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Rudzińska M, Sikorska K. Epidemiology of Blastocystis Infection: A Review of Data from Poland in Relation to Other Reports. Pathogens 2023; 12:1050. [PMID: 37624010 PMCID: PMC10458783 DOI: 10.3390/pathogens12081050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
Blastocystis is a common gut protist of humans and various animals worldwide, with a high level of genetic diversity. Neither its zoonotic potential and transmission routes nor its pathogenicity are fully known. This fact, and the fact that Blastocystis is the most abundant eukaryote in human faeces, raises the question of its relevance to public health. Here, we summarise (in relation to other reports) the results of studies on the prevalence and genotypic variation of Blastocystis, which were carried out in animals, humans, and in water environments in Poland. In humans, the prevalence ranged between 0.14 and 23.6%, in some animals reached 58.97%, and in water environments was 5.1%. Seven subtypes were identified in humans (ST1-ST4, ST6, ST7, and ST9), of which ST3 was the most common. Among animals (wild, livestock, and pet animals), eleven STs were identified, with differential host specificity. Humans and animals shared ST1, ST2, ST3, ST6, and ST7, while ST1 and ST3 were present in humans, animals, and water sources. These observations indicate the possibility of Blastocystis transmission between animals and humans. Further studies should be continued in search of the sources and transmission routes of Blastocystis in order to prevent the spread of infections among humans and animals.
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Affiliation(s)
- Monika Rudzińska
- Department of Tropical Medicine and Epidemiology, Faculty of Health Sciences, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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Rojas‐Jaimes J, Vesco‐Monteagudo E. Remission of chronic blastocystosis using ciprofloxacin. Clin Case Rep 2023; 11:e7446. [PMID: 37305861 PMCID: PMC10248208 DOI: 10.1002/ccr3.7446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023] Open
Abstract
Blastocystis hominis is a controversial parasite because of its taxonomy and its treatment. In this report, an immunocompetent person with chronic blastocystosis, in whom a series of treatments were used without success, except for the use of ciprofloxaci. Ciprofloxacin could be an antibiotic of choice in chronic blastocystosis.
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Distribution and Phylogenetic Analysis of Subtypes and Alleles of Blastocystis sp. in the Stool Samples Collected from Patients with Gastrointestinal Complaints in İzmir, Turkey. Acta Parasitol 2023:10.1007/s11686-023-00665-2. [PMID: 36806111 DOI: 10.1007/s11686-023-00665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/19/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Blastocystis sp. is one of the most prevalent intestinal protozoa found in humans and many other animals. The present study aimed to examine the distribution and genetic diversity of Blastocystis sp. in stool samples from patients with gastrointestinal complaints in İzmir, Turkey. METHODS All stool samples of 439 patients with gastrointestinal complaints were examined by native-Lugol and trichrome staining. To investigate the presence of Blastocystis sp. in stool samples, DNA was isolated, and PCR was performed with the barcode region in the SSU rRNA gene. PCR positive samples were sequenced to identify subtypes and alleles of Blastocystis sp. RESULTS The prevalence of Blastocystis sp. was found to be 16.6% (73/439) in patients with gastrointestinal complaints in İzmir, Turkey. Three different Blastocystis sp. subtypes were identified. ST3 (28/55; 51.0%) was the most common subtype followed by ST2 (19/55; 34.5%) and ST1 (8/55; 14.5%). Itching and diarrhea were the most prominent clinical symptoms in Blastocystis sp. positive patients. When clinical symptoms and subtypes were compared, diarrhea was found in 62.5%, 47.4%, and 46.4% of patients with ST1, ST2, and ST3 subtypes, respectively. In addition, itching was found in 37.5%, 32.1%, and 21.1% of patients with ST1, ST3, and ST2, respectively. Six distinct alleles were identified by allele analysis of Blastocystis 18S rRNA gene: allele 4 for ST1, alleles 9, 11, and 12 for ST2, and alleles 34 and 36 for ST3. In this study, Blastocystis sp. was detected in 16 of 21 districts, including the central and rural districts of İzmir. Although ST1 was detected in central districts, it was not found in rural districts. CONCLUSION This study provides comprehensive data on the prevalence and molecular epidemiology of the genetic diversity at the level of subtypes and alleles of Blastocystis sp. in different districts of İzmir province in Turkey. To the best of our knowledge, this is the first study which evaluates the distribution of subtypes and alleles of Blastocystis sp. according to PCR and SSU rRNA gene sequencing in patients with gastrointestinal complaints in different districts of İzmir province in Turkey.
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Evaluation of association with subtypes and alleles of Blastocystis with chronic spontaneous urticaria. Acta Trop 2022; 231:106455. [PMID: 35413246 DOI: 10.1016/j.actatropica.2022.106455] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 12/18/2022]
Abstract
Blastocystis is a single-celled parasite commonly found in humans and its pathogenic role is still controversial. In recent years, some studies have suggested that Blastocystis may be a possible agent of gastrointestinal and dermatological symptoms such as acute or chronic urticaria, angioedema, rash, itch, palmoplantar, and diffuse pruritus. We aimed to investigate whether there is a relationship between Blastocystis subtypes and alleles in patients with chronic spontaneous urticaria (CSU) as a case-control study. In this study, stool samples were collected from patients with CSU (n=135) and healthy individuals (n=54). The presence of Blastocystis was investigated using the direct saline smear, Lugol's iodine staining, trichrome staining, Jones' medium culture and PCR assays in stool samples and subtypes (STs) were determined by sequencing according to DNA barcoding. The presence of Blastocystis was identified in 30.4% (64/210) the stool samples, including 31.9% (43/135) of the patients with CSU and 14.8% (8/54) of the control group. Moreover, it was found statistically significant the presence of Blastocystis in terms of both groups (p<0.018). ST3 was detected in 45.9% and 62.5 % as the most prevalent subtype the patients with CSU and the control group, respectively. ST1 (18.9%), ST2 (27%) and ST7 (8.1%) was identified in the patients with CSU group. There was no statistically significant correlation between Blastocystis subtypes and both the groups (p<0.240, p<0.323). Allele 4 for ST1; alleles 9, 10, 11 and 12 for ST2; alleles 34, 36 and 38 for ST3; alleles 41 and 101 for ST7 were detected. Allele 34 (ST3) was found significant in the patients with CSU as compared with control group (p<0.020). Moreover, statistically significant association was found between total IgE value and the certain subtypes (ST2 and ST3) (p<0.0001). As a result of this study, the presence of Blastocystis ST3 allele 34 significantly associated with chronic spontaneous urticaria was revealed.
