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A case-controlled study of Dientamoeba fragilis infections in children

Published online by Cambridge University Press:  27 April 2011

G. R. BANIK ,
J. L. N. BARRATT ,
D. MARRIOTT ,
J. HARKNESS ,
J. T. ELLIS  and
D. STARK
G. R. BANIK
Affiliation:
Division of Microbiology, SydPath, St Vincent's Hospital, Darlinghurst, Australia University of Technology Sydney, i3 Institute, Broadway, Australia University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
J. L. N. BARRATT
Affiliation:
Division of Microbiology, SydPath, St Vincent's Hospital, Darlinghurst, Australia University of Technology Sydney, i3 Institute, Broadway, Australia University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
D. MARRIOTT
Affiliation:
Division of Microbiology, SydPath, St Vincent's Hospital, Darlinghurst, Australia University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
J. HARKNESS
Affiliation:
Division of Microbiology, SydPath, St Vincent's Hospital, Darlinghurst, Australia University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
J. T. ELLIS
Affiliation:
University of Technology Sydney, i3 Institute, Broadway, Australia University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
D. STARK*
Affiliation:
Division of Microbiology, SydPath, St Vincent's Hospital, Darlinghurst, Australia University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
*
*Corresponding author: Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW, Australia. Tel: +61 2 8382 9196. Fax: +61 2 8382 2989 E-mail: [email protected]
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Summary

Dientamoeba fragilis is a pathogenic protozoan parasite that is implicated as a cause of human diarrhoea. A case-controlled study was conducted to determine the clinical signs associated with D. fragilis infection in children presenting to a Sydney Hospital. Treatment options are also discussed. Stool specimens were collected from children aged 15 years or younger and analysed for the presence of D. fragilis. In total, 41 children were included in the study along with a control group. Laboratory diagnosis was performed by microscopy of permanently stained, fixed faecal smears and by real-time PCR. 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. 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. Follow-up treatment comprised of an additional course of metronidazole or iodoquinol was needed in order to achieve complete resolution of infection and symptoms in this group. This study demonstrates the pathogenic potential of D. fragilis in children and as such it is recommended that all laboratories must routinely test for this organism and treat if detected.

Keywords

Dientamoeba fragilischildrengastrointestinal symptomsmetronidazolediarrhoea
Type
Research Article
Information
Parasitology , Volume 138 , Issue 7 , June 2011 , pp. 819 - 823
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

