1
|
Yildiz İ, Erdem Aynur Z. First detection and molecular characterization of Dientamoeba fragilis in cattle. Zoonoses Public Health 2022; 69:897-903. [PMID: 35796090 DOI: 10.1111/zph.12986] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 01/25/2023]
Abstract
Dientamoeba fragilis is a flagellated protozoan with amoeba-like morphology that inhabits the human gastrointestinal tract. It is endemic in a vast geography around the world, including developed countries. There are limited studies on non-human hosts of the parasite, and suitable hosts have not been clarified. The parasite has been detected in non-human primates, pigs, cats, dogs and rats. There is no study in the literature investigating and detecting the presence of this parasite in cattle. In this study, stool samples taken from 163 different cattle and calves from 11 different farms between March 2017 and May 2022 were examined for the detection of D. fragilis via PCR. Trichrome staining was performed on all PCR-positive samples. The isolates with the expected amplicon size were sequenced using the 18S ribosomal RNA region, and their genotypes were determined by BLAST analysis. Sequences were analysed with the most similar and reference sequences in the literature, forming a phylogenetic tree. We detected D. fragilis in 31 (19.01%) of the 163 stool samples. D. fragilis cysts/trophozoites were detected by trichrome staining method in six of 31 samples. All PCR products selected for molecular analysis from positive samples had the same nucleotide sequence. As a result of BLAST analysis, all sequences were determined to belong to D. fragilis genotype 1. This study determined for the first time that cattle are suitable hosts for D. fragilis. Furthermore, the parasite subtype we detected belongs to genotype 1, which is the most common type in humans, suggesting that the parasite may have a zoonotic character. Our result is important in terms of the epidemiology of the parasite, as the mode of transmission is controversial, and available data on its suitable hosts are limited.
Collapse
Affiliation(s)
- İbrahim Yildiz
- Faculty of Medicine, Department of Parasitology, Adnan Menderes University, Aydin, Turkey
| | - Zeynep Erdem Aynur
- Faculty of Medicine, Department of Parasitology, Adnan Menderes University, Aydin, Turkey
- Recombinant DNA and Recombinant Protein Application and Research Center, Adnan Menderes University, Aydin, Turkey
| |
Collapse
|
2
|
Montraveta-Querol M, Bovo MV, Roig-Abraham N, Romaní N, Alcaraz A, Fernández-Rivas G. Should Dientamoeba fragillis be looked for in pediatric digestive pathology of an unknown cause? A proposed pilot case-control study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:436-440. [PMID: 36195407 DOI: 10.1016/j.eimce.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/22/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Dientamoeba (D.) fragilis is a common intestinal protozoan with an unresolved clinical significance. The association between D. fragilis and the etiology of gastrointestinal symptoms in children is unclear. Metronidazole is often used for treatment. The aims of this study are to clarify the clinical relevance of D. fragilis in children with gastrointestinal symptoms, and to determine the clinical and microbiological efficacy of metronidazole in D. fragilis-infected children with gastrointestinal complaints. METHODS A prospective case-control study was performed from October 2017 to February 2019. A total of 106 individuals aged 1-17 were included. Out of the 106; 59 showed gastrointestinal symptoms (case group), and 47 were without gastrointestinal symptoms (control group). We excluded 2 patients from the case group. D. fragilis was diagnosed by real-time PCR in stool samples. A 10-day course of oral Metronidazole was prescribed in D. fragilis positive children with GI symptoms. Clinical data before and after the treatment as well as peripheral eosinophilia in previous blood samples, were recorded. RESULTS Of the 104 participants, D. fragilis was found in 17 (29.8%) children from the case group, whereas in the control group the parasite was detected in 11 patients (23.4%) with an odds ratio (OR) of 1.39 (IC 95% 0.53-3.75, p=0.46). The most prevalent clinical manifestation was abdominal pain (46/57, 80.7%). Seventeen cases with a positive PCR received anti-parasitic treatment according to the established protocol, although during the collection period we received only 11 stool samples to perform the post-treatment follow-up. The PCR of the D. fragilis remained positive in 3 patients (3/11, 27.27%). Despite achieving the eradication of the parasite, 4/8 patients (50%) continued with digestive symptoms. CONCLUSIONS According to our study there were no differences between the D. fragilis infection in children with or without gastrointestinal symptoms. No relation was found between the clinical and microbiological responses after said D. fragilis treatment. Therefore, we conclude that it is not justified to look specifically for D fragilis in pediatric patients with abdominal symptoms.