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Blastocystis hominis undergoing programmed cell death via cytotoxic gamma irradiation. Exp Parasitol 2022; 240:108341. [DOI: 10.1016/j.exppara.2022.108341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
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Kumarasamy V, Atroosh WM, Anbazhagan D, Abdalla MMI, Azzani M. Association of Blastocystis hominis with colorectal cancer: A systematic review of in vitro and in vivo evidences. World J Gastrointest Oncol 2022; 14:734-745. [PMID: 35321272 PMCID: PMC8919012 DOI: 10.4251/wjgo.v14.i3.734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/16/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recently, there have been several findings that showed intestinal colonisation of Blastocystis hominis (Blastocystis) as a risk factor to the worsening of colorectal cancer (CRC). However, studies have shown controversial results in the pathogenicity of Blastocystis.
AIM To review systematically the evidence available on the association between CRC and Blastocystis and the prevalence of Blastocystis in CRC patients and to investigate cytopathic and immunological effects of Blastocystis in in vitro and in vivo studies.
METHODS PRISMA guidelines were utilised in conducting this systematic review. Original articles published before February 2, 2020 were included. PubMed, Science Direct, Scopus and Google scholar databases were searched. Manual searching was carried out to find articles missed during the online search.
RESULTS Out of 12 studies selected for this systematic review, seven studies confirmed the prevalence of Blastocystis and found it to be between 2%-28% in CRC patients, whereby subtype 1 and subtype 3 were predominantly seen. A total of four studies employing in vitro human colorectal carcinoma cell line study models showed significant cytopathic and immunological effects of Blastocystis. In addition, one in vivo experimental animal model study showed that there was a significant effect of infection with Blastocystis on exacerbation of colorectal carcinogenesis.
CONCLUSION Blastocystis is a commonly identified microorganism in CRC patients. These studies have provided supportive data that Blastocystis could exacerbate existing CRC via alteration in host immune response and increased oxidative damage. Future studies of CRC and Blastocystis should attempt to determine the various stages of CRC that are most likely to be associated with Blastocystis and its relationship with other intestinal bacteria.
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Affiliation(s)
- Vinoth Kumarasamy
- Department of Microbiology and Parasitology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom 42610, Selangor, Malaysia
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang 43000, Selangor, Malaysia
| | - Wahib Mohammed Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden 00, Yemen
| | - Deepa Anbazhagan
- Department of Microbiology and Parasitology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom 42610, Selangor, Malaysia
| | | | - Meram Azzani
- Department of Community Medicine, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom 42610, Selangor, Malaysia
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Milner E, Stevens B, An M, Lam V, Ainsworth M, Dihle P, Stearns J, Dombrowski A, Rego D, Segars K. Utilizing Probiotics for the Prevention and Treatment of Gastrointestinal Diseases. Front Microbiol 2021; 12:689958. [PMID: 34434175 PMCID: PMC8381467 DOI: 10.3389/fmicb.2021.689958] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
Probiotics are heavily advertised to promote a healthy gastrointestinal tract and boost the immune system. This review article summarizes the history and diversity of probiotics, outlines conventional in vitro assays and in vivo models, assesses the pharmacologic effects of probiotic and pharmaceutical co-administration, and the broad impact of clinical probiotic utilization for gastrointestinal disease indications.
