PDF(Pubmed)
Abstract：
UNASSIGNED: Dientamoeba fragilis (DF), the most common intestinal protozoal pathogen in affluent countries, causes asymptomatic or symptomatic infections with severity ranging from mild to disabling. Currently, many studies of treatment options only have small sample sizes and report results that are partly contradictory.
UNASSIGNED: Investigating data retrieved from Helsinki University Hospital and Helsinki City patient records, we searched for the most effective antiprotozoal in treating DF infections. To study microbiological clearance of DF, we collected laboratory results of control samples from patients given one of four commonly used antiprotozoals: doxycycline, metronidazole, paromomycin, or secnidazole. For patients symptomatic prior to antiprotozoal treatment, we also retrieved data on clinical outcomes. Furthermore, we explored factors associated with faecal clearance and clinical cure.
UNASSIGNED: A total of 369 patients (median age 38) and 492 treatment episodes were included. Paromomycin (n = 297) proved effective (clearance rate 83%), showing strong association with faecal clearance (aOR 18.08 [7.24-45.16], p < 0.001). For metronidazole the rate was 42% (n = 84), for secnidazole 37% (n = 79), and doxycycline 22% (n = 32). In pairwise comparisons, paromomycin outdid the three other regimens (p < 0.001, χ2 test). Faecal clearance was associated with clinical cure (aOR 5.85 [3.02-11.32], p < 0.001).
UNASSIGNED: Faecal clearance, strongly associated with clinical cure, is most effectively achieved with a course of paromomycin, followed by metronidazole, secnidazole and doxycycline. Our findings will be useful in devising treatment guidelines for adults with symptomatic D. fragilis infection.
UNASSIGNED: Investigating data retrieved from Helsinki University Hospital and Helsinki City patient records, we searched for the most effective antiprotozoal in treating DF infections. To study microbiological clearance of DF, we collected laboratory results of control samples from patients given one of four commonly used antiprotozoals: doxycycline, metronidazole, paromomycin, or secnidazole. For patients symptomatic prior to antiprotozoal treatment, we also retrieved data on clinical outcomes. Furthermore, we explored factors associated with faecal clearance and clinical cure.
UNASSIGNED: A total of 369 patients (median age 38) and 492 treatment episodes were included. Paromomycin (n = 297) proved effective (clearance rate 83%), showing strong association with faecal clearance (aOR 18.08 [7.24-45.16], p < 0.001). For metronidazole the rate was 42% (n = 84), for secnidazole 37% (n = 79), and doxycycline 22% (n = 32). In pairwise comparisons, paromomycin outdid the three other regimens (p < 0.001, χ2 test). Faecal clearance was associated with clinical cure (aOR 5.85 [3.02-11.32], p < 0.001).
UNASSIGNED: Faecal clearance, strongly associated with clinical cure, is most effectively achieved with a course of paromomycin, followed by metronidazole, secnidazole and doxycycline. Our findings will be useful in devising treatment guidelines for adults with symptomatic D. fragilis infection.
摘要：
■脆弱的Dientamoeba（DF），富裕国家最常见的肠道原生动物病原体，导致无症状或有症状的感染，严重程度从轻度到致残。目前,许多治疗方案研究的样本量很小,报告的结果部分矛盾.
■调查从赫尔辛基大学医院和赫尔辛基市患者记录检索的数据，我们寻找治疗DF感染最有效的抗原虫。为了研究DF的微生物清除，我们收集了来自患者的对照样本的实验室结果，给予四种常用的抗原生动物药物之一：多西环素，甲硝唑,巴龙霉素,或者塞克硝唑.对于在抗原生动物治疗之前有症状的患者，我们还检索了有关临床结局的数据.此外，我们探讨了与粪便清除和临床治愈相关的因素。
■共纳入369名患者（中位年龄38岁）和492次治疗事件。巴龙霉素（n=297）被证明是有效的（清除率83%），显示与粪便清除率有很强的相关性(aOR18.08[7.24-45.16]，p<0.001)。甲硝唑的比率为42%(n=84)，塞克硝唑37%(n=79)，和强力霉素22%（n=32）。在成对比较中，巴龙霉素优于其他三种方案(p<0.001，χ2检验)。粪便清除与临床治愈相关（aOR5.85[3.02-11.32]，p<0.001)。
■粪便清除，与临床治愈密切相关，用一个疗程的巴龙霉素最有效地实现了，其次是甲硝唑，塞克硝唑和强力霉素.我们的发现将有助于为有症状的D.fragilis感染的成年人制定治疗指南。
■调查从赫尔辛基大学医院和赫尔辛基市患者记录检索的数据，我们寻找治疗DF感染最有效的抗原虫。为了研究DF的微生物清除，我们收集了来自患者的对照样本的实验室结果，给予四种常用的抗原生动物药物之一：多西环素，甲硝唑,巴龙霉素,或者塞克硝唑.对于在抗原生动物治疗之前有症状的患者，我们还检索了有关临床结局的数据.此外，我们探讨了与粪便清除和临床治愈相关的因素。
■共纳入369名患者（中位年龄38岁）和492次治疗事件。巴龙霉素（n=297）被证明是有效的（清除率83%），显示与粪便清除率有很强的相关性(aOR18.08[7.24-45.16]，p<0.001)。甲硝唑的比率为42%(n=84)，塞克硝唑37%(n=79)，和强力霉素22%（n=32）。在成对比较中，巴龙霉素优于其他三种方案(p<0.001，χ2检验)。粪便清除与临床治愈相关（aOR5.85[3.02-11.32]，p<0.001)。
■粪便清除，与临床治愈密切相关，用一个疗程的巴龙霉素最有效地实现了，其次是甲硝唑，塞克硝唑和强力霉素.我们的发现将有助于为有症状的D.fragilis感染的成年人制定治疗指南。
