It is not clear that Blastocystis remains without damage to the digestive tract or has a pathogenic effect in relation to subtypes in immunocompromised people, such as cancer patients. The present study aimed to investigate the frequency and subtype distribution of Blastocystis in cancer patients who were followed-up and treated in the Oncology clinic of Firat University Hospital and to determine the clinical signs of infected sufferers.
201 patients aged ≥ 18 with a diagnosis of cancer were enrolled in this cross-sectional study. Patients’ stool samples were examined between September 2017 and August 2019 by native-Lugol, trichrome staining. Microscopy-positive stool samples were subjected to DNA isolation and subtyped by Sequence Tagged Site (STS)-PCR analysis. The symptoms and demographic characteristics of the patients were also evaluated.
Totally, 29 (14.4%) samples were positive for Blastocystis after all methods. 15 (51.7%) out of 29 samples were successfully subtyped by the sequenced-tagged site(STS)-PCR, while 14 (48.3%) could not be typed. Three subtypes of Blastocystis were detected: ST3 (40%), ST2 (33%), ST1 (20%), and one mixed infections with ST1/ST2 (6%). There was no statistically significant difference in terms of clinical findings and demographic characteristics.
The outcomes of our study promote the idea that Blastocystis could be an asymptomatic and harmless commensal organism. However, more comprehensive molecular and clinical studies are needed to fully determine the pathogenicity and epidemiology of Blastocystis in cancer patients.
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Ertug S, Malatyali E, Ertabaklar H, Caliskan SO, Bozdogan B (2015) Subtype distribution of Blastocystis isolates and evaluation of clinical symptoms detected in Aydin province. Turkey Mikrobiyol Bul 49(1):98–104. https://doi.org/10.5578/mb.8532
Denoeud F, Roussel M, Noel B, Wawrzyniak I, Da Silva C, Diogon M, Viscogliosi E, Brochier-Armanet C, Couloux A, Poulain J (2011) Genome sequence of the stramenopile Blastocystis, a human anaerobic parasite. Genome Biol 12(3):R29. https://doi.org/10.1186/gb-2011-12-3-r29
Aydin M, Yazici M, Demirkazik M, Koltas IS, Cikman A, Gulhan B, Duran T, Yilmaz A, Kara M (2019) Molecular characterization and subtyping of Blastocystis in urticarial patients in Turkey. Asian Pac J Trop Dis 12(10):450. https://doi.org/10.4103/1995-7645.269905
Cakir F, Cicek M, Yildirim IH (2019) Determination the subtypes of Blastocystis sp. and evaluate the effect of these subtypes on pathogenicity. Acta Parasitol 64(1):7–12. https://doi.org/10.2478/s11686-018-00002-y
Poirier P, Wawrzyniak I, Vivarès CP, Delbac F, El Alaoui H (2012) New insights into Blastocystis spp.: a potential link with irritable bowel syndrome. PLoS Pathog 8(3):e1002545. https://doi.org/10.1371/journal.ppat.1002545
El Safadi D, Cian A, Nourrisson C, Pereira B, Morelle C, Bastien P, Bellanger A-P, Botterel F, Candolfi E, Desoubeaux G (2016) Prevalence, risk factors for infection and subtype distribution of the intestinal parasite Blastocystis sp. from a large-scale multi-center study in France. BMC Infect Dis 16(1):451. https://doi.org/10.1186/s12879-016-1776-8
Yersal O, Malatyali E, Ertabaklar H, Oktay E, Barutca S, Ertug S (2016) Blastocystis subtypes in cancer patients: analysis of possible risk factors and clinical characteristics. Parasitol Int 65(6):792–796. https://doi.org/10.1016/j.parint.2016.02.010
