Dientamoeba fragilis - the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017

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Pietilä , J-P , Meri , T , Siikamäki , H , Tyyni , E , Kerttula , A-M , Pakarinen , L , Jokiranta , T S & Kantele , A 2019 , ' Dientamoeba fragilis - the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017 ' , Eurosurveillance , vol. 24 , no. 29 , 1800546 , pp. 31-41 . https://doi.org/10.2807/1560-7917.ES.2019.24.29.1800546

Title: Dientamoeba fragilis - the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017
Author: Pietilä, Jukka-Pekka; Meri, Taru; Siikamäki, Heli; Tyyni, Elisabet; Kerttula, Anne-Marie; Pakarinen, Laura; Jokiranta, T. Sakari; Kantele, Anu
Contributor: University of Helsinki, HUS Inflammation Center
University of Helsinki, Molecular and Integrative Biosciences Research Programme
University of Helsinki, HUS Inflammation Center
University of Helsinki, Clinicum
University of Helsinki, HUSLAB
University of Helsinki, Infektiosairauksien yksikkö
University of Helsinki, Medicum
University of Helsinki, HUS Inflammation Center
Date: 2019-07-18
Number of pages: 11
Belongs to series: Eurosurveillance
ISSN: 1560-7917
URI: http://hdl.handle.net/10138/304603
Abstract: Despite the global distribution of the intestinal protozoan Dientamoeba fragilis, its clinical picture remains unclear. This results from underdiagnosis: microscopic screening methods either lack sensitivity (wet preparation) or fail to reveal Dientamoeba (formalin-fixed sample). Aim: In a retrospective study setting, we characterised the clinical picture of dientamoebiasis and compared it with giardiasis. In addition, we evaluated an improved approach to formalin-fixed samples for suitability in Dientamoeba diagnostics. Methods: This study comprised four parts: (i) a descriptive part scrutinising rates of Dientamoeba findings; (ii) a methodological part analysing an approach to detect Dientamoebalike structures in formalin samples; (iii) a clinical part corn paring demographics and symptoms between patients with dientamoebiasis (n = 352) and giardiasis (n = 272), and (iv) a therapeutic part (n = 89 patients) investigating correlation between faecal eradication and clinical improvement. Results: The rate of Dientamoeba findings increased 20-fold after introducing criteria for Dientamoeba-like structures in formalin-fixed samples (88.9% sensitivity and 83.3% specificity). A further increase was seen after implementing faecal PCR. Compared with patients with giardiasis, the symptoms in the Dientamoeba group lasted longer and more often included abdominal pain, cramping, faecal urgency and loose rather than watery stools. Resolved symptoms correlated with successful faecal eradication (p<0.001). Conclusions: Previously underdiagnosed, Dientamoeba has become the most frequently recorded pathogenic enteroparasite in Finland. This presumably results from improved diagnostics with either PCR or detection of Dientamoeba-like structures in formalin-fixed samples, an approach applicable also in resource-poor settings. Symptoms of dientamoebiasis differ slightly from those of giardiasis; patients with distressing symptoms require treatment.
Subject: 3121 Internal medicine
Infektiosairaudet
REAL-TIME PCR
GASTROINTESTINAL SYMPTOMS
CLINICAL-RELEVANCE
CHILDREN
PREVALENCE
DIARRHEA
METRONIDAZOLE
TRANSMISSION
INFECTIONS
PARASITES
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