has been reported to have the higher sensitivity of these two methods (van Gestel et al, 2018). However, the correlation between PCR and clinical signs and symptoms seems to be lower than for light microscopy (Stark et al, 2010a, Stark et al, 2010b).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the percentage of spontaneous cures without treatment are elevated (almost 50%) (Stark et al, 2016). At a European level, eradication rates among children range from 49% to 100%, and from 57% to 98% in adults (van Gestel et al, 2018). Most studies of D. fragilis treatment are retrospective and have a small sample sizes (Nagata et al, 2012; Röser et al, 2014; van Gestel et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Paromomycin is superior to metronidazole in Dientamoeba fragilis treatment

Burgaña

Abellana

Yordanov

et al. 2019

International Journal for Parasitology: Drugs and Drug Resistan

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Dientamoeba fragilis is a trichomonad parasite of the human intestine that is found worldwide. However, the biological cycle and transmission of this parasite have yet to be elucidated. Although its pathogenic capacity has been questioned, there is increasing evidence that clinical manifestations vary greatly. Different therapeutic options with antiparasitic drugs are currently available; however, very few studies have compared the effectiveness of these drugs. In the present longitudinal study, we evaluate 13,983 copro-parasitological studies using light microscopy of stools, during 2013–2015, in Terrassa, Barcelona (Spain). A total of 1150 (8.2%) presented D. fragilis. Of these, 739 episodes were finally analyzed: those that involved a follow-up parasitology test up to 3 months later, corresponding to 586 patients with gastrointestinal symptoms (53% under 15 years of age). Coinfection by Blastocystis hominis was present in 33.6% of the subjects. Our aim was to compare therapeutic responses to different antiparasitic drugs and the factors associated with the persistence of D. fragilis post-treatment. Gender, age, and other intestinal parasitic coinfections were not associated with parasite persistence following treatment. Metronidazole was the therapeutic option in most cases, followed by paromomycin: 65.4% and 17.5% respectively. Paromomycin was found to be more effective at eradicating parasitic infection than metronidazole (81.8% vs. 65.4%; p = 0.007), except in children under six years of age (p = 0.538). Although Dientamoeba fragilis mainly produces mild clinical manifestations, the high burden of infection means we require better understanding of its epidemiological cycle and pathogenicity, as well as adequate therapeutic guidelines in order to adapt medical care and policies to respond to this health problem.

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“…Abdominal pain or cramps and diarrhea are common symptoms for Dientamoeba infection [7]. Other symptoms such as nausea, vomiting, anorexia, fever and eosinophilia have been also reported [8,9].…”

Section: Introductionmentioning

confidence: 99%

Dientamoeba fragilis Infection in Patients with Digestive and Non-Digestive Symptoms: A Case-Control Study

et al. 2020

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In most developing countries, Dientamoeba fragilis infection is an obscure protozoan infection. We aimed to determine a frequency and clinical importance of D. fragilis infection in Taif, Saudi Arabia. A 1-year case control study included patients with gastrointestinal (cases, n=114) or non-gastrointestinal symptoms (controls, n=90). The fecal samples were examined with the classical parasitological methods for intestinal protozoa, and by real time PCR for D. fragilis. The infection by D. fragilis was detected in 5.8% by PCR and in 4.4% patients by microscopy. The infection was identified more in control group (n=9) than in cases (n=3); a sole infection in 11 patients and mixed with Giardia in 1 patient. The other enteric parasites detected were Blastocystis sp. (8.3%), Giardia sp. (5.3%), Cryptosporidium sp. (2.9%), Entamoeba histolytica (1.4%), Entamoeba coli (0.9%) and Hymenolepis nana (0.4%). Our results tend to reinforce the need to increase awareness of D. fragilis infection in Saudi Arabia.

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A clinical guideline onDientamoeba fragilisinfections

Cited by 31 publications

References 67 publications

Dientamoeba fragilis – the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017

Dientamoeba fragilis – the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017

Paromomycin is superior to metronidazole in Dientamoeba fragilis treatment

Dientamoeba fragilis Infection in Patients with Digestive and Non-Digestive Symptoms: A Case-Control Study

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