Dientamoeba Fragilis: What You Need To Know

What Is Dientamoeba Fragilis?

Dientamoeba fragilis is one of the most common protozoan (single cell) parasite of the human intestine.

It has a prevalence ranging from 0 to 82%, depending on the region, the population, and the detection methods used. (source)

Many people with D. fragilis also carry other parasites, and it’s often found alongside blastocystis hominis.

How Do You Get Dientamoeba Fragilis?

Faecal–oral transmission is thought to be the most common route of infection in humans. This might explain why there is a high prevalence of D. fragilis in groups with poor hygiene.

Humans are considered as the preferred host of D. fragilis, but animals have also been reported to serve as natural hosts.

While most domestic animals do not normally carry D. fragilis, pigs are a natural host of and thus may form a substantial source of human infections. (source)

It’s been discussed in the research that this may explain why there is a high prevalence of infection in The Netherlands – they have a really high pig to human ratio!

Dientamoeba Fragilis Symptoms

The most frequently reported symptoms in patients infected with Dientamoeba fragilis are abdominal pain and diarrhoea. Other common symptoms include:

• Weight loss.
• Anorexia.
• Flatus.
• Fatigue.
• Looseness of stools.
• Nausea.
• Vomiting.
• Anal pruritis.

Other non-intestinal complaints include the following:

• Headache
• Fever
• Malaise
• Irritability
• Weakness
• Urticaria

But asymptomatic presence has also been reported. (source)

Interestingly, in one study Dinetamoeba fragilis was significantly associated with an increase in the alpha-diversity of the gut microbiome – considered one of there most important metrics of gut health. (source)

Dientamoebiasis should be considered in the differential diagnosis of gastrointestinal diseases, including inflammatory bowel disease (source)

Does Dientamoeba Fragilis Need Treatment?

While dientamoeba fragilis was originally described as a non-pathogenic parasite, and thus didn’t need treatment, over the years many reports have been published supporting the pathogenic potential of dientamoeba fragilis. Several case studies suggest significant symptom relief upon successful treatment of a D. fragilis infection indicating that it does need treatment. (source)

Nevertheless, the debate on this subject is not yet closed.

The below quote would make it clear that, at least sometimes, it absolutely needs treatment.

Case reports state that patients harbouring D. fragilis have symptoms correlated to infection and have clinical improvement after eradication. (source)

Larger studies with more patients provide evidence for a correlation between infection and symptoms, concluding that D. fragilis could be pathogenic. (source)

Conclusions on the pathogenic nature of D. fragilis are based mainly on eradication studies reporting relief of symptoms in patients after treatment.

In 2011, there was a review about D. fragilis where the authors stated: ‘when found in patients with gastrointestinal symptoms without any other pathogen, D. fragilis should be considered as cause of the symptoms and thus patients should receive appropriate treatment’. (source)

However, the correlation between the presence of the parasite and clinical symptoms is not always obvious or sometimes even absent. (source)

Why Do Some Have Symptoms And Others Don’t?

It remains somewhat unclear as to why some may experience symptoms, while others don’t. What we do know is:

1. There are reports that different subtypes may have different virulence factors (molecules that help the parasite colonise the host), comprising both pathogenic and non-pathogenic variants, or even that the subtypes consist of two different species. (source)
2. The health of the host (gut microbiome diversity, nutrient status, immune function, medications) could influence virulence and clinical symptoms of infection with D. fragilis.

Does Dientamoeba Fragilis Go Away?

It is generally accepted that D. fragilis infections can be self-limiting. This has been demonstrated in a study where spontaneous clearance was reported in 41% of 93 untreated patients within a 180-day period.

However this is not always the case, and treatment is needed for some people.

Interestingly, immune responses against Dientamoeba fragilis have been described. It could be, therefore, that only the first infection with Dientamoeba fragilis results in clinical symptoms. (source)

How Long Does Dientamoeba Fragilis Last?

There is no exact, or even typical, time period and it will vary based on numerous factors including the health status of the host, and the parasite itself. One study demonstrated spontaneous clearance in 41% of 93 untreated patients within a 180-day period.

How To Get Rid Of Dientamoeba Fragilis

D. fragilis is often treated with a single-drug based on a limited set of antibiotics. It’s important to note that the majority of treatment regimens are based on research studies with only small numbers, making them quite difficult to interpret, especially when we appreciate that D. fragilis infections are potentially self-limiting.

