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Backhaus J, Frickmann H, Hagen RM, Concha G, Molitor E, Hoerauf A, Kann S. Gastrointestinal Pathogens in Multi-Infected Individuals: A Cluster Analysis of Interaction. Microorganisms 2023; 11:2642. [PMID: 38004654 PMCID: PMC10673554 DOI: 10.3390/microorganisms11112642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Indigenous people live in remote areas of Colombia. Multiple infections with bacteria, protozoa and/or helminths are common, as well as colonization in various forms. This study focused on the question of whether and to what extent various pathogens interact with each other. Therefore, a mathematical approach was retrospectively applied to PCR-based data of 244 stool samples, collected in two datasets. A stable cluster solution of the pathogens assessed was determined, and a unique configuration between Blastocystis hominis/Campylobacter spp./Giardia lamblia forming cluster 1 and Dientaemoeba fragilis was verified. A pathogen density-dependent interplay appeared between the B. hominis/Campylobacter spp./G. lamblia cluster, D. fragilis and Ascaris lumbricoides. The applied mathematical approach demonstrated that co-infections with parasites of questionable pathological relevance such as B. hominis and D. fragilis can be of diagnostic relevance due to their ability to promote or repress other pathogens. With the increasing availability of highly sensitive multiplexed molecular diagnostic approaches even in resource-limited settings, where multiple colonization of infection events with enteric pathogens in parallel are common, the importance of interpreting whole pathogen patterns rather than just individual pathogen detection may become more and more relevant.
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Affiliation(s)
- Joy Backhaus
- Statistical Consulting, 97074 Wuerzburg, Germany;
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
- Department of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
| | - Ralf Matthias Hagen
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany;
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar 2000001, Colombia;
| | - Ernst Molitor
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, 53127 Bonn, Germany; (E.M.); (A.H.)
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, 53127 Bonn, Germany; (E.M.); (A.H.)
| | - Simone Kann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany;
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, 53127 Bonn, Germany; (E.M.); (A.H.)
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Burgaña A, Abellana R, Yordanov SZ, Kazan R, Pérez Ortiz AM, Ramos CC, Hernández CG, Rivero MM, Gonçalves AQ, Padilla E, Pérez J, García-Puig R, Perez-Porcuna TM. Paromomycin is superior to metronidazole in Dientamoeba fragilis treatment. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2019; 11:95-100. [PMID: 31759244 PMCID: PMC6880088 DOI: 10.1016/j.ijpddr.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/27/2019] [Accepted: 10/28/2019] [Indexed: 01/29/2023]
Abstract
Dientamoeba fragilis is a trichomonad parasite of the human intestine that is found worldwide. However, the biological cycle and transmission of this parasite have yet to be elucidated. Although its pathogenic capacity has been questioned, there is increasing evidence that clinical manifestations vary greatly. Different therapeutic options with antiparasitic drugs are currently available; however, very few studies have compared the effectiveness of these drugs. In the present longitudinal study, we evaluate 13,983 copro-parasitological studies using light microscopy of stools, during 2013–2015, in Terrassa, Barcelona (Spain). A total of 1150 (8.2%) presented D. fragilis. Of these, 739 episodes were finally analyzed: those that involved a follow-up parasitology test up to 3 months later, corresponding to 586 patients with gastrointestinal symptoms (53% under 15 years of age). Coinfection by Blastocystis hominis was present in 33.6% of the subjects. Our aim was to compare therapeutic responses to different antiparasitic drugs and the factors associated with the persistence of D. fragilis post-treatment. Gender, age, and other intestinal parasitic coinfections were not associated with parasite persistence following treatment. Metronidazole was the therapeutic option in most cases, followed by paromomycin: 65.4% and 17.5% respectively. Paromomycin was found to be more effective at eradicating parasitic infection than metronidazole (81.8% vs. 65.4%; p = 0.007), except in children under six years of age (p = 0.538). Although Dientamoeba fragilis mainly produces mild clinical manifestations, the high burden of infection means we require better understanding of its epidemiological cycle and pathogenicity, as well as adequate therapeutic guidelines in order to adapt medical care and policies to respond to this health problem. A high prevalence of D. fragilis was detected in individuals with gastrointestinal symptoms. Paromomycin was more effective than metronidazole in the eradication of D. fragilis. Persistence of infection by D. fragilis was not associated with age, gender or other parasitic coinfections.
