Dientamoeba fragilis: Symptoms, Testing and Natural Treatment

dientamoeba fragilis gut health byron bay australia herbalist herbal medicine digestive health parasite infection naturopath

Dientamoeba fragilis is a protozoan parasite.

It frequently comes hand in hand with another bug known as Blastocystis hominis.

As a human parasite goes it is reasonably prevalent with estimates of infection ranging from 0.4% to 42%. The interesting thing to note, especially when compared to other protozoan parasites, is the infection rate in developed countries.

Estimates put Dientamoeba fragilis infections at 9.4% in the US, 11.7% in Sweden and a whopping 16.9% in the UK (1).

In the following article we will outline what Dientamoeba fragilis is, possible symptoms, routes of infection, standard care for elimination, and finally some alternative treatment options to explore.

As a side note: This is a parasite that I have personal experience with. I found the infection, along with a number of others (Blastocystis hominis, Klebsiella and Citrobacter) after consuming unfiltered rain water while living in the Byron Bay area of Northern NSW. 

What Is Dientamoeba Fragilis Anyway?

As mentioned above Dientamoeba fragilis falls into the protozoan phylum. This makes it a single celled eukaryotic organism.

Dientamoeba fragilis was first described in 1918 by two scientists Jepps and Dobell. Until that point three other amoeba like organisms had been discovered, Entamoeba coli, Entamoeba nana, both considered harmless by many and Entamoeba histolytic, considered pathogenic and responsible for amoebic dysentery (2).

Dientamoeba fragilis was quite different in form and function that a whole new genus was created to classify it.

dientamoeba fragilis infection route natural treatment option gut health byron bay australian naturopath

Two particular things make Dientamoeba fragilis different.

One that it is fully mobile and two the lack of a cyst stage of development (3).

 The ability to form cysts is of paramount importance for many pathogenic microbes. Without that particular ability Dientamoeba fragilis cannot survive outside of a host (in the external environment.) Hence the name fragilis.

It is something that has baffled scientists and researchers for awhile now and although there has been mention of cyst formation it has still not been properly verified.

To some this point may seem trivial but the lack of a cystic stage of development excludes the fecal-oral route of infection (a very common route of infection for most parasites)

The other issue around the question ‘how did I become infected with Dientamoeba fragilis?’ is that this particular bug probably doesn’t have the ability to survive the stomach acid bath (one of our major defences against gut infections).

To prove his point, Dobell the same scientist that helped to discover the bug, actually consumed a culture with thousands of living Dientamoeba fragilis organisms! Dobell spent the next ten years inspecting his stools with no trace of Dientamoeba fragilis (4).

Is Dientamoeba Fragilis Really To blame here?

This is the million dollar question.

Some researchers and gut health clinicians think it is a parasitic infection that needs to be treated in anyone that presents with it. Some think that it is a commensal microbe that is simply blamed for poor gut health because it is easy to find on a cheap and readily available stool test.

It could be that certain strains of Dientamoeba fragilis are more pathogenic than others but the jury is still out here.

I think it is best to keep an open mind and not to blame Dientamoeba fragilis unless you have ruled out other possible gut disorders like small intestinal bacterial overgrowth, large bowel dysbiosis and even things like coeliac disease.

Symptoms of Dientamoeba Fragilis Infection

Dientamoeba fragilis infection presents with many of the same non-specific symptoms as many of the other GI infections.

Again keep in mind that other gut disorders may be causing your symptoms. Again, this is why it is important to work with someone who really knows the in’s and out’s of gut health. They may be hard to find and the good ones tend to be popular and hard to see but try your best to track one down!

On that note, I am offering a free 15 minute consultation (online for folks not in my locality or in person in Byron Bay) starting from mid December 2019. These one off short consults are set up to determine if I think I can help you and your gut issues and to see if we are a good fit.

Ok back to the symptoms that Dientamoeba may be causing…

  • Recurrent abdominal pain in children
  • Irritable Bowel Syndrome in adults (5).
  • Diarrhea
  • severe abdominal pain
  • Cramps
  • Nausea
  • Vomiting
  • mild fever
  • general fatigue (4).

There is even a paper published in 1983 that relates a case of ulcerative colitis (inflamed and ulcerated colon ie: large intestine) to an infection by Dientamoeba fragilis.

Treatment of the parasite subsequently cleared up the illness (6).

