Green synthesis of silver and iron oxide nanoparticles mediated photothermal effects on Blastocystis hominis.

The evolution of parasite resistance to antiparasitic agents has become a serious health issue indicating a critical and pressing need to develop new therapeutics that can conquer drug resistance. Nanoparticles are novel, promising emerging drug carriers that have demonstrated efficiency in treating many parasitic diseases. Lately, attention has been drawn to a broad-spectrum nanoparticle capable of converting absorbed light into heat via the photothermal effect phenomenon. The present study is the first to assess the effect of silver nanoparticles (Ag NPs) and iron oxide nanoparticles (Fe3O4 NPs) as sole agents and with the combined action of the light-emitting diode (LED) on Blastocystis hominins (B. hominis) in vitro. Initially, the aqueous synthesized nanoparticles were characterized by UV-Vis spectroscopy, zeta potential, and transmission electron microscopy (TEM). The anti-blastocyst efficiency of these NPs was tested separately in dark conditions. As these NPs have a wide absorption spectrum in the visible regions, they were also excited by a continuous wave LED of wavelength band (400-700 nm) to test the photothermal effect. The sensitivity of B. hominis cysts was evaluated using scanning laser confocal microscopy whereas the live and dead cells were accurately segmented based on superpixels and the k-mean clustering algorithm. Our findings showed that this excitation led to hyperthermia that induced a significant reduction in the number of cysts treated with photothermally active NPs. The results of this study elucidate the potential role of photothermally active NPs as an effective anti-blastocystis agent. By using this approach, new therapeutic antiparasitic agents can be developed.

[Progress of researches on Blastocystis hominis infection among patients with inflammatory bowel disease and irritable bowel syndrome].

Blastocystis is a common unicellular intestinal protozoa in humans and animals, and the most common clinical manifestations of infections include abdominal pain and diarrhea. Based on the sequence of the small-subunit ribosomal RNA (SSU rRNA) gene, 28 subtypes of B. hominis (ST1 to ST17, ST21 and ST23 to ST32) have been characterized. Previous studies have demonstrated that B. hominis infection is strongly associated with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and other intestinal diseases, which threatens the health and quality of life among patients with B. hominis infection and is considered as an important public health problem. This review summarizes the progress of researches on B. hominis infection among IBD and IBS patients during the past 20 years, so as to provide insights into management of blastocystosis in China.

IMPACT OF BLASTOCYSTIS HOMINIS INFECTION ON IMMUNOLOGICAL PARAMETERS IN PATIENTS WITH DIARRHEA: A CROSS-SECTIONAL STUDY.

Blastocystis parasites are common intestinal parasites found in various hosts, including humans. This study involved two groups: the patient group, consisting of 220 samples, and the control group, consisting of 100 samples. The participants' age range was 4-40 years, and the samples were obtained from Al-Kadhimiya Teaching Hospital and Al-Shaheed Mohammed Baqir Al-Hakeem Hospital in Baghdad, Iraq. Stool samples were examined under a light microscope using Lugal's Iodine Stain and direct wet smears. The age group did not show a significant difference (P≥0.05) in patients with diarrhea infected with the Blastocystis hominis parasite compared to the control group. Furthermore, males had a higher infection rate (58.00%) compared to females (42.00%), and this rate was statistically significant (P≤0.05). The aim of this study was to evaluate the effect of Blastocystis hominis infection on the levels of certain immunological parameters. The results of the ELISA technique for immunological examinations revealed a significant increase (P≤0.01) in the levels of IL-10 and IL-17 in the serum of patients with diarrhea infected with the Blastocystis hominis parasite compared to the control group. The immunological tests also showed a significant increase (P≤0.01) in IgG, IgM antibodies, and IgA levels in patients with diarrhea infected with Blastocystis hominis parasite compared to the control group. These findings suggest that Blastocystis infection may influence immunological responses.

Site-Specific Incidence Rate of Blastocystis hominis and Its Association with Childhood Malnutrition: Findings from a Multi-Country Birth Cohort Study.

