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Vol. 37. Issue 5.
Pages 287-358 (May 2019)
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Vol. 37. Issue 5.
Pages 287-358 (May 2019)
Original article
DOI: 10.1016/j.eimce.2018.07.016
Epidemiological and clinical characteristics of Dientamoeba fragilis infection
Características clínicoepidemiológicas de las infecciones por Dientamoeba fragilis
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Candela Menéndeza, Jonathan Fernández-Suarezb, Jose A. Boga Ribeirob, Mercedes Rodríguez-Pérezb, Fernando Vázquezb, Nieves Gonzalez-Sotorriosc, Azucena Rodríguez-Guardadod,
Corresponding author
azucenarodriguez@telecable.es

Corresponding author.
a Internal Medicine Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
b Microbiology Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Spain
c Gastrointestinal Diseases Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
d Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Table 1. Clinical and epidemiological Characteristics of patients.
Table 2. Characteristics of D. fragilis infection by several authors.
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Abstract
Introduction

The characteristics of D. fragilis infection are described, with special focus on the clinical and epidemiological aspects.

Materials and methods

A retrospective and descriptive study was performed, including all the patients with Dientamoeba fragilis infection who attended a specialized unit between January 2012 and December 2017. PCR was used to diagnose D. fragilis. Patients were treated with metronidazole or paromomycin and reviewed at four and eight weeks post-treatment. Cure was defined as the negativization of all parasitological tests, in absence of symptoms.

Results

163 patients were diagnosed. The most frequent symptoms were abdominal pain (36.2%), chronic diarrhoea (12.3%), anal itching (10.4%), abdominal discomfort (9.2%), skin disease (8%), acute diarrhoea (4.3%) and vomiting (4.3%). Fifty patients were asymptomatic. Forty-two patients had eosinophilia in blood. Thirty-eight cases (23.3%) had a coinfection by Enterobius vermicularis. One hundred and seven patients received treatment, sixty-one of them with metronidazole and the rest with paromomycin. Ninety-nine patients (91%) were cured. The rate of cure was 100% in the paromomycin group versus 86.8% in the metronidazole group (p=0.005; OR: 1.173 [1.057–1.302]). The absence of cure was associated with E. vermicularis coinfection (p=0.014; OR: 6.167 [1.432–26.563] and with longer duration of the symptoms (175 [±159SD]) versus 84 [±88SD] days, p=0.014) but multivariable analysis did not confirm these associations.

Conclusion

Dientamoeba fragilis is an important and underestimated cause of gastrointestinal disease in both the autochthonous and immigrant or traveller population. More studies are needed to clarify its optimal treatment and the role played by E. vermicularis in its transmission and maintenance.

Keywords:
Dientamoeba fragilis
Epidemiology
Treatment
Clinical
Protozoan
Resumen
Introducción

Se describen las características clínicas y epidemiológicas de la infección por Dientamoeba fragilis.

Material y métodos

Se realizó un estudio retrospectivo y descriptivo de los pacientes diagnosticados de infección por D. fragilis en una unidad especializada entre 2012-2017. El diagnóstico de D. fragilis se realizó mediante PCR. Los pacientes fueron tratados con metronidazol o paromomicina y revisados a las 4 y 8 semanas tras tratamiento. Se consideró a los pacientes curados tras negativización microbiológica en ausencia de síntomas.

Resultados

Se analizaron 163 pacientes. Los síntomas más frecuentes fueron: dolor abdominal (36,2%), diarrea crónica (12,3%), prurito anal (10,4%), malestar abdominal (9,2%), síntomas cutáneos (8%), diarrea aguda y vómitos (4,3%, respectivamente). Cincuenta pacientes estaban asintomáticos. Cuarenta y dos pacientes presentaron eosinofilia. En 38 pacientes se observó coinfección por Enterobius vermicularis. Ciento siete pacientes recibieron tratamiento, 61 con metronidazol y el resto con paromomicina, con una curación del 91%. La tasa de curación fue del 100% en los pacientes tratados con paromomicina y del 86,8% en el grupo del metronidazol (p=0,005; OR: 1,173 [1,057-1,302]). La no curación se asoció a la coinfección por E. vermicularis (p=0,014; OR: 6,167 [1,432-26,563]) y con la mayor duración de los síntomas (175 [±159 DE] versus 84 [±88 DE] días; p=0,014), pero el análisis multivariable no confirmó dichas asociaciones.

Conclusión

D. fragilis es causa importante y subestimada de enfermedad gastrointestinal tanto en poblaciones autóctonas como inmigrantes o viajeros. Se necesitan más estudios para aclarar su tratamiento óptimo y el papel desempeñado por E. vermicularis en su tratamiento.

Palabras clave:
Dientamoeba fragilis
Epidemiología
Tratamiento
Clínica
Protozoos

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