Emerging from obscurity: Biological, clinical, and diagnostic aspects of Dientamoeba fragilis

Clinical Microbiology Reviews

Volumn 17, Issue 3, 2004, Pages 553-570

  Johnson, Eugene H ^a   Windsor, Jeffrey J ^b   Clark, C Graham ^c  

^a SULTAN QABOOS UNIVERSITY   (Oman)

^b Bronglais General Hospital   (United Kingdom)

^c LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

RIBOSOME RNA;

ABDOMINAL PAIN; ANOREXIA; CLINICAL FEATURE; DIARRHEA; DIENTAMOEBA; ENTEROBIUS VERMICULARIS; FECES ANALYSIS; FLATULENCE; GENE SEQUENCE; GENOTYPE; NONHUMAN; PARASITE CULTIVATION; PARASITE VIRULENCE; REVIEW;

ADULT; ANIMALS; CHILD, PRESCHOOL; DIENTAMOEBA; DIENTAMOEBIASIS; FECES; FEMALE; HUMANS; INTESTINAL DISEASES, PARASITIC; MALE;

DIENTAMOEBA FRAGILIS; ENTEROBIUS VERMICULARIS; HISTOMONAS; HUMAN IMMUNODEFICIENCY VIRUS; PROTOZOA;

EID: 3242755880     PISSN: 08938512     EISSN: None     Source Type: Journal    
DOI: 10.1128/CMR.17.3.553-570.2004     Document Type: Review

References (147)

1. Addadi, K., Y. Le Corroller, Y. Guy, and A. Tabet-Derraz. 1972. Sur le role pathogene possible de Dientamoeba fragilis. Bull. Soc. Pathol. Exot. Fil. 65:274-275.
2. Aucott, J. N., and J. I. Ravdin. 1993. Amebiasis and " nonpathogenic" intestinal protozoa. Infect. Dis. Clin. North. Am. 7:467-485.
3. Ayadi, A., and I. Bahri. 1999. Dientamoeba fragilis: flagelle pathogene. Bull. Soc. Pathol. Exot. 5:299-301.
4. Balamuth, W. 1946. Improved egg yolk medium for cultivation of Entamoeba histolytica and other intestinal protozoa. Am. J. Clin. Pathol. 16:380-384.
5. Boeck, W. C., and J. Drbohlav. 1925. The cultivation of Endamoeba histolytica. Am. J. Hyg. 5:371-407.
6. Borody, T. J., E. F. Warren, A. Wettstein, G. Robertson, P. Recabarren, A. Fontella, K. Herdnman, and R. Surace. Eradication of Dientamoeba fragilis can resolve IBS-like symptoms. 2002. J. Gastroenterol. Hepatol. 17(Suppl.): A103.
7. Bruckner, D. A., L. S. Garcia, and M. Voge. 1979. Intestinal parasites in Los Angeles, California. Am. J. Med. Technol. 45:1020-1022.
8. Brug, S. L. 1936. Observations on Dientamoeba fragilis. Ann. Trop. Med. Parasitol. 30:441-452.
9. Burrows, R. B. 1967. A new fixative and technics for the diagnosis of intestinal parasites. Tech. Bull. Regist. Med. Technol. 37:208-212.
10. Burrows, R. B., and M. A. Swerdlow. 1956. Enterobius vermicularis as a probable vector of Dientamoeba fragilis. Am. J. Trop. Med. Hyg. 5:258-265.
11. Burrows, R. B., M. A. Swerdlow, J. K. Frost, and C. K. Leeper. 1954. Pathology of Dientamoeba fragilis infections of the appendix. Am. J. Trop. Med. Hyg. 3:1033-1039.
12. Butler, W. P. 1996. Dientamoeba fragilis. An unusual intestinal pathogen. Dig. Dis. Sci. 41:1811-1813.
13. Camp, R. R., C. F. Mattern, and B. M. Honigberg. 1974. Study of Dientamoeba fragilis Jepps & Dobell. I. Electronmicroscopic observations of the binucleate stages. II. Taxonomic position and revision of the genus. J. Protozool. 21:69-82.