In this study, we investigated the potential association between the burden of asymptomatic Blastocystis spp. (Blastocystis hominis) infection and nutritional status among children under 2 years of age using the data collected from 1,715 children from eight distinct geographic locations, including Bangladesh, Brazil, India, Peru, Tanzania, Pakistan, Nepal, and South Africa. Childhood stunting, wasting, and underweight were the outcome variables, and B. hominis infection was the exposure variable of this present study. The presence of B. hominis in nondiarrheal stools was evaluated by TaqMan Array Cards. Site-specific incidence rates were estimated using Poisson regression, and multiple generalized estimating equation was used to assess the association between the B. hominis infection and nutritional status. The site-specific incidence rates of asymptomatic B. hominis infections per 100 child-months were higher in Tanzania, Peru, and South Africa when compared with the other study sites. Moreover, in terms of site-specific association, childhood stunting was significantly associated with asymptomatic B. hominis infection in Bangladesh (odds ratio [OR]: 1.62; 95% CI: 1.26-2.08), India (OR: 1.78; 95% CI: 1.46-2.16), Nepal (OR: 2.26; 95% CI: 1.60-3.21), Peru (OR: 1.47; 95% CI: 1.26-1.71), South Africa (OR: 1.57; 95% CI: 1.35-1.83), and Tanzania (OR: 2.46; 95% CI: 2.18-2.79) sites. Wasting was associated with B. hominis in the Brazil site only (OR: 3.19; 95% CI: 1.31-7.77). On the other hand, underweight was associated in the Bangladesh (OR: 1.89; 95% CI: 1.48-2.42), Brazil (OR: 4.41; 95% CI: 1.57-12.4), Nepal (OR: 2.25; 95% CI: 1.52-3.35), and Tanzania (OR: 1.68; 95% CI: 1.42-1.99) sites. Our analysis further reveals that the presence of additional pathogens may play a pathogenic role in children who have B. hominis infection.

[Epidemiological characteristics and influencing factors of Blastocystis hominis infection among children with diarrhea under five years of age in Guangzhou City].

OBJECTIVE: To investigate the prevalence and influencing factors of Blastocystis hominis infection among children with diarrhea under five years of age in Guangzhou City. METHODS: Children with diarrhea under 5 years of age admitted to Guangzhou Children's hospital, Guangzhou Maternity and Child Healthcare Hospital and Guangzhou Women and Children's Medical Center during the period between January 1 and December 31, 2020, were enrolled. Participants' demographics, living environments and health status were collected using questionnaire surveys. Stool samples were collected from participants and nucleic acid was extracted. B. hominis infection was identified using PCR assay and sequence alignment, and the factors affecting B. hominis infection among children with diarrhea under 5 years of age were identified using univariate analysis and multivariate logistic regression analysis. RESULTS: A total of 684 children with diarrhea under 5 years of age were enrolled, including 468 male children and 216 female children, with a mean age of (1.79 ± 1.12) years. The overall prevalence of B. hominis infection was 4.97% [34/684, 95% confidential interval (CI): (3.59%, 6.86%)] among participants, and there was no significant difference in the prevalence of B. hominis infection between children with chronic [7.52% (20/266), 95% CI: (4.92%, 11.33%)] and acute diarrhea [3.35% (14/418), 95% CI: (2.01%, 5.54%)] (χ2 = 5.983, P = 0.014). Multivariate logistic regression analysis identified keeping pet [odds ratio (OR) = 6.298, 95% CI: (2.711, 14.633)], drinking non-tap water [OR = 4.522, 95% CI: (1.769, 11.561)], lactose intolerance [OR = 4.221, 95% CI: (1.043, 17.087)], antibiotic use [OR = 0.125, 95% CI: (0.017, 0.944)] and chronic diarrhea [OR = 2.172, 95% CI: (1.018, 4.637)] as factors affecting B. hominis infection among children with diarrhea under 5 years of age in Guangzhou City. CONCLUSIONS: B. hominis infections is detected in children with diarrhea under five years of age in Guangzhou City. Improving home environments and pet-keeping hygiene is recommended to reduce the likelihood of B. hominis infection among children.

Medicinal Plants as Natural Anti-Parasitic Agents Against Blastocystis Species.