Collapse
Affiliation(s)
- Montse Montraveta-Querol
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain; Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Spain.
| | - Maria Victoria Bovo
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Neus Roig-Abraham
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Nona Romaní
- Department of Microbiology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alba Alcaraz
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Gema Fernández-Rivas
- Department of Microbiology, Hospital Germans Trias i Pujol, Badalona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Spain
| |
Collapse
|
3
|
Should Dientamoeba fragillis be looked for in pediatric digestive pathology of an unknown cause? A proposed pilot case–control study. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
4
|
Venturini E, Scarso S, Prelazzi GA, Niccolai C, Bianchi L, Montagnani C, Lapini M, Chiappini E, Antonelli A, Rossolini GM, Galli L. Epidemiology and clinical features of intestinal protozoan infections detected by Real-time PCR in non-native children within an Italian tertiary care children's hospital: A cross-sectional study. Travel Med Infect Dis 2021; 43:102107. [PMID: 34116243 DOI: 10.1016/j.tmaid.2021.102107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Enteric parasite infections are underestimated due to the limited sensitivity and specificity of microscopy, which remains the diagnostic gold standard in routine clinical practice. This could be a major problem in high-income countries, where the burden of parasitic diseases is low. In recent years, Multiplex Real-Time polymerase chain reaction (RT-PCR) based methods have been implemented. Therefore, the aim of this study was to evaluate the prevalence of four enteric protozoan species detected by RT-PCR in non-native children in Italy, and to describe their clinical characteristics. METHODS Adopted and immigrant children, evaluated for migration health assessment between 2017 and 2020 in a tertiary care children's hospital in Italy, were enrolled. Molecular analysis for Giardia lamblia, Dientamoeba fragilis, Blastocystis hominis, and Entamoeba histolytica, was conducted by in-house RT-PCR. RESULTS Overall, 209 children were enrolled and 70% of them resulted positive by RT-PCR for at least one enteric parasite. B. hominis (47.8%) was the most commonly identified protozoa, followed by D. fragilis (44.5%). Co-infections with multiple pathogens were detected in 35.4% of the samples. Almost 80% of parasite-positive children were asymptomatic and the most common symptom was flatulence (60.7% of symptomatic children). Eosinophils were significantly increased in RT-PCR positive children compared to the negative ones and children with D. fragilis presented the highest eosinophils count. CONCLUSIONS The In-house Multiplex RT-PCR assay provides a valid molecular detection system for selected enteric parasites. This novel and accurate diagnostic method can help in increasing the detection rate of parasite infection, especially in high-risk population.
Collapse
Affiliation(s)
| | - Salvatore Scarso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Claudia Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Manuela Lapini
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Italy.
| |
Collapse
|
5
|
Hawash YA, Ismail KA, Saber T, Eed EM, Khalifa AS, Alsharif KF, Alghamdi SA. Dientamoeba fragilis Infection in Patients with Digestive and Non-Digestive Symptoms: A Case-Control Study. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:129-134. [PMID: 32418381 PMCID: PMC7231832 DOI: 10.3347/kjp.2020.58.2.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/02/2020] [Indexed: 12/23/2022]
Abstract
In most developing countries, Dientamoeba fragilis infection is an obscure protozoan infection. We aimed to determine a frequency and clinical importance of D. fragilis infection in Taif, Saudi Arabia. A 1-year case control study included patients with gastrointestinal (cases, n=114) or non-gastrointestinal symptoms (controls, n=90). The fecal samples were examined with the classical parasitological methods for intestinal protozoa, and by real time PCR for D. fragilis. The infection by D. fragilis was detected in 5.8% by PCR and in 4.4% patients by microscopy. The infection was identified more in control group (n=9) than in cases (n=3); a sole infection in 11 patients and mixed with Giardia in 1 patient. The other enteric parasites detected were Blastocystis sp. (8.3%), Giardia sp. (5.3%), Cryptosporidium sp. (2.9%), Entamoeba histolytica (1.4%), Entamoeba coli (0.9%) and Hymenolepis nana (0.4%). Our results tend to reinforce the need to increase awareness of D. fragilis infection in Saudi Arabia.