14. Cerva, L. 1962. Die Darmparasiten in den Kinderheimen des Prager Bezirkes. Angew. Parasitol. 2:119-124.
15. Cerva, L., M. Schrottenbaum, and V. Kliment. 1991. Intestinal parasites: a study of human appendices. Folia Parasitol. 38:5-9.
16. Chan, F., N. Stewart, M. Guan, I. Robb, L. Fuite, I. Chan, F. Diaz-Mitoma, J. King, N. MacDonald, and A. MacKenzie. 1996. Prevalence of Dientamoeba fragilis antibodies in children and recognition of a 39 kDa immunodominant protein antigen of the organism. Eur. J. Clin. Microbiol. Infect. Dis. 15:950-954.
17. Chan, F. T., M. X. Guan, A. M. MacKenzie, and F. Diaz-Mitoma. 1994. Susceptibility testing of Dientamoeba fragilis ATCC 30948 with iodoquinol, paromomycin, tetracycline, and metronidazole. Antimicrob. Agents Chemother. 38:1157-1160.
18. Chan, F. T. H., M. X. Guan, and A. M. MacKenzie. 1993. Application of indirect immunofluorescence to detection of Dientamoeba fragilis trophozoites in fecal specimens. J. Clin. Microbiol. 31:1710-1714.
19. Chang, S. 1973. Parasitization of the parasite. JAMA 223:1510.
20. Chatton, E. P. L. 1925. Pansporella perplexa, amoebien a spores protegees, parasite des daphnies. Reflexions sur la biologie et la phylogenie des protozoaires. Ann. Sci. Nat. Zool. 10e Ser. 8:5-85.
21. Clark, C. G., and L. S. Diamond. 2002. Methods for the cultivation of luminal parasitic protists of clinical importance. Clin. Microbiol. Rev. 15:329-341.
22. Cleveland, L. R., and J. Collier. 1930. Various improvements in cultivation of Endamoeba histolytica. Am. J. Hyg. 12:606-613.
23. Cline, B. 1982. Drug regimens for intestinal helminth infections. Med. Clinics North Am. 66:721-742.
24. Colea, A., R. Silard, D. Panaitescu, P. Florescu, N. Roman, and T. Capraru. 1980. Studies on Dientamoeba fragilis in Romania. II. Incidence of Dientamoeba fragilis in healthy persons. Arch. Roum. Pathol. Exp. Microbiol. 39:49-53.
25. Costa, R. S. 1948. Dientamoeba fragilis Jepps and Dobell, 1918. Primeros casos senelados en nuestro pais. Consideraciones epidemiologicas. Rev. Kuba Med. Trop. 4:115-118.
26. Craig, C. F. 1926. The nuclear structure of Dientamoeba fragilis. J. Parasitol. 13:137-140.
27. Crotti, D., and M. L. D'Annibale. 2001. Dientamoeba fragilis e dientamoebosi: aspetti di parassitologia clinicale diagnostica di laboratorio. Parassitologia 43:135-138.
28. Cuffari, C., L. Oligny, and E. G. Seidman. 1998. Dientamoeba fragilis masquerading as allergic colitis. J. Pediatr. Gastroenterol. Nutr. 26:16-20.
29. Dardick, K. 1983. Tetracycline treatment of Dientamoeba fragilis. Conn. Med. 47:69-70.
30. Das Gupta, B. M. 1936. A case of human infection with Dientamoeba fragilis Jepps and Dobell, 1918, in Calcutta. Indian Med. Gaz. 21:528-529.
31. De Jonckheere, J. B., S. Brown, P. J. Dobson, B. S. Robinson, and P. Pernin. 2001. The amoeba-to-flagellate transformation test is not reliable for the diagnosis of the genus Naegleria. Description of three new Naegleria sp. Protist 152:115-121.
