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PubMedDate not supplied

Dientamoeba fragilis infection, a cause of gastrointestinal symptoms in childhood.

Clinical and laboratory findings of 123 paediatric patients with infections due to intestinal protozoa were analysed. Dientamoeba fragilis (D.f.) was found in 102 cases. The other patients had infections with Giardia lamblia or mixed infections with several other protozoa. Acute and recurrent diarrhoea were the most common findings (56 cases), whereas abdominal pain was more common in children with chronic symptoms. Peripheral eosinophilia was present in 32% of the children with dientamoebiasis. Metronidazole, oxytetracycline, doxycycline, and erythromycin were the most effective drugs in the treatment of D.f. infections. The therapy led coincidentally to the sanitation of stools and elimination of abdominal complaints. The investigations underline the pathogenic role of D.f. in those children with gastrointestinal symptoms. Mixed infections of D.f. and Enterobius vermicularis suggest a vector bound transmission of D.f.

Adolescent↗
PubMed1991

On the clinical importance of Dientamoeba fragilis infections in childhood.

Clinical and laboratory findings among 123 paediatric patients infected by intestinal protozoa were analysed. Dientamoeba fragilis (D. f) was found in 102 cases. The other patients proved to be carriers of Giardia lamblia or of mixed infections with several protozoa. 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. Metronidazole, oxytetracycline, doxycycline, and erythromycin were effective drugs in the treatment of D. f. infections. The therapy coincidentally led to the elimination of protozoal infections as well as the abdominal complaints. These results underline the pathogenic role of D. f. in children with gastrointestinal symptoms.

Abdominal Pain↗
PubMed1983

Dientamoeba fragilis, a protozoan parasite in adult members of a semicommunal group.

Dientamoeba fragilis is an intestinal protozoan parasite associated with gastrointestinal symptoms. This study was undertaken in a semicommunal group reported to have a high prevalence of this parasite. Stools were collected from 81 adult group members. Intestinal parasites were observed in stool specimens of 45 (56%) of the 81 adults; D. fragilis was found in 33 (41%) subjects. This paper describes the clinical findings and treatment of 26 adults with D. fragilis alone or with a commensal. Gastrointestinal symptoms were observed in 22 (85%) of infected subjects; abdominal pain and excessive flatus were significantly more common in this group. diiohydroxyquin 650 mg three times a day for 20 days eliminated the parasite in 10 (83%) of the 12 treated, although three subjects required a second course of therapy. Parasitic infection should be considered in patients with vague gastrointestinal symptoms, especially those living in endemic areas, in close proximity, or with a history of foreign travel.

Adolescent↗
PubMed1996

Prevalence of Dientamoeba fragilis antibodies in children and recognition of a 39 kDa immunodominant protein antigen of the organism.

Dientamoeba fragilis, a common intestinal protozoan parasite in Canada, has been associated with diarrhoea and abdominal pain in some patients. Seroprevalence of this organism has not been reported previously. In the present study sera from three symptomatic patients, 12 age- and sex-matched controls, and 189 randomly selected healthy individuals (age 6 months to 19 years) were tested for antibodies against Dientamoeba fragilis by an indirect immunofluorescence (IIF) assay. All three symptomatic patients infected with Dientamoeba fragilis had positive IIF titres of 80, and all 12 matched controls had positive titres ranging 20 to 160 (geometric mean titre 48). Of the 189 healthy children, 172 (91%) were positive at a serum dilution of 1:10 or higher. The specificity of the IIF assay was reinforced by immunoblotting 20 representative serum samples against Dientamoeba fragilis. In all 17 IIF-positive serum samples, a 39 kDa protein band of Dientamoeba fragilis was identified, the same band recognized by a mouse monoclonal antibody raised in our laboratory. Findings over a five-year period indicate that Dientamoeba fra-gilis was the most common protozoan, followed closely by Giardia lamblia and more distantly by Cryptosporidium parvum. The high seropositivity of 91% for Dientamoeba fragilis compares reasonably well with serologic data obtained by IIF and reported previously for Giardia lamblia (85.6%) and Cryptosporidium parvum (86%).

Adolescent↗
PubMed1996

Dientamoeba fragilis. An unusual intestinal pathogen.

This is a case report of a gastrointestinal infection caused by Dientamoeba fragilis. 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. Diagnosis is made using multiple fresh stool samples that are preserved and permanently stained looking for the typical binucleate trophozoite. Since there is a distinct association with Enterobius vermicularis (possibly the mode of protozoan transmission), the human pinworm is also sought. Treatment of choice consists of diiodohydroxyquin in adults and metronidazole in children.

Abdominal Pain↗
PubMedDate not supplied

Diagnosis by faecal culture of Dientamoeba fragilis infections in Australian patients with diarrhoea.