Another interesting paper talks of IBS symptoms being relieved in 67% (n=21) of people when Dientamoeba fragilis was treated and cleared (7).

dientamoeba fragilis infection natural parasite treatment herbalist naturopath gut health specialist

Route of Infection for Dientamoeba Fragilis

If Dientamoeba fragilis wasn’t enigmatic before here is where it really gets interesting.

The route of infection for many parasitic microbes is via the fecal-oral route.

To survive the external environment a parasite will form a cyst. This stage of development also prevents the pathogen from being killed in a healthy humans extremely acidic stomach.

As of yet it hasn’t been confirmed whether Dientamoeba fragilis can actually form a cyst and the general consensus is that it can’t. Another proposed route of infection is human to human, but again this is not a strong theory as Dientamoeba fragilis is actually quite fragile outside of the human bowel.

The last theory that seems the strongest involves the ova of Enterobius vermicularis a parasitic pinworm. Apparently the DNA from organisms very similar to Dientamoeba fragilis have been found “hitching a ride” in the pinworm (8). 

Not a pleasant thought but there it is. Below is a close up of a pinworm (Enterobius vermicularis) egg that Dientamoeba fragilis may be hiding in.

pinworm and dientamoeba fragilis coinfection route of infection natural treatment for parasites

So this theory seems to beg the question of the likelihood of a pinworm co-infection with many Dientamoeba fragilis infected individuals. Or possibly it could be the other way around. Perhaps you, or your family (remember pinworm infections are actually quite common in children) has had a previous Dientamoeba fragilis infection that you have successfully cleared. Only to find out later on that you have been reinfected with Dientamoeba fragilis again. If this is ringing true then I would recommend looking into whether anyone in the family has pinworms. If you do find them it is best to treat the whole family as they spread easily.

pinworm lifecycle dientamoeba fragilis natural treatment options

Testing for Dienatamoeba Fragilis

There are only two tests that I came across that would test for Dientamoeba fragilis. More on recommended gut testing here.

  1. The CDSA – comprehensive digestive stool analysis that actually cultures the stool sample and analyses it microscopically
  2. A PCR test – A polymerase chain reaction that tests the DNA in the stool sample

I have read that it is smart to combine the two and if you are suffering from any GI distress then why not cover your bases. There is nothing worse than a “false negative” meaning that you run the test and it actually misses the infection.

No test is perfect. Speaking of imperfect tests, if you do opt for a conventional stool test from your doctor be sure it is the PCR testing.

The culture based tests are incredibly unreliable.

If you are trying to save some money then why not run the tests that are covered by your healthcare and if nothing comes back then maybe move onto the more comprehensive (and expensive) functional medicine tests.

Below is an example of a PCR test showing both Deintamoeba fragilis and Blastocystis hominis infections.

GI stool test PCR pathogen

Conventional and Natural Treatments for Dientamoeba Fragilis   

Conventional medicine reaches straight for the antibiotics.

Apparently metronidazole (a favourite) has a high rate of failures/relapses reported by numerous studies (7). 

Other conventional treatments include oxytetracycline, doxycycline, tinidazole, ornidazole and erythromycin (9).

As you may guess I am opposed to antibiotics unless they are absolutely and critically necessary. From what I have learned looking into antibiotics my personal opinion is strict avoidance unless absolutely necessary.

Many different human infections have developed a resistance to conventional medicines common antibiotic treatments. If one was to take the round of antibiotics and not 100% kill the infection (as happened to me) then you’re left with a disrupted gut microbiome, a compromised immune system and the presence of an opportunistic or pathogenic organism that can wreak havoc.

Alternative and Natural Treatments for Dientamoeba Fragilis

Functional Medicine approaches parasitic infections a bit differently than conventional medicine.

A functional medicine doctor may end up prescribing antibiotics (or referring to someone if they can’t.)

But before it comes to that there are a few essential steps to take.

  1. Remove all offending foods. The idea is to reduce inflammation in your stomach as much as possible. Things like sugar, refined foods, excess carbohydrates, gluten, grain and legumes as well as dairy are all possible offenders. It is advisable to eliminate these foods immediately!
  2. Replace your digestive enzymes and possibly supplement with herbal bitters, lemon juice, apple cider vinegar or even HCL to kick your digestion into gear. It is important to avoid HCL if you are taking steroids or NSAIDS. They damage your gut lining and adding HCL ontop can cause serious problems!
  3. The third step is to Repair a damaged gut lining. It might seem slightly odd to start into the repair phase before removing the offending organism but it is essential! It involves using things like bone broth, glutamine and other soothing herbs and nutrients to help with the gut repair.   
  4. Next comes the killing phase (sometimes referred to as a weeding phase) See below.
  5. After the weeding phase a repopulation phase is necessary. Supplementing with pre and probiotics as well as fermented foods is essential!
  6. RETEST! It’s commonly advised to wait a few months before retesting.

