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Almaw A, Berhan A, Solomon Y, Malkamu B, Eyayu T, Workineh L, Mekete G, Yayehrad AT. Balantidium coli; Rare and Accidental Finding in the Urine of Pregnant Woman: Case Report. Int Med Case Rep J 2022; 15:105-109. [PMID: 35345500 PMCID: PMC8957295 DOI: 10.2147/imcrj.s355536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Andargachew Almaw
- Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ayenew Berhan
- Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yenealem Solomon
- Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birhanemaskal Malkamu
- Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lemma Workineh
- Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Mekete
- Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia
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da Silva RKM, Dib LV, Amendoeira MR, Class CC, Pinheiro JL, Fonseca ABM, Barbosa ADS. Balantidiasis in humans: A systematic review and meta-analysis. Acta Trop 2021; 223:106069. [PMID: 34339668 DOI: 10.1016/j.actatropica.2021.106069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
Balantioides coli is a protozoan that infects different hosts species, including humans, with zoonotic transmission. The parasite, which lives in the large intestine and in other organs, can lead to serious infections that may culminate in death. Information about human balantidiasis is generally still very scanty. In view of the above, the purpose of this study was to analyze the epidemiological, clinical and laboratory characteristics of human balantidiasis based on a systematic review and meta-analysis. The scientific articles were retrieved from various databases and were subjected to descriptive analyses, chi-squared tests, and summarized on a forest plot and the heterogeneity index (I2). A total of 103 articles were eligible and included in this review. Out of these 103 articles, 75 were clinical case reports and 28 were epidemiological studies, indicating a frequency of 997 (3.98%) people potentially infected with B. coli. The publication dates of the analyzed articles ranged from 1910 to 2020, but the majority (68.9%) were published between 1998 and 2020. A considerable number of these articles were published in South America and Asia, mostly in Brazil and India, respectively. However, in Africa, Ethiopia, was observed the higher number of infected people (47.5%). A significant association (p < 0.05) was identified between proximity to pigs and positivity for B. coli, since more than 16% infected people were in proximity with pigs and/or their excreta. Infection by the protozoan was classified mainly as intestinal, and the predominant symptom was dysentery. Extraintestinal infections were found in 27 individuals, with colonization of the genitourinary tract frequently highlighted. Direct examination (17.2%), followed by an association of direct examination and sedimentation (45.7%), were the most commonly performed parasitological techniques, and the most frequently diagnosed form was trophozoites, corresponding to 22.5% of cases. The most common treatment for parasitized individuals (11.8%) was an association of tetracycline drugs with nitroimidazole derivatives. The articles retrieved, mainly epidemiological ones, used in meta-analysis showed high heterogeneity (I2> 50%, p < 0.05), impairing the retrieval and comparison of results. Some articles were found to provide incomplete information, making it difficult to retrieve and analyze variables. However, this review enabled us to compile and restate factors that appear to be associated with cases of human balantidiasis.
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Affiliation(s)
- Rayana Katylin Mendes da Silva
- Microbiology and Parasitology Department, Federal Fluminense University, Biomedical Institute, Professor Hernani de Mello Street, 101, São Domingos, Niterói, Rio de Janeiro 24210-130, Brazil
| | - Laís Verdan Dib
- Microbiology and Parasitology Department, Federal Fluminense University, Biomedical Institute, Professor Hernani de Mello Street, 101, São Domingos, Niterói, Rio de Janeiro 24210-130, Brazil; Toxoplasmosis and other Protozoosis Laboratory, Oswaldo Cruz Institut, Oswaldo Cruz Foudation, Brazil Avenue, 4365, Manguinhos, Rio de Janeiro 21045-900, Brazil
| | - Maria Regina Amendoeira
- Toxoplasmosis and other Protozoosis Laboratory, Oswaldo Cruz Institut, Oswaldo Cruz Foudation, Brazil Avenue, 4365, Manguinhos, Rio de Janeiro 21045-900, Brazil
| | - Camila Carvalho Class
- Microbiology and Parasitology Department, Federal Fluminense University, Biomedical Institute, Professor Hernani de Mello Street, 101, São Domingos, Niterói, Rio de Janeiro 24210-130, Brazil
| | - Jessica Lima Pinheiro
- Microbiology and Parasitology Department, Federal Fluminense University, Biomedical Institute, Professor Hernani de Mello Street, 101, São Domingos, Niterói, Rio de Janeiro 24210-130, Brazil
| | - Ana Beatriz Monteiro Fonseca
- Department of Statistics, Federal Fluminense University, Institute of Mathematics and Statistics, Professor Marcos Waldemar de Freitas Reis Street s / n, São Domingos, Niterói, Rio de Janeiro, 24210-200, Brazil.
| | - Alynne da Silva Barbosa
- Microbiology and Parasitology Department, Federal Fluminense University, Biomedical Institute, Professor Hernani de Mello Street, 101, São Domingos, Niterói, Rio de Janeiro 24210-130, Brazil; Toxoplasmosis and other Protozoosis Laboratory, Oswaldo Cruz Institut, Oswaldo Cruz Foudation, Brazil Avenue, 4365, Manguinhos, Rio de Janeiro 21045-900, Brazil.