BACKGROUND: Blastocystis species (sp.) are enteric parasites that live in both humans' and animals' gastrointestinal tracts. Blastocystis hominis (B. hominis) is the recognizable human isolates in clinical and diagnostic specimens. Human infection occurs via the oro-fecal route, particularly in developing areas due to the lack of sanitation and hygienic facilities. B. hominis can exist in the large intestine for weeks to years until treated appropriately. Metronidazole is the drug of choice for the treatment of Blastocystis infection. However, it induces intolerable side effects and has been shown to have teratogenic and carcinogenic potential. Several medicinal plant extracts have been experimentally tested against Blastocystis infection in comparison to currently available treatments. OBJECTIVE: Based on in vitro and in vivo studies, this article reviewed anti-Blastocystis activity of some medicinal plants. METHODS: To conduct the research for this review, Google Scholar and PubMed were the primary search engines used to find relevant literature. A total of 19 published in vitro and in vivo studies were evaluated to identify the anti-Blastocystis effects of various medicinal plants. RESULTS: Multiplication of Blastocystis parasites as well as nucleic acids and protein synthesis, all be inhibited by extracts from different medicinal plants. These natural agents have been shown to be both safe and effective when compared to the existing treatment options. CONCLUSION: Different medicinal plants can combat Blastocystis infection and could be a good substitute for metronidazole and other synthetic treatments.

Blastocystis hominis undergoing programmed cell death via cytotoxic gamma irradiation.

Blastocystis hominis is a worldwide common enteric parasite. Its pathogenic potential has not yet been established, although many reports suggest that it may cause the development of various gastrointestinal symptoms. The aim of the present study is to evaluate the destructive effect of different doses of cytotoxic gamma (γ) irradiation combined with and compared to metronidazole (MTZ) on Blastocystis spp. in vitro. The detection of the parasite in the stool specimen was conventionally done by light microscopic examination of direct smears, cultivation, followed by PCR-sequencing. Evaluation of γ-irradiation and MTZ effects on B. hominis was carried out by trypan blue exclusion assay, caspase activity detection, acridine orange staining, DNA fragmentation assay and transmission electron microscopic (TEM) examination. The current study demonstrated that exposure to γ-irradiation in a dose of 0.5 kGray (kGy) significantly (P < 0.05) reduced the viability of B. hominis subtype 2 by 95.2% compared to the untreated and MTZ-treated parasites (87.1%) after 48 h incubation. Combining the same dose of irradiation (0.5 kGy) with MTZ yielded a viability reduction of 94.2% and 94% after 24 and 48 h respectively, which were statistically significant (P < 0.05) compared to MTZ alone. Moreover, our results showed features of programmed cell death in the form of morphological, biochemical, and molecular changes (TEM abnormalities, caspase-like activity, and DNA fragmentation, respectively) with the high doses of γ-irradiation (0.3 and 0.5 kGy) either singly or combined with MTZ. In conclusion, cytotoxic γ-irradiation plays an important role in the inactivation of Blastocystis spp., so, it can be a promising prophylactic water-sterilizing tool against blastocystosis.

Phylogenetic tree of Blastocystis hominis in Iraqi children in Salah AL-Deen province, Iraq.

Blastocystis hominis is an intestinal protozoan that inhabits the large intestine of humans and a wide range of animals. Blastocystis species has a worldwide distribution. The current study aimed to determine the prevalence and the genetic variety of Blastocystis sp. in Iraqi children in Salah AL-Deen province, Iraq. 150 faecal samples were collected from children (5-10 years old) who attended the Salah AL-Deen hospital during the period from March to November 2020. The results revealed that 33.3% of children (50 out of 150) were found infected with Blastocystis sp., when the polymerase chain reaction (PCR) was used. The presence of ST3 gene was at a band of 526 bp where this gene was observed in 11 samples out of 50 samples. The results also showed significant differences in the prevalence rate between rural and urban regions; between symptomatic and asymptomatic children, and between children who contacted domestic animals and those who did not contact animals (P<0.05). No significant differences in the prevalence rate were between different age groups (P>0.05). Regarding the genetic variation in subtype 3(ST3) revealed in phylogenetic tree analysis, there were three variations (transversion, deletion, and transition) which were detected through the sequence alignment, also the similarity was 97% with the sequences of Blastocystis sp. registered in GenBank. The Iraqi ST3 isolate was registered with ID: OL410286 in GenBank.