Ok onto the antimicrobial herbs that have been effective in naturally treating Dientamoeba fragilis in the past. 

Herbal Medicine for Dientamoeba fragilis

As always the scientific papers come up short on the herbal side. It is quite expensive to run proper trials (double blind placebo studies) and there is very little money in a natural supplement or herb that very few papers are published.

This may eventually resolve itself but for the time being we will have to rely on traditional herbal wisdom.

  • Artemesia annua, aka Sweet Annie (14, 15).
  • Black Walnut
  • Goldenseal
  • Myrrh
  • Oregano leaf and oil
  • Garlic
  • Herbs high in berberine (Coptis chinensis, Barberry, Oregon Grape Root)

As with many intestinal microbes the pathogenic nature of Dientamoeba fragilis is a debated topic.

Some researchers consider it opportunistic, only moving in and creating issues when there is a disrupted microbiome while other have committed it to the “confirmed pathogen” list (2).

This makes the decision on whether to treat it or not something to seriously consider. Personally, as with many GI tract infections, I would consider herbal treatment if you are experiencing any gut related symptoms listed above and have explored other issues that may be causing them (food allergies and intolerances being top of the list)

gut health specialist byron bay digestive health herbalist australia

Work With A Gut Focused Herbalist

Oftentimes it takes looking at the whole picture when treating gut infections. I frequently see patients in the clinic who have tried a number of antibiotics, herbal medicines by the truckload and they still don’t feel better.

Over the years I have come to see good gut health as a complex ecosystem. We want to encourage the growth of our good bugs and selectively reduce the numbers of our bad bugs. At times it takes strong herbal antimicrobials. Other times you may only need a shift in your diet and a prebiotic supplement!

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Need help with your digestion?

Hi, my name is Todd Mansfield. I am a clinical herbalist with a special interest in all things gut health.

If you are looking for digestive health support consider working with me. I see people online as well as in person from my clinic in Byron Bay.

More booking information here.

Updated resource Herbal Medicine For Dientamoeba fragilis

An in vitro study looking into the effect of different dried plant extracts (garlic, pomegranate husk, goldenseal, black walnut, and two species of wormwood) found zero effect on the Dientamoeba fragilis cultures.

I’m not quite sure what to make of these findings but figured it was worth including to be thorough.

Also, I have recently come across some research on the effect of fresh, crushed garlic as well as pomegranate husk tincture on protozoal infections (giardia and blastocystis specifically).

Are you struggling with a parasite infection? Share your experience in the comments below. What has helped you?

References and Resources

  1. A review of the clinical presentation of dientamoebiasis
  2. Microbiology of Waterborne Diseases : Microbiological Aspects and Risks
  3. Dientamoeba fragilis the unflagellated human flagellate
  4. Emerging from Obscurity: Biological, Clinical, and Diagnostic Aspects of Dientamoeba fragilis
  5. History of antimicrobial use and the risk of dientamoeba fragilis infection
  6. Colitis Due to Dientamoeba fragilis
  7. Treatment of Dientamoeba fragilis in Patients with Irritable Bowel Syndrome
  8. The ambiguous life of Dientamoeba fragilis: the need to investigate current hypotheses on transmission
  9. A review of Dientamoeba fragilis carriage in humans Several reasons why this organism should be considered in the diagnosis of gastrointestinal illness
  10. https://chriskresser.com/the-high-price-of-antibiotic-use-can-our-guts-ever-fully-recover/
  11. https://chriskresser.com/has-antibiotic-overuse-caused-a-celiac-disease-epidemic/
  12. http://drhyman.com/blog/2010/09/27/5-steps-to-kill-hidden-bad-bugs-in-your-gut-that-make-you-sick/
  13. https://justinhealth.com/treat-gut-infections/
  14. Artemisinin and its derivatives in treating protozoan infections beyond malaria.
  15. Artemisinins: their growing importance in medicine
  16. Evaluation of the in vitro Antiprotozoal Activity of Various Dry Plant Extracts against Dientamoeba fragilis

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23 comments

    1. Thanks for that one Michael, definitely an interesting read. I’m adding it to the resources section now. I’ve recently come across some info on fresh, crushed garlic as well as pomegranate husk tincture being effective for different protozoal infections, as well as a the influence of colonic pH. Hoping to dive into that one soon and get an article up.