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Affiliation(s)
- Erin Milner
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Benjamin Stevens
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Martino An
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Victoria Lam
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Michael Ainsworth
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Preston Dihle
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Jocelyn Stearns
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Andrew Dombrowski
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Daniel Rego
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
| | - Katharine Segars
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, United States
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Aykur M, Karakavuk E, Karakavuk M, Akıl M, Can H, Döşkaya M, Gürüz Y, Dağcı H. Inhibitory effect of Tunceli garlic (Allium tuncelianum) on blastocystis subtype 3 grown in vitro. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1857725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Ege University Faculty of Medicine, İzmir, Turkey
- Department of Parasitology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Emrah Karakavuk
- Department of Nutrition and Dietetics, Munzur University Faculty of Health Sciences, Tunceli, Turkey
| | - Muhammet Karakavuk
- Department of Parasitology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mesut Akıl
- Department of Parasitology, Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Hüseyin Can
- Department of Biology, Molecular Biology Section, Ege University Faculty of Science, İzmir, Turkey
| | - Mert Döşkaya
- Department of Parasitology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yüksel Gürüz
- Department of Parasitology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hande Dağcı
- Department of Parasitology, Ege University Faculty of Medicine, İzmir, Turkey
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Hashan MR, Elhusseiny KM, Huu-Hoai L, Tieu TM, Low SK, Minh LHN, Nghia TLB, Loc LQ, Y MN, Eid PS, Abed M, Elkolaly SS, Tawfik GM, Huy NT. Effect of nitazoxanide on diarrhea: A systematic review and network meta-analysis of randomized controlled trials. Acta Trop 2020; 210:105603. [PMID: 32598920 DOI: 10.1016/j.actatropica.2020.105603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 01/30/2023]
Abstract
We aimed to systematically review evidence pertaining to the safety and efficacy of nitazoxanide in treating infectious diarrhea. On September 21, 2017, we identified relevant studies using 12 databases. The estimates of the included studies were pooled as a risk ratio (RR). We conducted a network and pairwise random-effects meta-analysis for both direct and indirect comparisons of different organisms that are known to cause diarrhea. The primary and secondary analysis outcomes were clinical response until cessation of illness, parasitological response and adverse events. We included 18 studies in our analysis. In cryptosporidiosis, the overall estimate favored nitazoxanide in its clinical response in comparison with placebo RR 1.46 [95% CI 1.22-1.74; P-value <0.0001]. Network meta-analysis among patients with Giardia intestinalis showed an increase in the probability of diarrheal cessation and parasitological responses in comparison with placebo, RR 1.69 [95% CI 1.08-2.64, P-score 0.27] and RR 2.91 [95% CI 1.72-4.91, P-score 0.55] respectively. In Clostridium difficile infection, the network meta-analysis revealed a non-significantly superior clinical response effect of nitazoxanide to metronidazole 31 days after treatment RR 1.21 [95% CI 0.87-1.69, P-score 0.26]. In Entamoeba histolytica, the overall estimate significantly favored nitazoxanide in parasitological response with placebo RR 1.80 [95% CI 1.35-2.40, P-value < 0.001]. We highlighted the effectiveness of nitazoxanide in the cessation of diarrhea caused by Cryptosporidium, Giardia intestinalis and Entamoeba histolytica infection. We also found significant superiority of NTZ to metronidazole in improving the clinical response to G. intestinalis, thus it may be a suitable candidate for treating infection-induced diarrhea. To prove the superiority of NTZ during a C. difficile infection may warrant a larger-scale clinical trial since its superiority was deemed insignificant. We recommend nitazoxanide as an appropriate option for treating infectious diarrhea.
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García-Flores L, Santillán-Benítez JG, Cuevas-Yáñez E, Caballero-Vásquez P, Zamudio-Chávez S, Morales-Ávila E. Evaluation of the effect of 1,3-bis-(4-phenyl-[1,2,3] triazole-1-il)2-propanol in comparison with metronidazole in an in vitro culture of Blastocystis in samples of patients with irritable bowel syndrome. J Parasit Dis 2019; 43:506-512. [PMID: 31406417 PMCID: PMC6667573 DOI: 10.1007/s12639-019-01118-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/23/2019] [Indexed: 12/17/2022] Open
Abstract
Metronidazole is the most-used pharmaceutical for the treatment of infection by Blastocystis. However, studies have reported resistance of the microorganism towards this pharmaceutical. In Mexico, studies concerning the prevalence of this parasite and its relationship to Irritable Bowel Syndrome have been carried out. To evaluate the in vitro effect of metronidazole and the compound 1,3-bis-(4-phenyl-[1,2,3] triazole-1-il)2-propanol over Blastocystis, as well as the prevalence of Blastocystis in patients with Irritable Bowel Syndrome. A prospective, transversal design study (April 2016-April 2017) of 51 samples of patients with Irritable Bowel Syndrome, obtained from the ISSEMyM Medical Center in Toluca, Mexico. For the identification of Blastocystis was done in three serial stool samples through direct microscopic examination and the Ritchie technique. The in vitro susceptibility test towards metronidazole and the triazolic compound was done through a microculture in concentrations of 1 to 1000 µg/mL, each one in triplicate. A 31.3% prevalence of Blastocystis was observed in the population, with greater prevalence in women (30.2%) than in men (25%). In the susceptibility test, a CL50 of 64 µg/mL was obtained for metronidazole, in comparison to the CL50 of 250 µg/mL for 1,3-bis-(4-phenyl-[1,2,3] triazole-1-il)2-propanol. This molecule in development has an effect for the treatment of infection by Blastocystis in vitro in patients with IBS and therefore, more studies should be performed.
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Affiliation(s)
- L. García-Flores
- Faculty of Chemistry, Autonomous University of the State of Mexico (UAEMex), Paseo Colón esq Paseo Tollocan, Col. Residencial Colón, Toluca, C.P. 50000 Mexico
| | - JG Santillán-Benítez
- Faculty of Chemistry, Autonomous University of the State of Mexico (UAEMex), Paseo Colón esq Paseo Tollocan, Col. Residencial Colón, Toluca, C.P. 50000 Mexico
- ISSEMyM Medical Center, Av. Baja Velocidad Km. 57.5 Carr. Méx./Tol. # 284 Col San Jerónimo Chicahualco. Municipio, Metepec, Mexico
| | - E. Cuevas-Yáñez
- Faculty of Chemistry, Autonomous University of the State of Mexico (UAEMex), Paseo Colón esq Paseo Tollocan, Col. Residencial Colón, Toluca, C.P. 50000 Mexico
| | - P. Caballero-Vásquez
- ISSEMyM Medical Center, Av. Baja Velocidad Km. 57.5 Carr. Méx./Tol. # 284 Col San Jerónimo Chicahualco. Municipio, Metepec, Mexico
| | | | - E. Morales-Ávila
- Faculty of Chemistry, Autonomous University of the State of Mexico (UAEMex), Paseo Colón esq Paseo Tollocan, Col. Residencial Colón, Toluca, C.P. 50000 Mexico
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Abstract
Human stool contains a myriad of microorganisms, of which the vast majority are nonpathogenic and represent an important component of the healthy microbiome. The increasing use of molecular techniques has allowed the rapid identification of bacteria, viruses and parasites in human stool. This review focuses on the 3 main classes of parasite responsible for human disease, helminths, protozoa and ectoparasites, and highlights the importance of differentiating between pathogenic and nonpathogenic parasites.
