What symptoms does Dientamoeba fragilis cause?

Infection with Dientamoeba fragilis usually causes the following characteristic symptoms:

  • abdominal distension and bloating
  • an alternating bowel movement pattern
  • especially in children: abdominal pain.
  • flatulence

Dientamoeba fragilis is an intestinal parasite. However, with a Dientamoeba fragilis infection, the symptoms are not limited to only intestinal problems. Sometimes people infected cannot absorb nutrients properly, and nutrient shortages occur. In such cases, symptoms also include:

  • fatigue
  • hair loss
  • sometimes skin irritation or pain in the joints.

Microbiologists now consider Dientamoeba fragilis to be a harmful organism. Dr. Gool has published a number of articles about Dientamoeba fragilis, also in the Dutch Journal of Medicine. He writes that children infected with the intestinal parasite Dientamoeba fragilis often suffer from symptoms such as abdominal pain and nausea. He also notes that Dientamoeba fragilis infection is regularly overlooked.


Dientamoeba fragilis Treatment

What to do in case of infection:

1. Let partners and family members get checked. Dientamoeba fragilis dies quickly outside the body, and only be transferred by sexual contact, or via lavatory.
2. In consultation with the GP, medication may be prescribed. Today, several organisms, including Dientamoeba fragilis, have become resistant to certain medication. It is therefore important to augment the course of treatment with a suitable diet. There are certain natural foods such as fresh garlic oil, which Dientamoebafragilis can not stand. By weakening the intestinal parasite with a natural diet, there is a greater chance to kill it with medication.
3. Treat all infected persons simultaneously.
4. Use during the cure for food as described in the book Bowel Complaints.
5. Provide hygiene at home and at school.
6. About a week after the treatment is finished, retest to determine success.

Dientamoeba fragilis testing

Dientamoeba fragilis is extremely fragile. The parasite dies off outside of the body almost immediately, and quickly is broken down by bacteria and enzymes and decomposes. Highly trained lab technicians and state of the art testing are needed to diagnose Dientamoeba fragilis. There are two methods: DNA testing (alo known as qPCR) and microscopy (also known as the triple feces test or TFT).

For the most reliable test results, it is recommended to use qPCR testing to identify Dientamoeba fragilis DNA. The PCR method is over 10% more accurate than the TFT (the triple feces test).

Some outdated laboratories still carry out the TFT, but the best laboratories, such MGlab, now use a considerably more reliable technique: qPCR. qPCR is a method where the DNA of Dientamoeba fragilis is identified in the laboratory. If  Dientamoeba fragilis DNA is present in the stool, it will be found.  The TFT technique is based on microscopy. The drawback with microscopy is that even highly skilled lab technicians miss Dientamoeba fragilis sometimes. 

Dientamoeba fragilis is 7-12 µm wide, and creates no cysts. Dientamoeba fragilis dies within 30 minutes, once outside the body. Because Dientamoeba fragilis do not create cysts, these intestinal parasites are impossible to identify using standard microscopic research.

DNA testing for Dientamoeba fragilis

The latest development in the field of Dientamoeba fragilis detection comes from Australia. Dr. D.J. Stark developed a DNA analysis of Dientamoeba fragilis. Subsequently, in Leiden, the Netherlands, Dr. J. J. Verwey established a DNA test for Dientamoeba fragilis. This analysis is available in the best laboratories available in the Netherlands, where it has replaced the TFT.

MGlab uses the qPCR method developed Verweij. The stool is fixed in order to avoid degradation of the DNA. This test replaces the TFT.

The qPCR DNA test provides more positive results than the TFT. Since the parasite is not secreted every day, it is also possible that the diagnosis can be missed using the DNA technique. It is therefore desirable to collect stool on two consecutive days and sending both samples to the laboratory. The chance of missing the diagnosis is very small.


For while, laboratories have made use of a fixation fluid for stool samples. The liquid is used to preserve Dientamoeba fragilis. In 1998 the AMC (Amsterdam Medical Center) and Dr. T. Mank (Dr. Mank’s discertation was on this) developed the TFT. In America a fixation fluid had already been used for some time.

The TFT is called Triple because the test consists of filling three tubes. Two of the tubes contain a fixation liquid. When the stool is collected in the tube, all the DNA of any living Dientamoeba fragilis is preserved. The patient should collect stool on three consecutive days. It is important that the patient takes a sample on at least on one of the 3 days, at a moment when there are intestinal symptoms, and the stool is abnormal.  MGlab is one of the only laboratories that have a very reliable qPCR test for intestinal parasites.

Dientamoeba fragilis testing online:

You can order a highly reliable qPCR test for Dientamoeba fragilis online, at www.parasiet.com (Parasiet is Dutch for Parasite). The laboratory is located in the Netherlands, but samples can be sent in from anywhere in the world.

Dientamoeba fragilis stool sample tube

Dientamoeba fragilis stool sample tube

The tests are done on stool samples collected on two different days. The samples are scooped with the spoons provided, and mixed in with a liquid DNA fixation agent. The liquid will preserve the DNA of the parasite indefinitely, if the parasite is present.

