BLASTOCYSTIS HOMINIS: A MYSTERIOUS AND COMMONLY DISREGARDED PARASITE

Nataša Tasić, Tatjana Milenković, Vera Bujić, Dragan Zdravković, Aleksandar Tasić

DOI Number
10.22190/FUMB161027001T
First page
39
Last page
47

Abstract


Blastocystis hominis (B. hominis) is an anaerobic, single-cell protozoan, commonly present in human and animal stool samples. It can be found in healthy people as well and it still has not been elucidated whether it is a commensal organism or a pathogen. Blastocystosis is a disease caused by the protozoan in humans. The prevalence of the parasitosis varies both between the countries, and between certain population groups within individual countries. Due to poor hygienic conditions, common exposure to animals and intake of contaminated water and food, people in the developing countries have got a higher prevalence of blastocystosis, but economically developed countries have not been spared either. The taxonomy of B. hominis is still a matter of debates. For the reasons of genetic diversity, it has been suggested that the name B. hominis should be replaced with „Blastocystis species‟. Seventeen subtypes of the species have been so far identified, and a definitive characterization of Blastocystis spp. is possible at the molecular level only. The parasite is transferred by the fecal-oral route. A variety of hosts have been identified, and animal-to-human and vice versa transfers have been documented. The most common manifestations of the infection with the organism are diarrhea, abdominal pain, nausea, and bloating. This infection has also been associated with the irritable bowel syndrome (IBS), non-specific colitis, chronic inflammatory bowel disease (CIBD), and urticaria. The diagnosis can be made using the methods of conventional microscopy (CVM), phase-contrast and electron microscopy, cultivation, serodiagnosis, and by using molecular methods. The infection caused by the parasite does not always require treatment. In symptomatic patients, the first line medical treatment is metronidazole. Further studies are required to resolve all dilemmas regarding the parasite.


Keywords

Blastocystis hominis, diarrheal syndrome, diagnosis, treatment

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Otašević S, Miladinović Tasić N, Tasić A. Paraziti nejasne taksonomije. In: Otašević S (ed). Medicinska parazitologija (udžbenik sa CD-om). 1st ed. Niš: Medicinski fakultet u Nišu & Galaksija; 2011. p. 101105.

Stensvold CR, Lewis HC, Hammerum AM et al. "Blastocystis: unravelling potential risk factors and clinical significance of a common but neglected parasite". Epidemiol Infect 2009; 137(11):1655–63.

Parija SC, Jeremiah S. Blastocystis: Taxonomy, biology and virulence. Trop Parasitol 2013; 3(1):17–25.

Zierdt CH. Blastocystis hominis: Past and future. Clin Microbiol Rev 1991; 4:61–79.

Zierdt CH, Rude WS, Bull BS. Protozoan characteristics of Blastocystis hominis. Am J Clin Pathol 1967; 48:495–501.

Silberman JD, Sogin ML, Leipe DD, Clark CG. Human parasite finds taxonomic home. Nature 1996; 380:398.

Ho LC, Armiugam A, Jeyaseelan K, Yap EH, Singh M. Blastocystis elongation factor-1alpha: Genomic organization, taxonomy and phylogenetic relationships. Parasitology 2000; 121:135–144.

Arisue N, Hashimoto T, Yoshikawa H, Nakamura Y, Nakamura G, Nakamura F et al. Phylogenetic position of Blastocystis hominis and of stramenopiles inferred from multiple molecular sequence data. J Eukaryot Microbiol 2002; 49:42–53.

Tan KS. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 2008; 21:639–665.

Riisberg I, Orr RJ, Kluge R, Shalchian-Tabrizi K, Bowers HA, Patil V et al. Seven gene phylogeny of heterokonts. Protist 2009; 160:191–204.

Cavalier-Smith, T. A revised six-kingdom system of life. Biol Rev Camb Philos Soc 1998; 73:203–266.

Cavalier-Smith T. Sagenista and Bigyra, two phyla of heterotrophic heterokont chromists. Archiv Protist 1997; 148:253–267.

