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Is paromomycin the drug of choice for eradication of Blastocystis in adults?

Abstract

Blastocystis is a protozoan parasite of controversial clinical significance that is often detected in stools of patients with gastrointestinal complaints. Patients infected with Blastocystis and persistent, unexplained gastrointestinal complaints are often treated with the intention to eradicate Blastocystis. However, there is no consensus on the most effective drug. We performed a retrospective follow-up study with a large cohort of patients in which the natural disease course and efficacy of treatment with either paromomycin, clioquinol, or metronidazole were evaluated. With an eradication rate of 77 %, treatment with paromomycin appeared significantly more effective than treatment with clioquinol (38 %), metronidazole (38 %), or no treatment (22 %). This study showed that (1) Blastocystis was frequently observed in the stools of our patient group (34 %), (2) spontaneous clearance of Blastocystis infections occurred only in a small proportion of patients (22 %), and therefore (3) drug treatment is required for more efficient eradication of Blastocystis. Paromomycin exhibited superior performance in comparison to both metronidazole and clioquinol.

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References

  1. Tan KS. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev. 2008;21:639–65.

    PubMed  Article  CAS  Google Scholar 

  2. Stensvold CR, Smith HV, Nagel R, Olsen KE, Traub RJ. Eradication of Blastocystis carriage with antimicrobials: reality or delusion? J Clin Gastroenterol. 2010;44:85–90.

    PubMed  Article  Google Scholar 

  3. 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.

    PubMed  Article  Google Scholar 

  4. Stensvold CR, Nielsen HV, Molbak K, Smith HV. Pursuing the clinical significance of Blastocystis—diagnostic limitations. Trends Parasitol. 2009;25:23–9.

    PubMed  Article  Google Scholar 

  5. Stensvold CR, Alfellani M, Clark CG. Levels of genetic diversity vary dramatically between Blastocystis subtypes. Infect Genet Evol. 2012;12:263–73.

    PubMed  Article  Google Scholar 

  6. Coyle CM, Varughese J, Weiss LM, Tanowitz HB. Blastocystis: to treat or not to treat. Clin Infect Dis. 2012;54:105–10.

    PubMed  Article  Google Scholar 

  7. Hassing RJ, Wismans PJ, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Comment on: frequency of enteric protozoan parasites among patients with gastrointestinal complaints in medical centers of Zahedan, Iran. Trans R Soc Trop Med Hyg 2009;103:1292–3 (author reply 1293–4).

    Google Scholar 

  8. 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;84:308–12.

    PubMed  Article  Google Scholar 

  9. Rossignol JF, Kabil SM, Said M, Samir H, Younis AM. Effect of nitazoxanide in persistent diarrhea and enteritis associated with Blastocystis hominis. Clin Gastroenterol Hepatol. 2005;3:987–91.

    PubMed  Article  CAS  Google Scholar 

  10. Nigro L, Larocca L, Massarelli L, Patamia I, Minniti S, Palermo F, et al. A placebo-controlled treatment trial of Blastocystis hominis infection with metronidazole. J Travel Med. 2003;10:128–30.

    PubMed  Article  Google Scholar 

  11. Heyland K, Friedt M, Buehr P, Braegger CP. No advantage for antibiotic treatment over placebo in Blastocystis hominis-positive children with recurrent abdominal pain. J Pediatr Gastroenterol Nutr. 2012;54:677–9.

    PubMed  Article  CAS  Google Scholar 

  12. van Gool T, Weijts R, Lommerse E, Mank TG. Triple Faeces Test: an effective tool for detection of intestinal parasites in routine clinical practice. Eur J Clin Microbiol Infect Dis. 2003;22:284–90.

    PubMed  Google Scholar 

  13. Mirza H, Teo JD, Upcroft J, Tan KS. A rapid, high-throughput viability assay for Blastocystis spp. reveals metronidazole resistance and extensive subtype-dependent variations in drug susceptibilities. Antimicrob Agents Chemother. 2011;55:637–48.

    PubMed  Article  CAS  Google Scholar 

  14. Stenzel DJ, Boreham PF. Blastocystis hominis revisited. Clin Microbiol Rev. 1996;9:563–84.

    PubMed  CAS  Google Scholar 

  15. van Hellemond JJ, Molhoek N, Koelewijn R, Wismans PJ, van Genderen PJJ. Is paromomycin the drug of choice for eradication of Dientamoeba fragilis in adults? Int J Parasitol Drugs Drug Resist. 2012;2:162–5.

    Article  Google Scholar 

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Conflict of interest

The Port of Rotterdam is acknowledged for its financial support of this study.

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Correspondence to Jaap J. van Hellemond.

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van Hellemond, J.J., Molhoek, N., Koelewijn, R. et al. Is paromomycin the drug of choice for eradication of Blastocystis in adults?. J Infect Chemother 19, 545–548 (2013). https://doi.org/10.1007/s10156-012-0496-2

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  • DOI: https://doi.org/10.1007/s10156-012-0496-2

Keywords

  • Blastocystis
  • Paromomycin
  • Metronidazole
  • Clioquinol
  • Diarrhea
  • Chronic gastrointestinal complaints