There are qPCR DNA tests available for the 3 different intestinal parasites that cause the most intestinal complaints at Parasiet.com:

Dientamoeba fragilis

Blastocystis hominis

Giardia lamblia 

Click to go directly to the order page: www.parasiet.com

Dientamoeba fragilis and IBS: Is Dientamoeba fragilis a pathogen?

dientamoeba fragilis

dientamoeba fragilis


The question is of specific importance to people suffering from Irritable Bowel Syndrome (IBS). Dientamoeba fragilis is found frequently in the stool of people diagnosed with IBS (about 35% of the time).

If Dientamoeba fragilis is considered to be a pathogen, all IBS patients should be routinely screened for it. In fact, people should not be diagnosed with IBS until first being screened for Dientamoeba fragilis. Not everyone is in agreement, however, about whether Dientamoeba fragilis is pathogenic or not.

Those who think Dientamoeba fragilis is a pathogen, point to the very high frequency of occurrence of the parasite with IBS patients. They also point to countless cases of patients feeling better (elimination / significant reduction of all IBS symptoms) after taking medication to eliminate Dientamoeba fragilis.

Those who think the parasite is not a pathogen, argue that Dientamoeba fragilis opportunistically occupies the intestines after the intestinal flora have already been disturbed (by antibiotics for example). They think Dientamoeba fragilis may be a opportunist, but not a pathogen.

In some countries Dientamoeba fragilis is officially classified as a pathogen, in other countries it is not. Some doctors routinely perform stool tests to identify the parasite and treat the patient, other doctors do not even look if it is there (or for that matter if other intestinal parasites are there, such as Blastocystis hominis or Giardia Lamblia, the two other most common intestinal parasites).

While this issue remains ambiguous in terms of theory, in practice it makes little difference how Dientamoeba fragilis is classified. The fact is, many people with chronic intestinal problems (such as irritable bowel syndrome [IBS]), are infected with Dientamoeba fragilis. Another fact is, many of the people suffering with IBS complaints feel better after receiving treatment and eliminating Dientamoeba fragilis.

Many doctors feel it isn’t worth while to test all IBS patients for Dientamoeba fragilis. Why not? Highly reliable lab tests, which make use of modern qPCR DNA analysis, are relatively cheap. Stool samples can be tested for Dientamoeba fragilis for under 100 $, and for under 200$, stool tests can be done for all the the known intestinal parasites that commonly cause IBS symptoms.  In most cases, patients feel better after receiving treatment to kill the parasite.

There is ample evidence to indicate that Dientamoeba fragilis (a single celled intestinal parasite) causes various symptoms. There is also plenty of evidence the parasite can also have an asymptomatic effect (people test positive for Dientamoeba fragilis, yet experience no symptoms). The fact that there are many people with Dientamoeba fragilis in the intestines, who do not experience symptoms, is one of the reasons why it remains undecided whether Dientamoeba fragilis should be classified as a pathogenic organism or not.

The question “is Dientamoeba fragilis a pathogen?” comes down to the same as “does Dientamoeba fragilis make otherwise completely healthy people sick?” The answer to the question is unclear. But the question itself is very limited: most people are not 100% healthy. People with less than perfect health are more likely to be affected by the parasite, especially when the health problems are located in the intestines. The essence of the debate comes down to this: Dientamoeba fragilis does not contribute anything beneficial to humans, and many people feel better after it is eradicated.

IBS in general represents one of the murkiest, least understood fields of medicine. Less is known of many types of bacteria in the intestines than any other bacteria in the human body.

A huge percentage of the population is diagnosed with IBS – without actually being diagnosed with a specific disease. IBS symptoms can be caused by the body’s reaction to a number of specific irritants in diet (lactose and gluten intolerance, for example) or microbial (such as intestinal parasites or yeast infection [Candida]). IBS can also be caused by bacterial infection, or by combinations of the factors mentioned above.

In other words, the effect of Dientamoeba fragilis on a healthy person is not the only relevant detail to consider. Equally (or more!) relevant is to consider the effect of the parasite on people who’s immune systems are already weakened by a(n IBS causing) disorder. Someone who has an undiagnosed food allergy or intolerance and suffers from a chronic yeast of the intestines, is much more vulnerable to symptomatic infection.

The risk of Dientamoeba fragilis infection:

Dientamoeba fragilis is one of the most common pathogenic colon parasites. Blastocystis hominis occurs slightly more often, but Blastocystis hominis has both harmful and harmless subtypes. Dientamoeba fragilis is harmful in all cases, when the parasites reaches a certain population size.

There are people who are infected with a small number of Dientamoeba fragilis, yet experience no symptoms. In a population where 685 (in the age group 18 to 64 yearspeople without symptoms were asked to participate) 17% tested positive for Dientamoeba fragilis.

The parasite is much more common with those who do have IBS symptoms. Research on people with intestinal complaints revealed that in more than 30% of cases Dientamoeba fragilis was present.

