title: Symptoms and treatment of Dientamoeba fragilis infection in children, a retrospective study.
abstract: BACKGROUND
  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 antiparasitic drugs.
  
  
  METHODS
  Children <18 years of age with a positive stool polymerase chain reaction 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 Centre Leeuwarden by repeated analysis of stool samples by the Centre 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%). Coinfection 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 metronidazole (74.7% versus 55.2%, P = 0.047).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University Medical Centre Utrecht, Utrecht, The Netherlands. jannaterschure@gmail.com
authors.forename: Janna M A Ter
authors.initials: JM
authors.lastname: Schure
authors.forename: Marrit
authors.initials: M
authors.lastname: de Vries
authors.forename: Jan F L
authors.initials: JF
authors.lastname: Weel
authors.forename: Eric N
authors.initials: EN
authors.lastname: van Roon
authors.forename: Tina E
authors.initials: TE
authors.lastname: Faber
mesh_terms: D000293:Adolescent; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D007464:Clioquinol / Q000627:therapeutic use; D004030:Dientamoebiasis / Q000188:drug therapy* / Q000473:pathology*; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D009426:Netherlands; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; D008795:Metronidazole; D007464:Clioquinol