Collapse
Affiliation(s)
- Yousry A Hawash
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Molecular and Clinical Parasitology, National Liver Institute, Menoufia University, Egypt
| | - Khadiga A Ismail
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Medical Parasitology, Faculty of Medicine, Ain-Shams University, Egypt
| | - Taisir Saber
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt
| | - Emad M Eed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Menoufia University, Egypt
| | - Amany S Khalifa
- Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Egypt.,Department of Medical Microbiology and Immunology, Faculty of Pharmacy, Taif University, Saudi Arabia
| | - Khalaf F Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia
| | - Saleh A Alghamdi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia
| |
Collapse
|
6
|
van Kalleveen MW, van Gool T, Klarenbeek N, Benninga MA, Savelkoul PHM, de Meij T, Plötz FB. Dientamoeba fragilis in children: a systematic review on diagnostic considerations and efficacy of treatment. Expert Rev Gastroenterol Hepatol 2020; 14:231-242. [PMID: 32155096 DOI: 10.1080/17474124.2020.1739520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The presence of D. fragilis in feces is characterized by an asymptomatic carrier ship to a spectrum of gastrointestinal symptoms. However, a causal relationship remains to be elucidated. In this systematic review, we aimed to evaluate the relationship between the eradication of D. fragilis and symptoms to establish the strength of evidence that D. fragilis in symptomatic children warrants antibiotic treatment.Areas covered: This systematic review covers a challenge in daily clinical practice. Is it necessary to test for D. fragilis in children with gastrointestinal symptoms and does a positive fecal PCR test warrant treatment?Expert opinion: Testing for D. fragilis seems justified in a selection of children with persistent unexplained chronic abdominal pain and diarrhea. Treatment of D. fragilis should be withhold until other causes like celiac disease have been excluded. Both microscopic and Real Time-PCR methods (or a combination of the two) can be used for diagnosis. Paromomycin or clioquinol are antibiotics of choice based on their small spectrum of activity, fewer side effects, and better eradication rates than metronidazole. Future randomized studies, with strict inclusion criteria, appropriate diagnostic testing, and doses of antibiotics based on bodyweight are warranted.
Collapse
Affiliation(s)
- Michael W van Kalleveen
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.,Department of Gastroenterology, Noordwest Hospital, Alkmaar, The Netherlands
| | - Tom van Gool
- Department of Medical Microbiology, Section Clinical Parasitology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nikki Klarenbeek
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, Section Clinical Parasitology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tim de Meij
- Department of Pediatric Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.,Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Abstract
Eosinophilia is defined as an elevated absolute number of eosinophilic leukocytes in peripheral blood or tissue. Its absolute number also defines the grade of eosinophilia. The main causes are allergic (including drug side effects) and infectious triggers but malignant and autoimmune diseases can also result in eosinophilia. Severe eosinophilia with the number of eosinophils >5000/µl are mostly caused by myeloproliferative disorders, eosinophilic granulomatosis with polyangiitis or during tissue migration in parasitic tissue infections. Hypereosinophilic syndrome is defined as eosinophilia with >1500 eosinophils/µl and a duration of more than 6 months by exclusion of parasitic infections, allergies or other causes of tissue eosinophilia with end-organ damage. For the diagnosis of a persistent eosinophilia a detailed medical history and physical examination should be followed by early organ screening, infection diagnostics especially for helminth infections and hematological laboratory analyses including bone marrow investigations.
Collapse
Affiliation(s)
- J C Henes
- Zentrum für Interdisziplinäre Klinische Immunologie, Rheumatologie und Autoimmunerkrankungen (INDIRA), Universitätsklinikum, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland. .,Medizinische Klinik II (Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie), Universitätsklinikum Tübingen, Tübingen, Deutschland.
| | - S Wirths
- Medizinische Klinik II (Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie), Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - B Hellmich
- Vaskulitiszentrum-Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken, Akademisches Lehrkrankenhaus, Universität Tübingen, Kirchheim u. Teck, Deutschland
| |
Collapse
|