Often, when people experience abdominal pain, infection with intestinal parasites such as Dientamoeba fragilis is not immediately thought of. This happens because many people don’t know of the parasite, and those who do often mistakenly think Dientamoeba fragilis infection is associated with a visit to the tropics. But it is also possible to get infected anywhere. This happens when using the toilet or having contact with people who are the carriers of parasites.

The risk of Dientamoeba fragilis infection is greater for professionals who come into contact with feces in the line of duty. Examples of high risk occupations include nursing, care of small children, the elderly and psychiatric patients, plumbers, recyclers or staff at (air) ports and on ships. Often several people within a family are infected at the same time.

Blastocystis hominis: the most common intestinal parasite.

Blastocystis hominis is a fascinating parasite, an is incredibly common in both humans and animals. About a quarter of people in europe carry the parasite, but most will never know. It isn’t until intestinal / bowel problems occur that people become inclined to look into medical testing, to try to identify the causes of  the symptoms. Only a laboratory stool test can confirm the parasite.

These parasites are widely regarded as intestinal ‘residents’ who never causes harm, but worldwide more and more doctors have found that Blastocystis hominis can cause problems and have engaged in the treatment of infected people.

The typical Blastocystis hominis resembles an empty cell. The name indicates this, because “blasto” means “cavity” (“cystis” because it creates cystes and “hominis” because it occurs in humans). The parasite can be diagnosed by means of an ordinary stool test which in may take place in a laboratory. Nevertheless, Blastocystis hominis by the laboratory are not always recognized as abnormal and difficult to recognize shapes. The parasite as a harmless yeast is not reflected, is a very complex organ, where much to tell.

Symptoms of Blastocystis hominis intestinal parasite

The most characteristic feature of infection is significant abdominal bloating and flatulence.


Blastocystis hominis infection caused, in addition to abdominal distension, aching, diarrhea, nausea, fatigue, itching, insomnia and even fever. The parasite can irritate the intestinal mucosa, but also cause infections by bacteria transferred. The itching is caused by an allergic reaction to the parasite.

Blastocystis hominis produce like other single-celled intestinal parasites alcohol and acetaldehyde, compounds contributing to the creation of the stomach and fatigue. A third of people infected has symptoms. Based on a large stock of publications is indeed to believe that Blastocystis can cause problems.

A remarkable phenomenon is that Blastocystis hominis and Dientamoeba fragilis often be found in each other’s company. Sometimes there are so many Blastocystis hominis, that other parasites are overlooked. When a patient with diarrhea “only” Blastocystis hominis are found, research can be repeated.

Situation in the Netherlands

A small study (A) showed that 37% of people who visited the GP, but no bowel complaints, Blastocystis hominis in the intestine had. RIVM (B) indicates that 40% of adults between 15 and 50 years in the Netherlands has Blastocystis hominis. The group of 5 to 14 years and people over age 50 are infected with over 30%.

Based on these data it is safe to assume that 25% of the Dutch population Blastocystis hominis carries, 4 million people were infected in the Netherlands.

In people with abdominal pain found higher scores. Data from my own practice in the table and are based on the already discussed special TFT analyzes. The studies were performed in a Dutch parasitological laboratory, the patients were almost exclusively of Dutch descent.

People with complaints:

Period Number of Number of persons examined Blastocystis hominis rate
October 2002 – April 2003 194 116 60
October 2003 – April 2004 130 78 60
That means that 60% of the people who was investigated for vague symptoms had Blastocystis hominis infection. Half of them had only Blastocystis hominis, the other half had multiple intestinal parasites.


What Blastocystis hominis look like?

Blastocystis hominis kunnn seem empty and therefore harmless. Under the microscope one can see a round white cell, a yeast cell or a Candidacel seems. It took decades before finally determined that Blastocystis is a parasite. It is remarkable that this conclusion did so long to wait, because parasite Blastocystis hominis have typical properties. They only grow on a medium for parasites form cysts (a characteristic of parasites) and are only to get away with parasietdodende drugs.

In recent years showed that Blastocystis hominis not only a yeastlike form, but different appearances can assume. The yeast form or granulated form is most common. They vary from small to “giant”, the dimensions are somewhere between 2 um and 100 um [i]. Blastocystis hominis may even assume the form of an amoeba, they seem so much white blood cells that they are hardly distinguishable,. This form is rarely seen.


The diagnosis of parasites is usually diagnosed by identifying the cyst form in the stool. Cysts on average every four to eight days excreted and therefore are not always present in stool in unusual cases, the cysts even once every twenty days and then it becomes very difficult to find them. [Ii] A single analysis is not sufficient, and if nothing is found, the laboratory repeated several times.

In the Netherlands, using the TFT-test Blastocystis hominis demonstrated very often

Also, it is possible the DNA of the parasite to be tone (qPCR).


The first step in the right direction is a change of the power supply. Consumption of sweets and starches causes problems, because the fermentation of sugars contributes to abdominal distension. The parasite has accumulated carbohydrates that are used for growth. When no sugar, bread, potatoes and pasta is used in the meal, the cell division slowed and abdomen relaxed. This way of eating is also called the ‘anticandida’ diet, but without sourdough bread and starchy products.