Most doctors often prescribe metronidazole, however this is less effective when compared with other agents, such as secnidazole, ornidazole, clioquinol, and paromomycin. (source)

Clinical guidelines differ throughout the world as they are based on small cohort studies since large-scale double-blind randomized placebo-controlled trials have not been described in the literature. (source)

How To Get Rid Of Dientamoeba Fragilis Naturally

Probiotics

I have found that probiotics can be very helpful in supporting natural treatment of dienatmoeba fragilis – and sometimes are enough without any additional interventions. Saccharomyces boulardii has been found to be as effective as antibiotics in eradicating certain parasites such as Blastocystis. (source) Read my blog all about Saccharomyces boulardii here. Finally various studies have discussed the efficacy of supplementing probiotics to help eradicate parasites. (source)

• Recommended Product (U.K): Saccharomyces Boulardii and Rhamnosus GG.
• Recommended Product (U.S.A): Saccharomyces Boulardii and Probiotic blend.

Prebiotics

Prebiotics may also be very helpful as they support the many aspects of gut immunity including the production of anti-microbial metabolites from our gut bacteria. PHGG is a good option which supports butyrate production – a metabolite of certain bacteria known to have anti-microbial properties.

• Recommended Product (U.K): PHGG
• Recommended Product (U.S.A): PHGG

Vitamins A & D

These two essential nutrients support the gut-immune system, thus may help the body naturally eliminate the parasite.

• Recommended Product (U.K): Vitamin A and vitamin D.
• Recommended Product (U.S.A): Vitamin A and Vitamin D

Anti-Parasitic Herbs

There are herbs such as oregano oil which are naturally anti-parasitic. Others include:

• Black Walnut.
• Goldenseal.
• Garlic.
• Herbs high in berberine (Oregon Grape Root)

• Recommended Product (U.K): Oregano Oil.
• Recommended Product (U.S.A): Oregano Oil

What’s The Best Diet For Dientamoeba Fragilis?

The addition of milk (2% fat) plus cereals, particularly wheat based, increased the bowel disturbance. (source)

A whole food diet is needed, with close attention to protein and total caloric needs. (source)

There are some key nutrients to be thinking about too. (source)

Vitamin A is required to support the gut-immune system. Vitamin A many also support the production of secretory IgA – an antibody produced that helps maintain healthy microbiome and immune system. Vitamin A-rich foods include:

• Liver
• Eggs
• Carrots
• Tomatoes

Selenium also supports the immune response in the gut and helps protect against oxidative stress. Good sources of selenium include:

• Pork
• Beef
• Turkey
• Poultry
• Fish
• Shellfish
• Eggs
• Brazil nuts

Zinc: Zinc deficiency is very common and low levels of zinc have been demonstrated in the research to impact immune function.  It has also been discussed in the research how low levels of zinc may contribute to an increased inflammatory response to a parasitic infection. The best sources of zinc include:

• Oysters
• Red meat
• Poultry
• Crab
• Lobster
• Beans
• Nuts

Papaya seed: The seeds of this fruit contain natural anti-parasitic compounds such as benzyl isothiocyanate and papain. A study from 2007 examined the use of these seeds to treat gut parasites in children aged between 2 and 6. It was found to successfully clear a range of parasites that include Giardia and Entamoeba histolytica.

The clearance rates with the formula of the parasites assessed were between 71.4% and 100%. (source)

Is Dientamoeba Fragilis Contagious?

It is possible to be re-infected from infected family members – who may be asymptomatic. It is advised, that when initial treatment fails, additional testing of family members might be needed. (source)

In one placebo-controlled double-blind trial in Denmark with 96 infected children, treating them with either metronidazole or placebo did not lead to significant differences in clinical outcome between these two groups. Parasitological eradication 2 weeks after treatment was significantly more frequent in the metronidazole group, suggesting an initial positive effect of antibiotic treatment. However, this difference in parasitoligical eradication rapidly changed 8 weeks after completion of treatment. The amount of infections in the placebo group decreased, whereas the infections in the treatment group increased.

This suggest a self-limiting disease in the controls, and/or re-infection in the treatment group through contact with infectious family members or environment. (source)

Can Dientamoeba Fragilis Cause Fatigue?

Yes. The most common symptoms in patients infected with this parasite appear to be intermittent diarrhea, abdominal pain, and fatigue. (source)

Dientamoeba Fragilis Die-Off Symptoms

It is possible to experience die-off symptoms when treating things like parasites. These may simply be an exacerbation of the symptoms you already have. You can read my blog on die-off for more detailed information.