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The high co-existence rate of Blastocystis and Dientamoeba fragilis in human faecal samples and the analysis of demographic and clinical findings

Year 2021, Volume: 4 Issue: 4, 422 - 427, 15.07.2021
https://doi.org/10.32322/jhsm.904858

Abstract

Aim: Blastocystis and Dientamoeba fragilis (D. fragilis) are among the most common protozoon species in human faecal samples. The cross-sectional studies have reported the frequencies in a variety of populations. However, we have very limited information about the co-existence rate of those protozoans. The study aimed to compare D. fragilis frequency in Blastocystis positive and negative faecal samples in order to determine the co-existence rate. The secondary objective was to analyse demographic characteristics and gastrointestinal (GI) symptoms in relation to both infections.
Material and Method: In the present study, we defined a study group that included 100 Blastocystis positive faecal samples and a control group that included 100 Blastocystis negative samples. The frequency of D. fragilis in samples was determined with a PCR assay specific to the small-subunit ribosomal RNA (SS rRNA) gene. A positive control of D. fragilis was used and the samples with amplification of the expected size (863 bp) were considered as positive. In addition to the statistical comparison of frequencies, the descriptive and clinical findings of cases were analysed retrospectively with Pearson chi-square or ANOVA tests.
Results: The frequency of D. fragilis was 21% in Blastocystis positive group and it was 10% in Blastocystis negative group. There was statistically significant difference in terms of D. fragilis positivity between the groups (p <0.05). Age, gender and GI symptoms did not reveal a significant difference between the following groups: only Blastocystis infected (n=77), only D. fragilis infected (n=11), infected with both protozoans (n=34) and non-infected individuals (n=89) (p >0.05).
Conclusion: Our study highlighted the high co-existence of D. fragilis and Blastocystis in human faecal samples. A possible explanation for this finding may be the faecal-oral transmission of these protozoans. In addition, analysis of clinical findings was supported common asymptomatic colonisation of Blastocystis and D. fragilis.