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Rajamanikam A, Hooi HS, Kudva M, Samudi C, Kumar S. Resistance towards metronidazole in Blastocystis sp.: A pathogenic consequence. PLoS One 2019; 14:e0212542. [PMID: 30794628 PMCID: PMC6386359 DOI: 10.1371/journal.pone.0212542] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 02/05/2019] [Indexed: 01/13/2023] Open
Abstract
Blastocsytis sp. is a protozoan parasite that has been linked to common gastrointestinal illnesses. Metronidazole, the first line therapy, was reported to show frequent inefficacy. Previously, Blastocystis sp. isolated from different population showed varying metronidazole resistance. However, the effect of metronidazole treatment on pathogenic potentials of Blastocystis sp. isolated from different populations, which is known to have different gut environment, is unclear. This study investigates the in vitro effect of metronidazole on the pathogenic potentials of Blastocystis sp. isolated from urban and orang asli individuals. Blastocystis sp. ST 3 isolated from symptomatic and asymptomatic individuals were treated with a range of metronidazole concentration. The parasites’ growth characteristics, apoptotic rate, specific protease activity and the ability to proliferate cancer cells were analyzed upon treatment with 0.001 mg/l metronidazole. The study demonstrates that Blastocystis sp. isolates showed increase in the parasite numbers especially the amoebic forms (only in urban isolates) after treating with metronidazole at the concentration of 0.001 mg/ml. High number of cells in post-treated isolates coincided with increase of apoptosis. There was a significant increase in cysteine protease of Blastocystis sp. isolates upon treatment despite the initial predominance of serine protease in asymptomatic isolates. Metronidazole resistant Blastocystis sp. also showed significant increase in cancer cell proliferation. Resistance to metronidazole did not show significant different influence on the pathogenicity between Blastocystis sp. isolated from urban and orang asli individual. However, an increase in parasite numbers, higher amoebic forms, cysteine protease and ability to proliferate cancer cells implicates a pathogenic role. The study provides evidence for the first time, the effect of metronidazole towards enhancing pathogenic potentials in Blastocystis sp. when isolated from different gut environment. This necessitates the need for reassessment of metronidazole treatment modalities.
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Affiliation(s)
- Arutchelvan Rajamanikam
- Depatment of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ho Shiaw Hooi
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Madhav Kudva
- Gastroenterology and Hepatology Specialist Clinic, Pantai Hospital, Kuala Lumpur, Malaysia
| | - Chandramathi Samudi
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Suresh Kumar
- Depatment of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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Dudlová A, Jarčuška P, Jurišová S, Vasilková Z, Krčméry V, Juriš P. Prevalence of non-pathogenic types of gastrointestinal protozoa in population in Slovakia and their potential importance in the aspect of public health. Acta Parasitol 2018; 63:819-825. [PMID: 30367755 DOI: 10.1515/ap-2018-0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 08/28/2018] [Indexed: 11/15/2022]
Abstract
The aim of the research was to determine the prevalence of non-pathogenic protozoa circulating in the human population of Slovakia. We particularly focused on the socially deprived areas with poor sanitation conditions, as they are one of the factors affecting the transmission of these infections. Within this study, 2760 people were coprologically screened for the presence of protozoan cysts. The analyzed group comprised 1173 men and 1587 women from different regions of Slovakia. The total prevalence (2.03%) of non-pathogenic protozoa species was determined. The prevalence of Entamoeba coli was 0.80%, the prevalence of Endolimax nana 0.58%, and the prevalence of Blastocystis hominis was 0.65%. The presence of non-pathogenic protozoa was more frequent in women than that in men, in all age groups. The highest incidence of Entamoeba coli was found in children aged one month - seven years (0.79%), the lowest in the age group of 19-88 years (0.66%). Endolimax nana was most frequent in 8-18 year-olds (0.95%), where the statistical significance was found (p<0.05). The prevalence of Blastocystis hominis by the age group ranged from 0.39 to 0.95%. We did not find any statistical significance (p>0.05) for Entamoeba coli, and similarly for Blastocystis hominis associated with the sex and age. Although the circulation of non-pathogenic protozoa in the human population is far from being limited to the developing countries, their occurrence is also frequent in the population of developed countries. Despite their controversial pathogenicity, they should not be neglected, particularly in the patients with gastrointestinal symptoms.