Sekar U., Shanthi M. Recent insights into the genetic diversity, epidemiology and clinical relevance of Blastocystis species. J Med Res 2015; 1(1):33–39.

Noël C, Dufernez F, Gerbod D, Edgcomb VP, Delgado-Viscogliosi P, Ho LC et al. Molecular phylogenies of Blastocystis isolates from different hosts: Implications for genetic diversity, identification of species, and zoonosis. J Clin Microbiol 2005; 43:348–55.

Stenzel DJ, Lee MG, Boreham PF. Morphological differences in Blastocystis cysts-an indication of different species? Parasitol Res 1997; 83:452–457.

Stensvold CR. Blastocystis: Genetic diversity and molecular methods for diagnosis and epidemiology. Trop Parasitol 2013; 3:26–34.

Zierdt CH, Swan JC. Generation time and growth rate of the human intestinal parasite Blastocystis hominis. J Protozool 1981; 28:483–485.

Dhurga DB, Suresh KG, Tan TC, Chandramathi S. Apoptosis in Blastocystis spp. is related to subtype. Trans R Soc Trop Med Hyg 2012; 106:725–730.

Bergamo do Bomfim TC, Carvalho Machado do Couto M. Morphological diagnosis and occurrence of Blastocystis spp. obtained from the stool samples of domestic bird species commercialized in municipal markets. J Parasitol Vector Biol 2013; 5(3):20-26.

Yamada M, Yoshikawa H. Blastocystis: Pathogen or Passenger? In: H. Mehlhorn et al. (eds), Parasitology Research Monographs 4. Berlin, Heidelberg: Springer-Verlag 2012.

Vassalos CM, Spanakos G, Vassalou E, Papadopoulou C, Vakalis N. Differences in clinical significance and morphologic features of Blastocystis sp. subtype 3. Am J Clin Pathol 2010; 133:251–258.

Vdovenko AA. Blastocystis hominis: Origin and significance of vacuolar and granular forms. Parasitol Res 2000; 86:8–10.

Yoshikawa H, Yoshida K, Nakajima A, Yamanari K, Iwatani S, Kimata I. Fecal-oral transmission of the cyst form of Blastocystis hominis in rats. Parasitol Res 2004; 94:391–396.

Lee LI, Chye TT, Karmacharya BM, Govind SK. Blastocystis sp.: Waterborne zoonotic organism, a possibility? Parasit Vectors 2012; 5:130.

Li LH, Zhou XN, Du ZW, Wang XZ, Wang LB, Jiang JY et al. Molecular epidemiology of human Blastocystis in a village in Yunnan province, China. Parasitol Int 2007; 56:281–286.

Zhang X, Qiao JY, Zhou XJ, Yao FR, Wei ZC. Morphology and reproductive mode of Blastocystis hominis in diarrhea and in vitro. Parasitol Res 2007; 101:43–51.

Tan KS, Mirza H, Teo JD, Wu B, Macary PA. Current Views on the Clinical Relevance of Blastocystis spp. Curr Infect Dis Rep 2010; 12:28–35.

Scanlan PD. Blastocystis: Past pitfalls and future perspectives. Trends Parasitol 2012; 28:327–334.

Tan TC, Suresh KG. Predominance of amoeboid forms of Blastocystis hominis in isolates from symptomatic patients. Parasitol Res 2006; 98:189–193.

Abdel-Hameed DM, Hassanin OM. Proteaese activity of Blastocystis hominis subtype 3 in symptomatic and asymptomatic patients. Parasitol Res 2011; 109:321–327.

Puthia MK, Vaithilingam A, Lu J, Tan KS. Degradation of human secretory immunoglobulin A by Blastocystis. Parasitol Res 2005; 97:386–389.

Poirier P, Wawrzyniak I, Vivarès CP, Delbac F, El Alaoui H. New insights into Blastocystis spp.: A potential link with irritable bowel syndrome. PLoS Pathog 2012; 8:e1002545.