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References

  • Silberman JD, Clark CG, Sogin ML. Dientamoeba fragilis shares a recent common evolutionary history with the trichomonads. Mol Biochem Parasitol 1996; 76: 311-4.
  • Garcia LS. Dientamoeba fragilis, one of the neglected intestinal protozoa. J Clin Microbiol 2016; 54: 2243-50.
  • Caccio SM. Molecular epidemiology of Dientamoeba fragilis. Acta Trop 2018; 184: 73-7.
  • Pietila JP, Meri T, Siikamaki H, et al. Dientamoeba fragilis - the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017. European Com Dis Bul 1019; 24: 1800546.
  • Roser D, Simonsen J, Nielsen HV, et al. Dientamoeba fragilis in Denmark: epidemiological experience derived from four years of routine real-time PCR. Eur J Clin Microbiol Infect Dis 2013; 32: 1303-10.
  • Oliveira-Arbex AP, David ÉB, Cacciò SM, et al. Prevalence and genetic characterization of Dientamoeba fragilis in asymptomatic children attending daycare centers. Rev Inst Med Trop Sao Paulo 2021; 63, e39.
  • Stark D, Barratt J, Roberts T, Marriott D, Harkness J, Ellis J. A review of the clinical presentation of dientamoebiasis. Am J Trop Med Hyg 2010; 82: 614-9.
  • Torgerson PR, Devleesschauwer B, Praet N, et al. World Health Organization estimates of the global and regional disease burden of 11 foodborne parasitic diseases, 2010: a data synthesis. PLoS Med 2015; 12: e1001920.
  • Kurt O, Oktem Okullu S, Ozen NM, et al. Is Dientamoeba fragilis friend or foe? A study from Istanbul on patients and healthy individuals from different cohorts. Turk Mikrobiyol Cem Derg 2020; 50: 244-9.
  • Mumcuoğlu İ, Coşkun FA, Aksu N, Pürnak T, Güngör Ç. İrrite bağırsak sendromunda Dientamoeba fragilis ve Blastocystis spp’ nin rolü. Türkiye Parazitol Derg 2013; 37: 73-7.
  • Tan KS. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 2008; 21: 639-65.
  • Stensvold CR, Clark CG. Current status of Blastocystis: a personal view. Parasitol Int 2016; 65: 763-71.
  • Scanlan PD, Stensvold CR. Blastocystis: getting to grips with our guileful guest. Trends Parasitol 2013; 29: 523-9.
  • Légeret C, Rüttimann C, Fankhauser H, Köhler H. Parasitic infections in Swiss children: are we overtesting? BMC Gastroenterol 2021; 21: 39.
  • Lappan R, Henry R, Chown SL, et al. Monitoring of diverse enteric pathogens across environmental and host reservoirs with TaqMan array cards and standard qPCR: a methodological comparison study. Lancet Planet Health 2021; 5: e297-e308.
  • Alsuwaidi AR, Al Dhaheri K, Al Hamad S, et al. Etiology of diarrhea by multiplex polymerase chain reaction among young children in the United Arab Emirates: a case-control study. BMC Infect Dis 2021; 21: 7.
  • Deng L, Chai Y, Zhou Z, et al. Epidemiology of Blastocystis sp. infection in China: a systematic review. Parasite 2019; 26: 41.
  • Celik T, Daldal N, Karaman U, Aycan MO, Atambay M. Malatya ili merkezinde üç ilköğretim okulu çocuklarında bağırsak parazitlerinin dağılımı. Türkiye Parazitol Derg 2006; 30: 35-8.
  • Hamamci B, Çetinkaya U, Delice S, Erçal BD, Gücüyetmez S, Yazar S. Investigation of intestinal parasites among primary school students in Kayseri-Hacılar. Türkiye Parazitol Derg 2011; 35: 96-9.
  • Mumcuoğlu I, Coşkun FA, Aksu N, Pürnak T, Güngör C. Role of Dientamoeba fragilis and Blastocystis spp. in irritable bowel syndrome. Turkiye Parazitol Derg 2013; 37: 73-7.
  • Rostami A, Riahi SM, Haghighi A, Saber V, Armon B, Seyyedtabaei SJ. The role of Blastocystis sp. and Dientamoeba fragilis in irritable bowel syndrome: a systematic review and meta-analysis. Parasitol Res 2017; 116: 2361-71.
  • Scicluna SM, Tawari B, Clark CG. DNA barcoding of Blastocystis. Protist 2006; 157: 77-85.