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Affiliation(s)
- Adriána Dudlová
- St Elisabeth University of Health Care and Social Work, Námestie 1. mája, 080 00 Bratislava, Slovak Republic
| | - Pavol Jarčuška
- Department of Infectology and Travel Medicine, Faculty of Medicine, University of P. J. Šafárik, Rastislavova 43, 041 90 Košice, Slovak Republic
| | - Silvia Jurišová
- National Cancer Institute, Klenova 3019/1, 833 10 Bratislava, Slovak Republic
| | - Zuzana Vasilková
- Institute of Parasitology, Slovak Academy of Sciences, Hlinkova 3, 040 01 Košice, Slovak Republic
| | - Vladimír Krčméry
- St Elisabeth University of Health Care and Social Work, Námestie 1. mája, 080 00 Bratislava, Slovak Republic
| | - Peter Juriš
- Department of Epidemiology, Faculty of Medicine, University of P. J. Šafárik, Šrobárova 2, 041 80 Košice, Slovak Republic
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Viability Screen of LOPAC 1280 Reveals Phosphorylation Inhibitor Auranofin as a Potent Inhibitor of Blastocystis Subtype 1, 4, and 7 Isolates. Antimicrob Agents Chemother 2018; 62:AAC.00208-18. [PMID: 29866860 DOI: 10.1128/aac.00208-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/26/2018] [Indexed: 01/23/2023] Open
Abstract
Blastocystis is an enteric parasite with extensive global prevalence. Studies have linked infection with this protist with a variety of gastrointestinal disorders, including irritable bowel syndrome. Due to the polymorphic nature of Blastocystis, studies on the parasite could be complicated, as results can be easily misinterpreted. Metronidazole is the commonly prescribed drug for Blastocystis infection, although there have been increasing reports of drug resistance. Hence, there is a need to identify alternative drugs to eliminate Blastocystis infection. In this study, LOPAC1280 was screened and drugs that can decrease the viability of three Blastocystis isolates in cultures were identified. Using apoptosis assay and imaging flow cytometry, phenotypic changes in Blastocystis cells after treatment were also analyzed to obtain insights into the possible mechanism of action of these drugs. Three drugs-diphenyleneiodonium chloride, auranofin, and BIX 01294 trihydrochloride hydrate-were effective against all three isolates tested. Repurposing of these drugs for Blastocystis treatment could be a way of combating metronidazole resistance relatively quickly and at a lower cost.
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Clinical and epidemiological characteristics of intestinal parasite infection by Blastocystis hominis. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Características clínicas y epidemiológicas de la parasitación intestinal por Blastocystis hominis. Rev Clin Esp 2018; 218:115-120. [DOI: 10.1016/j.rce.2018.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 12/13/2022]
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Forsell J, Bengtsson-Palme J, Angelin M, Johansson A, Evengård B, Granlund M. The relation between Blastocystis and the intestinal microbiota in Swedish travellers. BMC Microbiol 2017; 17:231. [PMID: 29228901 PMCID: PMC5725903 DOI: 10.1186/s12866-017-1139-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/30/2017] [Indexed: 01/07/2023] Open
Abstract
Background Blastocystis sp. is a unicellular eukaryote that is commonly found in the human intestine. Its ability to cause disease is debated and a subject for ongoing research. In this study, faecal samples from 35 Swedish university students were examined through shotgun metagenomics before and after travel to the Indian peninsula or Central Africa. We aimed at assessing the impact of travel on Blastocystis carriage and seek associations between Blastocystis and the bacterial microbiota. Results We found a prevalence of Blastocystis of 16/35 (46%) before travel and 15/35 (43%) after travel. The two most commonly Blastocystis subtypes (STs) found were ST3 and ST4, accounting for 20 of the 31 samples positive for Blastocystis. No mixed subtype carriage was detected. All ten individuals with a typable ST before and after travel maintained their initial ST. The composition of the gut bacterial community was not significantly different between Blastocystis-carriers and non-carriers. Interestingly, the presence of Blastocystis was accompanied with higher abundances of the bacterial genera Sporolactobacillus and Candidatus Carsonella. Blastocystis carriage was positively associated with high bacterial genus richness, and negatively correlated to the Bacteroides-driven enterotype. These associations were both largely dependent on ST4 – a subtype commonly described from Europe – while the globally prevalent ST3 did not show such significant relationships. Conclusions The high rate of Blastocystis subtype persistence found during travel indicates that long-term carriage of Blastocystis is common. The associations between Blastocystis and the bacterial microbiota found in this study could imply a link between Blastocystis and a healthy microbiota as well as with diets high in vegetables. Whether the associations between Blastocystis and the microbiota are resulting from the presence of Blastocystis, or are a prerequisite for colonization with Blastocystis, are interesting questions for further studies. Electronic supplementary material The online version of this article (10.1186/s12866-017-1139-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joakim Forsell
- Department of Clinical Microbiology, Umeå University, -901 87, Umeå, SE, Sweden.
| | - Johan Bengtsson-Palme
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Martin Angelin
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Anders Johansson
- Department of Clinical Microbiology, Bacteriology, and the Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Birgitta Evengård
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Margareta Granlund
- Department of Clinical Microbiology, Umeå University, -901 87, Umeå, SE, Sweden
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Large-scale comparative metagenomics of Blastocystis, a common member of the human gut microbiome. ISME JOURNAL 2017; 11:2848-2863. [PMID: 28837129 PMCID: PMC5702742 DOI: 10.1038/ismej.2017.139] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/05/2017] [Accepted: 07/14/2017] [Indexed: 12/12/2022]
Abstract
The influence of unicellular eukaryotic microorganisms on human gut health and disease is still largely unexplored. Blastocystis spp. commonly colonize the gut, but its clinical significance and ecological role are currently unsettled. We have developed a high-sensitivity bioinformatic pipeline to detect Blastocystis subtypes (STs) from shotgun metagenomics, and applied it to 12 large data sets, comprising 1689 subjects of different geographic origin, disease status and lifestyle. We confirmed and extended previous observations on the high prevalence the microrganism in the population (14.9%), its non-random and ST-specific distribution, and its ability to cause persistent (asymptomatic) colonization. These findings, along with the higher prevalence observed in non-westernized individuals, the lack of positive association with any of the disease considered, and decreased presence in individuals with dysbiosis associated with colorectal cancer and Crohn's disease, strongly suggest that Blastocystis is a component of the healthy gut microbiome. Further, we found an inverse association between body mass index and Blastocystis, and strong co-occurrence with archaeal organisms (Methanobrevibacter smithii) and several bacterial species. The association of specific microbial community structures with Blastocystis was confirmed by the high predictability (up to 0.91 area under the curve) of the microorganism colonization based on the species-level composition of the microbiome. Finally, we reconstructed and functionally profiled 43 new draft Blastocystis genomes and discovered a higher intra subtype variability of ST1 and ST2 compared with ST3 and ST4. Altogether, we provide an in-depth epidemiologic, ecological, and genomic analysis of Blastocystis, and show how metagenomics can be crucial to advance population genomics of human parasites.