Valsecchi R, Leghissa P, Greco V. Cutaneous lesions in Blastocystis hominis infection. Acta Derm Venereol 2004; 84:322–323.

Yavasoglu I, Kadikoylu G, Uysal H, Ertug S, Bolaman Z. Is Blastocystis hominis a new etiologic factor or a coincidence in iron deficiency anemia? Eur J Haematol 2008; 81:47–50.

Tan TC, Suresh KG, Smith HV. Phenotypic and genotypic characterisation of Blastocystis hominis isolates implicates subtype 3 as a subtype with pathogenic potential. Parasitol Res 2008; 104:85–93.

Vassalos CM, Vakalis N, Papadopoulou C. Blastocystis and its pathogenic potential: latest aspects. Rev Med Microbiol 2008; 19:87–97.

Boorom KF, Smith H, Nimri L, Viscogliosi E, Spanakos G, Parkar U et al. Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection. Parasit Vectors 2008; 1:40.

Roberts T, Barratt J, Harkness J, Ellis J, Stark D. Comparison of microscopy, culture, and conventional polymerase chain reaction for detection of Blastocystis sp. in clinical stool samples. Am J Trop Med Hyg 2011; 84(2):308–312.

Abdel-Hameed DM, Hassanin OM. Proteaese activity of Blastocystis hominis subtype 3 in symptomatic and asymptomatic patients. Parasitol Res 2011; 109:321–327

Abou Gamra MM, Elwakil HS, El Deeb HK, Khalifa KE, Abd Elhafiz HE. The potential use of 29 kDa protein as a marker of pathogenicity and diagnosis of symptomatic infections with Blastocystis hominis. Parasitol Res 2011; 108(5):1139–1146.

Mahmoud MS, Saleh WA. Secretory and humoral antibody responses to Blastocystis hominis in symptomatic and asymptomatic human infections. J Egypt Soc Parasitol 2003; 33(1):13–30.

Iguchi A, Yoshikawa H, Yamada M, Kimata I, Arizono N. Expression of interferon gamma and proinflammatory cytokines in the cecal mucosa of rats experimentally infected with Blastocystis sp. strain RN94-9. Parasitol Res 2009; 105(1):135–140.

Moe KT, Singh M, Howe J, Ho LC, Tan SW, Chen XQ et al. Experimental Blastocystis hominis infection in laboratory mice. Parasitol Res 1997; 83(4):319–325.

Yao FR, Qiao JY, Zhao Y, Zhang X, Yang JH, Li XQ. Experimental infection of mice with Blastocystis hominis. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2005; 23(6):444–448.

Zhang HW, Li W, Yan QY, He LJ, Su YP. Impact of Blastocystis hominis infection on ultrastructure of intestinal mucosa in mice. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2006; 24(3):187–191. (in Chinese)

Elwakil HS, Hewedi IH. Pathogenic potential of Blastocystis hominis in laboratory mice. Parasitol Res 2010; 107(3):685–689.

Chandramathi S, Suresh KG, Mahmood AA, Kuppusamy UR. Urinary hyaluronidase activity in rats infected with Blastocystis hominis–evidence for invasion? Parasitol Res 2010; 106(6):1459–1463.

Li J, Deng T, Li X, Cao G, Li X, Yan Y. A rat model to study Blastocytis subtype 1 infections. Parasitol Res 2013; 112(10):3537–3541.

Katsarou-Katsari A, Vassalos CM, Tzanetou K, Spanakos G, Papadopoulou C, Vakalis N. Acute urticaria associated with amoeboid forms of Blastocystis sp. subtype 3. Acta Derm Venereol 2008; 88(1):80–81.

Vogelberg C, Stensvold CR, Monecke S, Ditzen A, Stopsack K, Heinrich-Grafe U, Pohlmann C. Blastocystis sp. subtype 2 detection during recurrence of gastrointestinal and urticarial symptoms. Parasitol Int 2010; 59(3):469–471.