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Affiliation(s)
- Ander Burgaña
- Atenció Primària, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | - Rosa Abellana
- Departament Fonaments Clínics, Universitat de Barcelona, Barcelona, Spain
| | | | - Rabee Kazan
- Atenció Primària, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | | | | | | | | | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain; Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain
| | - Emma Padilla
- Àrea de Microbiologia de CATLAB, Terrassa, Spain
| | - Josefa Pérez
- Àrea de Microbiologia de CATLAB, Terrassa, Spain
| | - Roger García-Puig
- Unitat de Gastroenterologia, Hepatologia i Nutrició Pediàtrica, Mútua Terrassa, Terrassa, Spain
| | - Tomas M Perez-Porcuna
- Atenció Primària, Fundació Assistencial Mútua Terrassa, Terrassa, Spain; Unitat de Salut Internacional, Departament de Pediatria, Fundació Recerca Mútua Terrassa, Atenció Primària, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain.
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Miguel L, Salvador F, Sulleiro E, Sánchez-Montalvá A, Molina-Morant D, López I, Molina I. Clinical and Epidemiological Characteristics of Patients with Dientamoeba fragilis Infection. Am J Trop Med Hyg 2019; 99:1170-1173. [PMID: 30328410 DOI: 10.4269/ajtmh.18-0433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dientamoeba fragilis is an intestinal protozoan, usually considered nonpathogenic. However, in the last years, there has been an attempt to clarify its possible pathogenic role. We aim to evaluate the clinical and epidemiological characteristics of D. fragilis-infected patients. Adults with D. fragilis detection in feces who attended the Vall d'Hebron University Hospital (Barcelona, Spain) were evaluated retrospectively from April 2009 to March 2014. We classified the patients in asymptomatic, symptomatic without other causes except infection of D. fragilis, and symptomatic with another cause. Among symptomatic patients, treatment response was evaluated. One hundred eight patients were included. Sixty-three percent of the patients were immigrants, 29.6% were autochthonous, and 7.4% were travelers. Forty-nine (45.3%) patients presented symptoms, and eosinophilia was observed in 26 (24.1%) patients. Overall, 59 (54.7%) patients were asymptomatic, 15 (13.8%) presented symptoms which were attributable to other causes, and 34 (31.5%) patients presented symptoms with no other causes. In this last group, 29 patients received specific treatment and 65.5% of them presented a complete resolution of the symptoms. The group of symptomatic patients with no other cause had more proportion of women, more proportion of autochthonous people, and were older compared with the group of asymptomatic patients. Dientamoeba fragilis infection should be considered as pathogenic when other causes are ruled out.
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Affiliation(s)
- Lucía Miguel
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Daniel Molina-Morant
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Isabel López
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
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Menéndez C, Fernández-Suarez J, Boga Ribeiro JA, Rodríguez-Pérez M, Vázquez F, Gonzalez-Sotorrios N, Rodríguez-Guardado A. Epidemiological and clinical characteristics of Dientamoeba fragilis infection. Enferm Infecc Microbiol Clin 2019; 37:290-295. [DOI: 10.1016/j.eimc.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022]
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Does Dientamoeba fragilis cause diarrhea? A systematic review. Parasitol Res 2018; 117:971-980. [PMID: 29404747 DOI: 10.1007/s00436-018-5771-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
It remains controversial whether Dientamoeba fragilis is a commensal parasite or a pathogen. The objective of this systematic review was to establish the strength of the evidence that Dientamoeba fragilis would cause diarrhea. A search was performed for studies that reported either the association between D. fragilis detection in stools and diarrhea or diarrhea outcomes with D. fragilis therapy or challenge. Data from seven studies of specific populations reported that 22% had D. fragilis in stools of which only 23% had diarrhea. Eleven studies of stool samples submitted to laboratories reported that 4.3% of individuals had D. fragilis of which 54% had diarrhea. Twelve studies reported that D. fragilis was detected from 1.6% of individuals with diarrhea and 9.6% of diarrheal stools. Five studies analyzed the prevalence of D. fragilis in individuals with and without diarrhea; the two with a statistically significant difference between groups had discordant results. The only cohort study with an appropriate control group reported diarrhea in a higher proportion of children with D. fragilis than in controls. No D. fragilis treatment studies included diarrhea as an outcome. There were only two challenge studies involving one person each. In conclusion, the evidence that D. fragilis would cause diarrhea or that treatment would hasten diarrhea resolution is inconclusive.
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