Advertisement

Blastocystis hominis as a cause of hypoalbuminemia and anasarca

  • E. Nassir
  • J. Awad
  • A. B. Abel
  • J. Khoury
  • M. Shay
  • F. Lejbkowicz
Concise Article

Abstract

The protozoan Blastocystis hominis has been considered nonpathogenic, but this classification has come under scrutiny in light of reports in the medical literature indicating it could be the cause of intestinal disorders and, in one case, hypoalbuminemia. Reported here is a severe case of infection with B. hominis that caused acute gastroenteritis with prolonged diarrhea, hypoalbuminemia and anasarca. The diagnosis was based on the parasitological finding, since no other pathological evidence was found. The patient responded favorably to treatment with metronidazole for 10 days. This case supports the idea that B. hominis should be considered as a cause of opportunistic infection in debilitated patients despite the controversy surrounding its pathogenicity.

Keywords

Human Immunodeficiency Virus Methylene Blue Irritable Bowel Syndrome Stool Sample Enteric Pathogen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work is dedicated to Alter L. Lejbkowicz in memorium.

References

  1. 1.
    Zierdt CH (1988) Blastocystis hominis, a long-misunderstood intestinal parasite. Parasitol Today 4:15–17CrossRefGoogle Scholar
  2. 2.
    Windsor JJ, Macfarlane L, Whiteside TM, Chalmers RM, Thomas AL, Joynson DH (2001) Blastocystis hominis: a common yet neglected human parasite. Br J Biomed Sci 58:129–130CrossRefPubMedGoogle Scholar
  3. 3.
    Waring L, Reed C (2001) Blastocystis hominis. Causative organism or harmless commensal? Aust Fam Physician 30:374PubMedGoogle Scholar
  4. 4.
    Qadri HS (1989) Clinical significance of Blastocystis hominis. J Clin Microbiol 27:2407–2409PubMedGoogle Scholar
  5. 5.
    Nimri LF, Batchoun R (1994) Intestinal colonization of symptomatic and asymptomatic school children with Blastocystis hominis. J Clin Microbiol 32:2865–2866PubMedGoogle Scholar
  6. 6.
    Lee MG, Rawlins SC, Didier M, DeCeulaer K (1990) Infective arthritis due to Blastocystis hominis. Ann Rheum Dis 49:192–193PubMedGoogle Scholar
  7. 7.
    Urbina D, Arzuza O, Young G, Parra E, Castro R, Puello M (2003) Rotavirus type A and other enteric pathogens in stool sample from children with acute diarrhea on the Colombian northern coast. Int Microbiol 6:27–32PubMedGoogle Scholar
  8. 8.
    Svenungsson B, Lagergren A, Ekwall E, Evengard B, Hedlund KO, Karnell A, Lofdahl S, Svensson L, Weintraub A (2000) Enteropathogens in adult patients with diarrhea and healthy control subjects: a 1-year prospective study in a Swedish clinic for infectious diseases. Clin Infect Dis 30:770–778CrossRefPubMedGoogle Scholar
  9. 9.
    Garavelli PL (1991) The therapy of blastocystosis. J Chemother 3(Suppl 1):245–246Google Scholar
  10. 10.
    Nimri LF (1993) Evidence of an epidemic of Blastocystis hominis infections in preschool children in northern Jordan. J Clin Microbiol 31:2706–2708PubMedGoogle Scholar
  11. 11.
    Khalifa AM (1999) Diagnosis of Blastocystis hominis by different staining techniques. J Egypt Soc Parasitol 29:157–165PubMedGoogle Scholar
  12. 12.
    Windsor JJ, Macfarlane L, Hughes-Thapa G, Jones SK, Whiteside TM (2002) Incidence of Blastocystis hominis in faecal samples submitted for routine microbiological analysis. Br J Biomed Sci 59:154–157PubMedGoogle Scholar
  13. 13.
    Suresh K, Smith H, Kumar S (2004) Comparison of methods for detecting Blastocystis hominis. Eur J Clin Microbiol Infect Dis 23. DOI 10.1007/s10096-004-1123-7Google Scholar
  14. 14.
    Vdovenko AA (2000) Blastocystis hominis: origin and significance of vacuolar and granular forms. Parasitol Res 86:8–10PubMedGoogle Scholar
  15. 15.
    Moe KT, Singh M, Howe J, Ho LC, Tan SW, Chen XQ, Yap EH (1999) Development of Blastocystis hominis cysts into vacuolar forms in vitro. Parasitol Res 85:103–108CrossRefPubMedGoogle Scholar
  16. 16.
    Wang KX, Li CP, Wang J, Cui YB (2002) Epidemiological survey of Blastocystis hominis in Huainan City, Anhui Province, China. World J Gastroenterol 8:928–932PubMedGoogle Scholar
