A Mexican Honeymoon Marred by Gastrointestinal Upset: A Case of Dientamoeba fragilis Causing Post-infectious Irritable Bowel Syndrome

Saeed Ali; Neelam Khetpal; Muhammad Talha Khan; Mamoon Rasheed; Fnu Asad-Ur-Rahman; Karen Echeverria-Beltran

doi:10.7759/cureus.1992

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A Mexican Honeymoon Marred by Gastrointestinal Upset: A Case of Dientamoeba fragilis Causing Post-infectious Irritable Bowel Syndrome

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A Mexican Honeymoon Marred by Gastrointestinal Upset: A Case of Dientamoeba fragilis Causing Post-infectious Irritable Bowel Syndrome

Saeed Ali, Neelam Khetpal, Muhammad Talha Khan, Mamoon Rasheed, Fnu Asad-Ur-Rahman and Karen Echeverria-Beltran

Curēus (Palo Alto, CA), Vol.9(12), p.e1992

12/27/2017

DOI: 10.7759/cureus.1992

PMCID: PMC5828670

PMID: 29503786

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Abstract

Dientamoeba fragilis (D. fragilis) is an anaerobic intestinal protozoan parasite that has been associated with irritable bowel syndrome (IBS)-like symptoms. We report a case of post-infectious IBS caused by D. fragilis treated successfully with metronidazole. A 33-year-old African American male with an unremarkable past medical history was seen in the office with a three-month history of intermittent, generalized, crampy abdominal pain with bloating and flatulence without associated weight loss. He visited Mexico for his honeymoon four months ago. Initial lab work was normal. Dietary changes including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet and loperamide were prescribed with the presumptive diagnosis of IBS; however, his symptoms persisted. Three samples of stool for ova and parasites (O&P) were positive for D. fragilis. The patient was treated with metronidazole for 14 days. Repeat fecal O&P were negative. Upon follow-up, the patient' symptoms substantially improved with a resolution of abdominal pain and flatulence. Infection caused by D. fragilis may be symptomatic or asymptomatic. It is transmitted by the fecal-oral route. Symptoms include abdominal pain, bloating, and alteration of bowel movements, resembling IBS. The diagnosis is made via the detection of D. fragilis trophozoites in appropriately fixed and stained stool samples or by a polymerase chain reaction. Treatment options include tetracyclines, paromomycin, metronidazole, and Iodoquinol. Further epidemiologic studies may help in elucidating the association between D. fragilis and IBS.

postinfectious ibs

dientamoeba fragilis

stool ova & parasite

Details

Title: Subtitle: A Mexican Honeymoon Marred by Gastrointestinal Upset: A Case of Dientamoeba fragilis Causing Post-infectious Irritable Bowel Syndrome
Creators: Saeed Ali - Internal Medicine Residency, Florida Hospital-Orlando
Neelam Khetpal - Internal Medicine Residency, Florida Hospital-Orlando
Muhammad Talha Khan - Internal Medicine, Khyber Medical College
Mamoon Rasheed - Internal Medicine Residency, Florida Hospital-Orlando
Fnu Asad-Ur-Rahman - Gastroenterology, Cleveland Clinic Florida
Karen Echeverria-Beltran - Internal Medicine Residency, Florida Hospital-Orlando
Resource Type: Journal article
Publication Details: Curēus (Palo Alto, CA), Vol.9(12), p.e1992
DOI: 10.7759/cureus.1992
PMID: 29503786
PMCID: PMC5828670
NLM abbreviation: Cureus
ISSN: 2168-8184
eISSN: 2168-8184
Language: English
Date published: 12/27/2017
Academic Unit: General Internal Medicine; Internal Medicine
Record Identifier: 9984094527302771

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