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Batista L, Pérez Jove J, Rosinach M, Gonzalo V, Sainz E, Loras C, Forné M, Esteve M, Fernández-Bañares F. Escasa eficacia de metronidazol en la erradicación de Blastocystis hominis en pacientes sintomáticos: serie de casos y revisión sistemática de la literatura. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:381-387. [DOI: 10.1016/j.gastrohep.2016.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/26/2016] [Accepted: 11/04/2016] [Indexed: 01/26/2023]
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Del Coco VF, Molina NB, Basualdo JA, Córdoba MA. [Blastocystis spp.: Advances, controversies and future challenges]. Rev Argent Microbiol 2017; 49:110-118. [PMID: 28189279 DOI: 10.1016/j.ram.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/09/2016] [Accepted: 08/29/2016] [Indexed: 01/24/2023] Open
Abstract
Blastocystis spp. is the most common protozoan detected in human stool samples. In developing countries, infection rates are higher than 20%. The presence of this parasite in the feces of several host species suggests its zoonotic potential. The clinical relevance and the pathogenic role of Blastocystis spp. in the intestinal tract remain unclear. There are several clinical reports that recognize it as the etiologic agent of several intestinal disorders such as diarrhea, inflammatory bowel disease and ulcerative colitis, although the pathogenicity of this parasite has not been proved yet. This wide range of clinical manifestations could be related to the genetic diversity exhibited by this parasite.
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Affiliation(s)
- Valeria F Del Coco
- Centro Universitario de Estudios Microbiológicos y Parasitológicos, Sede Cátedra de Microbiología y Parasitología, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CABA, Argentina.
| | - Nora B Molina
- Centro Universitario de Estudios Microbiológicos y Parasitológicos, Sede Cátedra de Microbiología y Parasitología, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Juan A Basualdo
- Centro Universitario de Estudios Microbiológicos y Parasitológicos, Sede Cátedra de Microbiología y Parasitología, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - María A Córdoba
- Centro Universitario de Estudios Microbiológicos y Parasitológicos, Sede Cátedra de Microbiología y Parasitología, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina; Comisión de Investigaciones Científicas de la Provincia de Buenos Aires, La Plata, Argentina
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Stensvold CR, Clark CG. Current status of Blastocystis: A personal view. Parasitol Int 2016; 65:763-771. [PMID: 27247124 DOI: 10.1016/j.parint.2016.05.015] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 05/10/2016] [Accepted: 05/27/2016] [Indexed: 12/15/2022]
Abstract
Despite Blastocystis being one of the most widespread and prevalent intestinal eukaryotes, its role in health and disease remains elusive. DNA-based detection methods have led to a recognition that the organism is much more common than previously thought, at least in some geographic regions and some groups of individuals. Molecular methods have also enabled us to start categorizing the vast genetic heterogeneity that exists among Blastocystis isolates, wherein the key to potential differences in the clinical outcome of Blastocystis carriage may lie. In this review we summarize some of the recent developments and advances in Blastocystis research, including updates on diagnostic methods, molecular epidemiology, genetic diversity, host specificity, clinical significance, taxonomy, and genomics. As we are now in the microbiome era, we also review some of the steps taken towards understanding the place of Blastocystis in the intestinal microbiota.
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Affiliation(s)
| | - C Graham Clark
- London School of Hygiene and Tropical Medicine, London, UK
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22
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Rebolla MF, Silva EM, Gomes JF, Falcão AX, Rebolla MVF, Franco RMB. HIGH PREVALENCE OF Blastocystis spp. INFECTION IN CHILDREN AND STAFF MEMBERS ATTENDING PUBLIC URBAN SCHOOLS IN SÃO PAULO STATE, BRAZIL. Rev Inst Med Trop Sao Paulo 2016; 58:31. [PMID: 27074325 PMCID: PMC4826084 DOI: 10.1590/s1678-9946201658031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/06/2015] [Indexed: 11/23/2022] Open
Abstract
After a gastroenteritis outbreak of unknown etiology in the municipality of
Sebastião da Grama, SãoPaulo, Brazil, we
conducted a parasitological survey to establish the epidemiological profile of
enteroparasitosis in children and staff members attending the public urban schools in
operation in town. The cross-sectional study evaluated 172 children aged 11 months to
6 years old and 33 staff members aged 19 to 58 years old. Overall, 96 (55.81%)
children and 20 (60.61%) staff members were mono-parasitized, while 58 (33.72%)
children and 4 (12.12%) workers were poly-parasitized. Protozoa (88.37%; 72.73%) was
more prevalent than helminthes (3.48%; 0%) in children and staff members
respectively.Blastocystis spp. was the most prevalent parasite in
children (86.63%) and staff members (66.67%). The age of 1 year old or less was found
to be associated with increased prevalence of giardiasis [OR = 13.04; 95%CI
2.89-58.91; p = 0.00] and public garbage collection was identified
as a protective factor against intestinal helminth infections [OR = 0.06; 95%CI
0.00-0.79; p = 0.03]. Although most of the children tested positive
for Blastocystis spp. and also presented clinical signs/symptoms
(62.2%), this association was not statistically significant [OR = 1.35; 95%CI
0.53-3.44; p = 0.51]. Intestinal parasites still represent a public
health concern and this study underscores the importance of further investigations to
better understand the pathogenic role of Blastocystis spp.