32. Reference deleted.
33. Diamond, L. S. 1982. A new liquid medium for xenic cultivation of Entamoeba histolytica and other lumen-dwelling protozoa. J. Parasitol. 68:958-959.
34. Diamond, L. S., and C. G. Clark. 1993. A redescription of Entamoeba histolytica Schaudinn, 1903 (Emended Walker, 1911) separating it from Entamoeba dispar Brumpt, 1925. J. Eukaryot. Microbiol. 40:340-344.
35. Dickinson, E. C., M. A. Cohen, and M. K. Schlenker. 2002. Dientamoeba fragilis: a significant pathogen. Am. J. Emerg. Med. 20:62-63.
36. Dobell, C. 1940. Researches on the intestinal protozoa of monkeys and man. X. The life history of Dientamoeba fragilis: observations, experiments, and speculations. Parasitology 32:417-461.
37. Dobell, C., and P. P. Laidlaw. 1926. On the cultivation of Entamoeba histolytica and some other entozoic amoeba. Parasitology 18:283-318.
38. Dobell, C., and F. W. O'Connor. 1921. The intestinal protozoa of man. J. Bale, Sons, and Danielson, London, United Kingdom.
39. Dwyer, D. M. 1972. Analysis of the antigenic relationships among Trichomonas, Histomonas, Dientamoeba, and Entamoeba. I. Quantitiative fluorescent antibody methods. J. Protozool. 19:316-325.
40. Dwyer, D. M. 1972. Analysis of the antigenic relationships among Trichomonas, Histomonas, Dientamoeba, and Entamoeba. II. Gel diffusion methods. J. Protozool. 19:316-325.
41. Dwyer, D. M. 1974. Analysis of the antigenic relationships among Trichomonas, Histomonas, Dientamoeba, and Entamoeba. III. Immunoelectrophoresis technics. J. Protozool. 21:139-145.
42. Fantham, H. B., and A. Porter. 1936. Some entozoa of man as seen in Canada and South Africa. Can Med. Assoc. J. 34:414-421.
43. Fleck, S. L., and A. H. Moody. 1988. Faecal parasites, p. 23-24. In S. L. Fleck and A. H. Moody (ed.), Diagnostic techniques in medical parasitology. Elsevier, Amsterdam, The Netherlands.
44. Garcia, L. 2002. Laboratory methods for diagnosis of parasitic infection, p. 776-861. In B. A. Forbes, D. F. Sahm, and A. S. Weissfeld (ed.), Bailey and Scott's Diagnostic Microbiology, 11th ed. C. V. Mosby, St. Louis, Mo.
45. Garcia, L. S. 1992. Parasitology, p. 2:7.10:13:13. In H. D. Isenberg (ed.), Clinical microbiology procedures handbook. American Society for Microbiology, Washington, DC.
46. Garcia, L. S., and R. Y. Shimizu. 1998. Evaluation of intestinal protozoan morphology in human fecal specimens preserved in EcoFix: comparison of Wheatley's trichrome stain and EcoStain. J. Clin. Microbiol. 36:1974-1976.
47. Garcia, L. S., R. Y. Shimizu, T. C. Brewer, and D. A. Bruckner. 1983. Evaluation of intestinal parasite morphology in polyvinyl alcohol preservative: comparison of copper sulfate and mercuric chloride bases for use in Schaudinn fixative. J. Clin. Microbiol. 17:1092-1095.
48. Gerbod, D., V. P. Edgcomb, C. Noel, L. Zenner, R. Wintjens, P. Delgado-Viscogliosi, M. E. Holder, M. L. Sogin, and E. Viscogliosi. 2001. Phylogenetic position of the trichomonad parasite of turkeys, Histomonas meleagridis (Smith) Tyzzer, inferred from small subunit rRNA sequence. J. Eukaryot. Microbiol. 48:498-504.
