The Scoop on Dientamoeba fragilis

Order a Dientamoeba fragilis test online:

You can order a highly reliable qPCR test for D. fragilis online, at www.parasiet.com (Parasiet is Dutch for Parasite). The laboratory is located in the Netherlands, but samples can be sent in from anywhere in the world.

Dientamoeba fragilis stool sample tube

The tests are done on stool samples collected on two different days. The samples are scooped with the spoons provided, and mixed in with a liquid DNA fixation agent. The liquid will preserve the DNA of the parasite indefinitely, if the parasite is present.

There are qPCR DNA tests available for the 3 different intestinal parasites that cause the most intestinal complaints at Parasiet.com:

Dientamoeba fragilis

Blastocystis hominis

Giardia lamblia 

Click to go directly to the order page: www.parasiet.com

Is Dientamoeba fragilis a pathogen?

The question is of specific importance to people suffering from Irritable Bowel Syndrome (IBS). Dientamoeba fragilis is found frequently in the stool of people diagnosed with IBS (about 35% of the time).

If the parasite is considered to be a pathogen, all IBS patients should be routinely screened for it. In fact, people should not be diagnosed with IBS until first being screened for Dientamoeba fragilis. Not everyone is in agreement, however, about whether the parasite is pathogenic or not.

Those who think Dientamoeba fragilis is a pathogen, point to the very high frequency of occurrence of the parasite with IBS patients. They also point to countless cases of patients feeling better (elimination / significant reduction of all IBS symptoms) after taking medication to eliminate the parasite.

Those who think the parasite is not a pathogen, argue that Dientamoeba fragilis opportunistically occupies the intestines after the intestinal flora have already been disturbed (by antibiotics for example). They think the parasite may be a opportunist, but not a pathogen.

In some countries Dientamoeba fragilis is officially classified as a pathogen, in other countries it is not. Some doctors routinely perform stool tests to identify the parasite and treat the patient, other doctors do not even look if it is there (or for that matter if other intestinal parasites are there, such as Blastocystis hominis or Giardia Lamblia, the two other most common intestinal parasites).

While this issue remains ambiguous in terms of theory, in practice it makes little difference how Dientamoeba fragilis is classified. The fact is, many people with chronic intestinal problems (such as irritable bowel syndrome [IBS]), are infected with Dientamoeba fragilis. Another fact is, many of the people suffering with IBS complaints feel better after receiving treatment and eliminating the parasite.

Many doctors feel it is worth while to test all IBS patients for Dientamoeba fragilis. Why not? Highly reliable lab tests, which make use of modern qPCR DNA analysis, are relatively cheap. Stool samples can be tested for Dientamoeba fragilis for under 100 $, and for under 200$, stool tests can be done for all the the known intestinal parasites that commonly cause IBS symptoms.  In most cases, patients feel better after receiving treatment to kill the parasite.

There is ample evidence to indicate that Dientamoeba fragilis (a single celled intestinal parasite) causes various symptoms. There is also plenty of evidence the parasite can also have an asymptomatic effect (people test positive for Dientamoeba fragilis, yet experience no symptoms). The fact that there are many people with Dientamoeba fragilis in the intestines, who do not experience symptoms, is one of the reasons why it remains undecided whether Dientamoeba fragilis should be classified as a pathogenic organism or not.

The question “is Dientamoeba fragilis a pathogen?” comes down to the same as “does Dientamoeba fragilis make otherwise completely healthy people sick?” The answer to the question is unclear. But the question itself is very limited: most people are not 100% healthy. People with less than perfect health are more likely to be affected by the parasite, especially when the health problems are located in the intestines. The essence of the debate comes down to this: Dientamoeba fragilis does not contribute anything beneficial to humans, and many people feel better after it is eradicated.

IBS in general represents one of the murkiest, least understood fields of medicine. Less is known of many types of bacteria in the intestines than any other bacteria in the human body.

A huge percentage of the population is diagnosed with IBS – without actually being diagnosed with a specific disease. IBS symptoms can be caused by the body’s reaction to a number of specific irritants in diet (lactose and gluten intolerance, for example) or microbial (such as intestinal parasites or yeast infection [Candida]). IBS can also be caused by bacterial infection, or by combinations of the factors mentioned above.

In other words, the effect of Dientamoeba fragilis on a healthy person is not the only relevant detail to consider. Equally (or more!) relevant is to consider the effect of the parasite on people who’s immune systems are already weakened by a(n IBS causing) disorder. Someone who has an undiagnosed food allergy or intolerance and suffers from a chronic yeast of the intestines, is much more vulnerable to symptomatic infection.

What symptoms does Dientamoeba fragilis cause?

Infection with Dientamoeba fragilis usually causes the following characteristic symptoms:

  • abdominal distension and bloating
  • an alternating bowel movement pattern
  • especially in children: abdominal pain.
  • flatulence

Dientamoeba fragilis is an intestinal parasite. However, with a Dientamoeba fragilis infection, the symptoms are not limited to only intestinal problems. Sometimes people infected cannot absorb nutrients properly, and nutrient shortages occur. In such cases, symptoms also include:

  • fatigue
  • hair loss
  • sometimes skin irritation or pain in the joints.