But the parasite disappears not, there are medications for that. Because this is not always ignite diet can make a significant contribution and treatment a success. Food and drugs work so complementary to each other.


Blastocystis hominis is a yeast-like cell and causes abdominal distention. An estimated 20 to 25% of the world Blastocystis hominis in the intestine. The detection can be done via regular laboratories, but not everyone recognizes the many variants of the parasite. Also vary the numbers in the feces from day to day.

While most doctors believe that these cells are harmless, a third of the infected persons suffer from the abdomen, nausea, or itching.

The complaints come from infecting large extent with IBS-irritable bowel syndrome symptoms.

The evidence that this parasite often causes complaints, is provided by the disappearance of symptoms after successful treatment.

Dientamoeba fragilis is officially classified as a flagellate, but has no flagella. Flagella are whip like organelles, often used for propulsion. The parasite presumably lost the flagella at some point during its evolution to its present form.

Giardia lamblia is an intestinal parasite with flagella.

Giardia lambia for example, another parasite responsible for intestinal problrms, has 8 flagella.  See the image on the right.

Dientamoeba fragilis lives in the mucus of the colon. It is only known to exist in a vegetative state – meaning it has no locomotion.

60% of D. fragilis parasites have the characteristic double nuclei (from which the di in the name is derived).

The rest of the genus name indicates that Dientamoeba fragilis is an ENTericAMOEBA, not that this parasite is related to the intestinal protozoa of the genus Entamoeba. The species name refers to the fragile Trophozoite stage. After leaving the body Dientamoeba fragilis cannot survive for very long.

Although Dientamoeba fragilis is occassionally regarded as non-pathogenic in certain countries, the parasite is increasingly regarded as a pathogen. Many infections are asymptomatic. The symptomatic infections cause diarrhea and abdominal pain, in addition to symptoms bloating, gas, skin irritation, weight loss and even vomiting.

The classification scoop on Dientamoeba fragilis

Phylum: Metamonada
Class; Parabasalia
Order: Trichomonadida
Family: Monocercomonadidae
Genus: Dientamoeba
Species: D. fragilis

Dientamoeba fragilis is an intestinal parasite. It is a tiny, fragile (hence the name fragilis), single-celled organism. Normally, healthy intestines are able to keep Dientamoeba fragilis and most other pathogenic organisms at bay or at least under control. The intestines can become weakend, however, by treatment with antibiotics, prolonged unhealthy diets and other causes. Dientamoeba fragilis can cause infection in weakend intestines, leading to a variety of IBS-like symptoms.

Dientamoeba fragilis and IBS

In certain cases Dientamoeba fragilis can cause IBS-like symptoms. Testing for Dientamoeba fragilis is recommended, as medication is required to treat the parasite. In some cases people who are infected with Dientamoeba fragilis believe they have IBS (irritable bowel syndrome). If the symptoms disappear once the parasite has been successfully treated, it means IBS was never the case.

Dientamoeba fragilis isn’t the only possible cause of IBS-like symptoms. Candida albicans and gluten intolerance are two other leading causes. A gluten intolerance test or candida test should be done in addition to testing for parasites, to rule out these causes of IBS symptoms.

Dientamoeba fragilis and flatulence

Flatulence is a medical term used to describe the passing of bowel gasses through the anus. Everyone experiences flatulence from time to time. It is perfectly natural for the digestion of the food we eat to produce gasses in the intestines. However, some people experience much more severe flatulence than others. Why is this? How come some people have so much more gas than other people?

We will address this question and many more on the website. We will discuss the main causes of excessive flatulence. The subjects we will discuss are micro-organisms in the intestines, the role of diet, intestinal parasites and yeast infection of the intestines with Candida. In many cases excessive and chronic flatulence can be attributed to one of the above-mentioned factors.

Flatulence and the micro-biota of the intestines

Gut bacteria have a very important effect on flatulence. Some bacteria make us produce more gas, while other bacteria actually eliminate gas from the gut. These bacteria reduce the gas in our gut, thereby reducing flatulence.

Much of the gas produced in our intestines is actually broken down by bacteria farther down the gastro-intestinal tract (GI tract) before leaving the body.

Micro-biota of the gut – a newly discovered “organ”

Micro-biota of the gut, or gut flora are the bacteria living in the large intestine. We have up to 3 lbs. (1.5 kg) of bacteria living in our large intestine. This mass of bacteria is essential for the digestion. A healthy gut flora can help prevent flatulence.

The gut flora represents a relatively new and undiscovered part of our body. Scientists are now starting to refer to the gut flora as an “organ.” The concept of a mass of microbial life forming an organ in the human body is somewhat difficult to imagine. But the contributions made by the gut flora to digestion, and health in general, are of such vital importance to the healthy functioning of the body, that seeing the gut flora as an organ makes sense.