      1. What about the use of Aloe vera juice? Just wondering if this would have an effect? I’m not sure about ridding the gut of the parasite but it certainly helps with bloating. Also I’ve been taking Black seed oil capsules (Nigella Sativa) but not sure of the effect on parasites? I know its known to support the immune system.

  1. So what have you found out about fresh pressed garlic?! Does it help? (or is it just very tasty and in the can do no harm bucket)

  2. Hi Todd. My family has had d fragilis for three years and we can’t seem to get rid of it. My son got it first. I believe from our trip to Bali. The whole family was tested and only he had it. I actually had . blastocystis hominis. Myself and my son were treated using an antibiotic called paromomycin. It was effective for me. I combined it with a diet similar to above and probiotics. However my son could not get rid of his. Then within 6 months myself, my son and now my daughter had d Fragilis. We went through treatment again and myself and my daughter got rid of it. I felt heaps better had more energy etc. but my son still had it. We waited another year as my sons gut was not doing well and went to treat my son again only to find that now the entire family had d fragilis, including my husband who had not had it previously. My son is young and does inot have the best after toilet cleaning habits despite my best efforts to encourage them. I think that d fragilis is actually easily spread based on my family ~8 pcr tests over the last 3 years.

    1. It sounds like you guys have been through it! Very well done that everyone in the family got tested.

      I have heard that paromomycin is more effective than Metronidazole (more commonly prescribed) if you want to go the antibiotic route. There could be a synergistic effect of combining herbal antimicrobials and this antibiotic particularly herbs high in berberine.

      Dientamoeba is a bizarre one. We are still not 100% on the transmission routes. I would look into all possible avenues (all water consumed, closing the toilet lid when flushing, clean hands when cooking).

    2. HI Sarah, my 13 year old daughter was diagnosed with D Fragilis at the start of 2019 and she took the antibiotics however she took Protectyn, Lactoferrin and probiotics daily for almost the whole year. We recently re-tested her and she came back negative which is great however she still has occasional nausea. My 10 year old son was also recently diagnosed with D Fraglis and he has on going stomach pain and fatigue even after antibiotics and I was also recently diagnosed with it too. I became highly suspicious that I had it too as I was feeling very fatigued and had occasional bloating. Anyhow I’m going to avoid the antibiotics and would love to know if the above herbs are available in one magic tablet?!! I live on the Gold Coast and have guinea pigs that run free on my property and often wondered if perhaps there was some cross contamination from their droppings?

  3. I came across this post and would love your opinion. I am about to start a round of IVF, I am waiting for my fertility specialist to get back to me but assume he is going to say do a round of antibiotics as it is the quicker option. I am reluctant to do this but also nervous to spend thousands on IVF knowing I have dientamoebe fragilis parasite. No idea if it is better to just leave the parasite for now as I am about to start IVF and I actually don’t suffer from symptoms. Very confused as to what I should be doing here??

    1. Hi Linzi,

      Just my opinion (can’t give specific health advice)…if you are not symptomatic I would avoid treating the Dientameoba fragilis. There is some evidence to show that these particular protozoan microbes can be commensal (ie not an issue in many people).

      That said, you should follow your feeling on this and take into account what your specialist recommends as well.

  4. Concerning Blasto cystis, started 2 years ago.Had pneumonia for 5 months, a mold, coughing, Dr said change diet(serious)wouldn’t ck xray. I’ve also been packing around EBV, Hashimotos and other herpes viruses. O had already cut gluten, sugar, no process foods.istarted having major acid reflux, bloating and u could feel crawling movement in anal area. Freaked me out.After insisting xray/ stool test came back pneumo and moderate Blasto suggesting more test later.took the antibiotics for pneumo and Metro for parasites. Pneumo gone but those parasites are a battle script only gave me relief for about 7 weeks. Since I’ve armed myself with the herbs you talked of, pomegranate husks too. I’ve taken 2 rounds of worm meds you get a Spanish store. They helped a lot. Now my go to is Myrrh extract and clove, potent. I feel these devils need to be addressed also with rectal suppositories. I’m determined to not feed them anything! I’m a lot better all the way around but know they aren’t gone. You can really tell around full moon.

