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An Emerging Or Re-Emerging Potential Zoonosis? Veterinaria Italiana, 44 (4), 679‐684 Blastocystosis: an emerging or re‐emerging potential zoonosis? Constantine M. Vassalos(1, 2), Chryssanthy Papadopoulou(1) & Nicholas C. Vakalis(2) Summary Blastocistosi (infezione da Blastocystis sp. is an intestinal protozoa that was formerly recognised as a yeast. However, Blastocystis sp.): potenziale it has since been classified in the Stramenopile zoonosi emergente o Kingdom. In addition to being observed in riemergente? humans, the disease has been diagnosed in a wide range of animals (mammals, amphibians, Riassunto birds, reptiles and arthropods). Extensive Blastocystis sp. è un protozoo intestinale noto un genetic heterogeneity has been demonstrated. tempo come lievito. Viene tuttavia classificato tra Βlastocystis sp. subtypes 1 to 9 were recently gli Stramenofili. E’ stato isolato nell’ uomo e in considered to be of zoonotic origin. While molti animali (mammiferi, anfibi, uccelli, rettili e some suggested that Blastocystis might play a artropodi); inoltre ne è stata provata una vasta pathogenic role in intestinal disorders in eterogeneità genetica. Studi recenti hanno humans, others reported that there was no dimostrato l’origine zoonotica di Βlastocystis sp. correlation. Furthermore, amoeboid forms of nei sottotipi da 1 a 9. Alcuni ricercatori suggeriscono Blastocystis might be implicated in che nell’uomo Blastocystis possa svolgere un ruolo pathogenesis. In spite of recent reports, earlier di patogeno in disordini intestinali; altri, al data on the prevalence of the parasite suggest contrario, che non vi sia alcuna correlazione; inoltre that blastocystosis could have occurred le ricerche hanno suggerito che le forme ameboidi di sporadically or continuously in the past. It Blastocystis potrebbero essere implicate nella might be speculated that in cases of zoonotic patogenesi. A differenza di quanto sostenuto da genotypes producing amoeboid forms, studi recenti, i dati iniziali sulla prevalenza del Blastocystis sp. infection might rather be parassita indicano che la blastocistosi potrebbe considered a potential re‐emerging zoonosis. essersi verificata , in passato, in maniera sporadica o ricorrente. In conclusione si può sostenere che nel Keywords caso di genotipi zoonotici che producono forme Amoeba, Blastocystis, Culture, Public health, ameboidi di Blastocystis sp., lʹinfezione potrebbe Travel, Zoonosis. essere considerata piuttosto una potenziale zoonosi riemergente. Parole chiave Ameboide, Blastocystis, Coltura, Sanità pubblica, Viaggio, Zoonosi. (1) Department of Microbiology, Medical School, University of Ioannina, Dourouti University Campus, 45110 Ioannina, Greece [email protected] (2) Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health, 196 Alexandras Av., 11521 Athens, Greece © IZS A&M 2008 www.izs.it/vet_italiana Vol. 44 (4), Vet Ital 679 Blastocystosis: an emerging or re‐emerging potential zoonosis? Constantine M. Vassalos, Chryssanthy Papadopoulou & Nicholas C. Vakalis Introduction Epidemiology Blastocystis is an intestinal protozoan once Blastocystis sp. infection is reported worldwide recognised as yeast (2). It has recently been (36). Blastocystis sp. infection prevalence varied classified in the Kingdom Stramenopiles (1). widely, depending on the country. Early All Blastocystis isolates were considered of reports from developed countries gave lower zoonotic origin (37). Wild and domesticated levels of prevalence of Blastocystis animals have been demonstrated to be (approximately 1.5‐10%), while it seemed more reservoirs for Blastocystis (37). Furthermore, prevalent (approximately 30‐50%) in Blastocystis isolates from humans and developing countries (36). Current data show mammals, amphibians, birds, reptiles and low prevalence rates of Blastocystis sp. arthropods have been reported (37). Since infection in Japan and Hawaii, while high Blastocystis isolates from humans and animals prevalence rates were recorded in Argentina, have been found to be included in all Chile, Malaysia and Turkey (5, 15, 23, 27, 29, Blastocystis sp. subtypes, it was suggested that 30, 32, 33). In addition, Blastocystis sp. is has low host specificity could be a feature of the been detected in Romanian and Turkish parasite (28). Moreover, there was evidence parasitology laboratories (7, 10). Several that Blastocystis organisms from animals could reports, including some very early data, infect humans and vice‐versa (28). showed regions of high Blastocystis endemicity Genetic variability (46). Epidemics attributed to human Blastocystis were reported in the early studies, High genotype polymorphism has been but outbreaks of infection appear to be observed among morphological identical uncommon (34, 46). Cases of clinical blasto‐ Blastocystis isolates from humans and animals cystosis have been referred to sporadically. (37, 38). Blastocystis isolates from reptiles and However, an increase in the number of cases of amphibians are also included in phylogenetic Blastocystis sp. infection recently observed both tree branches (44). In addition, small subunit in developed and in developing countries (ssu) rRNA gene sequence variability observed could be due to the improved testing methods in morphologically similar human Blastocystis and to animal trade (3, 11, 45). isolates might imply that the genus Blastocystis In animals, the prevalence of Blastocystis includes many different species (28). Since appeared to vary from animal to animal (37). extensive genetic heterogeneity has been demonstrated, mammalian and avian isolates Studies revealed that the prevalence of have been identified as Blastocystis sp. with a Blastocystis sp. infection is high among standardised subtype number in Arabic laboratory rats (60%), pigs (70‐95%) and birds numerals, such as 1 to 9, without further (50‐100%) (37). It was also demonstrated that the prevalence of Blastocystis in dogs and in subtype subclassification (6, 35, 44). Thus, cattle differs from country to country (37). Blastocystis organisms might adapt and survive Furthermore, an epizootic with mortalities was at different temperatures (44). reported in a primate colony (46). No correlation has been found between the country of origin of Blastocystis isolates and the Population at risk variety of Blastocystis sp. genotypes Travellers to developing tropical countries encountered in different areas of the world. were thought to be more prone to diarrhoea Besides, different genotypes have been associated with Blastocystis (34). A high reported in the same country (14). Our results percentage of Blastocystis infection was found from genotyped Blastocystis isolates in faecal in soldiers transferred to endemic countries or specimens from humans in Greece (22) were in regions, such as Egypt, the Middle East and agreement with observations that had been Central America (34). Blastocystis was also reported previously in that subtype 3 was the highly prevalent among refugees and predominant genotype, whereas zoonotic immigrants (36). An extremely high Blastocystis genotypes were observed occasionally. prevalence was noted in pre‐school children 680 Vol. 44 (4), Vet Ital www.izs.it/vet_italiana © IZS A&M 2008 Constantine M. Vassalos, Chryssanthy Papadopoulou Blastocystosis: an emerging or re‐emerging potential zoonosis? & Nicholas C. Vakalis and school children in developing countries Morphology (36). Food and animal handlers were found to be at The cyst is the parasite’s infective form and the risk of being infected by Blastocystis (33, 38). In amoeboid form might be considered a stage in addition, individuals who come into contact the life cycle of Blastocystis (37, 39). It was with animals, mainly pets, could be found to recently suggested that amoeboid forms could give positive results for Blastocystis (8). We originate from vacuolar forms (39, 40). screened stool samples from household cats from a high‐income urban Greek area, for Pathogenicity Blastocystis sp. infection by direct microscopy In humans, blastocystosis has been implicated and culture using the Robinson medium. in a variety of non‐specific symptoms (12). Although Blastocystis‐like particles were Intense abdominal disorders, together with observed microscopically, Blastocystis organisms pain, diarrhoea and constipation were were not been cultured (E. Papadogiannakis, reported in most cases (46). Although some E. Vassalou & C.M. Vassalos, unpublished data). suggested that the parasite might play a This initial findings concur with the suggestion pathogenic role, mainly in intestinal disorders, that either the culture conditions used for others reported that there was no correlation culturing human Blastocystis might not have (19, 36). We examined Blastocystis sp. isolates been appropriate for growth of feline from human carriers by direct microscopy, Blastocystis or improved sanitation could Giemsa‐ and trichrome‐stained smears and contribute to the absence of the parasite (9, 15). culture using the Robinson medium. Apart Thus, further molecular studies will be from viewing vacuolar organisms, we found required to clarify this point. On the other irregular and amoeboid Blastocystis organisms hand, faecal specimens from primate pets that present in symptomatic isolates (17; came into close contact with humans were C.M. Vassalos & E. Vassalou, unpublished positive for Blastocystis in Indonesia and in the data). Thorough in vitro observations and Rift Valley in Ethiopia (16, 20). In addition, further molecular analysis might be required Blastocystis sp. isolates
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