Acquired long QT syndrome due to antiemetics, COVID-19 and Blastocystis hominis induced exacerbation of congenital chloride losing diarrhoea.

Congenital chloride losing diarrhoea (CCLD) is a rare disease caused by mutations in an intestinal chloride/bicarbonate ion exchange channel. Few reports describe CCLD in adults and none has described the impact of a parasitic infection on CCLD. Severe diarrhoea may result in hypokalaemia with QT interval prolongation. Treatment with antiemetics may further increase the QT interval. To raise awareness of this preventable complication, we describe the course of a woman in her 20s with CCLD who developed COVID-19 and a Blastocystis hominis infestation. Treatment with antiemetics and hypokalaemia resulted in prolongation of the QT interval to 640 ms. While, the QT interval normalised with discontinuation of antiemetics and electrolyte replacement, patients with CCLD must take precautions to prevent gastrointestinal infections. Regardless, whenever patients with CCLD present to hospital, the authors recommend monitoring the QT interval and avoiding medications that predispose to torsade de pointes.

Frequency of Intestinal Parasites in Substance Abusers

Objective: This study was conducted to investigate the frequency of intestinal parasites in substance abusers and to reveal its significance. Methods: The study was conducted in Van Yüzüncü Yil University Medical Faculty Parasitology Research Laboratory and University of Health Sciences Turkey Van Training and Research Hospital between May 2019 and February 2020. The patient group included 150 patients with substance abuse who applied to the Alcohol and Drug Addicted Treatment Center of University of Health Sciences Turkey Van Training and Research Hospital, while the control group included 75 patients who had no chronic illness and did not use cigarettes, alcohol, or drugs. Stool samples were examined using native-Lugol and modified acid-fast staining methods. Results: In this study, one or more intestinal parasites were found in 21.3% of 150 patients who applied to the internal medicine outpatient clinic and had no chronic illness and did not use cigarettes, alcohol, or drugs. There was a statistically significant difference between the two groups in terms of the parasite frequency (p=0.03). In the patient group, Giardia intestinalis was detected in 7.3% (p=0.02), Blastocystis hominis in 6.7%, and Hymenolepis nana in 0.7%. Considering the frequency of parasites in terms of age groups, intestinal parasites were found at a higher rate in the 35 and younger age group (23.8%) than in the 36 and older age group (17.2%). Intestinal parasite positivity was found at the highest rate (23.8%) in those using methamphetamine. Constipation (79.3%) was the most prevalent in parasite-positive substance abusers, followed by diarrhea (23%). Conclusion: This study contributed to the literature by determining the frequency of intestinal parasites in people addicted to substance, and it was revealed that intestinal parasite infections are a negative consequence of substance addiction. Conclusively, our findings revealed that intestinal parasites should be considered in substance abusers. Also, more detailed studies involving more individuals should be conducted to obtain information about intestinal parasite infections.

MOLECULAR STUDY OF BLASTOCYSTIS HOMINIS ISOLATED FROM DIFFERENT REGIONS OF DIYALA GOVERNORATE.

OBJECTIVE: The aim: To detect the infection rate of Blastocystis hominis in children less than 10 years old with diarrhea in Diyalaby polymerase chain reaction (PCR) method, to determine the subtype of Blastocystis hominis by sequencing the product of the positive result, and to determine the association between Blastocystis hominis infection and different factors such as gender, age, the level of mother education and the presence or absence animals in their houses. PATIENTS AND METHODS: Materials and methods: A cross-sectional study was conducted on children with diarrhea at Al-Batool Teaching Hospital in Diyala governorate, during the period from November 2020 to April 2021, a total of 100 children 55 males and 45 females, then, stool samples were collected and examined by conventional polymerase chain reaction. RESULTS: Results: The rate of infection with the parasite Blastocystis hominis was 8%, 8 out of 100. The infection was higher among females 62.5% than to males 37.5%, while the positive result was higher in the age group less than two years 75%, the highest percentage occur with patient whose mothers were incomplete primary and primary education was reached 37.5% and 25%; respectively and the study showed the highest percentage was with those who kept animals at homes was 75%. CONCLUSION: Conclusions: According to the genetic analysis of the sequence of eight samples that were positive for Blastocystis hominis parasite using the conventional polymerase chain reaction and they were back to the subtypes 3.

