Blastocystis Hominis

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Blastocystis hominis (a) • Not in same phylum than Ameoba any longer • Phylum : Heterokontophyta • RNA sequencing makes it closer to some diatoms or brown algae but still controversial • Widespread distribution. High rates in people working with animals and in developing countries • Various sub-types with various pathogenicity though this is still under discussion 1 Blastocystis hominis (b) • Some reports of symptoms (diarrhea, nausea, abdominal cramps, excessive gaz, anal itching) but usually asymptomatic • Faeco-oral transmission via cysts • Transmission from animal to man may be possible • Various morphological forms: »Vacuolar »Granular »Amoeboid »cyst 2 Blastocystis hominis • Above vacuolar form. Below a granular form 3 Cycle of Blastocystis hominis 4 B.hominis Cycle 5 Cycle • The classic form found in human stools is the cyst, which varies tremendously in size from 6 to 40 μm • The cysts infect epithelial cells of the digestive tract and multiply asexually • Vacuolar forms of the parasite give origin to multi vacuolar and ameboid forms • The multi-vacuolar develops into a pre-cyst that gives origin to a thin-walled cyst thought to be responsible for autoinfection • The ameboid form gives origin to a pre-cyst which develops into thick-walled cyst by schizogony • The thick-walled cyst is excreted in faeces 6 Pathology • Not sure if Blastocystis hominis can cause symptomatic infection in humans • Both asymptomatic and symptomatic persons • Watery diarrhea, abdominal pain, peri -anal pruritus and excessive flatulence have been described 7 Diagnosis • Finding the cyst-like stage in faeces • Permanently stained smears (trichrome stained smears) are preferred over wet mount preparations because fecal debris may be mistaken for the organisms in the latter A. Multiple stool samples (at least 3) should be tested before a negative result is reported B. To maximize recovery of cyst-like forms, stool samples in formalin, or other fixatives, should be concentrated prior to microscopic examination C. Choice of diagnostic techniques depends on available equipment and reagents, experience, and considerations of time and cost 8 Management • Metronidazole or iodoquinol have been reported to be effective but still under investigation • Trimethoprim/sulfamethoxazole also reported effective • Nitazoxanide has been effective in clearing organism and improving symptoms 9.

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Are Blastocystis Species Clinically Relevant to Humans?
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