Dientamoeba Fragilis Infection Medication

  • Author: David R Mack, MD, FRCPC; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 28, 2010
 

Medication Summary

The goal of therapy is eradication of the parasite Dientamoeba fragilis. The drugs used are considered investigational by the US Food and Drug Administration because of a lack of clinical trials. Response rates for a single course of therapy are 70-90% in the limited data published.

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Anthelmintics

Class Summary

Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class. Antiparasitic actions may include the following:

  1. Inhibition of microtubules, causing irreversible block of glucose uptake
  2. Tubulin polymerization inhibition
  3. Depolarizing neuromuscular blockade
  4. Cholinesterase inhibition
  5. Increased cell membrane permeability, resulting in intracellular calcium loss
  6. Vacuolization of the schistosome tegument
  7. Increased cell membrane permeability to chloride ions via chloride channels alteration
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Metronidazole (Flagyl)

 

Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa.

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Tetracycline (Sumycin)

 

Inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunits.

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Iodoquinol (Yodoxin)

 

Amebicide used in treatment of D fragilis.

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Paromomycin (Humatin)

 

Amebicidal and antibacterial aminoglycoside obtained from strain of Streptomyces rimosus; active in intestinal amebiasis.

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Contributor Information and Disclosures
Author

David R Mack, MD, FRCPC  Professor, Departments of Pediatrics and Biochemistry, Microbiology, and Immunology, University of Ottawa Faculty of Medicine; Head, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Eastern Ontario, Canada

David R Mack, MD, FRCPC is a member of the following medical societies: American Gastroenterological Association, Canadian Association of Gastroenterology, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Axcan Honorarium to CHEO Foundation Review panel membership; Novartis Honorarium to CHEO Foundation Consulting; AstraZeneca Honorarium to CHEO Foundation Speaking and teaching; Merck Frosst Honorarium to CHEO Foundation Speaking and teaching; Schering Plough Honorarium to CHEO Foundation Review panel membership; Schering Plough Honorarium to CHEO Foundation Speaking and teaching; Abbott Speaking and teaching; Ross Nutritionals Honorarium to CHEO Foundation Review panel membership; Nestle Honorarium to CHEO Foundation Review panel membership; Nestle Honorarium to CHEO Foundation Speaking and teaching

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diesases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: None None None

References

  1. Stark D, Barratt J, Roberts T, Marriott D, Harkness J, Ellis J. A review of the clinical presentation of dientamoebiasis. Am J Trop Med Hyg. Apr 2010;82(4):614-9. [Medline]. [Full Text].

  2. Cuffari C, Oligny L, Seidman EG. Dientamoeba fragilis masquerading as allergic colitis. J Pediatr Gastroenterol Nutr. Jan 1998;26(1):16-20. [Medline].

  3. Johnson EH, Windsor JJ, Clark CG. Emerging from obscurity: biological, clinical, and diagnostic aspects of Dientamoeba fragilis. Clin Microbiol Rev. Jul 2004;17(3):553-70, table of contents. [Medline].

  4. Verweij JJ, Mulder B, Poell B, van Middelkoop D, Brienen EA, van Lieshout L. Real-time PCR for the detection of Dientamoeba fragilis in fecal samples. Mol Cell Probes. Oct-Dec 2007;21(5-6):400-4. [Medline].

  5. Butler WP. Dientamoeba fragilis. An unusual intestinal pathogen. Dig Dis Sci. Sep 1996;41(9):1811-3. [Medline].

  6. Frenkel LM. Dientamoeba fragilis infection. In: Textbook of Pediatric Infectious Diseases. Vol 2. 4th ed. Elsevier Health Sciences; 1998:2403-6.

  7. Grendon JH, DiGiacomo RF, Frost FJ. Descriptive features of Dientamoeba fragilis infections. J Trop Med Hyg. Oct 1995;98(5):309-15. [Medline].

  8. Keystone JS, Yang J, Grisdale D, et al. Intestinal parasites in metropolitan Toronto day-care centres. Can Med Assoc J. Oct 1 1984;131(7):733-5. [Medline].

  9. Kurt O, Girginkardesler N, Balcioglu IC, Ozbilgin A, Ok UZ. A comparison of metronidazole and single-dose ornidazole for the treatment of dientamoebiasis. Clin Microbiol Infect. Jun 2008;14(6):601-4. [Medline].

  10. Medical Letter on Drugs and Therapeutics. Drugs for parasitic infections. Med Lett Drugs Ther. Mar 6 1992;34(865):17-26. [Medline].

  11. Norberg A, Nord CE, Evengard B. Dientamoeba fragilis--a protozoal infection which may cause severe bowel distress. Clin Microbiol Infect. Jan 2003;9(1):65-8. [Medline].

  12. Preiss U, Ockert G, Broemme S, Otto A. On the clinical importance of Dientamoeba fragilis infections in childhood. J Hyg Epidemiol Microbiol Immunol. 1991;35(1):27-34. [Medline].

  13. Shein R, Gelb A. Colitis due to Dientamoeba fragilis. Am J Gastroenterol. Oct 1983;78(10):634-6. [Medline].

  14. Spencer MJ, Garcia LS, Chapin MR. Dientamoeba fragilis. An intestinal pathogen in children?. Am J Dis Child. Apr 1979;133(4):390-3. [Medline].

  15. Spencer MJ, Millet VE, Garcia LS, et al. Parasitic infections in a pediatric population. Pediatr Infect Dis. Mar-Apr 1983;2(2):110-3. [Medline].

  16. Stark DJ, Beebe N, Marriott D, et al. Dientamoebiasis: clinical importance and recent advances. Trends Parasitol. Feb 2006;22(2):92-6. [Medline].

  17. Turner JA. Giardiasis and infections with Dientamoeba fragilis. Pediatr Clin North Am. Aug 1985;32(4):865-80. [Medline].

  18. Vandenberg O, Peek R, Souayah H, Dediste A, Buset M, Scheen R. Clinical and microbiological features of dientamoebiasis in patients suspected of suffering from a parasitic gastrointestinal illness: a comparison of Dientamoeba fragilis and Giardia lamblia infections. Int J Infect Dis. May 2006;10(3):255-61. [Medline].

  19. Vandenberg O, Souayah H, Mouchet F, Dediste A, van Gool T. Treatment of Dientamoeba fragilis infection with paromomycin. Pediatr Infect Dis J. Jan 2007;26(1):88-90. [Medline].

 
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This is an illustration of the assumed life cycle of Dientamoeba fragilis, the cause of a protozoan parasitic infection.
 
 
 
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