Balantidiasis in humans: A systematic review and meta-analysis.

Balantioides coli is a protozoan that infects different hosts species, including humans, with zoonotic transmission. The parasite, which lives in the large intestine and in other organs, can lead to serious infections that may culminate in death. Information about human balantidiasis is generally still very scanty. In view of the above, the purpose of this study was to analyze the epidemiological, clinical and laboratory characteristics of human balantidiasis based on a systematic review and meta-analysis. The scientific articles were retrieved from various databases and were subjected to descriptive analyses, chi-squared tests, and summarized on a forest plot and the heterogeneity index (I2). A total of 103 articles were eligible and included in this review. Out of these 103 articles, 75 were clinical case reports and 28 were epidemiological studies, indicating a frequency of 997 (3.98%) people potentially infected with B. coli. The publication dates of the analyzed articles ranged from 1910 to 2020, but the majority (68.9%) were published between 1998 and 2020. A considerable number of these articles were published in South America and Asia, mostly in Brazil and India, respectively. However, in Africa, Ethiopia, was observed the higher number of infected people (47.5%). A significant association (p < 0.05) was identified between proximity to pigs and positivity for B. coli, since more than 16% infected people were in proximity with pigs and/or their excreta. Infection by the protozoan was classified mainly as intestinal, and the predominant symptom was dysentery. Extraintestinal infections were found in 27 individuals, with colonization of the genitourinary tract frequently highlighted. Direct examination (17.2%), followed by an association of direct examination and sedimentation (45.7%), were the most commonly performed parasitological techniques, and the most frequently diagnosed form was trophozoites, corresponding to 22.5% of cases. The most common treatment for parasitized individuals (11.8%) was an association of tetracycline drugs with nitroimidazole derivatives. The articles retrieved, mainly epidemiological ones, used in meta-analysis showed high heterogeneity (I2> 50%, p < 0.05), impairing the retrieval and comparison of results. Some articles were found to provide incomplete information, making it difficult to retrieve and analyze variables. However, this review enabled us to compile and restate factors that appear to be associated with cases of human balantidiasis.

Balantidium coli in pigs of distinct animal husbandry categories and different hygienic-sanitary standards in the central region of Rio Grande do Sul State, Brazil

Background: Balantidium coli is a commensal protozoan that infects several animals, but it has pigs as its natural reservoir. In the presence of predisposing factors, B. coli can become pathogenic for swine, causing enteric lesions. Infections determined by this protozoan may be a risk to public health, due to dysentery in animal keepers and veterinarians. This study aimed to determine the occurrence of infection by B. coli in pigs of distinct husbandry categories, as well as unlike physiological state, kept in farms with different hygienic-sanitary standards, located in the central region of Rio Grande do Sul State in Brazil. Materials, Methods & Results: Stool samples were collected from 12 different farms with different hygienic-sanitary standards being four farms of finisher pigs (G1; n = 287), four farms with pregnant females (G2; n = 60) and four farms with lactation sows (G3; n = 40), and all samples were submitted to coproparasitological analyses to verify the presence of cysts or trophozoites of B. coli. The infection levels were considered mild (1-100 cyst/trophozoite), moderate (101- 300 cyst/trophozoite) and high (>300 cysts/trophozoite). In addition, information about hygienic-sanitary conditions of each farm was collected. The occurrence of B. coli infection in all swine stool samples analyzed was 60.9% (236/387); however, in G1, G2 and G3 was 54.7% (157/287), 91.7% (55/60) and 65% (26/40) respectively. There was significant difference in the occurrence of G1 (P < 0.05) except between farms B and C (67.9% and 56.6% respectively). There was also a significant difference (P < 0.05) between the occurrence of B. coli found in G2 and G3. The infection levels were considered predominantly mild in G1; and mild to moderate in G2 and G3. Discussion: In this research it was confirmed the presence of B. coli in swine farms located in the central region of Rio Grande do Sul State in Brazil. […]