  5. My son has been diagnosed with Dientamoeba fragilis. He has candida, and a lot of food allergies; leaky gut. We are changing his diet and giving a lot of probiotics. What is your opinion about the herbal formula, Paradex ( contains garlic and black walnut) and apple cider vinegar and lemon juice to kill the parasite.

  6. Hi there Todd,
    How long would you recommend doing the repair phase for? During this time, would you recommend using pre and pro biotics… or saving this for after the “killing” phase?
    Thanks, this article is extremely useful and helpful 🙂

    1. I have found that prebiotics and probiotics can be a standalone treatment for d. fragilis. Here I am focusing more on rebalancing rather than complete eradication. Sometimes we need to go in a bit harder to completely knock it out but I am finding this to be less and less needed.

  7. Hi Todd,

    My husband and older daughter got DF about 4 years ago. I put the whole family on a parasite cleanse (herbal for the adults and homeopathic for the 2 kids) and when we re-tested it seemed it was gone. I have definitely felt symptoms of pinworms/parasites (itchy anus and pain around naval) for about a year now. I did 2 rounds of the same herbal cleanse that worked before but had to stop after 2 as my adrenals were exhausted. So just before March, my little daughter was found to have DF in her stool and was regurgitating after each meal, then it turned into throwing up and stomach pain. Especially at night. We were working with a homeopath, then finally did the metronidazole; however, she has been finished for the last 4 days and is still throwing up at night and having stomach pain. We are at our wits end. We are still working with the Homeopath but there doesn’t seem to be much improvement. From what I’m reading above, it looks like many of the herbs you initially listed have been found to have no effect on DF. Is this the case? We just don’t know where to go from here. I am a holistic nutritionist by training so I learned about parasite cleansing in school and am familiar with the parasite cleanse diet, pre and probiotics, and certain herbs etc. that kill parasites but it looks like they are not effective from what you wrote above. I’m so frustrated as our family just can’t seem to get rid of this!! Can you please point me in the right direction? Thanks!

    1. Hi Melissa,

      Thanks for taking the time to share your experiences. I would look into other infections. Many times when patients experience vomiting I recommend testing for H. pylori. This lines up with the abdominal pain as well (especially if the pain is just around the lower ribs).

      Many of the herbs listed are very effective, I included that last study to be thorough, but can see now that it could be confusing!

      Best,

      Todd

  8. Hi Todd – thanks so muck for all your information. Very helpful article. Our 8-year old son was just diagnosed with dientamoeba fragilis. This wasn’t the first time. Seems like it came back. We would definitely like to follow the herbal medicine treatment along with diet change and the other steps you outline. My question is around dosage for the herbs you recommend. We have many of these but there is only one recommended dosage (I’m assuming for adults). Can you recommend dosage for an 8 year old for these herbs? Thanks so much!
    Erik

    1. Hi Erik, so sorry to hear that your son is experiencing digestive troubles. I would recommend working with a gut health specialist. Many times there is more to the picture than simply one infection! Not the best answer I know.
      Best,
      Todd

  9. Hey Todd!
    For months we as a family have been battling reoccurring pinworm infestation. We have done the usual over the counter medication and with no luck. Myself and youngest- 2 year old are the ones with confirmed cases (pinworms seen!)
    We had an appointment with a naturopath who prescribed chondroitin sulfate for a 2 week course for the whole family- the pinworm cycle seems to coincide with my periods- I had pains, bloating etc we haven’t had a infestation now for about 8 weeks-
    Our youngest of 4 has just completed a stool sample and confirmation of Dientamoeba Fragilis and Campylobacter spp. I knew the sample would be positive for D.f as my eldest boys suffered this parasite a couple of years back- unbelievable abdominal cramps, irregular stools (soft then hard) and the pain only became apparent at night (because they are quiet and still?) Our alternate GP suggested at the time a infection from Pork eaten, but l am positive now it’s from a Pinworm infestation! Rachel Arthur on here website has some great information there! Thanks for your info and now to readjust our diets!
    Samara

  10. Hi Todd,

    A friend of mine 🙂 has d fragilis and suffers from stomach bloating, constant offensive flatulence and loose stools verging on diarrhea. I, I mean he took probiotics for several months and then tested clear. However, I was recently positive again. I am not sure what my next steps should be. Any suggestions about what I might try next?

    Tony

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