![]() ![]() From our prospective study it is clear that the use of SAF fixative is crucial in the detection of DF. ![]() A laboratory which offers comprehensive stool testing should be used.Ĭomplete data of long, post treatment follow up has recently been reviewed for 21 consecutive patents who presented with at least two months to a lifelong history of IBS-like symptoms and were positive (exclusively) for Dientamoeba fragilis (DF). Many of these symptoms mirror the symptoms of IBS.Ĭlinical suspicion of DF in patients with diarrhea predominant IBS needs to be confirmed by the demonstration of the parasite in stools. In the literature, abdominal pain, persistent diarrhea, pruritus, abnormal stool with mucus, flatulence, fatigue or weakness, occasional eosinophilia, alternating diarrhea and constipation, nausea or vomiting, weight loss, constipation, belching and tenesmus are found in decreasing order of frequency as symptoms in patients in whom only DF was identified. Numerous observations have shown that treatment which eliminates the organism results in clinical improvement. Onset of infection is accompanied by onset of colicky pain, loss of appetite, soft stools covered with mucus and irritation of the rectum. Though the ability of DF to cause disease is still questioned by some, the circumstantial evidence incriminating this organism as a pathogen is overwhelming. By contrast infection with DF by ingesting DF trophozoites has failed. Now that’s dedication! Two other successful attempts at infecting humans with DF from pinworms were also described by Ockert. In fact, Ockert experimentally infected himself with pinworm eggs from a child and subsequently developed DF infection. Many authors have now reported a higher than anticipated co-incidence of DF and E. DF forms have been documented in the lumen of pinworms found in the human appendix. vermicularis) are the vector responsible for person to person spread. Transmission of DF still remains unclear although there has been fair substantiation of the hypothesis that pinworms (E. Therefore, methods used in the detection of DF are of crucial importance. When stool slides are suitably stained there is a five fold increase in the rate of detection. There is also debate about whether the detection rate is higher in soft or fluid stool. Identification is more probable when the fecal samples are examined in three rather than one sample and is not possible without the use of a fixative agent such as SAF ( sodium acetate / acetic acid / formalin). Sampling and detection methods have an immense influence on the ability of a laboratory to detect DF. Higher rates of infection are seen in crowded conditions with poor personal hygiene. The use of adequate culture techniques has increased detection of DF significantly with reported rates as high as 18% in Israel, 36% in Holland and 42% in Germany. Over the past four decades its global incidence has been studied varying considerably, generally being higher in immune compromised patients. By 1924, only 33 DF cases were recorded world-wide. Much has been learned about the epidemiology of DF since its original description. Chronic infection occurs after 1-2 months of illness and is manifested by abdominal pain. Morbidity related to acute infection is in the first 1-2 weeks of the disease, with symptomatology predominated by diarrhea. No specific mortality is associated with this enteropathogen. ![]() In children, the opposite is true disease develops in as many as 90% of those colonized. ![]() In adults, asymptomatic colonization is present in 75-85% of individuals affected by the parasite. Colonization may occur without development of disease. ![]()
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