Most of the causes of flatulence will be influenced in one way or another by the intestinal bacteria – the gut flora. A healthy gut flora can protect against unhealthy bacteria, intestinal parasites, Candida infection and other causes of flatulence. Antibiotics can damage the gut flora. Once the gut flora is damaged or weakened  it becomes easier for pathogenic micro-organisms to flourish, which can lead to problems with bloating, cramps and flatulence.

Differences in the gut flora of different people is one of the primary reasons someone may experience more flatulence than someone else: they may be lacking in the right bacteria, and have too many of the wrong kinds.

The wrong bacteria feed by breaking down sugar and starch. These bacteria also produce alcohol from the sugars and simple carbohydrates that reach them. In essence, they turn the gut into a miniature distillery! These processes produce a lot of gas, and cause continuous flatulence so long as sugar and starch is eaten.

This is also an important reason why some people have more of a problem with flatulence than others. The reaction to food is different in the guts of different people, because everyone has a different gut flora. Differences in diet are also very important.

Flatulence and the role of diet and digestion

Not only do some people eat more sugar and starch than others, everyone digests food differently. Some people digest starch very poorly. Normally starch and sugar should be digested in the stomach and small intestine. It should never reach all the way to the large intestine, where most of the bacteria are that cause flatulence. When sugar and starch are poorly digested and reach the large intestines, it provides a feast for the bacteria that digest it. Bacteria can multiply rapidly, especially when provided with access to all the food they can eat. A sudden but significant change to the environment of the intestine can involve the creation of a lot of gas.

People who suffer from flatulence can benefit from experimenting with diet. The logical step is to eliminate the foods that provide a feast for the “bad” bacteria in the intestines. At the same time, feed the good bacteria. Cut out sugar and starch (that means fruit too!) and eat green leafy vegetables.

Sometimes a sudden switch can upset the stomach – causing even more flatulence! Trying to cut back on sugar and starch is the best bet for anyone trying to reduce flatulence.

Intestinal parasites and flatulence

Intestinal Parasites can cause flatulence, even for people with otherwise healthy diets. Parasites colonize the intestines in such a way that their numbers swell and shrink. When the numbers are low, there are no symptoms. When the parasites begin to increase in numbers, this can cause a bloated feeling, cramps and flatulence. Two of the most common intestinal parasites are Dientamoeba fragilis and Blastocystis hominis.

Both of these intestinal parasites produce gasses in a similar way to bacteria. These parasites are single celled organisms, and live off of sugars and starch as well.

Candida and flatulence

Candida is a type of yeast, which can cause problems in the mouth, vagina and intestines. Yeast infection with Candida can cause flatulence. Candida causes flatulence much in the same way bacteria and parasites do – by eating sugars and starch.

About half of the people tested by a laboratory in the Netherlands had Candida albanicans in their intestines. MGlab, in Leeuwarden the Netherlands have done fecal diagnostics testing for tens of thousands of people with intestinal problems. Thousands of the test subjects suffer from chronic flatulence.

The laboratory measured the precense of Candida in about half of the tested stool samples, however in the majority of cases there was only a small amount. About 5% of the test subjests had significant amounts of Candida in the intestines. Treatment and diet against Candida for people with significant amounts of Candida in the intestines can help reduce flatulence.

The sugar and starch have to go

Although flatulence can be caused and exacerbated by a wide variety of factors, there is one common theme: the eating of sugar and starch makes it worse.

Here is a list of some of the foods that should be avoided to reduce flatulence:

  • Potatoes: fries, mashed potatoes, hash browns, potato chips etc.
  • Corn: corn flakes, corn chips etc.
  • Rice: rice crispies, rice crackers
  • Wheat: bread, pasta, pastries etc.
  • Sugar: candy, ice-cream, candy bars etc.
  • High sugar fruits. Though the vitamins in fruit are nice, many fruits are very sugary. Sugary fruits can cause flatulence, instead, eat low sugar alternatives, like raspberries  strawberries or blueberries.

Finding a solution for flatulence

The most important step to take in getting rid of flatulence is finding the right help. A doctor can help by having the right tests done and interpreting them. Stool samples can by studied in a lad and can reveal a vast array of causes of flatulence. A diet expert can also help with figuring out the foods that trigger flatulence. We have focused on starch and sugar, as these cause flatulence universally. There are many cases that are unique to the individual. In other words, everyone reacts to foods differently, in terms of flatulence. A diet expert can help you find out what your personal sources of flatulence are, by setting up a system of elimination to test foods and design a personalized diet.

Dientamoeba fragilis treatment

Most people who discover that they are infected with Dientamoeba fragilis and begin treatment, have had symptoms for a long time. Often years go by before the cause of the symptoms is detected. Children who are treated for Dientamoeba fragilis often have abdominal pain, are pale and are sometimes no  longer even able to regularly attend school.
The scientist Damien Stark has numerous Dientamoeba fragilis publications to his name. He found that 77% of the children infected with Dientamoeba fragilis experience abdominal pain and 72% have abnormal stool. In the Netherlands, a number of recent studies have been published on the subject of Dientamoeba fragilis. In 2013, the researcher J.M. Schure described that of the 238 children who were infected with Dientamoeba fragilis, 72% and 33% had abdominal pain and loose stool respectively.

