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Balantidiasis

Human balantidiasis, Balantidiosis, Balantidium coli infection, Large-intestinal infection with Balantidium coli, B coli infection

Overview

Balantidiasis is defined as large-intestinal infection with Balantidium coli, which is a ciliated protozoan (and the largest protozoan that infects humans). B coli is known to parasitize the colon, and pigs may be its primary reservoir.

Symptoms - Balantidiasis

  • Diarrhea (watery, bloody, mucoid)
  • Nausea
  • Vomiting
  • Abdominal pain
  • Anorexia
  • Weight loss
  • Headache
  • Mild colitis
  • Fever
  • Severe and marked fluid loss (resembling amebic dysentery)
  • Dysenteric syndrome

Causes - Balantidiasis

Balantidium coli exists as a trophozoite and a cyst and usually affects the large intestine, from the caecum to the rectum. Humans ingest infective cysts, which then migrate to the large intestine, cecum, and terminal ileum. The organisms primarily dwell in the lumen but can also penetrate the mucosa and cause ulcers.

Risk factors for balantidiasis include contact with pigs, handling fertilizer contaminated with pig excrement, and living in areas where the water supply may be contaminated by the excrement of infected animals. Poor nutrition, achlorhydria, alcoholism, and immunosuppression may also be contributing factors.

Prevention - Balantidiasis

A clean water supply and hygienic living conditions can prevent balantidiasis.

Avoiding contact with pigs and fertilizer that is contaminated with pig excrement can decrease the risk of balantidiasis.

Diagnosis - Balantidiasis

Diagnosis is based on detection of trophozoites in stool specimens or in tissue collected during endoscopy. Balantidium coli is passed intermittently and once outside the colon is rapidly destroyed. Thus stool specimens should be collected repeatedly, and immediately examined or preserved to enhance detection of the parasite.

Prognosis - Balantidiasis

In the antibiotic era, severe balantidiasis carries an improved prognosis, and most affected patients now recover.

Treatment - Balantidiasis

Three antibiotics are used most often to treat Balantidium coli: tetracycline, metronidazole, and iodoquinol. Tetracycline is the treatment of choice, with metronidazole being the primary alternative. Iodoquinol, puromycin, and nitazoxanide are also effective against balantidiasis.

Special attention should be paid to volume replacement and electrolyte repletion in patients with balantidiasis who have severe diarrhea.

Resources - Balantidiasis

  • NIH
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