A clinical guideline on Dientamoeba fragilis infections

• Published in: Parasitology Vol. 146; no. 9; pp. 1131 - 1139
• Main Authors: van Gestel, Rosanne SFE, Kusters, Johannes G, Monkelbaan, Jan F
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.08.2019
• Subjects: Adult; adults; Animals; Antibiotics; Antiprotozoal Agents - therapeutic use; Child; children; Cysts; Diagnostic systems; diagnostic techniques; Diarrhea; Diarrhea - parasitology; Dientamoeba - genetics; Dientamoeba - pathogenicity; Dientamoeba fragilis; Dientamoebiasis - diagnosis; Dientamoebiasis - drug therapy; Dientamoebiasis - parasitology; Families & family life; Feces; Feces - parasitology; guidelines; Humans; Infections; Intestinal parasites; Intestine; intestines; Laboratories; Light; Microscopy; Pain; Parasites; Pathogenicity; Pathogens; Patients; Polymerase chain reaction; Practice Guidelines as Topic; therapeutics; Netherlands; Vietnam; Pakistan; United States > US; Denmark; Italy; Australia; Antibiotic treatment; Gastro-intestinal parasite; enteric parasite; diagnosis and therapy; E. coli Escherichia coli; PCR polymerase chain reaction; D. fragilis Dientamoeba fragilis
• ISSN: 0031-1820; 1469-8161; 1469-8161
• DOI: 10.1017/S0031182018001385

Dientamoeba fragilis (D. fragilis) is an intestinal parasite frequently detected in humans with abdominal pain and diarrhoea, but it is also commonly found in asymptomatic subjects. Hence its clinical relevance is often disputed. The introduction of polymerase chain reaction (PCR) is a versatile and sensitive diagnostic technique for the detection of intestinal parasites, and in some Western world countries PCR has almost completely replaced microscopic diagnostics. PCR has however resulted in an increase in the number of D. fragilis-positive patients. The disputed pathogenic nature of this intestinal parasite and an apparent increase in the incidence of patients with positive PCR results have renewed the discussions between clinicians and microbiologists on how to deal with an infected patient. Moreover, treatment guidelines differ throughout the world which makes it difficult for clinicians to choose an optimal therapeutic regimen.