[Advances in the research of comorbidity of Blastocystis hominis infections and other diseases].

Blastocystis hominis is a common intestinal protozoan parasite. Most individuals with B. hominis infections have no apparent clinical symptoms; however, a few patients, notably those with co-infections or impaired immune system function may present abdominal pain, diarrhea, nausea, vomiting, and even death. This paper reviews the co-infections of B. hominis and other pathogens and comorbidity of B. hominis infections and other diseases, so as to provide insights into the management of B. hominis infections.

Improved diagnosis of gastrointestinal infections using a semi-automated multiplex real-time PCR for detection of enteropathogens.

Introduction. The identification of enteropathogens is critical for the clinical management of patients with suspected gastrointestinal infection. The FLOW multiplex PCR system (FMPS) is a semi-automated platform (FLOW System, Roche) for multiplex real-time PCR analysis.Hypothesis/Gap Statement. FMPS has greater sensitivity for the detection of enteric pathogens than standard methods such as culture, biochemical identification, immunochromatography or microscopic examination.Aim.The diagnostic performance of the FMPS was evaluated and compared to that of traditional microbiological procedures.Methodology. A total of 10 659 samples were collected and analysed over a period of 7 years. From 2013 to 2018 (every July to September), samples were processed using standard microbiological culture methods. In 2019, the FMPS was implemented using real-time PCR to detect the following enteropathogens: Shigella spp., Salmonella spp., Campylobacter spp., Giardia intestinalis, Entamoeba histolytica, Blastocystis hominis, Cryptosporidum spp., Dientamoeba fragilis, adenovirus, norovirus and rotavirus. Standard microbiological culture methods (2013-2018) included stool culture, microscopy and immunochromatography.Results. A total of 1078 stool samples were analysed prospectively using the FMPS from July to September (2019): bacterial, parasitic and viral pathogens were identified in 15.3, 9.71 and 5.29 % of cases, respectively. During the same period of 6 years (2013-2018), the proportion of positive identifications using standard microbiological methods from 2013 to 2018 was significantly lower. A major significant recovery improvement was observed for all bacteria species tested: Shigella spp./enteroinvasive Escherichia coli (EIEC) (P <0.05), Salmonella spp. (P <0.05) and Campylobacter spp. (P <0.05). Marked differences were also observed for the parasites G. intestinalis, Cryptosporidium spp. and D. fragilis.Conclusion. These results support the value of multiplex real-time PCR analysis for the detection of enteric pathogens in laboratory diagnosis with outstanding performance in identifying labile micro-organisms. The identification of unsuspected micro-organisms for less specific clinical presentations may also impact on clinical practice and help optimize patient management.

Intestinal parasitic infection among mentally handicapped students in the Islamic Republic of Iran

Background: Intestinal parasitic infections are among the most common public health problems in populations with poor hygiene. Consequently, mental retardation increases the risk of infection. Aims: The aim of this study was to investigate the prevalence of intestinal parasitic infections among mentally disabled young people in Hamadan, western Islamic Republic of Iran. Methods: This descriptive cross-sectional study was conducted on 318 students in 9 special schools in 2017. Triplicate faecal specimens for each student were subjected to stool analysis using direct wet mount, sedimentation concentration, and permanent staining technique. Chi-squared or Fisher’s exact test were used for statistical analysis. Results: Out of 318 students, 135 (42.5%, 95% CI: 37.1–47.9) were infected with intestinal parasites. Prevalence rates for fe-males and males were 45.2% (61/135) and 40.4% (74/183) respectively. Protozoan infections (42.5%, 135) were more numerous than helminthiasis (0.6%, 2). Blastocystis hominis (28%, 89) was the most common parasite, followed by Giardia lamblia (9.7%, 31), Entamoeba coli (9.1%, 29) and Trichomonas hominis (6%, 19). Conclusions: The high prevalence rate of intestinal protozoan infection reflects poor personal hygiene among the stu-dents and inappropriate environmental conditions. Therefore, specific public health measures are required for the men-tally handicapped students in special schools.

