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Am. J. Trop. Med. Hyg., 72(5), 2005, pp. 501-502
Copyright © 2005 by The American Society of Tropical Medicine and Hygiene

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LETTER TO THE EDITOR


IRRITABLE BOWEL SYNDROME: THE NEED TO EXCLUDE DIENTAMOEBA FRAGILIS

Javed Yakoob, PhD
Wasim Jafri
Nadim Jafri
Rustam Khan
Muhammad Islam
Muhammad A. Beg, PhD
Viqar Zaman
Department of Medicine and Pathology
Aga Khan University Hospital
Stadium Road
Karachi 74800
Pakistan
Telephone: 92-21-4859-4661
Fax: 92-21-493-4294
E-mail: yakoobjaved{at}hotmail.com

Dear Sir:

We have read the comments of Windsor and Macfarlane regarding our study.1 This study was designed to examine stool specimens of patients with irritable bowel syndrome (IBS) for Blastocystis hominis, a common intestinal parasite. They stated that the diagnostic methods used were not optimal for the detection of all intestinal protozoa, although more than adequate for B. hominis. We agree that Jones media without rice starch is less likely to exclude Dientamoeba fragilis from either the IBS or control groups. In recent studies of parasitic infections in Pakistan, the prevalence of Giardia lamblia was 47% and that of Entamoeba histolytica was 49%,2 with helminthic infestations showing a prevalence > 81% in children.3 Blastocystis hominis is a common finding by routine stool microscopy and stool culture has a better yield in diagnosing infection with B. hominis. In addition, Dientamoeba fragilis has rarely been reported in patients we studied. However, it is possible that cultures using rice starch for D. fragilis may improve the diagnostic yield. We respect your concern and this will be addressed in a future study looking at the role of D. fragilis in various subgroups of patients.

 

REFERENCES

  1. Yakoob J, Jafri W, Jafri N, Islam M, Beg MA, Zaman V, 2004. Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis. Am J Trop Med Hyg 70: 383–385.[Abstract/Free Full Text]
  2. Siddiqui MI, Bilqees FM, Iliyas M, Perveen S, 2002. Prevalence of parasitic infections in a rural area of Karachi, Pakistan. J Pak Med Assoc 52: 315–320.[Medline]
  3. Ahmed AK, Malik B, Shaheen B, Yasmeen G, Dar JB, Mona AK, Gulab S, Ayub M, 2003. Frequency of intestinal parasitic infestation in children of 5–12 years of age in Abbottabad. J Ayub Med Coll Abbottabad 15: 28–30.[Medline]




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