Ayadi, A. and Bahri, I. (1999). Dientamoeba fragilis: pathogenic flagellate? Bulletin de la Société de Pathologie Exotique 92, 299–301.Google ScholarPubMed
Barratt, J. L. N., Harkness, J., Marriott, D., Ellis, J. T. and Stark, D. (2011 a). A review of Dientamoeba fragilis carriage in man: several reasons why this organism should be considered in the diagnosis of gastrointestinal illness. Gut Microbes 2, 3–12.CrossRefGoogle Scholar
Barratt, J. L. N., Harkness, J., Marriott, D., Ellis, J. T. and Stark, D. (2011 b). The ambiguous life of Dientamoeba fragilis: the need to investigate current hypotheses on transmission. Parasitology 138, 557–572.CrossRefGoogle ScholarPubMed
Bosman, D. K., Benninga, M. A., van De Berg, P., Kooijman, G. C. and van Gool, T. (2004). Dientamoeba fragilis: possibly an important cause of persistent abdominal pain in children. Nederlands Tijdschrift Voor Geneeskunde 148, 575–579.Google ScholarPubMed
Butler, W. P. (1996). Dientamoeba fragilis. An unusual intestinal pathogen. Digestive Diseases and Sciences 41, 1811–1813.CrossRefGoogle ScholarPubMed
Cepicka, I., Hampl, V. and Kulda, J. (2010). Critical taxonomic revision of Parabasalids with description of one new genus and three new species. Protist 161, 400–433.CrossRefGoogle ScholarPubMed
Chan, F., Stewart, N., Guan, M., Robb, I., Fuite, L., Chan, I., Diaz-Mitoma, F., King, J., MacDonald, N. and Mackenzie, A. (1996). Prevalence of Dientamoeba fragilis antibodies in children and recognition of a 39 kDa immunodominant protein antigen of the organism. European Journal of Clinical Microbiology & Infectious Diseases 15, 950–954.CrossRefGoogle ScholarPubMed
Crotti, D. and D'annibale, M. L. (2007). Intestinal infections caused by Dientamoeba fragilis and Giardia duodenalis in our experience. Recenti Progressi in Medicina 98, 361–366.Google ScholarPubMed
Crotti, D., D'annibale, M. L., Fonzo, G., Lalle, M., Caccio, S. M. and Pozio, E. (2005). Dientamoeba fragilis is more prevalent than Giardia duodenalis in children and adults attending a day care centre in Central Italy. Parasite 12, 165–170.CrossRefGoogle Scholar
Cuffari, C., Oligny, L. and Seidman, E. G. (1998). Dientamoeba fragilis masquerading as allergic colitis. Journal of Pediatric Gastroenterology and Nutrition 26, 16–20.Google ScholarPubMed
De Wit, M. A., Koopmans, M. P., Kortbeek, L. M., van Leeuwen, N. J., Vinjé, J. and van Duynhoven., Y. T. (2001). Etiology of gastroenteritis in sentinel general practices in the netherlands. Clinical Infectious Diseases 33, 280–288.CrossRefGoogle ScholarPubMed
Dickinson, E. C., Cohen, M. A. and Schlenker, M. K. (2002). Dientamoeba fragilis: a significant pathogen. The American Journal of Emergency Medicine 20, 62–63.CrossRefGoogle ScholarPubMed
Grendon, J. H., Digiacomo, R. F. and Frost, F. J. (1991). Dientamoeba fragilis detection methods and prevalence: a survey of state public health laboratories. Public Health Reports 106, 322–325.Google ScholarPubMed
Grendon, J. H., Digiacomo, R. F. and Frost, F. J. (1995). Descriptive features of Dientamoeba fragilis infections. The Journal of Tropical Medicine and Hygiene 98, 309–315.Google ScholarPubMed
Keystone, J. S., Yang, J., Grisdale, D., Harrington, M., Pillon, L. and Andreychuk, R. (1984). Intestinal parasites in metropolitan Toronto day-care centres. Canadian Medical Association Journal 131, 733–735.Google ScholarPubMed
Norberg, A., Nord, C. E. and Evengård, B. (2003). Dientamoeba fragilis – a protozoal infection which may cause severe bowel distress. Clinical Microbiology and Infection 9, 65–68.CrossRefGoogle ScholarPubMed
Oxner, R. B., Paltridge, G. P., Chapman, B. A., Cook, H. B. and Sheppard, P. F. (1987). Dientamoeba fragilis: a bowel pathogen? The New Zealand Medical Journal 100, 64–65.Google ScholarPubMed
Preiss, U., Ockert, G., Brömme, S., and Otto, A. (1990). Dientamoeba fragilis infection, a cause of gastrointestinal symptoms in childhood. Klinische Pädiatrie 202, 120–123.CrossRefGoogle ScholarPubMed
Preiss, U., Ockert, G., Broemme, S. and Otto, A. (1991). On the clinical importance of Dientamoeba fragilis infections in childhood. Journal of Hygiene, Epidemiology, Microbiology, and Immunology 35, 27–34.Google ScholarPubMed
Rayan, H. Z., Ismail, O. A. and El Gayar, E. K. (2007). Prevalence and clinical features of Dientamoeba fragilis infections in patients suspected to have intestinal parasitic infection. Journal of the Egyptian Society of Parasitology 37, 599–608.Google ScholarPubMed
Spencer, M. J., Garcia, L. S. and Chapin, M. R. (1979). Dientamoeba fragilis. An intestinal pathogen in children? American Journal of Diseases of Children 133, 390–393.CrossRefGoogle ScholarPubMed
Spencer, M. J., Millet, V. E., Garcia, L. S., Rhee, L. and Masterson, L. (1983). Parasitic infections in a pediatric population. Pediatric Infectious Diseases 2, 110–113.CrossRefGoogle Scholar
Stark, D., Barratt, J., Ellis, J., Harkness, J. and Marriott, D. (2009). ‘Repeated Dientamoeba fragilis infections: a case report of two families from Sydney, Australia’. Infectious Disease Reports 1, 7–9.CrossRefGoogle ScholarPubMed
Stark, D., Barratt, J., Roberts, T., Marriott, D., Harkness, J. and Ellis, J. (2010 a). Comparison of microscopy, two xenic culture techniques, conventional and real-time PCR for the detection of Dientamoeba fragilis in clinical stool samples. European Journal of Clinical Microbiology & Infectious Diseases 29, 411–416.CrossRefGoogle ScholarPubMed
Stark, D., Barratt, J., Roberts, T., Marriott, D., Harkness, J. and Ellis, J. (2010 b). A review of the clinical presentation of dientamoebiasis. The American Journal of Tropical Medicine and Hygiene 82, 614–619.CrossRefGoogle ScholarPubMed
Stark, D., Beebe, N., Marriott, D., Ellis, J. and Harkness, J. (2005). Prospective study of the prevalence, genotyping, and clinical relevance of Dientamoeba fragilis infections in an Australian population. Journal of Clinical Microbiology 43, 2718–2723.CrossRefGoogle Scholar
Stark, D. J., Beebe, N., Marriott, D., Ellis, J. T. and Harkness, J. (2006). Dientamoebiasis: clinical importance and recent advances. Trends in Parasitology 22, 92–96.CrossRefGoogle ScholarPubMed
Stark, D., Beebe, N., Marriott, D., Ellis, J. and Harkness, J. (2007 a). Dientamoeba fragilis as a cause of travelers’ diarrhea: report of seven cases. Journal of Travel Medicine 14, 72–73.CrossRefGoogle ScholarPubMed
Stark, D., Fotedar, R., Van Hal, S., Beebe, N., Marriott, D., Ellis, J. T. and Harkness, J. (2007 b). Prevalence of enteric protozoa in human immunodeficiency virus (HIV)-positive and HIV-negative men who have sex with men from Sydney, Australia. The American Journal of Tropical Medicine and Hygiene 76, 549–552.CrossRefGoogle ScholarPubMed
Wenrich, D. H. (1944). Studies on Dientamoeba fragilis (protozoa). IV. Further observations, with an outline of present-day knowledge of this species. The Journal of Parasitology 30, 322–338.CrossRefGoogle Scholar
Yakoob, J., Jafri, W., Beg, M. A., Abbas, Z., Naz, S., Islam, M. and Khan, R. (2010). Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria. Parasitology Research 107, 679–684.CrossRefGoogle ScholarPubMed
Yang, J. and Scholten, T. (1977). Dientamoeba fragilis: a review with notes on its epidemiology, pathogenicity, mode of transmission, and diagnosis. The American Journal of Tropical Medicine and Hygiene 26, 16–22.CrossRefGoogle ScholarPubMed