Dientamoeba fragilis diagnosis by fecal screening: relative effectiveness of traditional techniques and molecular methods.

INTRODUCTION: Dientamoeba fragilis, an intestinal trichomonad, occurs in humans with and without gastrointestinal symptoms. Its presence was investigated in individuals referred to Milad Hospital, Tehran. METHODOLOGY: In a cross-sectional study, three time-separated fecal samples were collected from 200 participants from March through June 2011. Specimens were examined using traditional techniques for detecting D. fragilis and other gastrointestinal parasites: direct smear, culture, formalin-ether concentration, and iron-hematoxylin staining. The presence of D. fragilis was determined using PCR assays targeting 5.8S rRNA or small subunit ribosomal RNA. RESULTS: Dientamoeba fragilis, Blastocystis sp., Giardia lamblia, Entamoeba coli, and Iodamoeba butschlii were detected by one or more traditional and molecular methods, with an overall prevalence of 56.5%. Dientamoeba was not detected by direct smear or formalin-ether concentration but was identified in 1% and 5% of cases by culture and iron-hematoxylin staining, respectively. PCR amplification of SSU rRNA and 5.8S rRNA genes diagnosed D. fragilis in 6% and 13.5%, respectively. Prevalence of D. fragilis was unrelated to participant gender, age, or gastrointestinal symptoms. CONCLUSIONS: This is the first report of molecular assays to screen for D. fragilis in Iran. The frequent finding of D. fragilis via fecal analysis indicated the need to include this parasite in routine stool examination in diagnostic laboratories. As the length of amplification target correlates to the sensitivity of PCR, this assay targeting the D. fragilis 5.8S rRNA gene seems optimal for parasite detection and is recommended in combination with conventional microscopy for diagnosing intestinal parasites.

Prevalence and Risk Factors of Human Intestinal Parasites in Roudehen, Tehran Province, Iran.

BACKGROUND: Intestinal parasitic infections are among the most common infections and health problems worldwide. Due to the lack of epidemiologic information of such infections, the prevalence of, and the risk factors for, enteric parasites were investigated in residents of Roudehen, Tehran Province, Iran. METHODS: In this cross-sectional study, 561 triple fecal samples were collected through a two-stage cluster-sampling protocol from Jun to Dec 2014. The samples were examined by formalin-ether concentration, culture, and with molecular methods. RESULTS: The prevalence of enteric parasites was 32.7% (95% CI 27.3-38). Blastocystis sp. was the most common intestinal protozoan (28.4%; 95% CI 23.7-33.0). The formalin-ether concentration and culture methods detected Blastocystis sp., Entamoeba coli, Giardia intestinalis, Dientamoeba fragilis, Iodamoeba butschlii, Entamoeba complex cysts or trophozoite, Chilomastix mesnilii, and Enterobius vermicularis. Single-round PCR assay for Entamoeba complex were identified Entamoeba dispar and E. moshkovskii. E. histolytica was not observed in any specimen. Multivariate analysis showed a significant association of parasites with water source and close animal contact. There was no correlation between infections and gender, age, occupation, education, or travel history. Protozoan infections were more common than helminth infections. CONCLUSION: This study revealed a high prevalence of enteric protozoan parasite infection among citizens of Rodehen. As most of the species detected are transmitted through a water-resistant cyst, public and individual education on personal hygiene should be considered to reduce transmission of intestinal parasites in the population.