Balantidium coli in pigs of distinct animal husbandry categories and different hygienic-sanitary standards in the central region of Rio Grande do Sul State, Brazil

Background: Balantidium coli is a commensal protozoan that infects several animals, but it has pigs as its natural reservoir. In the presence of predisposing factors, B. coli can become pathogenic for swine, causing enteric lesions. Infections determined by this protozoan may be a risk to public health, due to dysentery in animal keepers and veterinarians. This study aimed to determine the occurrence of infection by B. coli in pigs of distinct husbandry categories, as well as unlike physiological state, kept in farms with different hygienic-sanitary standards, located in the central region of Rio Grande do Sul State in Brazil. Materials, Methods & Results: Stool samples were collected from 12 different farms with different hygienic-sanitary standards being four farms of finisher pigs (G1; n = 287), four farms with pregnant females (G2; n = 60) and four farms with lactation sows (G3; n = 40), and all samples were submitted to coproparasitological analyses to verify the presence of cysts or trophozoites of B. coli. The infection levels were considered mild (1-100 cyst/trophozoite), moderate (101- 300 cyst/trophozoite) and high (>300 cysts/trophozoite). In addition, information about hygienic-sanitary conditions of each farm was collected. The occurrence of B. coli infection in all swine stool samples analyzed was 60.9% (236/387); however, in G1, G2 and G3 was 54.7% (157/287), 91.7% (55/60) and 65% (26/40) respectively. There was significant difference in the occurrence of G1 (P < 0.05) except between farms B and C (67.9% and 56.6% respectively). There was also a significant difference (P < 0.05) between the occurrence of B. coli found in G2 and G3. The infection levels were considered predominantly mild in G1; and mild to moderate in G2 and G3. Discussion: In this research it was confirmed the presence of B. coli in swine farms located in the central region of Rio Grande do Sul State in Brazil. […](AU)

Gastrointestinal parasites of swine raised in different management systems in the State of Rio de Janeiro, Brazil / Parasitos gastrintestinais de suínos criados sob diferentes sistemas de manejo no Estado do Rio de Janeiro

From 2012 to 2013 were surveyed gastrointestinal parasites from pig farms located in different municipalities in the state of Rio de Janeiro. Fecal samples from 790 pigs were collected from the rectum on 88 family farms and 702 farms with industrial production. The samples were subjected to Faust et al., Sheather, Ritchie, Lutz and direct examination faecal techniques. The estimated parasite prevalence was 93.1% in family farms and 59.1% in industrial farms. Balantidium coli, coccidia and Entamoeba sp. were the parasites with the highest frequencies, and the male and female reproductive categories and fatteners pigs the most infected (p<0.05). Trophozoites of B. coli were most evident in stool samples from semi-solid followed by solid and diarrheal consistencies. Strongyles eggs and Trichuris suis have been detected exclusively in family farms. Ascaris suum eggs and Strongyloides ransomi showed low frequency. The high degree of parasitism, especially protozoa, indicates the need to reassess the management of pigs in both types of production.(AU)

De 2012 a 2013 foram pesquisados parasitos gastrintestinais de suínos de granjas localizadas em diferentes municípios do estado do Rio de Janeiro. Amostras fecais de 790 suínos foram coletadas da ampola retal, sendo 88 de propriedades familiares e 702 de granjas com produção industrial. As amostras foram submetidas às técnicas de Faust et al., Sheather, Ritchie, Lutz e exame direto. A prevalência estimada foi de 93,1% nas granjas familiares e 59,1% nas granjas industriais. Balantidium coli, coccídios e Entamoeba sp. foram os parasitos que apresentaram as maiores frequências, sendo as categorias machos e fêmeas reprodutoras e leitões de terminação as mais infectadas (p<0,05). Trofozoítas de B. coli foram mais evidenciados nas amostras fecais de consistências semi-sólida, seguida pelas fezes com consistências sólida e diarreica. Ovos de estrongilídeos e Trichuris suis foram detectados exclusivamente em criações familiares. Ovos de Ascaris suum e de Strongyloides ransomi apresentaram baixa frequência. O alto grau de parasitismo, principalmente de protozoários, indica a necessidade de reavaliação do manejo dos suínos em ambos os tipos de produção.(AU)