Dientamoeba fragilis infectivity

The theory is that Dientamoeba fragilis should be treated when it causes symptoms and complaints. When there are no symptoms it is not always necessary to treat Dientamoeba fragilis. When we focus on the symptoms, the debate about the harmfulness of Dientamoeba fragilis becomes unnecessary. Symptoms such as bloating, gas and irregular stools can be disruptive, and should be prevented if possible. This brings us to an important problem: The parasite is contagious. A partner or family member with Dientamoeba fragilis often has no symptoms; but they do cause a source of contamination for people who may experience symptoms.
With infectious diseases, different rules apply. It is unwise to treat one only person when there are several people living together who are infected.
The answer to the question “Do you have to be treated for a Dientamoeba fragilis infection?” The answer is:

  1. If you live alone, practice good hygiene so as not to infect anyone, and have no symptoms: then no treatment is necessary.
  2. If you have had symptoms for a long time, treatment is recommended.
  3. When both you and your partner or family members are infected with Dientamoeba fragilis, everyone should be treated, including those who have no symptoms.


The treatment of parasites should be approached systematically:

  • Selection of the right medicine
  • All affected people in the family are treated
  • Nutrition / diet advice
  • The follow-up stool test should take place a week after treatment

Medications and preparation:
There are two medicines available for treating Dientamoeba fragilis: clioquinol and paramomycine, they both have a success rate of 75%.
• The first choice of medicine for the treatment of both Dientamoeba fragilis and Blastocystis hominis is clioquinol.
• The probability of success increases when the diet is adjusted at the same time. You can boost the immune system and improve the composition of the intestinal flora by eating a lot of vegetables and foods such as seaweed, shiitake mushrooms and herbs. Also slow cooked chicken broth improves conditions of the gut in favour of healthy microbes. This is because broth contains gelatine and cartilage which help the body produce healthy intestinal mucus.

Metronidazole should be avoided. Although metronidazole treatment fails in almost half of the cases, and causes damage to both the intestinal flora and the parasite, doctors still use metronidazole in many cases.

Clioquinol limitations
1. Clioquinol contains a preservative, methyl, and allergy for this is uncommon but possible.
2. Clioquinol contains iodine, so watch out for people with thyroid disorders. During breastfeeding it should not be used.
3. One week before starting with the treatment, begin taking 20 mg of zinc per day, for children half the dose. Clioquinol leaches zinc from the body, so it needs to be supplemented.
4. People with liver or hepatic disorders or a strong intolerance to chemicals may not be able to complete the treatment because of side effects such as headaches and nausea.

Clioquinol can cause symptoms that are similar to a hangover. If you become very sick after a few days of taking it, and experience severe headaches, you should stop immediately, but you do not have to worry because there nothing will be permanently damaged.
The side effects mainly occur with people who are sensitive to alcohol and chemicals. The naturopathic practice is often visited by people who do not tolerate alcohol or chemical well or are hypersensitive to smells. Experience has shown that they can not withstand clioquinol in many cases.

Clioquinol dosage to treat contamination with Dientamoeba fragilis or Blastocystis hominis in adults, is 250 mg three times daily for ten days. That’s a total of 7.5 grams.
When the total intake of clioquinol does not exceed 10 grams, there are no harmful side effects.
Children are treated with 15 mg per kilogram of body weight per day. The raw material is prepared into a drink, and should not be presented in capsule form.

Babies and very young children should not be treated with clioquinol. It needs to be stated very clearly that the treatment should always be done in consultation with the doctor or specialist. Never self medication without a prescription.


Repeating the treatment:
Treatment fails 25% of the time. This means treatment must be repeated. A 2014 study warned the following: Clioquinol should not be used too often – possibly only once in your life. The following advice was included in the instructions of drug clioquinol: “because of the neurotoxicity that can occur with a cumulative dose of 10 grams, one needs to examine whether clioquinol has ever used before. ”
That raises a lot of questions.
Cumulative means an accumulation of total use. Frequently the question is asked, “can I use clioquinol once, I’ve heard that because of the cumulative effect, you can take it only once?”
Some doctors argue that treatment should not be repeated and the maximum use for all your life total is 10 grams.
Upon inquiry by the Working Party of the Antibiotic Policy Foundation, the advice given is to limit the use of clioquinol  to a maximum of three treatments per year. You have to wait for at least 2 months before you can use it again.

The dose of clioquinol is 7.5 grams spread over 10 days. If ingestion of a cumulative dose of 10-50 g can ‘subacute myelo-optico-neuropathy (optic nerve damage) may occur by degeneration of the rear strands of the spinal cord and of the facial nerve. Associated symptoms in the early acute or chronic abdominal pain with diarrhea followed by the sensitivity and motor impairments. Also, visual disturbances occur, which can lead to blindness. Cumulatively adding up, so if you could count on the doses in a second course, you get 15 grams inside.

This can be interpreted that you can use only once in your life it means.

The Foundation Working Group recommends antibiotic policy in the 2014 guidelines to prevent accumulation of clioquinol by restricting the use of clioquinol for up to three courses a year and maintain a minimum interval of 2 months.

