Dientamoeba fragilis

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Dientamoeba fragilis

Causal Agent:
Despite its name, Dientamoeba fragilis is not an ameba but a flagellate. This
protozoan parasite produces trophozoites; cysts have not been identified.
Infection may be either symptomatic or asymptomatic.

Life Cycle:

The complete life cycle of this parasite has not yet been determined, but
assumptions were made based on clinical data. To date, the cyst stage has not
been identified in D. fragilis life cycle, and the trophozoite is the only stage
found in stools of infected individuals . D. fragilis is probably transmitted by
fecal-oral route and transmission via helminth eggs (e.g., Ascaris, Enterobius
spp.) has been postulated . Trophozoites of D. fragilis have characteristically
one or two nuclei ( , ), and it is found in children complaining of intestinal
(e.g., intermittent diarrhea, abdominal pain) and other symptoms (e.g., nausea,
anorexia, fatigue, malaise, poor weight gain).

Geographic Distribution:
Worldwide
Clinical Features:
Symptoms that have been associated with infection include diarrhea, abdominal
pain, anorexia, nausea, vomiting, fatigue, and weight loss.

Laboratory Diagnosis:
Infection is diagnosed through detection of trophozoites in permanently stained
fecal smears (e.g., trichrome). This parasite is not detectable by stool
concentration methods. Dientamoeba fragilis trophozoites can be easily
overlooked because they are pale-staining and their nuclei may resemble those
of Endolimax nana or Entamoeba hartmanni.

Diagnostic findings
Microscopy

Treatment:
Safe and effective drugs are available. The drug of choice is iodoquinol.
Paromomycin*, tetracycline*, (contraindicated in children under age 8, pregnant
and lactating women) or metronidazole can also be used.

Microscopy
Dientamoeba fragilis is a flagellate that must be morphologically differentiated
from the small nonpathogenic amebas. Dientamoeba fragilis has no cyst stage,
and its trophozoites measure 5 to 15 µm. The flagella is not usually evident and
the pseudopodia are angular to broad-lobed and transparent. While most
trophozoites are typically binucleate, some have only one nucleus.

A B
A, B: Binucleate forms of trophozoites of D. fragilis, stained with trichrome.
 C D

C: Binucleate form of a trophozoite of D. fragilis, stained with trichrome.

D: Binucleate and uninucleate forms of trophozoites of D. fragilis, stained with
trichrome.

E F

E: Uninucleate form of a trophozoite of D. fragilis.

F: Binucleate form of a trophozoite of D. fragilis, stained with trichrome. A cyst-
like form of Blastocystis hominis lies to the left of the D. fragilis.