Gastrointestinal parasites of swine raised in different management systems in the State of Rio de Janeiro, Brazil / Parasitos gastrintestinais de suínos criados sob diferentes sistemas de manejo no Estado do Rio de Janeiro

From 2012 to 2013 were surveyed gastrointestinal parasites from pig farms located in different municipalities in the state of Rio de Janeiro. Fecal samples from 790 pigs were collected from the rectum on 88 family farms and 702 farms with industrial production. The samples were subjected to Faust et al., Sheather, Ritchie, Lutz and direct examination faecal techniques. The estimated parasite prevalence was 93.1% in family farms and 59.1% in industrial farms. Balantidium coli, coccidia and Entamoeba sp. were the parasites with the highest frequencies, and the male and female reproductive categories and fatteners pigs the most infected (p<0.05). Trophozoites of B. coli were most evident in stool samples from semi-solid followed by solid and diarrheal consistencies. Strongyles eggs and Trichuris suis have been detected exclusively in family farms. Ascaris suum eggs and Strongyloides ransomi showed low frequency. The high degree of parasitism, especially protozoa, indicates the need to reassess the management of pigs in both types of production...

De 2012 a 2013 foram pesquisados parasitos gastrintestinais de suínos de granjas localizadas em diferentes municípios do estado do Rio de Janeiro. Amostras fecais de 790 suínos foram coletadas da ampola retal, sendo 88 de propriedades familiares e 702 de granjas com produção industrial. As amostras foram submetidas às técnicas de Faust et al., Sheather, Ritchie, Lutz e exame direto. A prevalência estimada foi de 93,1% nas granjas familiares e 59,1% nas granjas industriais. Balantidium coli, coccídios e Entamoeba sp. foram os parasitos que apresentaram as maiores frequências, sendo as categorias machos e fêmeas reprodutoras e leitões de terminação as mais infectadas (p<0,05). Trofozoítas de B. coli foram mais evidenciados nas amostras fecais de consistências semi-sólida, seguida pelas fezes com consistências sólida e diarreica. Ovos de estrongilídeos e Trichuris suis foram detectados exclusivamente em criações familiares. Ovos de Ascaris suum e de Strongyloides ransomi apresentaram baixa frequência. O alto grau de parasitismo, principalmente de protozoários, indica a necessidade de reavaliação do manejo dos suínos em ambos os tipos de produção...

A survey of intestinal parasites including associated risk factors in humans in Panama.

BACKGROUND: Intestinal parasitic infections are among the most common infections worldwide, leading to illness with serious and long lasting implications in children and immunocompromised people. Transmission of intestinal parasites is more frequent in tropical and sub-tropical areas where sanitation is poor and socioeconomic conditions are deficient. Panama is a country where climate and social conditions could be reflected in a high number of people infected with intestinal parasites. The presence, prevalence, and distribution of intestinal parasites in this country have been approached to date only in very restricted areas and population groups, but the impact of intestinal parasite infections at the national level is unknown. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional survey between 2008 and 2010 to determine the prevalence of intestinal parasites across Panama. Overall, 14 municipalities in seven provinces of Panama were surveyed. The presence of eggs, cysts, and larvae was assessed by microscopy in 1123 human fecal samples using a concentration technique. A questionnaire to identify risk factors associated with the frequency of intestinal parasites in the study population was also prepared and performed. Overall, 47.4% of human samples presented parasites. Variables including community type, age group, occupation, co-presence of commensals and socioeconomic factors (use of shoes and type of sanitation) were significantly associated with intestinal parasites (p<0.05). CONCLUSIONS/SIGNIFICANCE: The preliminary data obtained in the current study, showing a high prevalence of fecal-oral transmitted parasites in Panama, place intestinal parasitism as a major health problem in this country. Specific interventions should be planned for the indigenous population, the group most afflicted by intestinal parasites.