Abdulsalam AM, Ithoi I, Al-Mekhlafi HM, Al-Mekhlafi AM, Ahmed A, Surin J (2013) Subtype distribution of Blastocystis isolates in Sebha. Libya PLoS One 8(12):e84372. https://doi.org/10.1371/journal.pone.0084372
El Safadi D, Gaayeb L, Meloni D, Cian A, Poirier P, Wawrzyniak I, Delbac F, Dabboussi F, Delhaes L, Seck M (2014) Children of Senegal River Basin show the highest prevalence of Blastocystis sp. ever observed worldwide. BMC Infect Dis 14(1):164. https://doi.org/10.1186/1471-2334-14-164
Eassa SM, Masry S (2016) Blastocystis hominis among immunocompromised and immunocompetent children in Alexandria. Egypt Ann Clin Lab Res 4(2):92. https://doi.org/10.21767/2386-5180.100092
Stensvold CR, Clark CG (2016) Current status of Blastocystis: a personal view. Parasitol Int 65(6):763–771. https://doi.org/10.1016/j.parint.2016.05.015
Stensvold CR (2013) Blastocystis: genetic diversity and molecular methods for diagnosis and epidemiology. Trop Parasitol 3(1):26. https://doi.org/10.4103/2229-5070.113896
Stensvold CR, Clark CG (2020) Pre-empting pandora’s box: Blastocystis subtypes revisited. Trends Parasitol 36(3):229–232. https://doi.org/10.1016/j.pt.2019.12.009
Maloney JG, Molokin A, da Cunha MJR, Cury MC, Santin M (2020) Blastocystis subtype distribution in domestic and captive wild bird species from Brazil using next generation amplicon sequencing. Parasite Epidemiol Control 9:e00138. https://doi.org/10.1016/j.parepi.2020.e00138
Lhotská Z, Jirků M, Hložková O, Brožová K, Jirsová D, Stensvold CR, Kolísko M, Jirků Pomajbíková K (2020) A Study on the prevalence and subtype diversity of the intestinal protist Blastocystis sp. in a gut-healthy human population in the Czech Republic. Front Cell Infect Microbiol. https://doi.org/10.3389/fcimb.2020.544335
Ramírez JD, Sánchez A, Hernández C, Flórez C, Bernal MC, Giraldo JC, Reyes P, López MC, García L, Cooper PJ (2016) Geographic distribution of human Blastocystis subtypes in South America. Infect Genet Evol 41:32–35. https://doi.org/10.1016/j.meegid.2016.03.017
Yoshikawa H, Tokoro M, Nagamoto T, Arayama S, Asih PB, Rozi IE, Syafruddin D (2016) Molecular survey of Blastocystis sp. from humans and associated animals in an Indonesian community with poor hygiene. Parasitol Int 65(6):780–784. https://doi.org/10.1016/j.parint.2016.03.010
Villanueva-Garcia C, Gordillo-Chavez EJ, Lopez-Escamilla E, Rendon-Franco E, Muñoz-Garcia CI, Gama L, Martinez-Flores WA, Gonzalez-Rodriguez N, Romero-Valdovinos M, Diaz-Lopez H (2017) Clarifying the cryptic host specificity of Blastocystis spp. isolates from Alouatta palliata and A. pigra howler monkeys. PLoS ONE 12(1):e0169637. https://doi.org/10.1371/journal.pone.0169637
Dagci H, Özgür K, Demirel M, Mandiracioglu A, Aydemir S, Ulas S, Aldert B, Tom V (2014) Epidemiological and diagnostic features of Blastocystis infection in symptomatic patients in Izmir province. Turkey Iran J Parasitol 9(4):519
Yazar S, Kuk S, Miman Ö, Saygı G (2016) SAYGI’nın Temel Tıbbi PARAZİTOLOJİ’si, vol 1. Erciyes Üniversitesi, Kayseri
WHO (2011) Guidelines for Drinking-water Quality. Water Sanitation Health, FOURTH edn.,
Mehlhorn H, Tan KS, Yoshikawa H (2012) Blastocystis: pathogen or passenger?: an evaluation of 101 years of research, vol 4. Springer Science & Business Media, London
Tan T, Ong S, Suresh K (2009) Genetic variability of Blastocystis sp. isolates obtained from cancer and HIV/AIDS patients. Parasitol. Res 105(5):1283. https://doi.org/10.1007/s00436-009-1551-5
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(3):133–136. https://doi.org/10.18926/AMO/32298
