Balantidiasis: what is it, symptoms, treatment, prevention, prognosis

What is balantidiasis?

Balantidiasis (also known as balantidiosis) Is a rare intestinal infection caused by bacteria, Balantidium coli, a unicellular parasite (protozoan ciliate) that often infects pigs, but sometimes (rarely) infects humans.

Some infected people are asymptomatic, others have mild diarrhea and abdominal discomfort, but some people may experience more severe symptoms that resemble acute inflammation intestines.

Symptoms of balantidiasis can be similar to those of other infections that cause intestinal inflammation, such as amoebic dysentery.

Signs and symptoms

Most people with balantidiasis have asymptomatic or mild symptoms. Some people who are sick may experience serious signs and symptoms, including:

• abnormally high temperature;
• nausea;
• vomiting;
• stomach ache;
• diarrhea;
• blood in stool.

These symptoms (vomiting, diarrhea) can lead to excessive loss of water from the body, causing

dehydration and excessive exhaustion (prostration), especially if the parasite Balantidium coli attacks the intestinal mucosa, causing inflammation and possibly "crater-like" lesions (ulceration).

In very severe cases, the ulceration (sores) may be deep enough to cause holes in the intestinal wall (perforations), leading to acute inflammation of the peritoneum, the membrane lining the abdominal cavity (peritonitis). In rare cases, an ulcer can impair lung function.

Causes of balantidiasis

Balantidiasis is a rare infectious disease caused by a single-celled (protozoan) parasite Balantidium coli. This parasite can be transmitted to humans directly through contact with pig feces or indirectly through the ingestion of contaminated water. Poor diet, a weakened immune system, or other medical conditions can leave a person vulnerable to more serious symptoms of the condition.

Morphology

Balantidium coli exists in two stages of development: trophozoites and cysts. In the form of trophozoites, parasites can be oblong or spherical and are usually 30-50 microns long (micrometer = 1 millionth of a meter) and 25-120 microns wide. It is the size at this stage that makes it possible to characterize Balantidium coli as the largest protozoan parasite in humans. Trophozoites possess both a macronucleus and a micronucleus, and both are commonly seen. The macrokernel is large and sausage-like, while the microkernel is less visible. At this stage, the organism is not contagious, but the parasite can multiply by transverse binary fission.

At the cyst stage, the parasite acquires a smaller, more spherical shape with a diameter of 40-60 microns. Unlike trophozoite, the surface of which is covered only with cilia, the cyst form has a rigid wall, consisting of one or more layers. The shape of the cyst also differs from the shape of the trophozoite, because it is immobile and does not undergo reproduction. A cyst is the form that a parasite takes when it causes an infection.

Affected populations

Balantidiasis is a rare infection that affects men and women in equal numbers. The disease usually occurs in tropical regions such as Brazil, New Guinea, and southern Iran.

Diagnostics

Diagnosing balantidiosis can be challenging, in part because associated symptoms may not be present. However, a diagnosis of balantidiasis may be considered when the patient has diarrhea in combination with a likely history of current exposure to amebiasis from travel, contact with infected people, or anal penetration hole.

Additionally, the diagnosis can be made by microscopic examination of stool specimens. Immature parasites B. coli (trophozoites) are usually found in the stool. A more complex and more invasive diagnostic method includes scraping the ulcer and examining the tissue for the presence of trophozoites.

Symptomatic Disorders

Symptoms of the following disorders may be similar to those of balantidiosis. Comparisons can be useful for differential diagnosis:

• Ulcerative colitis - spicy inflammatory bowel diseasecharacterized by diarrhea and blood in the stool due to multiple irregular ulcerations (ulcers) of the intestine. Initial symptoms of the disorder may include a general feeling of weakness (malaise) and fatigue. There may also be abdominal discomfort, changes in stool frequency and consistency. Other symptoms may include abdominal pain, cramping, and an urgent need for a bowel movement (tenesmus). Weight loss and decreased appetite also associated with ulcerative colitis.
• Crohn's disease - inflammatory bowel diseasecharacterized by severe chronic inflammation of the intestinal wall or any part of the gastrointestinal tract. Symptoms of the disorder include nausea, vomiting, fever, night sweats, loss of appetite, a general feeling of weakness, waves of abdominal pain and discomfort, diarrhea, and rectal bleeding.
• Irritable bowel syndrome - a common digestive disorder affecting both the small and large intestine. The disorder is characterized by abdominal pain, constipation, bloating, nausea, headache and / or diarrhea.
• Chronic erosive gastritis - an inflammatory disease characterized by multiple lesions of the gastric mucosa. Symptoms of the disorder include a burning or heavy feeling in the stomach, mild nausea, vomiting, loss of appetite, and general weakness. In severe cases of chronic erosive gastritis there may be bleeding from the stomach, which can lead to anemia.

Other infectious diseases can also have symptoms similar to those of balantidiasis, including amoebic dysentery, shigellosis, yersiniosis, chronic fungal infections of the intestine, intestinal tuberculosis and pseudomembranous colitis caused by overuse of antibiotics. Ischemic colitis and certain cancers, such as abdominal lymphoma, can also cause symptoms similar to balantidiasis.

Balantidiasis treatment

The antibiotic most commonly used to treat balantidiasis is tetracycline. When tetracycline cannot be prescribed (for example, due to allergies), drug replacement therapy may include iodoquinol or metronidazole. There is no need to isolate a patient with balantidiasis. However, the faeces of infected people must be disposed of so that they do not come into contact with drinking water or food.

Forecast

In the era of antibiotics, balantidiasis has a good prognosis. Most of the patients are currently recovering.

Prophylaxis

Preventive measures require effective personal and public hygiene. Some specific precautions include:

• thorough hand washing with soap;
• purification of drinking water;
• proper handling of food;
• careful disposal of human feces;
• monitoring of contacts of patients with balantidiasis.