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Dientamoeba fragilis masquerading as allergic colitis
C Cuffari1, L Oligny, E G Seidman
1Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Canada.
Insights
Dientamoeba fragilis, a rare cause of chronic diarrhea in children, should be considered in differential diagnoses. Early identification and treatment are crucial for managing symptoms like eosinophilic colitis.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Dientamoeba fragilis is an uncommon pathogen causing chronic infectious diarrhea and colitis in pediatric patients.
- Recognizing D. fragilis requires awareness of its epidemiological risk factors and clinical presentations.
Observation:
- A review of 11 pediatric cases revealed diverse symptoms including anorexia, vomiting, abdominal pain, and prolonged diarrhea.
- Seven patients presented with peripheral eosinophilia, and one with a bovine protein allergy experienced recurrent gastrointestinal issues.
- Colonoscopy confirmed D. fragilis as the cause of eosinophilic colitis in one patient.
Findings:
- Metronidazole and iodoquinol were effective treatments for D. fragilis infection in the studied pediatric cohort.
- Travel history was noted in seven of the eleven pediatric patients diagnosed with D. fragilis.
Implications:
- D. fragilis should be included in the differential diagnosis for pediatric chronic diarrhea and eosinophilic colitis.
- Accurate laboratory identification methods are essential for diagnosing D. fragilis infections.
Background:
Dientamoeba fragilis is a rare cause of chronic infectious diarrhea and colitis in children.
Methods:
Review of the clinical manifestations, diagnostic methods, and clinical course of D. fragilis infection in our hospital.
Results:
Eleven pediatric patients are discussed, seven of whom had a history of recent travel. Clinical manifestations of infectious diarrhea included anorexia, intermittent vomiting, abdominal pain, and diarrhea, ranging from 1 to 100 weeks in duration. Peripheral eosinophilia was present in seven patients. One patient with well-documented bovine protein allergy had intermittent episodes of diarrhea and abdominal pain, despite an appropriate elimination diet. Eosinophilic colitis documented by colonoscopy, was due to D. fragilis. Metronidazole was effective in treating five patients, and iodoquinol was effective in treating four others.
Conclusions:
D. fragilis should be included in the differential diagnosis of chronic diarrhea and eosinophilic colitis. The identification of this pathogen requires clinical awareness of epidemiologic risk factors and presenting complaints, as well as the laboratory staining procedures essential to its proper identification.