If using routine microscopic methods to diagnose Giardia, multiple stool samples may need to be examined since cysts are often shed intermittently. Recovering trophozoites is more difficult since they adhere to the mucosa. Therefore, other methods may be more useful such as the string test or duodenal aspirate (see section on other methods of diagnosis).
For Dientamoeba, since only a trophozoite form exists for the most part, it is important to have a fresh stool. Permanently stained slides are recommended instead of direct wet preps because these organisms may be difficult to recognize.
Table 6 shows some means of differentiating the trophozoites of the two pathogens from some of the more common non-pathogens.
Table 6. Differentiating Giardia and Dientamoeba Trophozoites from Commensal Trophs.Organism | Image | Nuclei # | Other Features |
Giardia duodenalis Pear shaped Length: 10-20 μm; Width: 5-15μm | (21)
(22) | 2 (not visible if unstained) | A total of 8 flagella but they are often difficult to see Sucking disk |
Dientamoeba fragilis Shaped like an amoeba Size: 5-15 μm | (23)
(24) | 40% have 1 nucleus; 60% have 2 | Internal flagella are not visible; granular or vacuolated cytoplasm |
Chilomastix mesnili Pear shaped Length: 6-24 μm (usual 10-15) Width: 4-8 μm | (25) | 1 nucleus | 4 flagella total |
Pentatrichomonas hominis | (26) | 1 nucleus | 3-6 flagella Undulating membrane |
21. DPDx. "Parasites - Giardia." CDC.gov, 9 Dec 2017, https://www.cdc.gov/dpdx/giardiasis/index.html22. DPDx. "Parasites - Giardiasis - Figure A: G. duodenalis trophozoite stained with trichrome." CDC.gov, 9 Dec 2017, https://www.cdc.gov/dpdx/giardiasis/index.html23. DPDx. "Parasites - Dientamoeba - Figure C: Binucleate form of a trophozoite of D. fragilis, stained with trichrome." CDC.gov, 1 May 2019, https://www.cdc.gov/dpdx/dientamoeba/index.html24. DPDx. "Parasites - Dientamoeba - Figure B: Uninucleate form of a trophozoite of D. fragilis, stained with trichrome." CDC.gov, 1 May 2019, https://www.cdc.gov/dpdx/dientamoeba/index.html25. DPDx. "Parasites - Chilomastix mesnili - Figure A: Trophozoite of C. mesnili from a stool specimen, stained with trichrome. Image taken at 1000x magnification." CDC.gov, 5 June 2019, https://www.cdc.gov/dpdx/chilomastix/index.html26. DPDx. "Parasites - Non-pathogenic Flagellates - Figure D: Two trophozoites of P. hominis in a stool specimen, stained with trichrome." CDC.gov, 31 Jul 2019, https://www.cdc.gov/dpdx/nonpathogenic_flagellates/index.html