Microbiologists now consider Dientamoeba fragilis to be a harmful organism. Dr. Gool has published a number of articles about Dientamoeba fragilis, also in the Dutch Journal of Medicine. He writes that children infected with the intestinal parasite Dientamoeba fragilis often suffer from symptoms such as abdominal pain and nausea. He also notes that Dientamoeba fragilis infection is regularly overlooked.

Testing for Dientamoeba fragilis

For the most reliable test results, it is recommended to use qPCR DNA testing to identify Dientamoeba fragilis. The PCR method is over 10% more accurate than the TFT (the triple faeces test).

Some smaller laboratories still carry out the TFT, but the best laboratories, such MGlab, now use a considerably more reliable technique: the qPCR. qPCR is a method where the DNA of Dientamoeba fragilis is identified in the laboratory. The TFT technique is based on microscopy.

Dientamoeba fragilis is 7-12 µm wide, and creates no cysts. Dientamoeba fragilis dies within 30 minutes, once outside the body. Because Dientamoeba fragilis do not create cysts, these intestinal parasites are impossible to identify using standard microscopic research.

DNA analysis

The latest development in the field of Dientamoeba fragilis detection comes from Australia. Dr. D.J. Stark developed a DNA analysis of Dientamoeba fragilis. Subsequently, in Leiden, the Netherlands, Dr. J. J. Verwey established a DNA test for Dientamoeba fragilis. This analysis is available in the best laboratories available in the Netherlands, where it has replaced the TFT.

MGlab uses the qPCR method developed Verweij. The stool is fixed in order to avoid degradation of the DNA. This test replaces the TFT.

The qPCR DNA test provides more positive results than the TFT. Since the parasite is not secreted every day, it is also possible that the diagnosis can be missed using the DNA technique. It is therefore desirable to collect stool on two consecutive days and sending both samples to the laboratory. The chance of missing the diagnosis is very small.

TFT

For while, laboratories have made use of a fixation fluid for stool samples. The liquid is used to preserve Dientamoeba fragilis. In 1998 the AMC (Amsterdam Medical Center) and Dr. T. Mank (Dr. Mank’s discertation was on this) developed the TFT. In America a fixation fluid had already been used for some time.

The TFT is called Triple because the test consists of filling three tubes. Two of the tubes contain a fixation liquid. When the stool is collected in the tube, all the DNA of any living Dientamoeba fragilis is preserved. The patient should collect stool on three consecutive days. It is important that the patient takes a sample on at least on one of the 3 days, at a moment when there are intestinal symptoms, and the stool is abnormal.  MGlab is one of the only laboratories that have a very reliable qPCR test for intestinal parasites.

Dientamoeba fragilis Treatment

What to do in case of infection:

1. Let partners and family members get checked. Dientamoeba fragilis dies quickly outside the body, and only be transferred by sexual contact, or via lavatory.
2. In consultation with the GP, medication may be prescribed. Today, several organisms, including Dientamoeba fragilis, have become resistant to certain medication. It is therefore important to augment the course of treatment with a suitable diet. There are certain natural foods such as fresh garlic oil, which Dientamoebafragilis can not stand. By weakening the intestinal parasite with a natural diet, there is a greater chance to kill it with medication.
3. Treat all infected persons simultaneously.
4. Use during the cure for food as described in the book Bowel Complaints.
5. Provide hygiene at home and at school.
6. About a week after the treatment is finished, retest to determine success.

The risk of Dientamoeba fragilis infection:

Dientamoeba fragilis is one of the most common pathogenic colon parasites. Blastocystis hominis occurs slightly more often, but Blastocystis hominis has both harmful and harmless subtypes. Dientamoeba fragilis is harmful in all cases, when the parasites reaches a certain population size.

There are people who are infected with a small number of Dientamoeba fragilis, yet experience no symptoms. In a population where 685 (in the age group 18 to 64 yearspeople without symptoms were asked to participate) 17% tested positive for Dientamoeba fragilis.

The parasite is much more common with those who do have IBS symptoms. Research on people with intestinal complaints revealed that in more than 30% of cases Dientamoeba fragilis was present.

Often, when people experience abdominal pain, infection with intestinal parasites such as Dientamoeba fragilis is not immediately thought of. This happens because many people don’t know of the parasite, and those who do often mistakenly think Dientamoeba fragilis infection is associated with a visit to the tropics. But it is also possible to get infected anywhere. This happens when using the toilet or having contact with people who are the carriers of parasites.

The risk of Dientamoeba fragilis infection is greater for professionals who come into contact with feces in the line of duty. Examples of high risk occupations include nursing, care of small children, the elderly and psychiatric patients, plumbers, recyclers or staff at (air) ports and on ships. Often several people within a family are infected at the same time.