  • Stark D, Beebe N, Marriott D, Ellis J, Harkness J. Detection of Dientamoeba fragilis in fresh stool specimens using PCR. Int J Parasitol 2005; 35: 57-62.
  • Boughattas S, Behnke JM, Al-Ansari K, et al. Molecular analysis of the enteric protozoa associated with acute diarrhea in hospitalized children. Front Cell Infect Microbiol 2017; 7: 343.
  • Heydari-Hengami M, Hamedi Y, Najafi-Asl M, Sharifi-Sarasiabi K. Prevalence of ıntestinal parasites in food handlers of Bandar Abbas, Southern Iran. Iran J Public Health 2018; 47: 111-8.
  • Maas L, Dorigo-Zetsma JW, de Groot CJ, Bouter S, Plötz FB, van Ewijk BE. Detection of intestinal protozoa in paediatric patients with gastrointestinal symptoms by multiplex real-time PCR. Clin Microbiol Infect 2014; 20: 545-50.
  • Norberg A, Nord CE, Evengard B. Dientamoeba fragilis– a protozoal infection which may cause severe bowel distress. Clin Microbiol Infect 2003; 9: 65-8.
  • Aykur M, Caliskan Kurt C, Dirim Erdogan D, et al. Investigation of Dientamoeba fragilis prevalence and evaluation of sociodemographic and clinical features in patients with gastrointestinal symptoms. Acta Parasitol 2019; 64: 162-70.
  • Piubelli C, Soleymanpoor H, Giorli G, et al. Blastocystis prevalence and subtypes in autochthonous and immigrant patients in a referral centre for parasitic infections in Italy. PloS One 2019; 14: e0210171.
  • Engsbro AL, Stensvold CR, Vedel Nielsen H, Bytzer P. Prevalence, incidence, and risk factors of intestinal parasites in Danish primary care patients with irritable bowel syndrome. Scand J Infect Dis 2014; 46: 204-9.
  • Sivcan E, Charyyeva A, Ceylan ŞS, Yürük M, Erdoğan E, Şahin İ. Gastrointestinal şikayeti olan hastalarda Dientamoeba fragilis enfeksiyonu. Mikrobiyol Bul 2018; 52, 166-79.
  • Kurt O, Girginkardesler N, Ozbilgin A, Ok UZ, The effectiveness of the culture for Dientamoeba fragilis from the stool. Infect Dis Clin Microbiol 2019; 1: 34-41.
  • Hamidi N, Meamar AR, Akhlaghi L, Rampisheh Z, Razmjou E. Dientamoeba fragilis diagnosis by fecal screening: relative effectiveness of traditional techniques and molecular methods. J Infect Dev Ctries 2018; 12: 52-9.
  • Dağcı H, Kurt O, Demirel M, et al. Epidemiological and diagnostic features of Blastocystis infection in symptomatic patients in Izmir province, Turkey. Iranian J Parasitol 2014; 9: 519-29.
  • de Boer MD, Schuurs TA, Vermeer M, et al. Distribution and relevance of Dientamoeba fragilis and Blastocystis species in gastroenteritis: results from a case-control study. Eur J Clin Microbiol Infect Dis 2020; 39: 197-203.
  • Hawash YA, Ismail KA, Saber T, et al. Dientamoeba fragilis infection in patients with digestive and non-digestive symptoms: a case-control study. Korean J Parasitol 2020; 58: 129-34.
  • Intra J, Sarto C, Besana S, Tiberti N, Brambilla P. The importance of considering the neglected intestinal protozoan parasite Dientamoeba fragilis. J Med Microbiol 2019; 68: 890-2.
  • O'Brien Andersen L, Karim AB, Roager HM, et al. Associations between common intestinal parasites and bacteria in humans as revealed by qPCR. Eur J Clin Microbiol Infect Dis 2016; 35: 1427-31.
  • Audebert C, Even G, Cian A, et al. Colonization with the enteric protozoa Blastocystis is associated with increased diversity of human gut bacterial microbiota. Sci Rep 2016; 6: 25255.
  • Krogsgaard LR, Andersen LO', Johannesen TB, et al. Characteristics of the bacterial microbiome in association with common intestinal parasites in irritable bowel syndrome. Clin Transl Gastroenterol 2018; 9: 161.
Year 2021, Volume: 4 Issue: 4, 422 - 427, 15.07.2021
https://doi.org/10.32322/jhsm.904858