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Aninagyei E, Nanga S, Acheampong DO, Mensah R, Boadu MN, Kwansa-Bentum HT, Tettey CO. Prevalence and risk factors of human Balantidium coli infection and its association with haematological and biochemical parameters in Ga West Municipality, Ghana. BMC Infect Dis 2021; 21:1047. [PMID: 34627168 PMCID: PMC8502288 DOI: 10.1186/s12879-021-06731-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Enoch Aninagyei
- School of Basic and Biomedical Sciences, Department of Biomedical Sciences, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
| | - Salifu Nanga
- School of Basic and Biomedical Sciences, Department of Basic Sciences, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Desmond Omane Acheampong
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Rita Mensah
- Ghana Health Service, Ga North Municipal Hospital, Ofankor, Accra, Ghana
| | - Mercy Nelly Boadu
- Department of Nursing and Midwifery, Faculty of Health and Allied Sciences, Pentecost University, Accra, Ghana
| | - Henrietta Terko Kwansa-Bentum
- School of Basic and Biomedical Sciences, Department of Biomedical Sciences, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Clement Okraku Tettey
- School of Basic and Biomedical Sciences, Department of Biomedical Sciences, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
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Ponce-Gordo F, García-Rodríguez JJ. Balantioides coli. Res Vet Sci 2020; 135:424-431. [PMID: 33183780 DOI: 10.1016/j.rvsc.2020.10.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023]
Abstract
Balantioides coli (=Balantidium coli) is the only ciliate that parasitizes humans. Pigs are the main reservoir. Other species, as camels, cattle, donkey, sheep and goat have been also proposed as reservoirs for human infections. The parasite has a direct life cycle, being transmitted by the faecal-oral route. This type of cycle and the large number of host species imply an important potential for zoonotic transmission of the parasite. Infections are most commonly found in tropical and temperate regions, with prevalence up to 100% in pigs; high prevalence values have been also recorded in some non-human primates and camels. In humans, prevalence is usually under 10% in the population at risk. The main epidemiological factors involved in the transmission of this parasite include close contact with pigs, lack of basic sanitation infrastructures (water supply, wastewater disposal) and hygiene. Individual health status, intestinal microbiota and diet are also important for the onset of the infection. Outbreaks caused by this parasite are rare; those reported to date were related to poor hygienic conditions or to catastrophic natural disasters. Balantioides coli infections can be asymptomatic and symptomatic, which can be chronic (with intermittent diarrhoea), or acute (a dysenteric form which can be life-threatening). Efective treatments include tetracycline, iodoquinol and 5-nitroimidazole compounds (metronidazole, secnidazole). The main effective individual preventive measure is the use of disinfected water for drinking and other uses. Adequate water supply infrastructures, proper disposal of wastewater and animal faeces, and regular monitoring programs on farms will help limit transmission.
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Affiliation(s)
- Francisco Ponce-Gordo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain.
| | - Juan José García-Rodríguez
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
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Martviset P, Sirisabhabhorn K, Pumpa S, Rhongbutsri P, Taylor A, Taylor WRJ. Urinary balantidiasis in a patient with systemic lupus erythematosus and lupus nephritis: a case report. J Med Case Rep 2020; 14:63. [PMID: 32460876 PMCID: PMC7254769 DOI: 10.1186/s13256-020-02389-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balantidium coli, a parasitic unicellular ciliate, often causes asymptomatic balantidiasis of the colon, but extraintestinal disease may occur rarely in immunosuppressed individuals. Renal balantidiasis associated with systemic lupus erythematosus has not been reported before. CASE PRESENTATION We present a case of a 48-year-old Thai woman who presented with nephrotic syndrome due to systemic lupus erythematosus-related nephritis. Initially, few B. coli cysts were found in urine sediment, but these increased substantially following treatment with prednisolone. She made an uneventful recovery with 10 days of oral tetracycline therapy. No B. coli cysts were found in her stool. CONCLUSION The route of infection in our patient was unclear but is likely to have been orofecal. Neither her infection nor its treatment caused a deterioration in her renal function.
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Affiliation(s)
- Pongsakorn Martviset
- Division of Parasitology, Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand.
| | - Kridsada Sirisabhabhorn
- Department of Medical Technology Laboratory, Thammasat University Hospital, Pathumthani, Thailand
| | - Supaporn Pumpa
- Department of Medical Technology Laboratory, Thammasat University Hospital, Pathumthani, Thailand
| | - Pochong Rhongbutsri
- Division of Parasitology, Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Aree Taylor
- Division of Parasitology, Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Walter R J Taylor
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Yu P, Rong J, Zhang Y, Du J. Dysentery Caused by Balantidium coli in China. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:47-49. [PMID: 32145726 PMCID: PMC7066439 DOI: 10.3347/kjp.2020.58.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022]
Abstract
Balantidium coli human infection predominantly occurs in tropical and subtropical regions in the world. Human case is extremely rare in China. This report details a case of B. coli infection in a 68-year-old man in China, who presented with history of abdominal pain, tenesmus, diarrhea with blood and was diagnosed as B. coli-caused dysentery. Our case indicates possible occurrence of Balantidium coli-related disease in cooler climates. This case is presented not only because of its rarity but also for future references.
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Affiliation(s)
- Peixia Yu
- Department of Clinical Laboratory Medicine, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Taiyuan, 030009, Shanxi, PR China
| | - JianRong Rong
- Department of Clinical Laboratory Medicine, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Taiyuan, 030009, Shanxi, PR China
| | - Yan Zhang
- Department of Clinical Laboratory Medicine, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Taiyuan, 030009, Shanxi, PR China
| | - Jingjing Du
- Department of Clinical Laboratory Medicine, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Taiyuan, 030009, Shanxi, PR China
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