TY - JOUR
T1 - Dientamoeba fragilis in children
T2 - a systematic review on diagnostic considerations and efficacy of treatment
AU - van Kalleveen, Michael W.
AU - van Gool, Tom
AU - Klarenbeek, Nikki
AU - Benninga, Marc A.
AU - Savelkoul, Paul H.M.
AU - de Meij, Tim
AU - Plötz, Frans B.
PY - 2020/4/2
Y1 - 2020/4/2
N2 - 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.
AB - 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.
KW - Clioquinol
KW - Dientamoeba fragilis
KW - dientamoebiasis
KW - metronidazole
KW - paromomycin
KW - pediatrics
KW - polymerase Chain Reaction
KW - protozoa
KW - triple Feces Test
UR - http://www.scopus.com/inward/record.url?scp=85082411149&partnerID=8YFLogxK
U2 - 10.1080/17474124.2020.1739520
DO - 10.1080/17474124.2020.1739520
M3 - Review article
C2 - 32155096
AN - SCOPUS:85082411149
VL - 14
SP - 231
EP - 242
JO - Expert review of gastroenterology and hepatology
JF - Expert review of gastroenterology and hepatology
SN - 1747-4132
IS - 4
ER -