Clioquinol and Japan
Worldwide, there are no serious complications occurred. Is Clioquinol may still dangerous? After World War II the problems occurred almost exclusively in Japan. Researchers have come to the conclusion that the damage to the optic nerve or neurological symptoms that they experienced in Japan by using clioquinol largely came not by the administration of this drug.
There were at the end of the second world war two atomic bombs dropped on Japan. People in Japan and surroundings had a weakened immune system. Many people have been exposed to irradiation. A second problem was malnutrition, which is associated with a deficiency of vitamins and minerals. Zinc deficiency reduces the resistance and increase the risk of complications when using clioquinol.

Clioquinol is a zinc-chelator. That is to say that clioquinol and zinc binds withdraws from the body. A zinc deficiency is strengthened. A zinc deficiency due to poor diet is a worldwide problem. It is not easy to get enough zinc from food, except oysters and lobster catches your little zinc in foods. The need is 10 mg of zinc per day. A zinc deficiency can cause low birth weight, abnormal fetal development, diabetes, schizophrenia, decreased immunity and impaired intellectual development. In mice, an acute shortage of zinc leads to rapid weight loss, disturbed bowel integrity and ultimately death. People with Crohn’s disease, celiac disease or alcoholism absorb zinc not good, and often have a defect.

It is important to prescribe 20 to 25 mg of zinc per day during a clioquinolkuur. Early in any case a week with advance. Children 15 mg per day.

The intestinal flora and Clioquinol
Clioquinol is not an antibiotic. Laboratory studies show that metronidazole use causes a decrease in the intestinal flora. Clostridium, Veillonella, Prevotella and Eubacteria species decline in numbers. Clioquinol has in the intestine only slight antibacterial activity. There occurs no drop in the favorable E.coli bacteria in the intestine. Also allows the use of this drug and Veillonella Clostridium species intact.
In the inflammatory reactions of the gut wall takes the binding of parasites, while clioquinol will reduce the adhesion of parasites. It is a powerful tool that prevents adhesion.

Protection by clioquinol
When mice Clioquinol 2000 mg per kg body weight administering, you see no toxic reactions (the dosage in children is 15 mg per kg). It is noteworthy that clioquinol acts as a potent antioxidant. It is prescribed to people with brain disorders, for example in Alzheimer’s disease. In mice, made use of clioquinol in combination with zinc supplementation has a beneficial effect on the brains. It prevents the degeneration of the brain cells but stimulates nerve cells. Use also restores the stem cell division in the intestine, causing an accelerated growth of the mice and dramatically increased life span.
Another study shows that use cancer cells do die. Clioquinol stimulates the process of self-destruction of harmful cells that result in leukemia

• A week before you should start with 25 mg of zinc per day, children 10-15 mg.
• It is important to shake the bottle before use because the drug lowered.
• Take the drug every 8 or 7 hours, for example at 7 o’clock in the morning,
15.00 and 23.00. Eat a little soup, salad or yogurt with, so the drug does not reach an empty stomach. Drink during the day is sufficient water, so that the drug can be excreted through urine well.
• Wanner you become very sick after a few days and severe headaches you should stop immediately, but you do not have to worry because there is nothing damaged.
A week later, the follow-up place.

Paromomycinesulfaat is an antibiotic. Use often causes a temporary decrease in the intestinal flora. It is important for the use to be analyzed the intestinal flora, thus monitoring the intestinal flora for the use of the drugs, if necessary, to make more robust.
In the year 2001 did Drs. Saskia van As a comparative study of the effect of drugs on Dientamoeba fragilis. One group of patients was treated with clioquinol and the other group with paromomycin. Paromomycin was prescribed for four days and was found to have a 100% success rate; it was more effective than a week clioquinol.
In recent years, the success of paromomycin treatment decreased. 2014 was decreased efficacy of paromomycin course of seven days to 75%. The success rate is now equal to that of clioquinol.
It is prescribed in a dose of 500 mg 3 times daily for 7 days, some physicians prescribe the agent for 10 days. Children use 35 mg per kilogram of weight per day.
The drug is only 20% absorbed into the blood, the drug levels in the blood are very low. Acute poisoning only occurs when ingested ten times the normal dosage.
Paromomycin is better tolerated than clioquinol by people with chemical sensitivities.
The disadvantage of the use of this agent is an antibiotic that kills healthy bacteria in the gut.

Intestinal flora
Paromomycin kills gut friendly bacteria. The numbers of Lactobacillus spp. and Escherichia coli wane, other favorable permanent residents intestine decrease in number. It is therefore recommended to have a comprehensive flora analysis before making the cure. You can then assess whether there is a Candida overgrowth or a decrease of beneficial bacteria. Especially in children who already have undergone multiple antibiotics, is the making of an intestinal flora analysis of interest. The environment of the intestine should be improved first.