Yan Y, Su S, Lai R, Liao H, Ye J, Li X, et al. Genetic variability of Blastocystis hominis isolates in China. Parasitol Res 2006; 99(5):597–601.

Ramirez JD, Sanchez LV, Bautista DC, Corredor AF, Florez AC, Stensvold CR. Blastocystis subtypes detected in humans and animals from Colombia. Infect Genet Evol 2014; 22:223–228.

Bálint A, Dóczi I, Bereczki L, Gyulai R, Szűcs M, Farkas K, et al. Do not forget the stool examination!-cutaneous and gastrointestinal manifestations of Blastocystis sp. infection. Parasitol Res 2014; 113(4):1585–1590.

Hussein EM, Hussein AM, Eida MM, Atwa MM. Pathophysiological variability of different genotypes of human Blastocystis hominis Egyptian isolates in experimentally infected rats. Parasitol Res 2008; 102(5):853–860.

Yoshikawa H, Wu Z, Kimata I, Iseki M, Ali IKMD, Hossain MB, et al. Polymerase chain reaction-based genotype classification among human Blastocystis hominis populations isolated from different countries. Parasitol Res 2004; 92(1):22–29.

Dogruman-Al F, Dagci H, Yoshikawa H, Kurt Ö, Demirel M. A possible link between subtype 2 and asymptomatic infections of Blastocystis hominis. Parasitol Res 2008; 103(3):685–589.

Roberts T, Stark D, Harkness J, Ellis J. Subtype distribution of Blastocystis isolates identified in a Sydney population and pathogenic potential of Blastocystis. Eur J Clin Microbiol Infect Dis 2013; 32(3):335–343.

Stensvold CR, Christiansen DB, Olsen KEP, Nielsen HV. Blastocystis sp. Subtype 4 is Common in Danish Blastocystis-Positive Patients Presenting with Acute Diarrhea. Am J Trop Med Hyg 2011; 84(6):883–885.

Meloni D, Sanciu G, Poirier P, El Alaoui H, Chabe M, Delhaes L, et al. Molecular subtyping of Blastocystis sp. isolates from symptomatic patients in Italy. Parasitol Res 2011; 109(3):613–619.

Stensvold CR, Lewis HC, Hammerum a M, Porsbo LJ, Nielsen SS, Olsen KEP, et al. Blastocystis: unravelling potential risk factors and clinical significance of a common but neglected parasite. Epidemiol Infect 2009; 137(11):1655–1663.

Yan Y, Su S, Ye J, Lai X, Lai R, Liao H, et al. Blastocystis sp. subtype 5: a possibly zoonotic genotype. Parasitol Res 2007; 101(6):1527–1532.

Stark D, Van Hal S, Marriott D, Ellis J, Harkness J. Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis. Int J Parasitol 2007; 37:11–20.

Hussain R, Jaferi W, Zuberi S, Baqai R, Abrar N, Ahmed A et al. Significantly increased IgG2 subclass antibody levels to Blastocystis hominisin patients with irritable bowel syndrome. Am J Trop Med Hyg 1997; 56:301–306.

Basak S, Rajurkar MN, Mallick SK. Detection of Blastocystis hominis: A controversial human pathogen. Parasitol Res 2014; 113(1):261–265.

Ozyurt M, Kurt O, Molbak K, Nielsen HV, Haznedaroglu T, Stensvold CR. Molecular epidemiology of Blastocystis infections in Turkey. Parasitol Int 2008; 57(3):300–306.

Young CR, Yeo FE. Blastocystis and Schistosomiasis Coinfection in a Patient with Chronic Kidney Disease. Case Rep Med 2014; 2014:1–3.

Omrani VF, Fallahi S, Rostami A, Siyadatpanah A, Barzgarpour G, Mehravar S, et al. Prevalence of intestinal parasite infections and associated clinical symptoms among patients with end-stage renal disease undergoing hemodialysis. Infection 2015; 43(5):537–544.

