Dientamoeba fragilis and chronic abdominal pain in children: a case-control study

Jong, Marin J de; Korterink, Judith; Benninga, Marc A.; Hilbink, Mirrian; Widdershoven, J.; Deckers-Kocken, Judith M.

doi:10.1136/archdischild-2014-305942

Cited by 38 publications

(27 citation statements)

References 32 publications

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“…The reported prevalence of D. fragilis in individuals suffering from GI symptoms varies from 1 to 70 % [ 4 , 7 , 8 ]. No difference in the prevalence of D. fragilis has been found in patients suffering from irritable bowel syndrome [ 6 ] or children with chronic abdominal pain [ 9 ] compared to individuals without symptoms. The life cycle of D. fragilis and its mode of transmission are not fully understood and a faecal–oral transmission seems unlikely [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Dientamoeba fragilis prevalence coincides with gastrointestinal symptoms in children less than 11 years old in Sweden

Ögren

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Löfgren

et al. 2015

Eur J Clin Microbiol Infect Dis

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Dientamoeba fragilis is a protozoan with a debated role in gastrointestinal (GI) disease. Although correlated to GI symptoms, no virulence factors have been described. In this study, we evaluated the cause of GI symptoms in children at two schools, with children aged 1 to 10 years, in the county of Jönköping, Sweden. D. fragilis infection correlated to GI symptoms in children and Enterobius vermicularis correlated to D. fragilis infection.

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Section: Introductionmentioning

confidence: 99%

Dientamoeba fragilis prevalence coincides with gastrointestinal symptoms in children less than 11 years old in Sweden

Ögren

Dienus

Löfgren

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…ientamoeba fragilis is an intestinal protozoan of debated clinical significance (1)(2)(3)(4)(5)(6)(7). In Denmark, D. fragilis appears to be common in the apparently healthy adult population (8); meanwhile, baseline data on the prevalence in apparently healthy children are lacking.…”

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confidence: 99%

Dientamoeba fragilis, a Commensal in Children in Danish Day Care Centers

et al. 2017

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Dientamoeba fragilis is an intestinal protozoan of debated clinical significance. Here, we present cross-sectional and longitudinal observations on D. fragilis in children aged 0 to 6 years from a 1-year multi-day-care-center cohort study set in Copenhagen, Denmark. The inclusion period for the cohort was 2009 through 2012. Stool samples collected from the children were accompanied by questionnaires completed by the parents or guardians of the children. Using real-time PCR, D. fragilis was detected in the first stool sample from 97 of 142 (68.3%) children. We evaluated the associations between seven plausible risk factors (age, sex, having siblings, having domestic animals at home, having had infant colic, recent history of intake of antibiotics, and recent history of travel abroad) as well as six reported symptoms (lack of appetite, nausea, vomiting, abdominal pain, weight loss, and diarrhea) and testing positive for D. fragilis. The final multivariable model identified being Ͼ3 years old and having a history of recent travel abroad as risk factors for testing positive for D. fragilis. Moreover, univariable analyses indicated that having siblings was a risk factor. There was no statistical association between a recent history of gastrointestinal symptoms and testing positive for D. fragilis. Among the 108 children who were represented by Ն2 samples and thus included in the longitudinal analysis, 32 tested negative on the first sample and positive later, and the last sample from each of the 108 children was positive. The results are in support of D. fragilis being a common enteric commensal in this population.KEYWORDS Denmark, dientamoebiasis, infants, preschoolers, risk factors, symptoms, toddlers D ientamoeba fragilis is an intestinal protozoan of debated clinical significance (1-7). In Denmark, D. fragilis appears to be common in the apparently healthy adult population (8); meanwhile, baseline data on the prevalence in apparently healthy children are lacking. Dientamoeba fragilis is commonly detected in stools from children tested for gastrointestinal pathogens, with a peak (ca. 70% of samples positive) in 7-year-olds (9). A randomized placebo-controlled clinical trial failed to show improved clinical outcome in D. fragilis-positive children treated with metronidazole compared with those treated with a placebo, and the observed eradicative effect of metronidazole was moderate and transient, and a spontaneous decrease in the proportion of children testing positive was observed in the placebo group (10).We recently established an open cohort of children aged 0 to 6 years attending municipal day care centers in Copenhagen, Denmark, with a primary research focus on investigating enteroaggregative Escherichia coli over time (11-13). Using real-time PCR (14), DNA of D. fragilis was detected in the majority (516/688 [75.0%]) of the stool

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“…The observation that D. fragilis is more commonly detected in healthy, non-symptomatic individuals than in symptomatic patients was previously done by numerous other adult and paediatric case–control studies 11–15. All of these studies questioned the pathogenicity of D. fragilis (see table 1).…”

Section: Discussionmentioning

confidence: 95%

No association between abdominal pain and Dientamoeba in Dutch and Belgian children

et al. 2019

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ObjectiveTo study the association between Dientamoebafragilis colonisation and faecal calprotectin to see whether the parasite is a harmless commensal or a gut pathogen.DesignCross-sectional study of previously collected stool samples.Setting and patientsTwo hundred stool samples originated from children aged 5–19 years with chronic abdominal pain and diarrhoea, who were seen in paediatric clinics in the Netherlands and Belgium and in whom somatic gastrointestinal disorders were excluded. Another 122 samples came from a healthy community-based reference population of the same age. All stool samples were analysed with real-time PCR for the detection of D. fragilis and with an ELISA for calprotectin—a biomarker of gastrointestinal inflammation.Main outcome measuresPrevalence of D. fragilis colonisation and results of stool calprotectin testing.ResultsD. fragilis was detected in 45% (95% CI 38% to 51%) of patients and in 71% (95% CI 63% to 79%) of healthy children. Median (IQR) concentrations of calprotectin in patients and healthy children with a positive PCR result were not different from those with a negative PCR result (40 (40–55) μg/g vs 40 (40–75) μg/g, respectively).ConclusionSince D. fragilis colonisation is most prevalent in healthy children and is not associated with an increase in faecal calprotectin concentration, our data do not support the inference that D. fragilis is a pathogenic parasite. Routinely testing for D. fragilis in children with chronic abdominal pain should therefore be discouraged.

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Dientamoeba fragilis and chronic abdominal pain in children: a case-control study

Cited by 38 publications

References 32 publications

Dientamoeba fragilis prevalence coincides with gastrointestinal symptoms in children less than 11 years old in Sweden

Dientamoeba fragilis prevalence coincides with gastrointestinal symptoms in children less than 11 years old in Sweden

Dientamoeba fragilis, a Commensal in Children in Danish Day Care Centers

No association between abdominal pain and Dientamoeba in Dutch and Belgian children

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