Dientamoeba fragilis- friend or foe?

Dientamoeba fragilis

Dientamoeba fragilis- friend or foe?

Dientamoeba fragilis

Dientamoeba fragilis is a protozoan parasite. A protozoan parasite is a type of microscopic organism, which lives on a ‘host’. The host is you or your child!

You may have heard of Dientamoeba fragilis.

This little guy is often associated with gastro and may be picked up on a standard stool test your GP runs for your child with loose stools or diarrhoea.

So, naturally, he is believed to be the culprit. 

But, should we really be blaming Dientamoeba fragilis?

The pathogenicity of Dientamoeba fragilis (D. fragilis for short), remains unclear.

We don’t really know if he is a true pathogen (aka bad guy) or not. Is he being unfairly blamed for crimes he did not commit?

If you do a deep dive into the literature, research is inconclusive.

You can find studies to support that he is found in those presenting with diarrhoea, abdominal pain, excess flatulence and other irritable digestive complaints. And you can find studies showing he is found in the guts of healthy kids as well and regarded as a “common enteric commensal”.

This is why we at The Paediatric Naturopath believe that D. fragilis is not usually the problem and finding it on a stool test can be a bit of a red herring. So, as always, we lean to the side of ‘dig a little deeper’ and assess the whole child and the whole gut microbial terrain.

So, let’s have a look at that research.

First rule of thumb: you can’t always take research at face value.

Studies that show Dientamoeba fragilis is a bad thing

One study that supports the ‘bad guy’ role of D. fragilis actually states at the bottom of the paper that gastro-causing pathogens such as norovirus and E.coli were not completely ruled out from all of the patients in their study. So whilst the study proclaimed D. Fragilis was a bad thing, they didn’t exclude the possibility that it was actually other known pathogens that were the problem.

And in another that concluded a strong association between D. fragilis and gastro, the authors admitted to the possibility of bias in who they chose to be included in the study.

So, can we truly be confident that D. fragilis is the bad guy here?

Studies that are on the fence

The results of one single study can be informative but a summary of a collection of studies has greater strength in the generalisability of the findings to the wider population. These papers are called systematic reviews and one done in 2018 could not fully support one way or the other. While another really questions the causality of gastro symptoms with D. fragilis.

Look a little further and you find researchers questioning whether or not finding D. fragilis on a stool test is clinically relevant or not so they go into the wider community and see how many healthy kids actually carry this guy as well.

Studies that found D. Fragilis is not a bad thing

A 2019 study in Europe collected data from stool samples taken from a group of kids who presented to a paediatric clinic with gastro and/or digestive complaints PLUS a group of healthy kids from the same communities. What did they find???

D. fragilis was found in almost half of the unwell kids BUT almost three-quarters of the healthy ones. They even compared gut inflammation scores using the marker Faecal Calprotectin and found no difference.

Their summary: D. fragilis “is merely a harmless commensal”.

There are more studies showing this finding. 

It seems this parasite is coming up more and more due to advancements in detection methods, but just because it is being detected doesn’t necessarily mean it needs to be treated.

The research on the microbiome- the collection of bacteria, viruses, fungi, parasites and more- that are live in our guts is forever expanding. There are new questions as to whether or not there are different strains of D. fragilis whereby some may be okay while others not.

Studies that show D. Fragilis is actually a good thing

An interesting study out of New Zealand found those positive for D. fragilis actually had a more diverse microbiome. It is also being questioned about a possible moderating role D. fragilis may be playing. Is he there to do something important or, in fact, instigating trouble? The research just cannot say yet.

So, with no clear evidence that yes D. fragilis is our bad guy, we need to rule out all other potential factors first through a thorough investigation and recall of event leading up to and after the gastro symptoms presented.

We recognise that post-gastro, it can take some kids a bit longer to heal. Ongoing changes in stools and abdominal pain can linger. These kids need a little extra TLC to get there guts back to optimal. Gastro infections can do a lot of damage to our gut wall. Some kids can become intolerant to certain foods such as lactose in dairy or even sensitive to other foods due to unresolved inflammation and a less than optimal digestive capacity. Even once the pathogen has cleared.

We often recommend a functional stool test that gives us the bigger picture of what is going on in your child’s gut and the balance of their gut microbiome- beneficial vs unfavourable vs pathogenic.

Do we ever consider treating Dientamoeba fragilis?

One of the very few times we think about dealing with this guy is when we have a case of chronic pinworms (threadworms), Enterobius vermicularis, on our hands.

A large proportion of kids with D. fragilis have a pinworm infection. Interestingly, one study found the most common symptom associated with testing positive for D. fragilis was an itchy bum; just like what we can see with worms.

So, bottom line is, D, fragilis is not generally the problem here. Work with us today so we can dig deeper into what is going on for your child. Book today!

You might also enjoy