The Pediatric infectious disease journal | 30 Nov 2012
JM Ter Schure, M de Vries, JF Weel, EN van Roon and TE Faber
INTRODUCTION:: Dientamoeba fragilis infection in children is common, and its incidence has increased since the introduction of more sensitive molecular techniques. There is no consensus on the optimal treatment. Current medical practice in the Netherlands is to treat symptomatic children with clioquinol or metronidazole. This study attempts to obtain more information about the clinical picture of D. fragilis infection in children and to evaluate responses to both anti parasitic drugs. METHODS:: Children < 18 years of age with a positive stool PCR test for D. fragilis infection were retrospectively evaluated. Clinical data and effectiveness of treatment were analyzed by examining patient's hospital records from the Medical Center Leeuwarden and of stool samples by the Center for Infectious Diseases in Friesland. RESULTS:: We analyzed 238 patients with an average age of 8.5 years (± 4.2 years). Most patients were symptomatic (95.8%) and presented with abdominal pain (72.7%), loose stools (32.8%), and hard stools (24.8%). Co-infection with other gastrointestinal pathogens was present in 29 patients (12.2%). A higher incidence of infection was found in the winter. Clioquinol had a higher clinical success rate than did metronidazole (74.7% vs 55.2%, p=0.047). CONCLUSION:: These results suggest that clioquinol could be more effective than metronidazole in alleviating symptoms of D. fragilis infection in children, but double-blind prospective placebo-controlled studies should be performed before final conclusions can be made.
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