Balantidium coli and other gastrointestinal parasites in captives non-human primates of the Rio de Janeiro, Brazil.

BACKGROUND: Parasites are agents of diarrhea in captive non-human primates (NHP). To broaden information about those etiological agents in captive animals in Brazil, gastrointestinal parasites in captive NHP were researched in nurturing Centers of Rio de Janeiro State. METHODS: Fecal samples were collected from primates, of which 960 came from the Research Center (Cecal/Fiocruz) and 115 from the Primate Center (CPRJ/Inea). The study involved species of the New World (NW) primates and of the Old World (OW). RESULTS: The estimated prevalence was 56.7%, of which 91.3% presented protozoans and 7.4% presented helminths. Statistical difference between the nurturing centers occurred in the overall value of parasitosis and in the isolated frequency of Balantidium coli and Entamoeba sp., especially in the samples of OW primates living in Cecal. CONCLUSIONS: These results demonstrated the need for implements of sanitation programs in the sites for captive primates nurturing.

Current world status of Balantidium coli.

Balantidium coli is a cosmopolitan parasitic-opportunistic pathogen that can be found throughout the world. Pigs are its reservoir hosts, and humans become infected through direct or indirect contact with pigs. In rural areas and in some developing countries where pig and human fecal matter contaminates the water supply, there is a greater likelihood that balantidiosis may develop in humans. The infection may be subclinical in humans, as it mostly is in pigs, or may develop as a fulminant infection with bloody and mucus-containing diarrhea; this can lead to perforation of the colon. The disease responds to treatment with tetracycline or metronidazole. Balantidiosis is a disease that need never exist given access to clean water and a public health infrastructure that monitors the water supply and tracks infections. Its spread can be limited by sanitary measures and personal hygiene, but it is a disease that will be around as long as there are pigs. Immunocompromised individuals have developed balantidiosis without any direct contact with pigs, perhaps with rats or contaminated produce as a possible source of infection. For the clinician, balanatidiosis should be included in the differential diagnosis for persistent diarrhea in travelers to or from Southeast Asia, the Western Pacific islands, rural South America, or communities where close contact with domestic swine occurs. Warming of the earth's surface may provide a more favorable environment, even in the now-temperate areas of the world, for survival of trophic and cystic stages of Balantidium, and its prevalence may increase. Effective sanitation and uncontaminated water are the most useful weapons against infection. Fortunately, balantidiosis responds to antimicrobial therapy, and there have been no reports of resistance to the drugs of choice.

Balantidiasis en niños: reporte de un caso fatal / Balantidiasis in children: report of a fatal case

Se presenta un caso de balantidiasis fulminante en una niña, procedente de Zarumilla-Tumbes, portadora de colostomía por malformación anorrectal y desnutrición crónica. Las manifestaciones clínicas fueron diarrea disentérica, vómitos y deshidratación, evolucionando con signos de sepsis y abdomen agudo. El diagnóstico de balantidiasis se realizó mediante exámen directo de heces, y el tratamiento inicial con metronidazol y cobertura antibiótica. Ante el curso desfavorable se utilizó tetraciclinas, pero dada su condición de inmunosupresión la paciente fallece. Debemos de considerar esta entidad ante la presencia de las manifestaciones clínicas señaladas en personas que proceden de la frontera con el Ecuador, realizar examen de heces e iniciar tratamiento de primera elección (tetraciclinas), valorando el riesgo-beneficio.

[Balantidiasis in a rural community from Bolivar State, Venezuela]. / Balantidiasis en una comunidad rural del Estado Bolívar, Venezuela.