This paper reports the first survey in Australia to use faecal culture to detect Dientamoeba fragilis in patients with diarrhoea. Of 3 different protozoal culture media evaluated on a case of known infection, modified Boeck & Drbohlav's medium was the most suitable. The organism could be grown from faeces stored for up to 24 h at room temperature, but for only 10 h at 4 degrees C. Culture was then used, in combination with microscopy of smears fixed with polyvinyl alcohol and trichrome-stained, to examine single stool specimens from 260 consecutive patients with diarrhoea in the city of Brisbane. D. fragilis was detected in 4 (1.5%) specimens, only 2 of which were positive by microscopy. Other protozoa were found in 36 (13.8%) specimens: Blastocystis hominis in 28 (10.8%), Giardia duodenalis in 4 (1.5%), Endolimax nana in 3 (1.2%), and Entamoeba coli in one (0.4%). One strain of Dientamoeba was cryopreserved in liquid nitrogen and recultured successfully 10 d later. Culture was more sensitive than microscopy in diagnosing D. fragilis infection and the organism, of dubious pathogenicity, was not common in patients with diarrhoea in this community. Prevalence surveys of intestinal protozoan infections should use faecal culture, and specimens should be less than 12 h old and not refrigerated. Dientamoeba strains isolated by culture can be cryopreserved.

Animals↗
PubMed1998

Dientamoeba fragilis masquerading as allergic colitis.

BACKGROUND: Dientamoeba fragilis is a rare cause of chronic infectious diarrhea and colitis in children. METHODS: Review of the clinical manifestations, diagnostic methods, and clinical course of D. fragilis infection in our hospital. RESULTS: Eleven pediatric patients are discussed, seven of whom had a history of recent travel. Clinical manifestations of infectious diarrhea included anorexia, intermittent vomiting, abdominal pain, and diarrhea, ranging from 1 to 100 weeks in duration. 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. Eosinophilic colitis documented by colonoscopy, was due to D. fragilis. Metronidazole was effective in treating five patients, and iodoquinol was effective in treating four others. CONCLUSIONS: D. fragilis should be included in the differential diagnosis of chronic diarrhea and eosinophilic colitis. 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.

Abdominal Pain↗
PubMedDate not supplied

Parasitic infections in a pediatric population.

We studied the frequency of parasitic infection and associated clinical symptoms in children who attended general pediatric and dental clinics at UCLA. Parasites were detected in stool specimens of 40 (38%) of the 1-4 children completing the study. Protozoan parasites were recovered in 39 (38%); one child had whipworm eggs. Parasites included Dientamoeba fragilis in 22 (21%) children and Giardia lamblia in 18 (17%) children; commensals were observed in 15 (14%) children. Parasitic infection was more frequent in younger children, those with a history of immigration or foreign travel and those attending a day care center. A significant proportion of children with parasites had vague gastrointestinal complaints; however, parasites had not been considered as the etiologic agent by the parent or child's physician. Anorexia, irritability and gas were frequent in children with G. lamblia; abdominal pain was more frequent in those with D fragilis. Intestinal parasitic infection should be considered in children with vague gastrointestional complaints, particularly those in endemic areas, with a history of foreign travel or immigration or attending a day care center. Siblings of infected children should have stool examination even if asymptomatic.

Adolescent↗
PubMed1993

Application of indirect immunofluorescence to detection of Dientamoeba fragilis trophozoites in fecal specimens.

An indirect fluorescent-antibody (IFA) assay was carried out to examine for the presence of Dientamoeba fragilis trophozoites in preserved fecal specimens. Antiserum to D. fragilis trophozoites was raised in a rabbit with a dixenic culture of D. fragilis (ATCC 30948) from the American Type Culture Collection. After absorption with Klebsiella pneumoniae and Bacteroides vulgatus, the immune rabbit serum was used for examination by the IFA assay. A total of 155 clinical samples were tested; 42 with no parasites, 9 with D. fragilis, and 104 with other parasites. The IFA assay identified seven D. fragilis organisms. Two specimens with doubtful IFA assay readings showed very scanty amounts of D. fragilis trophozoites on stained smears. There were no false-positive IFA assay readings. The IFA assay appeared to be a promising method because of its speed in screening. The specificity of the IFA assay indicates that other diagnostic tests such as an enzyme-linked immunosorbent assay could be developed to identify D. fragilis antigens in fecal specimens.

Animals↗
PubMed1977

Comparison of immediate polyvinyl alcohol (PVA) fixation with delayed Schaudinn's fixation for the demonstration of protozoa in stool specimens.

Immediate fixation of stool specimens in polyvinyl alcohol fixative (PVA) was compared with Schaudinn's fixation delayed until the specimens were received in the laboratory, in a series of 100 consecutive positive stool specimens. More specimens were found positive following PVA fixation, and the numbers of organisms present on the slides were greater in specimens processed by this technique than after Schaudinn's fixation. It is concluded that immediate fixation results in the preservation of larger numbers of organisms in a recognizable state. The routine use of PVA fixation prior to transportation of the specimen to the laboratory is recommended.