Prevalence and genetic characteristics of Blastocystis hominis and Cystoisospora belli in HIV/AIDS patients in Guangxi Zhuang Autonomous Region, China.

Blastocystis hominis and Cystoisospora belli are considered to be common opportunistic intestinal protozoa in HIV/AIDS patients. In order to investigate the prevalence and genetic characteristics of B. hominis and C. belli in HIV/AIDS patients, a total of 285 faecal samples were individually collected from HIV/AIDS patients in Guangxi, China. B. hominis and C. belli were investigated by amplifying the barcode region of the SSU rRNA gene and the internal transcribed spacer 1 (ITS-1) region of the rRNA gene, respectively. Chi-square test or Fisher's exact test were conducted to assess the risk factors related to B. hominis and C. belli infection. The prevalence of B. hominis and C. belli was 6.0% (17/285) and 1.1% (3/285) respectively. Four genotypes of B. hominis were detected, with ST3 (n = 8) and ST1 (n = 6) being predominant, followed by ST6 (n = 2) and ST7 (n = 1). Females had a statistically higher prevalence of B. hominis (11.6%) than males (4.2%). The statistical analysis also showed that the prevalence of B. hominis was significantly associated with age group and educational level. Our study provides convincing evidence for the genetic diversity of B. hominis, which indicates its potential zoonotic transmission and is the first report on the molecular characteristics of C. belli in HIV/AIDS patients in China.

Intestinal protozoan infections among Egyptian neutropenic patients with acute leukemia.

Several enteric protozoan species are linked to diarrhea in humans, with some causing debilitating illnesses, essentially in immunocompromised and neutropenic patients as in acute leukemias. The aim of this study was to detect intestinal protozoa in Egyptian neutropenic patients with acute leukemia. The study comprised two groups; 40 newly diagnosed neutropenic acute leukemia patients and 30 controls. Stool samples were collected from all participants and subjected to routine microscopic examination, special staining and detection of copro-antigen using rapid diagnostic test (RDT) RIDA®QUICK Entamoeba/ Giardia/ Cryptosporidium Combi. Cases were tested post-chemotherapy at the nadir of neutropenia (absolute neutrophil count ANC<= 0.5x109/L) and 19 cases were also tested initially prior to chemotherapy. Of examined patients, 15/40 (37%) were positive for Blastocystis hominis by wet mount, 10/40 (25%) had microsporidia using modified trichrome stain and only 2 cases (5%) of Cryptosporidium spp. by Ziehl-Neelsen stain. By RDT, 8/40 cases (20%) were positive compared to entirely negative controls. The positive cases included 4 patients with G. intestinalis 2 with Entamoeba and 2 with Cryptosporidium.19/40 cases were tested both pre- and post-chemotherapy. microsporidian spp. was diagnosed in 6/19 cases at the nadir of neutropenia compared to none of the cases pre-chemotherapy and the difference was statistically significant (p= 0.031*). Intestinal protozoa in acute leukemia patients post-chemotherapy are common especially B. hominis. Furthermore, RDT might be helpful for diagnosing intestinal protozoa in acute leukemia. Attention is highly required as intestinal protozoa infection can emerge after chemotherapy such as microsporidia.

