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February 2016 Vol. 37 No.1 FEBRUARY 2016 FEBRUARY VOL. 37 No. 1 Pages 1 - 32 AUSTRALIAN JOURNAL OF MEDICAL SCIENCE 1 - 32 AUSTRALIAN 37 No. 1 Pages VOL. ORIGINAL ARTICLE ORIGINAL ARTICLE HAEMATOLOGY UPDATE Blastocystis hominis: the What are the potential outcomes A case of hairy cell leukaemia in fascinating enigma of allowing Australian consumers a 39 year old male direct access to community pathology services? HISTOLOGY UPDATE Small bowel diverticulum February 2016 Vol. 37 No.1 Vol. Australian Journal of Medical Science ADMINISTRATION CONTENTS AIMS National Office February 2016 Vol. 37 No. 1 Chief Executive: Mr Edward Fraser MBA BAppSc GAICD AFCHSM Administration: Mr Keith Done Email: [email protected] Website: www.aims.org.au Original Articles Telephone: 61 7 3876 2988 Blastocystis hominis: the fascinating enigma Facsimile: 61 7 3876 2999 Address: PO Box 1911 Milton Qld 4064 Australia James B Sinclair 2 Editorial Board Editors Mr John Stirling, BSc(Hons) MLett AFRCPA MAIMS FRS-SA What are the potential outcomes of allowing Australian consumers Honorary Lecturer direct access to community pathology services? Flinders University, South Australia A review of patient initiated testing Assoc Prof Tony Woods, BA BSc(Hons) PhD MAIMS FFSc(RCPA) Associate Head, School of Pharmacy and Medical Sciences Sue Drummond 14 University of South Australia Board Members Haematology Update Dr Ross Brown, PhD MSc MBA FAIMS FFSc(RCPA) Principal Hospital Scientist A case of hairy cell leukaemia in a 39-year-old male Royal Prince Alfred Hospital Gillian Rozenberg 20 Ms Robyn Wells, BAppSc MAIMS General Haematology Pathology Queensland Histology Update Princess Alexandra Hospital Small bowel diverticulum Assoc Prof Rob Siebers, PGCertPH, FNZIC, FNZIMLS, CBiol FSB Piero Nelva, Hock Kua, Ann Niap, Stephen Bare 22 Research Associate Professor School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand Editor, NZ Journal of Medical Laboratory Science Regular Features Dr Richard Bradbury, BBMedSc PhD FFSc (RCPA) FASM MAIMS* Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention Book Reviews 24 Atlanta, Georgia United States of America. Journal Based CPD No. 47 25 *in his personal capacity Prof Adrian Esterman, PhD AStat DLSHTM Books for Review 27 Foundation Chair of Biostatistics School of Nursing and Midwifery Instructions to Authors 30 University of South Australia AJMS Statistical Adviser Dr Stuart D. Blacksell, BAppSc (MedLabSc) MPH PhD RBP FASM FACTM MAIMS Senior Researcher AIMS Mahidol-Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Fellowship 19 Dr Geoffrey Bosson MSc PhD CertHSM CertTQM CertT(HE) CSci MAIMS FIBMS School of Biomedical Sciences, Faculty of Medical Sciences, Newcastle University, Immunohaematology Quality Assurance Program 29 Newcastle upon Tyne, United Kingdom Advertising Index The Australian Journal of Medical Science is the official publication of the Australian Diagnostica Stago IFC Institute of Medical Scientists. Circulation 2000 per issue. The Journal is circulated to members in pathology InterSystems 13 laboratories, universities and research institutes throughout Australia and overseas. Annual subscription rates are available from the AIMS National Office. AACB/AIMS Combined Scientific Meeting IBC Article reprints may be organised on request from AIMS National Office. Advertising rates are available from AIMS National Office. Abstraction of the Australian Journal of Medical Science is through the following serial catalogue listings: Australasian Medical Index, Chemical Abstracts, and EMBASE/Excerpta Medica. The Australian Journal of Medical Science is listed on the Register of Refereed Journals by the Australian Commonwealth Department of Education Employment and Workplace Relations. ISSN 1038-1643 Printed by Westminster Eagle Eye Printing, PO Box 161, Paddington Qld 4064. Design Cover and layout design by Kim Brown, 23 Denman St Exeter SA 5019 kimbo@ internode.on.net. Cover photograph courtesy of Prof Ian Gibbins, Flinders Medical Centre, Adelaide. Instructions to authors are available on the AIMS website www.aims.org.au Copyright: All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic, mechanical, including photocopying, recording, or by an information storage and retrieval system, without permission in writing from the AIMS. Copyright by the Australian Institute of Medical Scientists, 2016. Disclaimer: The opinions expressed in this Journal including those of the technological and advertisement sections are not necessarily those of the Editorial Board. Australian Journal of Medical Science February 2016 Vol. 37 No. 1 1 ORIGINAL ARTICLE Blastocystis hominis: the fascinating enigma James B Sinclair Central Queensland