Poirier P, Wawrzyniak I, Albert A, El Alaoui H, Delbac F, Livrelli V (2011) Development and evaluation of a real-time PCR assay for detection and quantification of Blastocystis parasites in human stool samples: prospective study of patients with hematological malignancies. J Clin Microbiol 49(3):975–983. https://doi.org/10.1128/JCM.01392-10
Chandramathi S, Suresh K, Anita ZB, Kuppusamy UR (2012) Infections of Blastocystis hominis and microsporidia in cancer patients: are they opportunistic? Trans R Soc Trop Med Hyg 106(4):267–269. https://doi.org/10.1016/j.trstmh.2011.12.008
Yoshikawa H, Wu Z, Kimata I, Iseki M, Ali IKM, Hossain MB, Zaman V, Haque R, Takahashi Y (2004) Polymerase chain reaction-based genotype classification among human Blastocystis hominis populations isolated from different countries. Parasitol Res 92(1):22–29. https://doi.org/10.1007/s00436-003-0995-2
Tatar M, Tatar F (2010) Colorectal cancer in Turkey: current situation and challenges for the future. Eur J Health Econ 10(Suppl 1):S99-105. https://doi.org/10.1007/s10198-009-0197-7
Tasić N, Milenković T, Bujić V, Zdravković D, Tasić A (2016) Blastocystis hominis: a mysterious and commonly disregarded parasite. Facta Univ Med Biol. https://doi.org/10.22190/FUMB161027001T
Wawrzyniak I, Poirier P, Viscogliosi E, Dionigia M, Texier C, Delbac F, Alaoui HE (2013) Blastocystis, an unrecognized parasite: an overview of pathogenesis and diagnosis. Ther Adv Infect Dis 1(5):167–178. https://doi.org/10.1177/2049936113504754
Parija SC, Jeremiah S (2013) Blastocystis: taxonomy, biology and virulence. Trop Parasitol 3(1):17. https://doi.org/10.4103/2229-5070.113894
Adiyaman Korkmaz G, Dogruman Al F, Mumcuoglu I (2015) Diski örneklerinde Blastocystis spp. varliginin mikroskobik, kültür ve moleküler yöntemlerle arastirilmasi. Mikrobiyol Bul. https://doi.org/10.5578/mb.8439
Souppart L, Sanciu G, Cian A, Wawrzyniak I, Delbac F, Capron M, Dei-Cas E, Boorom K, Delhaes L, Viscogliosi E (2009) Molecular epidemiology of human Blastocystis isolates in France. Parasitol Res 105(2):413. https://doi.org/10.1007/s00436-009-1398-9
Parkar U, Traub R, Kumar S, Mungthin M, Vitali S, Leelayoova S, Morris K, Thompson R (2007) Direct characterization of Blastocystis from faeces by PCR and evidence of zoonotic potential. Parasitology 134(3):359–367. https://doi.org/10.1017/S0031182006001582
Santos HJ, Rivera WL (2013) Comparison of direct fecal smear microscopy, culture, and polymerase chain reaction for the detection of Blastocystis sp. in human stool samples. Asian Pac J Trop Med. 6(10):780–784. https://doi.org/10.1016/S1995-7645(13)60138-8
Yoshikawa H, Dogruman-Ai F, Turk S, Kustimur S, Balaban N, Sultan N (2011) Evaluation of DNA extraction kits for molecular diagnosis of human Blastocystis subtypes from fecal samples. Parasitol Res 109(4):1045–1050. https://doi.org/10.1007/s00436-011-2342-3
Stensvold CR (2013) Comparison of sequencing (barcode region) and sequence-tagged-site PCR for Blastocystis subtyping. J Clin Microbiol 51(1):190–194. https://doi.org/10.1128/jcm.02541-12
Koltas I, Ozcan K, Tanrtverdi S, Paydas S, Paydas S, Baslamtslt F (1999) The prevalence of Blastocystis hominis in immunosupressed patients. Ann Med Sci 8(2):117–119
Zhang W, Ren G, Zhao W, Yang Z, Shen Y, Sun Y, Liu A, Cao J (2017) Genotyping of Enterocytozoon bieneusi and subtyping of Blastocystis in cancer patients: relationship to diarrhea and assessment of zoonotic transmission. Front Microbiol 8:1835. https://doi.org/10.3389/fmicb.2017.01835