Lee MG, Rawlins SC, Didier M, DeCeulaer K. Infective arthritis due to Blastocystis hominis. Ann Rheum Dis 1990; 49(3):192–193.

Lakhanpal S, Cohen SB, Fleischmann RM. Reactive arthritis from Blastocystis hominis. Arthritis Rheum 1991; 34(2):251–253.

Tejera B, Grados D, Martinez-Morillo M, Roure S. Reactive Arthritis Caused by Blastocistys hominis. Reumatol Clin 2012; 8(1):50–51.

Young CR, Yeo FE. Blastocystis and schistosomiasis coinfection in a patient with chronic kidney disease. Case Rep Med 2014; 2014:1–3.

Idris NS, Dwipoerwantoro PG, Kurniawan A, Said M. Intestinal parasitic infection of immunocompromised children with diarrhoea: clinical profile and therapeutic response. J Infect Dev Ctries 2010; 4(5):309–317.

Armentia A, Mendez J, Gomez A, Sanchis E, Fernandez A, de la Fuente R et al. Urticaria by Blastocystis hominis. Successful treatment with paromomycin. Allergol Immunopathol 1993; 21:149–151.

Kick G, Rueff F, Przybilla B. Palmoplantar pruritus subsiding after Blastocystis hominis eradication. Acta Derm Venereol 2002; 82:60.

Pasqui A L, Savini E, Saletti M, Guzzo C, Puccetti L, Auteri A. Chronic urticaria and Blastocystis hominis infection: a case report. Eur Rev Med Pharmacol Sci 2004; 8:117–120.

Valsecchi R, Leghissa P, Greco V. Cutaneous lesions in Blastocystis hominis infection. Acta Derm Venereol 2004; 84:322–323.

Yakoob J, Abbas Z, Beg MA, Naz S, Awan S, Hamid S, et al. In vitro sensitivity of Blastocystis hominis to garlic, ginger, white cumin, and black pepper used in diet. Parasitol Res 2011; 109:379–385.

Sekar U, Shanthi M. Blastocystis: Consensus of treatment and controversies. Trop Parasitol 2013; 3:35–39.

Stenzel DJ, Boreham PF, McDougall R. Ultrastructure of Blastocystis hominis in human stool samples. Int J Parasitol 1991; 21:807–812.

Stenzel DJ, Boreham PF. Blastocystis hominis Revisited. Clin Microbiol Rev 1996; 9:563–584.

Sukthana Y. Is Blastocystis hominis a human pathogenic protozoan? J Trop Med Parasitol 2001; 24:16–22.

Basak S, Rajurkar MN, Mallick SK. Detection of Blastocystis hominis: a controversial human pathogen. Parasitol Res 2014; 113(1):261–265.

Jones, W. R. The experimental infection of rats with Entamoeba histolytica. Ann Trop Med Parasitol 1946; 40:130.

Boeck W C, Drbohlav J. The cultivation of Entamoeba histolytica. Am J Hyg 1925; 5:371–407.

Leelayoova S, Taamasri P, Rangsin R, Naaglor T, Thathaisong U, Mungthin M. In-vitro cultivation: a sensitive method for detecting Blastocystis hominis. Ann Trop Med Parasitol 2002; 96:803–807.

Parkar U, Traub RJ, Kumar S, Mungthin M, Vitali S, Leelayoova S et al. Direct characterization of Blastocystis from faeces by PCR and evidence of zoonotic potential. Parasitology 2007; 134:359–367.

Stensvold CR, Arendrup MC, Jespersgaard C, Mølbak K, Nielsen HV. Detecting Blastocystis using parasitologic and DNA-based methods: a comparative study. Diagn Microbiol Infect Dis 2007; 59:303–307.

Stensvold R, Brillowska-Dabrowska A, Nielsen HV, Arendrup MC. Detection of Blastocystis hominis in unpreserved stool specimens by using polymerase chain reaction. J Parasitol 2006; 92:1081–1087.

Ho LC, Singh M, Suresh G, Ng GC, Yap EH. Axenic culture of Blastocystis hominis in Iscove’s modified Dulbecco’s medium. Parasitol Res 1993; 79:614–616.