49. Girginkardesler, N., S. Coskun, I. Cuneyt Balcioglu, P. Ertan, and U. Z. Ok. 2003. Dientamoeba fragilis, a neglected cause of diarrhea, successfully treated with secnidazole. Clin. Microbiol. Infect. 9:110-113.
50. Goldman, M., and M. M. Brooke. 1953. Protozoans in stools unpreserved and preserved in PVA fixative. Public Health. Rep. 68:703-706.
51. Grassé, P. P. 1953. Famille des Dientamoebidae Grasse, nov., (E. Chatton, principal author: Ordre des amoebiens nus ou Amoebaea), p. 50-54. In P. P. Grasse (ed.), Traité de zoologie. Masson et Cie., Paris, France.
52. Greenway, D. 1928. Dientamoeba fragilis en la Argentina. Arch. Argent. Enferm. Aparato Dig. (Buenos Aires) 3:897.
53. Grendon, J. H., R. F. Digiacomo, and F. J. Frost. 1995. Descriptive features of Dientamoba fragilis infections. J. Trop. Med. Hyg. 98:309-315.
54. Grendon, J. H., R. F. Digiacomo, and F. J. Frost. 1991. Dientamoeba fragilis detection methods and prevalence: a survey of State Public Health Laboratories. Public Health Rep. 106:322-325.
55. Hakansson, E. G. 1936. Dientamoeba fragilis, a cause of illness: report of case. Am. J. Trop. Med. 16:175-183.
56. Hakansson, E. G. 1937. Dientamoeba fragilis: some further observations. Am. J. Trop. Med. 17:349-362.
57. Halawani, A. E. 1930. Dientamoeba fragilis from a culture of human faeces. Trans. R. Soc. Trop. Med. Hyg. 23:326-327.
58. Haughwout, F. G., and F. S. Horrilleno. 1920. The intestinal animal parasites found in one hundred sick Filipino children. Philipp. J. Sci. 16:1-73.
59. Hegner, R., and H. J. Chu. 1930. A comparative study of the intestinal protozoa of wild monkeys and man. Am. J. Hyg. 12:62-108.
60. Hiatt, R. A., E. K. Markell, and E. Ng. 1995. How many stool examinations are necessary to detect pathogenic intestinal protozoa? Am. J. Trop. Med. Hyg. 53:36-39.
61. Hollande, A., and J. Carruette-Valentin. 1971. Les atractophores, l'induction du fuseau et la division cellulaire chez les Hypermastigines. Etude infrastructurale et revision systematique des Trichonymphines et des Spirotrichonymphines. Protistologica 7:5-100.
62. Horen, W. P. 1981. Modification of Schaudinn fixative. J. Clin. Microbiol 13:204-205.
63. Jacobs, L. 1953. The cultivation of Dientamoeba fragilis. Ann. N. Y. Acad. Sci. 56:1057-1061.
64. Jepps, M. W. 1921. Notes on the intestinal protozoa of 971 men at the University War Hospital, Southampton. J. R. Army Med. Corps 97:366-375.
65. Jepps, M. W., and C. Dobell. 1918. Dientamoeba fragilis n.g., n. sp., new intestinal amoeba from man. Parasitology 10:352-367.
66. Johnson, J. A., and C. G. Clark. 2000. Cryptic genetic diversity in Diemamoeba fragilis. J. Clin. Microbiol. 38:4653-4654.
67. Kabani, A., G. Cadrain, C. Trevenen, T. Jadavji, and D. L. Church. 1995. Practice guidelines for ordering stool ova and parasite testing in a paediatric population. Am. J. Clin. Pathol. 104:272-278.
68. Katz, D. E., and D. N. Taylor. 2001. Parasitic infections of the gastrointestinal tract. Gastroenterol. Clin. North Am. 30:797-815.
69. Kean, B. H., and C. L. Malloch. 1966. The neglected ameba: Dientamoeba fragilis. A report of 100 "pure" infections. Am. J. Dig. Dis. 11:735-746.