Balantidium coli is the etiologic agent of balantidiasis, an infrequent zoonose of worldwide distribution. The objective of the present study was to determine the clinical and epidemiological aspects of balantidiasis in a rural community in the Bolivar State in Venezuela. Fifty persons and 12 pigs were evaluated. Fecal samples were analyzed by direct examination and by the methods of Faust and Willis. The global rate of intestinal parasitoses detected was 88.0% for the human population and 83.3% for the pigs. The prevalence of human and porcine balantidiais was 12.0% (6/50) and 33.3% (4/12), respectively. The disease was only detected in children, all of them with multiple parasites and with clinical manifestations. Deficient environmental sanitation, absence of basic services in the dwellings, low socioeconomic level, and the presence of pigs infected with B. coli are the factors that explain and maintain the conditions favorable to the transmission of balantidiasis in the population studied.

Balantidiasis en una comunidad rural del Estado Bolívar, Venezuela / Balantidiasis in a rural community from Bolivar state, Venezuela

Balantidium coli is the etiologic agent of balantidiasis, an infrequent zoonose of worldwide distribution. The objective of the present study was to determine the clinical and epidemiological aspects of balantidiasis in a rural community in the bolivar state in Venezuela. Fifty persons and 12 pigs were evaluated. Fecal samples were analyzed by direct examination and by the methods of Faust and Willis. The global rate of intestinal parasitoses detected was 88.0 percent for the human population and 83.3 percent for the pigs. The prevalence of human and porcine balantidiais was 12.0 percent (6/50) and 33.3 percent (4/12), respectively. The disease was only detected in children, all of them with multiple parasites and with clinical manifestations. Deficient environmental sanitation, absence of basic services in the dwellings, low socioeconomic level, and the presence of pigs infected with B. coli are the factors that explain and maintain the conditions favorable to the transmission of balantidiasis in the population studied

Balantidiasis in Aymara children from the northern Bolivian Altiplano.

Balantidium coli infection was coprologically studied in 2,124 Aymara children 5-19 years of age from the schools of 22 communities of the northern Bolivian Altiplano over a five-year period. Infection with B. coli was found in 11 of the communities surveyed, with prevalences of 1.0-5.3% (overall prevalence=1.2%). The prevalences observed are some of the highest reported and did not differ significantly among the various age groups or between boys and girls. These prevalences, the apparent absence of symptoms or signs of illness due to this parasite in the schoolchildren surveyed at the time of stool sampling, and the consistency of stool samples of the infected students suggest that they are apparently asymptomatic carriers. Infection with B. coli must be considered as an endemic anthropozoonosis in the area studied. A relationship between B. coli infection and Altiplanic pigs is suggested.

Gastrointestinal illness associated with balantidium coli infection in rural communities in Ecuador

Un brote de enfermedad gastrointestinal caracterizada por diarrea y heces con sangre fueron investigadas en 4 comunidades diferentes en la provincia de Zamora Chinchipe en Ecuador. Un total de 322 personas fueron examinadas; trofozoitos de Balatidium coli fueron vistos en las heces de 62 de ellas (19,3 por ciento), de estas personas, en el 70,2 por ciento de las personas que tenían diarrea y en el 20.9 por ciento de las que tenían heces sanguinolientas. Así, demostramos una gran asociación entre infección por B. coli y diarrea (p<0,0005). La más alta prevalencia de infección fue vista en niños entre los 6 a 10 años de edad. El orígen de la infección parece provenir de los cerdos, los cuales viven dentro de las casas en pésimas condiciones de higiene. La balantidiasis fue tratada con una combinación de metronidazol y tetraciclina obteniéndose rápida curación

Balantidiase / Balantidiasis

O autor faz uma revisao detalhada da balantidiase, abrangendo os aspectos epidemiologico, clinico diagnostico e tratamento e salienta a raridade da infeccao entre nos

Balantidíase intestinal: relato de um caso / Intestinal balantidíasis: report of a case

A Balantidíase é uma doença rara em nosso meio. Na oportunidade, relatamos um caso em paciente idoso que veio a óbito, com perfuraçäo intestinal e revisamos a literatura pertinente