Amebiasis↗
PubMed1977

Dientamoeba fragilis: a review with notes on its epidemiology, pathogenicity, mode of transmission, and diagnosis.

Dientamoeba fragilis was found in 4.2% of approximately 43,000 individuals who submitted stools for parasitological examination during 1970 to 1974. The parasite was more frequently found in the younger age group (less than 20 years) than in older age groups, and more often in females than in males. Symptoms in 255 of patients in whom D. fragilis was the only parasite found and for whom detailed symptoms had been supplied, included: diarrhea, abdominal pains, anal pruritus, and loose stools. Analysis of mixed infections of D. fragilis with intestinal helminths suggests that such infections are random except for the combination of D. fragilis and Enterobius vermicularis. This combination occurred 9 times more often than theoretically expected. Daily periodicity and distribution of D. fragilis within stools of one patient were studied over a period of 6 months. More than twice as many organisms per ml of stool were present in the last than in the first portion evacuated. The total number of organisms excreted fluctuated markedly from day to day.

Adolescent↗
PubMed1983

Intestinal protozoan infection in a semicommunal group.

A survey was conducted to determine the prevalence of protozoan parasites in a large semicommunal group in Los Angeles. Protozoan parasites were observed in 151 (69%) of the 220 group members in the study. Parasites were observed in stool specimens from 105 (76%) of the 138 children and 46 (56%) of the 82 adults. Dientamoeba fragilis was observed in 115 (52%), Giardia lamblia in 50 (23%), Entamoeba histolytica in 9 (4%), and commensals in 61 (28%). Parasitic infection was infrequent in infants less than 1 year old, was demonstrated in 33 (89%) of the 2- to 4-year-olds, 69 (78%) of the 89 school age children 8-15 years of age, and in 46 (56%) of the 82 adults. G. lamblia was most prevalent in children younger than 6 years; whereas D. fragilis was common in all age groups. The fecal-oral route was the most likely means for parasite transmission. Since the group at times serves meals to the public, spread of parasites outside the community is a potential public health problems. Diagnosis of parasitic infection is dependent on optimal stool collection, proper laboratory techniques and trained personnel.

Adolescent↗
PubMed1984

Intestinal protozoa in homosexual men of the San Francisco Bay area: prevalence and correlates of infection.

To compare the prevalence of intestinal parasitic infection in male homosexuals selected from other sources with the levels previously reported from clinic-derived populations, various homosexual groups of the San Francisco Bay Area were checked by means of stool examination and questionnaires for prevalence of intestinal parasites and for related sexual behavioral patterns during a 3-year period. The prevalence of Entamoeba histolytica (28.6%) was similar to that reported in other studies, whereas that of Giardia lamblia was lower. Infection with E. histolytica was correlated significantly with a prior history of syphilis or gonorrhea (P less than 0.0001), with the number of sexual partners in the preceding 12-month period (P less than 0.0001), and with the reported frequency of oral-anal sexual contact (P less than 0.001). Giardial infection was also significantly related to oral-anal sex (P less than 0.001). No relation was seen between the presence or absence of gastrointestinal symptoms and infection with pathogenic protozoa. Factors associated with parasitic infection differed little from those found in previous studies, although significance levels were considerably higher because of the larger size of our study group.

Adult↗
PubMed1986

Blastocystis hominis: pathogen or fellow traveler?

Blastocystis hominis, an intestinal organism of uncertain taxonomic position, has long been considered nonpathogenic. Some recent studies suggest, however, that it may be associated with diarrhea and may respond to treatment with iodoquinol or metronidazole. To investigate this possibility, we identified 148 persons whose stools contained this organism. Of this number, 32 had at least 6 stool examinations performed. Twenty-seven of the 32 persons were later found to have greater than or equal to 1 recognized pathogens--Entamoeba histolytica, Giardia lamblia or Dientamoeba fragilis--and, after receiving appropriate therapy, became asymptomatic. The B hominis infection, however, was unaffected by therapy. Five persons with only B. hominis infection were treated with iodoquinol without effect; these persons fulfilled the medical criteria for irritable bowel syndrome. We believe that when an apparently symptomatic B. hominis infection responds to therapy, the improvement probably represents elimination of some other undetected organism causing the infection.

Diarrhea↗
PubMed1975

[Epidemiology of Dientamoeba fragilis Jepps and Dobell, 1918. 3. Further studies on Enterobius transmission through eggs].

In two new attempts to infect human subjects with pin-worms that were infested, at that time, with protozoa Dientamoeba fragilis, presence of these protoza in the intestinal canal was observed in one case for more than 84 days, and in another case for more than 31 days after contamination. The duration of latent periods fixed for Enterobius vermicularis was almost identical (51 and 50 days). New attempts implement and confirm the results of the first successful attempts to transfer the infection (Ockert, 1972b) as well as the hypothesis of the epidemiological interrelation between both parasites (Burrows and Swerdlow 1956).

Amebiasis↗