70. Keystone, J. S., E. Proctor, C. Glenn, and L. McIntyre. 1983. Safety and efficacy of diphetarsone in the treatment of amoebiasis, non-pathogenic amoebiasis and trichuriasis. Trans. R. Soc. Trop. Med. Hyg. 77:84-86.
71. Keystone, J. S., J. Yang, D. Grisdale, M. Harrington, L. Pillon, and R. Andreychuk. 1984. Intestinal parasites in metropolitan Toronto day-care centres. Can. Med. Assoc. J. 131:733-735.
72. Knoll, E. W., and K. M. Howell. 1945. Studies on Dientamoeba fragilis. Its incidence and possible pathogenicity. Am. J. Clin. Pathol. 15:178-183.
73. Knowles, R., and B. M. Das Gupta. 1936. Some observations on the intestinal protozoa of macaques. Indian J. Med. Res. 24:547-556.
74. Kofoid, C. A. 1923. Amoeba and man, p. 149-174, 219-312. In University of California Chronicle for 1923. University of California Press, Berkeley.
75. Lainson, R., and B. A. Da Silva. 1999. Intestinal parasites of some diarrhoeic HIV-seropositive individuals in North Brazil with particular reference to Isospora belli Wenyon, 1923 and Dientamoeba fragilis Jepps & Dobell, 1918. Mem. Inst. Oswaldo Cruz 94:611-613.
76. Lawless, D. K. 1953. A rapid permanent-mount stain technique for the diagnosis of intestinal protozoa. Am. J. Trop. Med. Hyg. 20:1137-1138.
77. Melvin, D. M., and M. M. Brooke. 1962. Parasitologic surveys on Indian reservations in Montana, South Dakota, New Mexico, Arizona and Wisconsin. Am. J. Trop. Med. Hyg. 11:765-772.
78. Mendez, O. C., G. Szmulewicz, C. Menghi, S. Torres, G. Gonzalez, and C. Gatta. 1994. Comparison of intestinal parasite infestation indexes among HIV positive and negative populations. Medicina (Buenos Aires) 54:307-310.
79. Millet, V., M. J. Spencer, M. Chapin, M. Stewart, J. A. Yatabe, T. Brewer, and L. S. Garcia. 1983. Dientamoeba fragilis, a protozoan parasite in adult members of a semicommunal group. Dig. Dis. Sci. 28:335-339.
80. Mollari, M., and J. V. Anzulovic. 1938. Cultivation and pathogencity of Dientamoeba fragilis, with a case report. J. Trop. Med. Hyg. 41:246-247.
81. Moody, A. H., and S. L. Fleck. 1985. Versatile Field's stain. J. Clin. Pathol. 38:842-843.
82. Muller, M. 1975. Biochemistry of protozoan microbodies: peroxisomes, alpha-glycerophosphate oxidase bodies, hydrogenosomes. Annu. Rev. Microbiol. 29:467-483.
83. Myers, B. J., and R. E. Kuntz. 1968. Intestinal protozoa of the baboon Papio doguera Pucheran, 1856. J. Protozool. 15:363-365.
84. Naiman, H. L., L. Sekla, and W. L. Albritton. 1980. Giardiasis and other intestinal parasitic infections in a Manitoba residential school for the mentally retarded. Can. Med. Assoc. J. 122:185-188.
85. Norberg, A., C. E. Nord, and B. Evengard. 2003. Dientamoeba fragilis - a protozoal infection which may cause severe bowel distress. Clin. Microbiol. Infect. 9:65-68.
86. Ockert, G. 1990. Symptomatology, pathology, epidemiology, and diagnosis of Dientamoeba fragilis, p. 394-410. In B. M. Honigberg (ed.), Trichomonads parasitic in humans. Springer Publications, New York, N.Y.
87. Ockert, G. 1972. Zur epidemiologie von Dientamoeba fragilis Jepps et Dobell 1918. 1. Mitteilung: die Verbreitung der art in Kinderkollektiven. J. Hyg. Epidemiol. Microbiol. Immunol. 16:213-221.
