Urinary balantidiasis in a patient with systemic lupus erythematosus and lupus nephritis: a case report

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.

Balantidium coli; Rare and Accidental Finding in the Urine of Pregnant Woman: Case Report

Background

Balantidium coli is a ciliated protozoan parasite, which causes intestinal and extraintestinal infections in humans. It is transmitted feco-orally by ingesting infective cysts with food and water. Urinary balantidiasis may occur through contamination (direct spread from the anal area), secondarily to rectovaginal fistula and following immune suppression. Data about cases of urinary balantidiasis are rare in the world. Currently, there are no documented reports of urinary balantidiasis in Ethiopia. As our understanding, there are only eleven documented reports of urinary balantidiasis globally. However, cases of urinary balantidiasis among pregnant women have not been documented yet. The aim of this report is to alarm health professionals for considering the occurrence of such rare cases and conduct diagnosis.

Case Presentation

A 24-year old pregnant woman was admitted due to severe preeclampsia and preterm delivery at Debre Tabor Comprehensive Specialized Hospital, gynecology ward. Her urine was presented to inpatient laboratory for routine urinalysis. We detected unusual and ciliated parasite from her urine sediment characterized by its active and rotary motility through its cilia and possessing macro- and micro-nuclei, several food vacuoles and ingested red blood cells inside the cytoplasm. Hematuria, many white blood cells and epithelial cells were also detected from the urine sediment, which suggests genito-urinary tract infection due to this parasite. This rare parasite finding was confirmed to be B. coli.

Conclusion

The route of transmission and extraintestinal existence from this woman’s urine was unclear. It might be due to feco-oral transmission and spread to the genitourinary tract through direct anal contact. Moreover, it might be associated with immune suppression as she is pregnant woman.

Prevalence and risk factors of human Balantidium coli infection and its association with haematological and biochemical parameters in Ga West Municipality, Ghana

Background

In Ghana, Balantidium coli (B. coli) has been identified in vegetables and in pigs, although there is a paucity of data regarding human balantidiosis. This study sought to assess human B. coli infection in Ghana, factors associated with the infection as well as its association with haematological and biochemical parameters.

Methods

Two pig rearing communities in the Ga West Municipality, Ghana, were involved in this study. Stool and blood samples were collected from pig farmers and their exposed household members as well as relevant information on potential associated factors. Eosin-saline wet preparation was done on the same day of stool samples were collected while formol ether concentration technique was performed later. Haematological, biochemical parameters and serum electrolytes were determined using Celltac MEK-6500 K, PKL-125 biochemical analyser, and FT-320 electrolyte analyser, respectively.

Results

The overall prevalence of balantidiosis was 10.4 %, significantly higher among farmers (21.7 %) than in exposed household members (5.8 %) (x² = 17.8, p = 0.000025). Of the 43 infected individuals, 20.9 % were co-infected with either Entamoeba histolytica, Giardia lamblia, or Schistosoma mansoni. In B. coli infection, mild to moderate anaemia together with a reduction in levels of platelet, albumin and, sodium, chloride, and bicarbonate ions were observed. However, white blood cells were significantly elevated in infected states. Poor farming practices such as free-range systems, improper disposal of pig faeces, lack of use of protective farming clothing, and unavailability of dedicated farming clothing were found to be associated with B. coli infection status. Finally, frequent diarrhea (OR = 12.30, p = 0.006) with occult blood (OR = 25.94, p < 0.0001) were found to be predictors of B. coli infection.

Conclusions

Human balantidiosis is endemic in Ga West Municipality, Ghana. Individuals living closed to pig rearing communities presenting with frequent diarrhea with occult blood in stool should be screened and treated for balantidiosis to mitigate the clinical consequences of the infection.