Is paromomycin the drug of choice for eradication of Dientamoeba fragilis in adults?

Dientamoeba fragilis is a debated protozoan parasite that is often detected in stools of patients with chronic gastro-intestinal complaints. A retrospective follow-up study of a large cohort of patients was performed to better understand the natural course of the infection and possible treatment options. D. fragilis was spontaneously cleared in 41% of untreated cases. With an eradication rate of 98%, treatment with paromomycin appeared more effective than treatment with clioquinol (83%) or metronidazole (57%)

Recurrent amebic liver abscesses over a 16-year period: a case report

BACKGROUND: Amebic liver abscess is a rare disease in high-income countries. Recurrence of amebic liver abscess is even rarer with only a few previous reports. Here we present a patient who developed three subsequent amebic liver abscesses over a sixteen-year period. CASE PRESENTATION: A Caucasian male developed recurrent amebic liver abscesses, when aged 23, 27 and 39 years. Only on the first occasion did this coincide with a recent visit to the tropics. The patient received adequate treatment during each episode. Possible explanations are persistent asymptomatic carrier state, cysts passage in his family, re-infection or chance. CONCLUSION: We describe the unusual case of a healthy male who developed recurrent amebic liver abscesses over a long period despite adequate treatment. Possible pathophysiological explanations are explored

Is paromomycin the drug of choice for eradication of Blastocystis in adults?

Blastocystis is a protozoan parasite of controversial clinical significance that is often detected in stools of patients with gastrointestinal complaints. Patients infected with Blastocystis and persistent, unexplained gastrointestinal complaints are often treated with the intention to eradicate Blastocystis. However, there is no consensus on the most effective drug. We performed a retrospective follow-up study with a large cohort of patients in which the natural disease course and efficacy of treatment with either paromomycin, clioquinol, or metronidazole were evaluated. With an eradication rate of 77 %, treatment with paromomycin appeared significantly more effective than treatment with clioquinol (38 %), metronidazole (38 %), or no treatment (22 %). This study showed that (1) Blastocystis was frequently observed in the stools of our patient group (34 %), (2) spontaneous clearance of Blastocystis infections occurred only in a small proportion of patients (22 %), and therefore (3) drug treatment is required for more efficient eradication of Blastocystis. Paromomycin exhibited superior performance in comparison to both metronidazole and clioquinol