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Affiliation(s)
- Mayra Frozoni Rebolla
- Department of Animal Biology, Institute of Biology, University of Campinas, Brazil, ,
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Yason JA, Tan KSW. Seeing the Whole Elephant: Imaging Flow Cytometry Reveals Extensive Morphological Diversity within Blastocystis Isolates. PLoS One 2015; 10:e0143974. [PMID: 26618361 PMCID: PMC4664278 DOI: 10.1371/journal.pone.0143974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
Blastocystis is a common protist isolated in humans and many animals. The parasite is a species complex composed of 19 subtypes, 9 of which have been found in humans. There are biological and molecular differences between Blastocystis subtypes although microscopy alone is unable to distinguish between these subtypes. Blastocystis isolates also display various morphological forms. Several of these forms, however, have not been properly evaluated on whether or not these play significant functions in the organism's biology. In this study, we used imaging flow cytometry to analyze morphological features of Blastocystis isolates representing 3 subtypes (ST1, ST4 and ST7). We also employed fluorescence dyes to discover new cellular features. The profiles from each of the subtypes exhibit considerable differences with the others in terms of shape, size and granularity. We confirmed that the classical vacuolar form comprises the majority in all three subtypes. We have also evaluated other morphotypes on whether these represent distinct life stages in the parasite. Irregularly-shaped cells were identified but all of them were found to be dying cells in one isolate. Granular forms were present as a continuum in both viable and non-viable populations, with non-viable forms displaying higher granularity. By analyzing the images, rare morphotypes such as multinucleated cells could be easily observed and quantified. These cells had low granularity and lower DNA content. Small structures containing nucleic acid were also identified. We discuss the possible biological implications of these unusual forms.
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Affiliation(s)
- John Anthony Yason
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kevin Shyong Wei Tan
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
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In Vitro Antimicrobial Susceptibility Patterns of Blastocystis. Antimicrob Agents Chemother 2015; 59:4417-23. [PMID: 25987633 DOI: 10.1128/aac.04832-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/04/2015] [Indexed: 02/07/2023] Open
Abstract
Blastocystis is the most common human enteric protist with controversial clinical significance. Metronidazole is considered a first-line treatment for Blastocystis infection; however, there has been increasing evidence for the lack of efficacy of this treatment. Treatment failure has been reported in several clinical cases, and recent in vitro studies have suggested the occurrence of metronidazole-resistant strains. In this study, we tested 12 Blastocystis isolates from 4 common Blastocystis subtypes (ST1, ST3, ST4, and ST8) against 12 commonly used antimicrobials (metronidazole, paromomycin, ornidazole, albendazole, ivermectin, trimethoprim-sulfamethoxazole [TMP-SMX], furazolidone, nitazoxanide, secnidazole, fluconazole, nystatin, and itraconazole) at 10 different concentrations in vitro. It was found that each subtype showed little sensitivity to the commonly used metronidazole, paromomycin, and triple therapy (furazolidone, nitazoxanide, and secnidazole). This study highlights the efficacy of other potential drug treatments, including trimethoprim-sulfamethoxazole and ivermectin, and suggests that current treatment regimens be revised.
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25
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Fletcher S. Understanding the contribution of environmental factors in the spread of antimicrobial resistance. Environ Health Prev Med 2015; 20:243-52. [PMID: 25921603 DOI: 10.1007/s12199-015-0468-0] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/20/2015] [Indexed: 12/22/2022] Open
Abstract
The overuse and abuse of antibiotics have contributed to the global epidemic of antibiotic resistance. Current evidence suggests that widespread dependency on antibiotics and complex interactions between human health, animal husbandry and veterinary medicine, have contributed to the propagation and spread of resistant organisms. The lack of information on pathogens of major public health importance, limited surveillance, and paucity of standards for a harmonised and coordinated approach, further complicates the issue. Despite the widespread nature of antimicrobial resistance, limited focus has been placed on the role of environmental factors in propagating resistance. There are limited studies that examine the role of the environment, specifically water, sanitation and hygiene factors that contribute to the development of resistant pathogens. Understanding these elements is necessary to identify any modifiable interactions to reduce or interrupt the spread of resistance from the environment into clinical settings. This paper discusses some environmental issues that contribute to antimicrobial resistance, including soil related factors, animal husbandry and waste management, potable and wastewater, and food safety, with examples drawn mainly from the Asian region. The discussion concludes that some of the common issues are often overlooked and whilst there are numerous opportunities for environmental factors to contribute to the growing burden of antimicrobial resistance, a renewed focus on innovative and traditional environmental approaches is needed to tackle the problem.