Abstract

References

  • Silberman JD, Clark CG, Sogin ML. Dientamoeba fragilis shares a recent common evolutionary history with the trichomonads. Mol Biochem Parasitol 1996; 76: 311-4.
  • Garcia LS. Dientamoeba fragilis, one of the neglected intestinal protozoa. J Clin Microbiol 2016; 54: 2243-50.
  • Caccio SM. Molecular epidemiology of Dientamoeba fragilis. Acta Trop 2018; 184: 73-7.
  • Pietila JP, Meri T, Siikamaki H, et al. Dientamoeba fragilis - the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017. European Com Dis Bul 1019; 24: 1800546.
  • Roser D, Simonsen J, Nielsen HV, et al. Dientamoeba fragilis in Denmark: epidemiological experience derived from four years of routine real-time PCR. Eur J Clin Microbiol Infect Dis 2013; 32: 1303-10.
  • Oliveira-Arbex AP, David ÉB, Cacciò SM, et al. Prevalence and genetic characterization of Dientamoeba fragilis in asymptomatic children attending daycare centers. Rev Inst Med Trop Sao Paulo 2021; 63, e39.
  • Stark D, Barratt J, Roberts T, Marriott D, Harkness J, Ellis J. A review of the clinical presentation of dientamoebiasis. Am J Trop Med Hyg 2010; 82: 614-9.
  • Torgerson PR, Devleesschauwer B, Praet N, et al. World Health Organization estimates of the global and regional disease burden of 11 foodborne parasitic diseases, 2010: a data synthesis. PLoS Med 2015; 12: e1001920.
  • Kurt O, Oktem Okullu S, Ozen NM, et al. Is Dientamoeba fragilis friend or foe? A study from Istanbul on patients and healthy individuals from different cohorts. Turk Mikrobiyol Cem Derg 2020; 50: 244-9.
  • Mumcuoğlu İ, Coşkun FA, Aksu N, Pürnak T, Güngör Ç. İrrite bağırsak sendromunda Dientamoeba fragilis ve Blastocystis spp’ nin rolü. Türkiye Parazitol Derg 2013; 37: 73-7.
  • Tan KS. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 2008; 21: 639-65.
  • Stensvold CR, Clark CG. Current status of Blastocystis: a personal view. Parasitol Int 2016; 65: 763-71.
  • Scanlan PD, Stensvold CR. Blastocystis: getting to grips with our guileful guest. Trends Parasitol 2013; 29: 523-9.
  • Légeret C, Rüttimann C, Fankhauser H, Köhler H. Parasitic infections in Swiss children: are we overtesting? BMC Gastroenterol 2021; 21: 39.
  • Lappan R, Henry R, Chown SL, et al. Monitoring of diverse enteric pathogens across environmental and host reservoirs with TaqMan array cards and standard qPCR: a methodological comparison study. Lancet Planet Health 2021; 5: e297-e308.
  • Alsuwaidi AR, Al Dhaheri K, Al Hamad S, et al. Etiology of diarrhea by multiplex polymerase chain reaction among young children in the United Arab Emirates: a case-control study. BMC Infect Dis 2021; 21: 7.
  • Deng L, Chai Y, Zhou Z, et al. Epidemiology of Blastocystis sp. infection in China: a systematic review. Parasite 2019; 26: 41.
  • Celik T, Daldal N, Karaman U, Aycan MO, Atambay M. Malatya ili merkezinde üç ilköğretim okulu çocuklarında bağırsak parazitlerinin dağılımı. Türkiye Parazitol Derg 2006; 30: 35-8.
  • Hamamci B, Çetinkaya U, Delice S, Erçal BD, Gücüyetmez S, Yazar S. Investigation of intestinal parasites among primary school students in Kayseri-Hacılar. Türkiye Parazitol Derg 2011; 35: 96-9.
  • Mumcuoğlu I, Coşkun FA, Aksu N, Pürnak T, Güngör C. Role of Dientamoeba fragilis and Blastocystis spp. in irritable bowel syndrome. Turkiye Parazitol Derg 2013; 37: 73-7.
  • Rostami A, Riahi SM, Haghighi A, Saber V, Armon B, Seyyedtabaei SJ. The role of Blastocystis sp. and Dientamoeba fragilis in irritable bowel syndrome: a systematic review and meta-analysis. Parasitol Res 2017; 116: 2361-71.
  • Scicluna SM, Tawari B, Clark CG. DNA barcoding of Blastocystis. Protist 2006; 157: 77-85.
  • Stark D, Beebe N, Marriott D, Ellis J, Harkness J. Detection of Dientamoeba fragilis in fresh stool specimens using PCR. Int J Parasitol 2005; 35: 57-62.
  • Boughattas S, Behnke JM, Al-Ansari K, et al. Molecular analysis of the enteric protozoa associated with acute diarrhea in hospitalized children. Front Cell Infect Microbiol 2017; 7: 343.
