Balantidiasis in humans: A systematic review and meta-analysis

Prevalence and molecular characterisation of Balantioides coli in pigs raised in Italy

Balantioides coli is the only ciliated protist of both human and veterinary interest and colonises the large intestine of several hosts, including humans and pigs. Given the scarcity of data on B. coli circulation in pigs in Italy, a study was planned to record its prevalence and genetic types and compare the analytical sensitivity of two copromicroscopic techniques. For this purpose, 880 faecal samples were collected from pigs raised in 22 farms located in northern Italy and analysed with the sedimentation and the FLOTAC® dual technique, employing sodium chloride and zinc sulphate flotation solutions, and the Cohen's kappa coefficient was calculated to assess the agreement between these methods. Conventional PCR to amplify the ribosomal internal transcribed spacer region (ITS) was subsequently performed on 22 samples, one for each farm, which were positive for B. coli cysts by sedimentation; when more than one sequence was detected in the chromatograms, the PCR products were cloned. Overall, 813 samples were positive for B. coli cysts by sedimentation (92.4%), and moderate concordance with the zinc-based FLOTAC® technique was observed, whereas the agreement was slight with the salt-based FLOTAC® technique. Among the 22 sequenced samples, type B was amplified in 19 samples, type A in two samples, and both A and B types were co-expressed in one sample. This study demonstrated a high prevalence of B. coli in Italian pigs; further insights are needed to trace its distribution and genetic polymorphism in other pig production categories and in humans, defining its public health significance.

The Phylogenetic Characterization of Balantioides coli Isolated in the Pavlova Culture Medium Supplemented with Coconut Water and Animal Serum

Balantioides coli is a ciliated protist that can cause dysentery in humans, pigs and nonhuman primates and may have the potential for zoonotic transmission. Its diagnosis is routinely performed through conventional parasitological techniques, and few studies have used culturing techniques to isolate it, applying molecular tools for the characterization of this protozoan. Thus, the objective of this study was to confirm B. coli diagnosis using molecular tools and to characterize the genetic variants of this parasite isolated from pigs kept on family farms in Brazil using three different culture media that differed in the serum added. Fecal samples from pigs were inoculated in Pavlova medium plus coconut water (PC), fetal bovine serum (PB) and horse serum (PH). Of the 127 samples positive for forms compatible with the phylum Ciliophora, 31 were selected for isolation. The most successful medium for isolation was PB 19/31 (61.3%), followed by PH 18/31 (58.1%) and PC 11/31 (35.5%). Of the nucleotide sequences generated, 20 were classified as genetic variant type B0, two as A1 and 15 as A0. The results indicated that PC, despite having allowed the isolation of B. coli for a short period, was not an adequate medium for the maintenance of this parasite in vitro, therefore requiring improvement.

Case Report: A rare instance of acute appendicitis induced by Balantidium Coli parasitic infection

Introduction

Acute appendicitis secondary to parasitic infections is uncommon, being detected in less than 1% of cases. Balantidium coli is a parasite found in pigs and primates with zoonotic potential. To date, only three cases of acute appendicitis induced by this parasite have been documented globally.

Case

A 7-year-old female patient, who consumed pork daily, presented to the emergency department with a one-day history of abdominal pain in the lower quadrants, described as colic-like, alongside abdominal distension. Initial abdominal radiography led to a diagnosis of intestinal obstruction. Conservative management without therapeutic response necessitated referral to a higher complexity center. Upon admission, an abdominal computed tomography scan diagnosed acute appendicitis and secondary ileus. During surgical intervention, an appendiceal phlegmon formed by loops of the small intestine was mechanically released, revealing a perforated appendix with extensive fecal peritoneal contamination. Pathological analysis identified an inflammatory infiltrate and the presence of Balantidium coli trophozoites. Medical treatment included Piperacillin-Tazobactam and Metronidazole. The patient was discharged after 10 days of medical treatment.

Discussion

Acute appendicitis caused by Balantidium coli is a rare occurrence. It is crucial to identify parasites in pathological samples due to their impact on postoperative management. The close contact between humans and pigs, especially in developing countries, suggests that the prevalence of parasitic infection and colonization by Balantidium coli may be higher than currently recognized. Regarding the identification of this patient's specific exposure, the regular consumption of pork suggests the hypothesis that improper processing is linked to the acquisition of the parasitic infection.