Dolor abdominal crónico en un niño con Blastocystis hominis: a propósito de un caso / Chronic abdominal pain in a child with Blastocystis hominis: case report

RESUMEN El Blastocystis sp. es un parásito frecuente en el humano, identificado por el laboratorio en muestras de heces fecales. Se presentó el caso de un paciente de 5 años atendido en consulta de Gastroenterología en el Hospital Pediátrico Docente Provincial Eliseo Noel Caamaño, de Matanzas, por presentar dolor abdominal, heces pastosas, náuseas y vómitos desde hacía un año. Llevó tratamiento con ranitidina, omeprazol y domperidona, sin mejoría clínica. Se realizó estudio coproparasitológico en muestras de heces fecales seriadas, con la presencia del Blastocystis hominis. Se indicó tratamiento con metronidazol, sin mejoría clínica, y posteriormente se indicó como alternativa la nitazoxanida. Se evaluó a los 15 días, sin sintomatología y con negativización de las heces fecales seriadas. Resulta frecuente el desconocimiento y la poca importancia que los profesionales sanitarios muestran ante esta infestación, aunque cada vez más se confirma la participación del parásito en manifestaciones clínicas (AU).

ABSTRACT Blastocystis sp. is a frequent parasite in humans, identified in the laboratory in samples of fecal feces. The case of a 5-year-old patient is presented; he assisted the consultation of Gastroenterology in the Provincial Teaching Pediatric Hospital Eliseo Noel Caamaño in Matanzas, suffering abdominal pain, mash feces, nauseas and vomits for one year, and was treated with ranitidine, omeprazole and domperidone without clinical improvement. A coproparasitological study was carried out in serial fecal feces samples with the presence of Blastocystis hominis. Treatment with metronidazole was indicated without clinical improvement and them, as an alternative, nitazoxanide was indicated. He was evaluated at 15 days without symptoms and with negative serial fecal feces. The ignorance and the little importance that health professionals show towards this infestation are frequent, although more and more frequently it is confirmed the participation of the parasite in clinical manifestations (AU).

Unveiling the role of EVs in anaerobic parasitic protozoa.

The anaerobic or microaerophilic protozoan parasites such as the enteric human pathogens Entamoeba histolytica, Giardia intestinalis, Cryptosporidium parvum, Blastocystis hominis and urogenital tract parasites Trichomonas vaginalis are able to survival in an environment with oxygen deprivation. Despite living in hostile environments these pathogens adopted different strategies to survive within the hosts. Among them, the release of extracellular vesicles (EVs) has become an active endeavor in the study of pathogenesis for these parasites. EVs are heterogenous, membrane-limited structures that have played important roles in cellular communication, transferring information through cargo and modulating the immune system of the host. In this review, we described several aspects of the recently characterized EVs of the anaerobic protozoa, including their role in adhesion, modulation of the immune response and omics analysis to understand the potential of these EVs in the pathogenesis of these diseases caused by anaerobic parasites.

Prevalence of Cryptosporidium spp. and Blastocystis hominis in faecal samples among diarrheic HIV patients in Medan, Indonesia.

Aim To investigate the prevalence of Cryptosporidium sp. and B. hominis among human immunodeficiency virus (HIV) positive patients in two different outpatient clinics, Haji Adam Malik General Hospital and Primary Care Centre of Padang Bulan, Medan, Indonesia, between two interval periods. Method Cryptosporidium spp. microscopic examination, as well as Jones' medium for B. hominis, were conducted in the Parasitology Laboratory, enzyme-linked immunosorbent assay (ELISA) was done in the Multidisciplinary Laboratory, Faculty of Medicine, Universitas Sumatera Utara. This was a cross-sectional study, involving 54 diarrheic HIV positive patients (44 males, 10 females). The data were analysed by Spearmen rank correlation, interrater agreement, and 2 tests. Results Infection rate for Cryptosporidium spp. and B. hominis was 24% (13 patients) and 9% (five patients), respectively. The prevalence of CD4 cell count below 200 cell/mm3 was relatively high, 29.6% (16 patients). There was a significant relationship between cryptosporidiosis and CD4 cell count (p=0.01; OR 1.57; 95% CI 1.25-1.99). Microscopic examination was superior over ELISA, whose diagnostic value for sensitivity and specificity was 46.15% and 100.0%, respectively, and Kappa (K) coefficient of 0.56. Conclusion The prevalence of cryptosporidiosis among HIV patients was still relatively high. CD4 count showed a significant relationship with Cryptosporidium spp. infection, but not with Blastocystic hominis. Microscopic examination is still the most reliable technique to diagnose the parasites in faecal samples.