88. Ockert, G. 1972. Zur epidemiologie von Dientamoeba fragilis Jepps et Dobell 1918. 2. Mitteilung: Versuch der Uebertragung der Art mit Enterobius-Eiern. J. Hyg. Epidemiol. Microbiol. Immunol. 16:222-225.
89. Ockert, G. 1975. Zur epidemiologie von Dientamoeba fragilis, 3. Weitere zur Uebertragung der Art mit Enterobius-Eiern. J. Hyg. Epidemiol. Microbiol. Immunol. 19:17-21.
90. Ockert, G., and T. Schmidt. 1976. Zur epidemiologie von Dientamoeba fragilis Jepps et Dobell. 1918. 4. Mitteilung: Nachweis von Dientamoeba fragilis in Enterobius eirn mit hilfe von IEP-bestimmungen. J. Hyg. Epidemiol. Microbiol. Immunol. 20:76-81.
91. Ockert, G., and F. Schneider. 1974. Elektronenmikroskopische Befunde bei Dientamoeba fragilis. Z. Gesamte Hyg. 20:555-557.
92. Ockert, G., and U. Schulz. 1972. Zur pathogenetischen Rolle von Diemamoeba fragilis. Dtsch. Gesundheitsw. 27:1156-1158.
93. Panosian, C. 1988. Parasitic diarrhoea. Infect. Dis. Clin. North Am. 2:685-703.
94. Peek, R., F. R. Reedeker, and T. van Gool. 2004. Direct amplification and genotyping of Dientamoeba fragilis from human stool specimens. J. Clin. Microbiol. 42:631-635.
95. Piekarski, G. 1948. Zur Frage der Cystenbildung bei Dientamoeba fragilis. Z. Hyg. Infektionskr. 127:496-500.
96. Porter, A. 1934. Remarks on intestinal parasites in Montreal and the relation of Entamoeba histolytica to colitis. Can. Med. Assoc. J. 30:134-137.
97. Preiss, U., G. Ockert, S. Broemme, and A. Otto. 1990. Dientamoeba fragilis infection, a cause of gastrointestinal symptoms in childhood. Klin. Paediatr. 202:120-123.
98. Preiss, U., G. Ockert, S. Broemme, and A. Otto. 1991. On the clinical importance of Dientamoeba fragilis infections in childhood. J. Hyg. Epidemiol. Microbiol. Immunol. 35:27-34.
99. Rachet, J., A. Busson, and G. Terrial. 1945. Le role pathogene de 'Dientamoeba fragilis'. Arch. Mal. Appar. Dig. Mal. Nutr. 34:196-200.
100. Robertson, A. 1923. Notes on a case infected with Dientamoeba fragilis, Jepps and Dobell, 1917. J. Trop. Med. Hyg. 26:243-244.
101. Robinson, G. L. 1968. The laboratory diagnosis of human parasitic amoebae. Trans. R. Soc. Trop. Med. Hyg. 62:285-294.
102. Robinson, G. L., and P. H. T. Ng. 1968. The size of Dientamoeba fragilis in culture. Trans. R. Soc. Trop. Med. Hyg. 62:156-158.
103. Rothman, M. M., and H. J. Epstein. 1941. Clinical symptoms associated with the so-called non-pathogenic amoeba. JAMA 116:694-700.
104. Sapero, J. J. 1939. Clinical studies in non-dysenteric amoebiasis. Am. J. Trop. Med. 19:497-541.
105. Sapero, J. J., and C. M. Johnson. 1939. Entamoeba histolytica and other intestinal parasites: incidence in variously exposed groups of the Navy. U. S. Navy Med. Bull. 37:297-301.
106. Sapero, J. J., and D. K. Lawless. 1953. The 'MIF' stain-preservation technique for the identification of intestinal protozoa. Am. J. Trop. Med. Hyg. 2:613-619.