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Affiliation(s)
- Stephanie Fletcher
- Public Health Unit, South Western Sydney Local Health District, P.O. Box 38, Liverpool BC, NSW, 1871, Australia,
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26
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El-Taweel HA. Understanding drug resistance in human intestinal protozoa. Parasitol Res 2015; 114:1647-59. [DOI: 10.1007/s00436-015-4423-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 03/05/2015] [Indexed: 01/07/2023]
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Nagel R, Bielefeldt-Ohmann H, Traub R. Clinical pilot study: efficacy of triple antibiotic therapy in Blastocystis positive irritable bowel syndrome patients. Gut Pathog 2014; 6:34. [PMID: 25349629 PMCID: PMC4209510 DOI: 10.1186/s13099-014-0034-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/07/2014] [Indexed: 02/08/2023] Open
Abstract
Background Blastocystis species are common human enteric parasites. Carriage has been linked to Irritable Bowel Syndrome (IBS). Treatment of Blastocystis spp. with antimicrobials is problematic and insensitive diagnostic methods and re-infection complicate assessment of eradication. We investigated whether triple antibiotic therapy comprising diloxanide furoate, trimethoprim/sulfamethoxazole and secnidazole (TAB) given to diarrhoea-predominant IBS (D-IBS) patients positive for Blastocystis would achieve eradication. Methods In a longitudinal, prospective case study 10 D-IBS Blastocystis-positive patients took 14 days of diloxanide furoate 500 mg thrice daily, trimethoprim/sulfamethoxazole 160/80 mg twice daily and secnidazole 400 mg thrice daily. Faecal specimens were collected at baseline, day 15 and 4 weeks after completion of TAB. Specimens were analysed using faecal smear, culture and polymerase chain reaction (PCR) of the 16 SSU rRNA. Patients kept a concurrent clinical diary. Results Six (60%) patients cleared Blastocystis spp. after TAB, including three who had failed previous therapy. Subtypes detected were ST3 (60%), ST4 (40%), ST1 (20%) and ST7, 8 (10%); four patients had mixed ST infections. Serum immunoglobulin A (IgA) levels were low in 40% of patients. Higher rates of Blastocystis clearance were observed in patients symptomatic for less than a year (Mann–Whitney, p = 0.032, 95% confidence) with no associations found with age, previous antibiotic therapy, faecal parasite load, ST, IgA level or clinical improvement. Conclusions Clearance of Blastocystis spp. was achieved with TAB in 60% of D-IBS patients, an improvement over conventional monotherapy. Higher clearance rates are needed to facilitate investigation of the relevance of this parasite in clinically heterogenous IBS.
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Affiliation(s)
- Robyn Nagel
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia ; Toowoomba Gastroenterology Clinic, Suite 105 Medici Medical Centre, 15 Scott Street, Toowoomba 4350, Queensland, Australia
| | - Helle Bielefeldt-Ohmann
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia ; Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, Australia
| | - Rebecca Traub
- Faculty of Veterinary Science, The University of Melbourne, Parkville 3052, Victoria, Australia
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Fletcher S, Caprarelli G, Merif J, Andresen D, Hal SV, Stark D, Ellis J. Epidemiology and geographical distribution of enteric protozoan infections in sydney, australia. J Public Health Res 2014; 3:298. [PMID: 25343139 PMCID: PMC4207027 DOI: 10.4081/jphr.2014.298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Enteric protozoa are associated with diarrhoeal illnesses in humans; however there are no recent studies on their epidemiology and geographical distribution in Australia. This study describes the epidemiology of enteric protozoa in the state of New South Wales and incorporates spatial analysis to describe their distribution. DESIGN AND METHODS Laboratory and clinical records from four public hospitals in Sydney for 910 patients, who tested positive for enteric protozoa over the period January 2007 - December 2010, were identified, examined and analysed. We selected 580 cases which had residence post code data available, enabling us to examine the geographic distribution of patients, and reviewed the clinical data of 252 patients to examine possible links between protozoa, demographic and clinical features. RESULTS Frequently detected protozoa were Blastocystis spp. (57%), Giardia intestinalis (27%) and Dientamoeba fragilis (12%). The age distribution showed that the prevalence of protozoa decreased with age up to 24 years but increasing with age from 25 years onwards. The geographic provenance of the patients indicates that the majority of cases of Blastocystis (53.1%) are clustered in and around the Sydney City Business District, while pockets of giardiasis were identified in regional/rural areas. The distribution of cases suggests higher risk of protozoan infection may exist for some communities. CONCLUSIONS These findings provide useful information for policy makers to design and tailor interventions to target high risk communities. Follow-up investigation into the risk factors for giardiasis in regional/rural areas is needed. Significance for public healthThis research is significant since it provides the most recent epidemiological update on the common enteric protozoa affecting Australians. It reveals that enteric protozoa cause considerable disease burden in high risk city dwellers, and provides the evidence base for development of targeted interventions for their prevention and control in high risk populations. The prevalence of enteric protozoa in this metropolitan setting underscores that microorganisms do not respect borders and that a collaborative approach is needed to contain the global spread of infectious diseases. Incorporating spatial analysis is valuable in providing a compelling picture of the geographical distribution of these often neglected diseases. Local and State Public Health departments can use this information to support further inves-
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Affiliation(s)
- Stephanie Fletcher
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney
| | - Graziella Caprarelli
- Division of IT, Engineering and the Environment, University of South Australia, Adelaide
| | - Juan Merif
- Microbiology Department, South Eastern Area Laboratory Service (SEALS), Prince of Wales Hospital, Rand wick
| | - David Andresen
- Department of Microbiology, Children’s Hospital Westmead, Darlinghurst, Australia
| | - Sebastian Van Hal
- Department of Microbiology, Liverpool Hospital, Darlinghurst, Australia
| | - Damien Stark
- Division of Microbiology, St. Vincent’s Hospital, Darlinghurst, Australia
| | - John Ellis
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney
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Roberts T, Stark D, Harkness J, Ellis J. Update on the pathogenic potential and treatment options for Blastocystis sp. Gut Pathog 2014; 6:17. [PMID: 24883113 PMCID: PMC4039988 DOI: 10.1186/1757-4749-6-17] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/15/2014] [Indexed: 12/23/2022] Open
Abstract
Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole.
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Affiliation(s)
- Tamalee Roberts
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia ; School of Medical and Molecular Biosciences, University of Technology, Sydney, Ultimo, NSW 2007, Australia
| | - Damien Stark
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia
| | - John Harkness
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia
| | - John Ellis
- School of Medical and Molecular Biosciences, University of Technology, Sydney, Ultimo, NSW 2007, Australia
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