University, Rockhampton, Queensland Abstract This paper is a concise review of the accumulated studies for Blastocystis hominis, summarising the controversial issues, widely accepted theories, and prospective research for this organism. B. hominis is a common, albeit enigmatic and perplexing intestinal parasite that has confounded classification with a plethora of discordant studies. B. hominis is comprised of seven morphological forms and thirteen subtypes, nine of which are found in the lower gastrointestinal tract of humans, with subtypes one, three and four being controversially theorised as causing disease. Ingestion is via the faecal-oral route with reported enteric symptoms generally relating to gastrointestinal pathology and infection. This correlates with the immunocompromised patient, zoonotic transmission, and abased or unsanitary living conditions associated with faecal contaminated water. Standard laboratory diagnosis is by direct microscopy of samples; however recovering the small and morphologically disguised cyst forms are difficult and false negative reports are common.Alternative diagnostic techniques include in vitro cultivation, genotyping by polymerase chain reaction (PCR), and enzyme linked immunosorbent assay (ELISA) tests but there is no forthcoming consensus due to inherent problems of cost, time, sensitivity and specificity. Mainstream treatment is by metronidazole, however due to the inconclusive status of B. hominis pathogenicity, this is circumspectly indicated. Alternative treatments that have induced remission include nitazoxanide, paromomycin, trimethoprim, sulfamethoxazole, emetine dihydrochloride, iodoquinol, furazolidone, and dietary management. B. hominis has had prolific scientific attention and yet still presents a formidable and fascinating enigma with many exciting potential research projects that beckon the ambitious scientist. Keywords: Blastocystis, Blastocystis hominis, gastrointestinal diseases, parasite, immunocompromised patient, protozoa, cysts, microscopy, PCR Introduction ingestion is via the faecal-oral route which is speculated B. hominis is a chloroplastic alga that belongs to to cause predominately gastrointestinal symptoms the phylum Stramenopila and is the most common (Chen et al 2014) and in the immunocompromised, parasite found in the lower gastrointestinal tract of links have been made to irritable bowel syndrome (IBS), humans (Poirier et al 2012). B. hominis is distributed and colon carcinoma (Engsbro et al 2014, El-Gayar and globally with a human infection prevalence of 1.5-10% Mahmoud 2014). B. hominis has been morphologically and 30-50% for developed and developing countries distinguished into some seven forms: cyst intermediate, respectively (Chen et al 2014). The correlation of cyst, avacuolar, vacuolar, multivacuolar, granular, and pathogenicity with B. hominis is controversial because amoeboid (Stensvold et al 2012). it can be found in individuals with or without enteric symptoms. It has been surmised that this variation may Genotypically, B. hominis comprises 13 subtypes be due to the aetiological effects produced by different (ST1-ST13) with subtypes ST1-ST9 found in humans strains of varying virulence (Fouad et al 2011). Parasitic and ST1 and ST4 often linked with intestinal disease (Stensvold et al 2012). Despite the indistinguishable morphology between subtypes, future taxonomic Address correspondence to: speciation may occur because of the large intra- James B. Sinclair subtype genetic variability (Stensvold et al 2012). B. Central Queensland University hominis infection can be self-limiting and if treatment Bruce Highway Rockhampton, QLD, 4750 is considered warranted antiprotozoal drugs such as Email: [email protected] metronidazole are prescribed often with ineffectual remedial benefits (Chen et al 2014, Roberts et al 2014). 2 Australian Journal of Medical Science February 2016 Vol. 37 No. 1 The purpose of this paper is to provide a balanced unknown pathological agents or conditions that are and concise appraisal of the current theories of B. found to co-populate the stool sample in patients with hominis in regards to its potential pathogenicity in gastrointestinal disease, even if these alternate causes humans and to promote the reader’s motivation into in comparison to B. hominis represent a population further study of this perplexing parasite. minority (Mirza and Tan 2012, Stenzel and Boreham 1996). Clinical disease expression in humans Epidemiology Blastocystosis refers to the symptomatic infection B. hominis is a strictly anaerobic protozoan parasite with the parasite B. hominis with reported clinical found globally in the lower gastrointestinal tract of presentations
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