107. Sargeaunt, P. G., and J. E. Williams. 1982. The morphology in culture of the intestinal amoebae of man. Trans. R. Soc. Trop. Med. Hyg. 76:465-472.
108. Sawangjaroen, N., R. Luke, and P. Prociv. 1993. Diagnosis by faecal culture of Dientamoeba fragilis infections in Australian patients with diarrhoea. Trans. R. Soc. Trop. Med. Hyg. 87:163-165.
109. Scholten, T. 1972. An improved technique for the recovery of intestinal protozoa. J. Parasitol. 58:633-634.
110. Schulz, U., and G. Ockert. 1971. Darmprotozoen als Ursache intestinaler Stoerungen. Dtsch. Med. Wochenschr. 51:1963-1968.
111. Shein, R., and A. Gelb. 1983. Colitis due to Dientamoeba fragilis. Am. J. Gastroenterol. 78:634-636.
112. Silard, R., and B. Burghelea. 1986. Endosymbionts in Dientamoeba fragilis trophozoites resistant to antiprotozoal drugs. Arch. Roum. Pathol. Exp. Microbiol. 45:65-74.
113. Silard, R., B. Burghelea, D. Panaitescu, and V. Burcos. 1984. Ultrastructure of Dientamoeba fragilis: a study of the mononucleated stage. Arch. Roum. Pathol. Exp. Microbiol. 43:87-101.
114. Silard, R., A. Colea, D. Panaitescu, P. Florescu, and N. Roman. 1979. Studies on Dientamoeba fragilis in Romania. I. Dientamoeba fragilis isolated from clinical cases. Problems of diagnosis, incidence, clinical aspects. Arch. Roum. Pathol. Exp. Microbiol. 38:359-372.
115. Silberman, J. D., C. G. Clark, and M. L., Sogin. 1996. Dientamoeba fragilis shares a recent common evolutionary history with the trichomonads. Mol. Biochem. Parasitol. 76:311-314.
116. Spencer, M. J., M. R. Chapin, and L. S. Garcia. 1982. Dientamoeba fragilis: a gastrointestinal protozoan infection in adults. Am. J. Gastroenterol. 77:565-569.
117. Spencer, M. J., L. S. Garcia, and M. R. Chapin. 1979. Dientamoeba fragilis. An intestinal pathogen in children? Am. J. Dis. Child. 133:390-393.
118. Spencer, M. J., V. E. Millet, L. S. Garcia, L. Rhee, and L. Masterson. 1983. Parasitic infections in a pediatric population. Pediatr. Infect. Dis. J. 2:110-113.
119. Stabler, R. M. 1941. Intestinal protozoa in 106 parasitology students. J. Parasitol. 24:90.
120. Steinitz, H. 1973. Klinische Beobachtungen bei Infektionen mit Dientamoeba fragilis. Z. Gastroenterol. 11:179-182.
121. Steinitz, H. 1972. The treatment of chronic amoebic infection with metronidazole (flagyl). Digestion 6:75-82.
122. Stenzel, D. J., B. Stein, and J. Lengy. 1991. A cyst-like stage of Blastocystis hominis. Int. J. Parasitol. 21:613-615.
123. Sukanahaketu, S. 1977. The presence of Dientamoeba fragilis in the Ascaris lumbricoides ova: the first report from Thailand. J. Med. Assoc. Thail. 60:256-258.
124. Swerdlow, M. A., and R. B. Burrows. 1955. Dientamoeba fragilis, an intestinal pathogen. JAMA 158:176-178.
125. Taliaferro, W. H., and E. R. Becker. 1924. A note on the human intestinal amoeba, Dientamoeba fragilis. Am. J. Hyg. 4:71-74.
126. Talis, B., and B. Stein. 1961. The presence of Dientamoeba fragilis in the gall bladder. Harefueh 61:126.
127. Talis, B., B. Stein, and J. Lengy. 1971. Dientamoeba fragilis in human feces and bile. Isr. J. Med. Sci. 7:1063-1069.