Zierdt CH, Swan JC, Hosseini J. In vitro response of Blastocystis hominis to antiprotozoal drugs. J Protozool 1983; 30:332–334.

Tan KS, Ng GC, Quek E, Howe J, Ramachandran NP, Yap EH et al.. Blastocystis hominis: a simplified, high-efficiency method for clonal growth on solid agar. Exp Parasitol 2000; 96:9–15.

Hirata T, Nakamura H, Kinjo N, Hokama A, Kinjo F, Yamane N et al. Prevalence of Blastocystis hominis and Strongyloides stercoralis infection in Okinawa, Japan. Parasitol Res 2007; 101:1717–1719.

Lanuza MD, Carbajal JA, Villar J, Borrás R. Description of an improved method for Blastocystis hominis culture and axenization. Parasitol Res 1997; 83:60–63.

Chen XQ, Singh M, Ho LC, Tan SW, Ng GC, Moe KT, et al. Description of a Blastocystis species from Rattus norvegicus. Parasitol Res 1997; 83:313–318.

Ng GC, Tan KS. Colony growth as a step towards axenization of Blastocystis isolates. Parasitol Res 1999; 85:678–679.

Teow WL, Ng GC, Chan PP, Chan YC, Yap EH, Zaman V et al. A survey of Blastocystis in reptiles. Parasitol Res 1992; 78:453–455.

Petersen AM, Stensvold CR, Mirsepasi H, Engberg J, Friis-Møller A, Porsbo LJ, et al. Active ulcerative colitis associated with low prevalence of Blastocystis and Dientamoeba fragilis infection. Scand J Gastroenterol 2013; 48(5):638–639.

Scanlan PD, Stensvold CR, Rajilić-Stojanović M, Heilig HGHJ, De Vos WM, O’Toole PW, et al. The microbial eukaryote Blastocystis is a prevalent and diverse member of the healthy human gut microbiota. FEMS Microbiol Ecol 2014; 90(1):326–30.

Kappus KK, Juranek DD, Roberts JM. Results of testing for intestinal parasites by state diagnostic laboratories, United States, 1987. MMWR CDC Surveill Summ. 1991; 40(4):25–45.

Amin OM. Seasonal prevalence of intestinal parasites in the United States during 2000. Am J Trop Med Hyg 2002; 66(6):799–803.

Lagace-Wiens PR, VanCaeseele PG, Koschik C. Dientamoeba fragilis: an emerging role in intestinal disease. Can Med Assoc J 2006; 175(5):468–469.

Kurniawan A, Karyadi T, Dwintasari SW, Sari IP, Yunihastuti E, Djauzi S. et al. Intestinal parasitic infections in HIV/AIDS patients presenting with diarrhoea in Jakarta, Indonesia. Trans R Soc Trop Med Hyg 2009; 103:892–898.

Tasova Y, Sahin B, Koltas S, Paydas S. Clinical significance and frequency of Blastocystis hominisin Turkish patients with hematological malignancy. Acta Med Okayama 2000; 54:

–136.

Pegelow K, Gross R, Pietrzik K, Lukito W, Richards AL, Fryauff DJ. Parasitological and nutritional situation of school children in the Sukaraja district, West Java, Indonesia. Southeast Asian J Trop Med Public Health 1997; 28:173–190.

Wong H, Ng GC, Lin RT, Yoshikawa H, Taylor MB, Tan KS. Predominance of subtype 3 among Blastocystis isolates from a major hospital in Singapore. Parasitol Res 2008; 102:663–670.

Mirjana Stojšić. The role Blastocistis hominis in the development of colitis in children. PhD Thesis, Medical Faculty, University of Novi Sad, 2016.

Tasić S, Miladinović-Tasić N, Zdravković D, Tasić A, Mišić M. Prevalence of infection by Blastocystis hominis parasite, III Macedonian Congress of preventive medicine 2006; (492):136.




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