Kumarasamy V, Roslani AC, Rani KU, Govind SK (2014) Advantage of using colonic washouts for Blastocystis detection in colorectal cancer patients. Parasit Vectors 7(1):162. https://doi.org/10.1186/1756-3305-7-162
Shaker D, Anvari D, Hosseini SA, Fakhar M, Mardani A, Hezarjaribi HZ, Gholami S, Gholami S (2019) Frequency and genetic diversity of Blastocystis subtypes among patients attending to health centers in Mazandaran, northern Iran. J Parasit Dis. https://doi.org/10.1007/s12639-019-01123-5
Özyurt M, Kurt Ö, Mølbak K, Nielsen HV, Haznedaroglu T, Stensvold CR (2008) Molecular epidemiology of Blastocystis infections in Turkey. Parasitol Int 57(3):300–306. https://doi.org/10.1016/j.parint.2008.01.004
Alfellani MA, Stensvold CR, Vidal-Lapiedra A, Onuoha ESU, Fagbenro-Beyioku AF, Clark CG (2013) Variable geographic distribution of Blastocystis subtypes and its potential implications. Acta Trop 126(1):11–18. https://doi.org/10.1016/j.actatropica.2012.12.011
Mohamed AM, Ahmed MA, Ahmed SA, Al-Semany SA, Alghamdi SS, Zaglool DA (2017) Predominance and association risk of Blastocystis hominis subtype I in colorectal cancer: a case control study. Infect Agent Cancer 12(1):21. https://doi.org/10.1186/s13027-017-0131-z
Boral ÖB, Payçu DGÇ, Akgül A, İşsever H (2017) Blastocystis spp. saptanan 50 semptomatik hastada subtip dağilimin saptanmasi. KOU Sag Bil Derg 3(1):6–10. https://doi.org/10.30934/KUSBED.359174
Li L-H, Zhou X-N, Du Z-W, Wang X-Z, Wang L-B, Jiang J-Y, Yoshikawa H, Steinmann P, Utzinger J, Wu Z (2007) Molecular epidemiology of human Blastocystis in a village in Yunnan province. China Parasitol Int 56(4):281–286. https://doi.org/10.1016/j.parint.2007.06.001
Zhan T, Liu T, Shi H, He S, Yan H, Liu D (2014) PCR-based genotype classification of Blastocystis hominis isolates from college students of Guangxi. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 32(3):209–211
Tan KS, Mirza H, Teo JD, Wu B, MacAry PA (2010) Current views on the clinical relevance of Blastocystis spp. Curr Infect Dis Rep 12(1):28–35. https://doi.org/10.1007/s11908-009-0073-8
Andersen LOB, Stensvold CR (2016) Blastocystis in health and disease: are we moving from a clinical to a public health perspective? J Clin Microbiol 54(3):524–528. https://doi.org/10.1128/JCM.02520-15
Dogan N, Aydin M, Tuzemen NU, Dinleyici EC, Oguz I, Dogruman-Al F (2017) Subtype distribution of Blastocystis spp. isolated from children in Eskisehir. Turkey. Parasitol Int 66(1):948–951. https://doi.org/10.1016/j.parint.2016.10.008
Asghari A, Zare M, Hatam G, Shahabi S, Gholizadeh F, Motazedian M (2020) Molecular identification and subtypes distribution of Blastocystis sp. isolated from children and adolescent with cancer in Iran: evaluation of possible risk factors and clinical features. Acta Parasitol. https://doi.org/10.2478/s11686-020-00186-2
We are grateful to Adnan Yüksel Gürüz and Mert Döşkaya for help in the field and laboratory work.
This work was funded by scientific and technological research council of Turkey (TUBITAK) (Grant 315S262).
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The authors declare that they have no conflict of interest.
The present study was approved by Fırat University Clinical Research Ethics Committee ( Protocol No: 2017/14-03).
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Mülayim, S., Aykur, M., Dağcı, H. et al. Investigation of Isolated Blastocystis Subtypes from Cancer Patients in Turkey. Acta Parasit. (2021). https://doi.org/10.1007/s11686-020-00322-y