  • Heydari-Hengami M, Hamedi Y, Najafi-Asl M, Sharifi-Sarasiabi K. Prevalence of ıntestinal parasites in food handlers of Bandar Abbas, Southern Iran. Iran J Public Health 2018; 47: 111-8.
  • Maas L, Dorigo-Zetsma JW, de Groot CJ, Bouter S, Plötz FB, van Ewijk BE. Detection of intestinal protozoa in paediatric patients with gastrointestinal symptoms by multiplex real-time PCR. Clin Microbiol Infect 2014; 20: 545-50.
  • Norberg A, Nord CE, Evengard B. Dientamoeba fragilis– a protozoal infection which may cause severe bowel distress. Clin Microbiol Infect 2003; 9: 65-8.
  • Aykur M, Caliskan Kurt C, Dirim Erdogan D, et al. Investigation of Dientamoeba fragilis prevalence and evaluation of sociodemographic and clinical features in patients with gastrointestinal symptoms. Acta Parasitol 2019; 64: 162-70.
  • Piubelli C, Soleymanpoor H, Giorli G, et al. Blastocystis prevalence and subtypes in autochthonous and immigrant patients in a referral centre for parasitic infections in Italy. PloS One 2019; 14: e0210171.
  • Engsbro AL, Stensvold CR, Vedel Nielsen H, Bytzer P. Prevalence, incidence, and risk factors of intestinal parasites in Danish primary care patients with irritable bowel syndrome. Scand J Infect Dis 2014; 46: 204-9.
  • Sivcan E, Charyyeva A, Ceylan ŞS, Yürük M, Erdoğan E, Şahin İ. Gastrointestinal şikayeti olan hastalarda Dientamoeba fragilis enfeksiyonu. Mikrobiyol Bul 2018; 52, 166-79.
  • Kurt O, Girginkardesler N, Ozbilgin A, Ok UZ, The effectiveness of the culture for Dientamoeba fragilis from the stool. Infect Dis Clin Microbiol 2019; 1: 34-41.
  • Hamidi N, Meamar AR, Akhlaghi L, Rampisheh Z, Razmjou E. Dientamoeba fragilis diagnosis by fecal screening: relative effectiveness of traditional techniques and molecular methods. J Infect Dev Ctries 2018; 12: 52-9.
  • Dağcı H, Kurt O, Demirel M, et al. Epidemiological and diagnostic features of Blastocystis infection in symptomatic patients in Izmir province, Turkey. Iranian J Parasitol 2014; 9: 519-29.
  • de Boer MD, Schuurs TA, Vermeer M, et al. Distribution and relevance of Dientamoeba fragilis and Blastocystis species in gastroenteritis: results from a case-control study. Eur J Clin Microbiol Infect Dis 2020; 39: 197-203.
  • Hawash YA, Ismail KA, Saber T, et al. Dientamoeba fragilis infection in patients with digestive and non-digestive symptoms: a case-control study. Korean J Parasitol 2020; 58: 129-34.
  • Intra J, Sarto C, Besana S, Tiberti N, Brambilla P. The importance of considering the neglected intestinal protozoan parasite Dientamoeba fragilis. J Med Microbiol 2019; 68: 890-2.
  • O'Brien Andersen L, Karim AB, Roager HM, et al. Associations between common intestinal parasites and bacteria in humans as revealed by qPCR. Eur J Clin Microbiol Infect Dis 2016; 35: 1427-31.
  • Audebert C, Even G, Cian A, et al. Colonization with the enteric protozoa Blastocystis is associated with increased diversity of human gut bacterial microbiota. Sci Rep 2016; 6: 25255.
  • Krogsgaard LR, Andersen LO', Johannesen TB, et al. Characteristics of the bacterial microbiome in association with common intestinal parasites in irritable bowel syndrome. Clin Transl Gastroenterol 2018; 9: 161.
There are 40 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Erdogan Malatyali 0000-0002-3943-467X

İbrahim Yıldız 0000-0001-8525-6280

Evren Tileklioglu 0000-0003-2141-1311

Hatice Ertabaklar 0000-0001-7997-6433

Sema Ertuğ 0000-0002-6448-7482

Publication Date July 15, 2021
Published in Issue Year 2021 Volume: 4 Issue: 4

Cite

AMA Malatyali E, Yıldız İ, Tileklioglu E, Ertabaklar H, Ertuğ S. The high co-existence rate of Blastocystis and Dientamoeba fragilis in human faecal samples and the analysis of demographic and clinical findings. J Health Sci Med / JHSM. July 2021;4(4):422-427. doi:10.32322/jhsm.904858

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