Diet in combination with the cure
When a decrease in the number of beneficial bacterial species is recommended in order to restore the intestinal flora before the treatment. You start at least two weeks before the course of eating large amounts of vegetables, broth and oily fish. Cereals can be omitted.
When the intestinal flora is restored, do less complications.
Three weeks after completion of the paromomycin treatment can be re-flora analysis to ensure that the gut has recovered well.

Even with a normal intestinal flora is the advice 10 days before start vegetable diet. Some of the people who used this drug develops intestinal complaints such as often happens with antibiotics. . About 4% of adults who Drs Van As has treated felt tired after a cycle and found that they were in bad shape; they had been less affected by the parasite than the cure. The more important it is to follow an optimal diet to limit the damage to the intestinal flora.

Regularly demonstrated a parasitic infection in mothers.
It is always a difficult decision to take medication during the
pregnancy. Of course enables you prefer use of drugs until after the birth. But in this case it does not. It is better to treat an infection Dientamoeba timely manner so that the mother no parasites reproduce on the baby. When the baby gets parasites inside during childbirth, the baby may get diarrhea and abdominal pain, while nothing can be done about the complaints.
Infants may namely not with anti-parasitic drugs to be treated, because their intestine absorbs too much medication. The use of paromomycin is therefore dangerous for them.
In the leaflet of paromomycin indicated that the drug can not be used in pregnancy. Medications should not be used too early in the pregnancy. In many articles, however, indicated that use safe during the last term of pregnancy. The drugs are only for a portion in the blood absorbed through the intestine. One can see very low drug levels in the blood. Animal experiments show that pregnant females who receive very high doses administered paromomycin get healthy offspring without birth defects.
If the mother is treated for at least a month before the birth, there is enough time to restore the intestinal flora so the baby with good flora is inoculated at birth. Even with infection with Giardia lamblia paromomycin during pregnancy is recommended.

Paromomycin is not marketed in the Netherlands. Paromomycin in the Netherlands and Germany also called Humatin® and is not prohibited or dangerous, but for technical reasons never marketed in the Netherlands.
The doctor can sign a medical certificate which the pharmacist can request it through the international pharmacy, but order via the Netherlands is very pricey. It is much cheaper to buy paromomycin in Belgium, it is called there Gabbroral®.
This medication should not be used by people with poor kidney function. Because paromomycin is also used in veterinary medicine is much known. The European Agency for Evaluation of drugs in veterinary medicine (EMEA) released in 2000 a detailed report on this medication. Their website contains a lot of information.

After you gladly have taken the medication you want to know if the parasites are really gone. After using the medication you send seven days later a stool sample to see if the parasites are gone. Clioquinol not kill everyone all parasites. One in four people failed the course. Most people notice itself that the symptoms have disappeared. Others feel that the treatment has failed and that is also common. Still, you have to have hard evidence.
It is often advised to wait six weeks before doing a follow-up, in case the DNA of the dead parasites still gives a response. The dead parasites are at a normal defecation pattern disappeared after a week. It is important to know as soon as possible whether the treatment has started. When you fail to take a second course. Prompt treatment is important because other family members can become infected again. Then again from the need to start over.

An important step is a visit to the sink. You can practice with the children to wash their hands. Take a plain piece of soap, it need not be a pump and certainly no decontaminant. Clean hands thoroughly wet and rub the soap in your hands. Most children wash their hands off too quickly. You rub your hands together until bubbles appear beautiful. You count to 20 or sing a song. The 20 second wash line is important. The next step is that the hands are dried with a paper towel. Subsequently, the valve is being closed with the paper. If there is no paper towels at school to join hands to dry, you can give the children paper towels.

In people with chronic bowel symptoms is found in 36% Dientamoeba fragilis. Infection causes symptoms that match with irritable bowel syndrome. Anyone with this pattern of symptoms can be examined for parasites. Infection can also chronic fatigue, skin disorders and psychological problems may result. Children with disorders will often have parasites or worms; Therefore, research is of importance.
Drs. Axis has a lot of families and children accompanied infected with intestinal parasites. And it is striking that usually there in the family that children are pale and tired, who as a child had bowel complaints. These children often have siblings who are also infected but have no symptoms. The lesson to learn is that there is less healthy children rather get complaints infection. The children without complaints are dealt with in the best interests of the child who is ill. It is a group action.
To get free family parasite describes Drs. Of As well as a military operation: your endeavors you to the limit in because you want to succeed at one time.

All people examined with bowel symptoms and nausea. A test on Dientamoeba fragilis can be requested at darmklachten.nl.
Dientamoeba fragilis stood for nearly a century as pathogenic known.
Upon infection inspected the family and partner.
Everyone who is infected should be treated simultaneously.
One week before and during the cure is a diet used zetmeelarm
There are two treatment options:
Clioquinol for 10 days with a success rate of 75%
Paromomycin, an antibiotic for 7 days, which also has a success rate of 75%.

People with liver problems or chemical sensitivities, can be treated with paromomycin. Paromomycin can get you best prescription in Belgium.
When the parasite not gone there follows a course of the drug that has not been used before. When using paromomycin restoration of the intestinal flora is important and can, if desired, can be made an analysis of the intestinal flora.