  17. 17.
    Nigro L, Larocca L, Massarelli L, Patamia I, Minniti S, Palermo F, Cacopardo B (2003) A placebo-controlled treatment trial of Blastocystis hominis infection with metronidazole. J Travel Med 10:128–130PubMedGoogle Scholar
  18. 18.
    Ok UZ, Girginkardesler N, Balcioglu C, Ertan P, Pirildar T, Kilimcioglu AA (1999) Effect of trimethoprim–sulfamethaxazole in Blastocystis hominis infection. Am J Gastroenterol 94:3245–3247CrossRefPubMedGoogle Scholar
  19. 19.
    Wolfe MS (1982) The treatment of intestinal protozoan infections. Med Clin N Am 66:707–720PubMedGoogle Scholar
  20. 20.
    Albrecht H, Stellbrink HJ, Koperski K, Greten H (1995) Blastocystis hominis in human immunodeficiency virus-related diarrhea. Scand J Gastroenterol 30:909–914PubMedGoogle Scholar
  21. 21.
    Cegielski JP, Msengi AE, Dukes CS, Mbise R, Redding-Lallinger R, Minjas JN, Wilson ML, Shao J, Durack DT (1993) Intestinal parasites and HIV infection in Tanzanian children with chronic diarrhea. AIDS 7:213–221PubMedGoogle Scholar
  22. 22.
    Levy Y, George J, Shoenfeld Y (1996) Severe Blastocystis hominis in an elderly man. J Infect 33:57–59PubMedGoogle Scholar
  23. 23.
    Cheng HS, Guo YL, Shin JW (2003) Hematological effects of Blastocystis hominis infection in male foreign workers in Taiwan. Parasitol Res 90:48–51PubMedGoogle Scholar
  24. 24.
    Sheehan DJ, Raucher BG, McKitrick JC (1986) Association of Blastocystis hominis with signs and symptoms of human disease. J Clin Microbiol 24:548–550PubMedGoogle Scholar
  25. 25.
    Arribas JM, Fernandez GH, Escalera GI, Pardilla AI, Martin TA, Gonzalez De La Rosa JB (2001) Acute infectious lymphocytosis associated to Giardia lamblia and Blastocystis hominis coinfection [Article in Spanish]. An Esp Pediatr 54:518–520Google Scholar
  26. 26.
    Kaneda Y, Horiki N, Cheng XJ, Fujita Y, Maruyama M, Tachibana H (2001) Ribodemes of Blastocystis hominis isolated in Japan. Am J Trop Med Hyg 65:393–396PubMedGoogle Scholar
  27. 27.
    Yoshikawa H, Abe N, Iwasawa M, Kitano S, Nagano I, Wu Z, Takahashi Y (2000) Genomic analysis of Blastocystis hominis strains isolated from two long-term health care facilities. J Clin Microbiol 38:1324–1330PubMedGoogle Scholar
  28. 28.
    Tasova Y, Sahin B, Koltas S, Paydas S (2000) Clinical significance and frequency of Blastocystis hominis in Turkish patients with hematological malignancy. Acta Med Okayama 54:133–136PubMedGoogle Scholar
  29. 29.
    Menon BS, Abdullah MS, Mahamud F, Singh B (1999) Intestinal parasites in Malaysian children with cancer. J Trop Pediatr 45:241–242PubMedGoogle Scholar
  30. 30.
    Horiki N, Kaneda Y, Maruyama M, Fujita Y, Tachibana H (1999) Intestinal blockage by carcinoma and Blastocystis hominis infection. Am J Trop Med Hyg 60:400–402PubMedGoogle Scholar
  31. 31.
    Giacometti A, Cirioni O, Fiorentini A, Fortuna M, Scalise G (1999) Irritable bowel syndrome in patients with Blastocystis hominis infection. Eur J Clin Microbiol Infect Dis 18:436–439CrossRefPubMedGoogle Scholar
  32. 32.
    Cirioni O, Giacometti A, Drenaggi D, Ancarani F, Scalise G (1999) Prevalence and clinical relevance of Blastocystis hominis in diverse patient cohorts. Eur J Epidemiol 15:389–393PubMedGoogle Scholar
  33. 33.
    Taamasri P, Leelayoova S, Rangsin R, Naaglor T, Ketupanya A, Mungthin M (2002) Prevalence of Blastocystis hominis carriage in Thai army personnel based in Chonburi, Thailand. Mil Med 167:643–646PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • E. Nassir
    • 1
  • J. Awad
    • 1
  • A. B. Abel
    • 2
  • J. Khoury
    • 3
  • M. Shay
    • 1
  • F. Lejbkowicz
    • 2
    • 4
  1. 1.Department of Internal MedicineWestern Galilee HospitalNahariyaIsrael
  2. 2.Clinical Microbiology LaboratoryWestern Galilee HospitalNahariyaIsrael
  3. 3.Institute for Nuclear MedicineWestern Galilee HospitalNahariyaIsrael
  4. 4.Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael

Personalised recommendations