128. Thomson, J. G., and A. Robertson. 1923. Dientamoeba fragilis, Jepps and Dobell 1917. A case of human infection in England. J. Trop. Med. Hyg. 26:135-136.
129. Van Gool, T., and J. Dankert. 1996. Drie opkomende protozoaire infectieziekten in Nederland: Cyclospora-, Dientamoeba-en Microspora-infecties. Ned. Tijdschr. Geneeskd. 140:155-160.
130. Van Gool, T., R. Weijts, E. Lommerse, and T. G. Mank. 2003. Triple faeces test: an effective tool for detection of intestinal parasites in routine clinical practice. Eur. J. Clin. Microbiol. Infect. Dis. 22:284-290.
131. Velat, C. A., P. P. Weinstein, and G. F. Otto. 1950. A stain for the rapid differentiation of the trophozoites of the intestinal amoeba in fresh, wet preparations. Am. J. Trop. Med. 30:43-51.
132. Warren, K. S., and A. A. Mahmoud. 1975. Algorithms in the diagnosis and management of exotic diseases. V. Enterobiasis. J. Infect. Dis. 132:229-232.
133. Wenrich, D. H. 1936. Studies on Dientamoeba fragilis (protozoa). I. Observations with special reference to nuclear structure. J. Parasitol. 22:76-83.
134. Wenrich, D. H. 1937. Studies on Dientamoneba fragilis (protozoa). II. Report of unusual morphology in one case with suggestions as to pathogenicity. J. Parasitol. 23:183-196.
135. Wenrich, D. H. 1939. Studies on Dientamoeba fragilis (protozoa). III. Binary fission with special reference to nuclear division. J. Parasitol. 25:43-45.
136. Wenrich, D. H. 1944. Nuclear structure and nuclear division in Dientamoeba fragilis (protozoa). J. Morphol 74:467-491.
137. Wenrich, D. H. 1944. Studies on Dientamoeba fragilis (protozoa). IV. Further observations, with an outline of present-day knowledge of this species. J. Parasitol. 30:322-337.
138. Wenrich, D. H., R. M. Stabler, and J. H. Arnett. 1935. Entamoeba histolytica and other intestinal protozoa in 1060 college freshmen. Am. J. Trop. Med. 15:331-345.
139. Wheatley, W. B. 1951. A rapid staining procedure for intestinal amoebae and flagellates. Am. J. Clin. Pathol. 21:990-991.
140. Windsor, J. J., and E. H. Johnson. 1999. Dientamoeba fragilis: the unflagellated human falgellate: a review. Br. J. Biomed. Sci 56:293-306.
141. Windsor, J. J., L. MacFarlane, G. Hughes-Thapa, S. K. A. Jones, and T. M. Whiteside. 2003. Detection of Dientamoeba fragilis by culture. Br. J. Biomed. Sci. 60:79-83.
142. Windsor, J. J., and A. M. Rafay. 1997. Laboratory detection of Dientamoeba fragilis. Br. J. Biomed. Sci. 54:223-224.
143. Windsor, J. J., A. M. Rafay, A.K. Shenoy, and E. H. Johnson. 1998. The incidence of Dientamoeba fragilis in faecal samples submitted for routine microbiological analysis. Br. J. Biomed. Sci. 55:172-175.
144. Yang, J., and T. Scholten. 1976. Celestin blue B stain for intestinal protozoa. Am. J. Clin. Pathol. 65:715-718.
145. Yang, J., and T. Scholten. 1977. A fixative for intestinal parasites permitting the use of concentration and permanent staining procedures. Am. J. Clin. Pathol. 67:300-304.
146. Yang, J., and T. H. Scholten. 1977. Dientamoeba fragilis: a review with notes on its epidemiology, pathogenicity, mode of transmission, and diagnosis. Am. J. Trop. Med. Hyg. 26:16-22.
147. Yoeli, M. 1955. A report on intestinal disorders accompained by large numbers of Dientamoeba fragilis. J. Trop. Med. Hyg. 58:38-41.