Prevalence and sequence diversity of Balantioides coli in pigs in Xinjiang, China

Balantioides coli is a common intestinal parasitic protozoan in pigs. In the present study, 801 fecal samples of pigs from seven farms in Xinjiang were analyzed based on the ITS1-5.8S rRNA-ITS2 gene. The prevalence of B. coli was 4.2% (34/801), with the highest prevalence of 18.9% (18/95) occurring in Alaer, Xinjiang. B. coli was detected in all age groups (pre-weaned pigs, post-weaned pigs, fattening pigs and sows), with the highest rate in fatteners (6.9%, 9/129) and the lowest (1.2%, 2/169) in pre-weaned pigs. Significant differences (P = 0.000) were found among sampling sites but not among age groups (P = 0.084). Sequence analysis indicated that 34 sequence variants, including sequence type A (n = 11) and sequence type B (n = 23), occurred in all age groups. In this study, the existence of sequence type A suggested that B. coli poses a potential threat to human health. More studies are needed to better understand the distributions and public health significance of B. coli in China.

Uninvited guest, Balantidium coli in urine in a patient with bladder cancer: A case report and review of the literature

Key Clinical Message

In contrast to intestinal balantidiasis, which is widespread throughout the world, urinary balantidiasis is uncommon. It often affects people with underlying diseases, and acute infections may be fatal. Even though urine is not typical for this parasite, specific morphologic characteristics can aid in accurate diagnosis.

Abstract

Balantidium coli is a ciliated protozoan which can infect intestinal system. Urinary balantidiasis is an extremely rare infection that may cause serious issues in patients with underlying diseases. Herein, we present a case of urinary balantidiasis in a patient with bladder cancer.

Family-Run Pig Farms: Research and Extension Activities for Parasite Control in a Municipality in the State of Rio de Janeiro, Brazil

The parasites infesting pigs and pig farmers on family farms in Rio de Janeiro city, Brazil, were analyzed, and extension activities were carried out to impart information about parasites. Between 2020 and 2021, fecal samples were collected from 180 pigs as well as ear scrapings from 142 pigs. In addition, 34 stool specimens from farmers and their families were analyzed. The collected material was processed by parasitological techniques. Parasites were detected in 86.1% of the pigs, forms of phylum Ciliophora (70.5%), strongylids (56.7%), Strongyloides ransomi (44.4%), coccidia (38.3%) and Ascaris suum (32.2%). Sarcoptes scabiei var. suis were identified in 3.5% of the pigs. An analysis of infections by age group revealed that the general frequency of phylum Ciliophora and strongylid parasites was statistically significant. Other factors also associated with the frequency of the parasites included the type of food fed to the pigs, cleaning of the facilities, care of piglets and type of facility. The frequency of intestinal parasites of farmers themselves was low; however, the high rate of parasite infections detected in pigs highlighted the precarious conditions of hygiene of the farms. Lastly, the farmers’ participation in extension activities was a step forward in actions to improve their farm management.

Neglected Case of Human Balantidiasis: Presumed as Antibiotic-Associated Diarrhoea

Background

Balantidiasis, due to its rare human incidence and nonspecific clinical presentations often neglected from the diagnosis considerations; however, a potent pathogen. Herein, we report a case of neglected balantidiasis presumed as antibiotic-associated diarrhoea. Case Presentation. A 27-year-old policeman presented in Sindhuli Hospital, with a chief complaint of epigastric pain, nausea, decreased appetite for several days, and loose stools (3-4 episodes per day). Previously, he was under antibiotic therapy (amoxycillin) for tonsillitis. The health post clinician made a presumptive diagnosis as the side effects of the antibiotics; however, the symptoms were not resolved. Complete blood cell count (CBC) was normal; renal function test (RFT) and liver function (LFT) were within the normal ranges. Ultrasonography of the abdomen and ECG (electrocardiogram) showed normal findings. However, on routine stool actively motile trophozoites of Balantidium coli (B. coli) were seen. He was treated successfully with metronidazole 750 mg tabs orally three times daily for 5 days.

Conclusion

Protozoal infections, like balantidiasis, might be excluded from the diagnostic consideration in antibiotic-associated diarrhoea cases. Therefore, meticulous review of nonspecific clinical presentation and validation of an etiology with support of diagnostic tests are mandatory.