Case Report: A rare instance of acute appendicitis induced by Balantidium Coli parasitic infection.

Introduction: Acute appendicitis secondary to parasitic infections is uncommon, being detected in less than 1% of cases. Balantidium coli is a parasite found in pigs and primates with zoonotic potential. To date, only three cases of acute appendicitis induced by this parasite have been documented globally. Case: A 7-year-old female patient, who consumed pork daily, presented to the emergency department with a one-day history of abdominal pain in the lower quadrants, described as colic-like, alongside abdominal distension. Initial abdominal radiography led to a diagnosis of intestinal obstruction. Conservative management without therapeutic response necessitated referral to a higher complexity center. Upon admission, an abdominal computed tomography scan diagnosed acute appendicitis and secondary ileus. During surgical intervention, an appendiceal phlegmon formed by loops of the small intestine was mechanically released, revealing a perforated appendix with extensive fecal peritoneal contamination. Pathological analysis identified an inflammatory infiltrate and the presence of Balantidium coli trophozoites. Medical treatment included Piperacillin-Tazobactam and Metronidazole. The patient was discharged after 10 days of medical treatment. Discussion: Acute appendicitis caused by Balantidium coli is a rare occurrence. It is crucial to identify parasites in pathological samples due to their impact on postoperative management. The close contact between humans and pigs, especially in developing countries, suggests that the prevalence of parasitic infection and colonization by Balantidium coli may be higher than currently recognized. Regarding the identification of this patient's specific exposure, the regular consumption of pork suggests the hypothesis that improper processing is linked to the acquisition of the parasitic infection.

Uninvited guest, Balantidium coli in urine in a patient with bladder cancer: A case report and review of the literature.

Key Clinical Message: In contrast to intestinal balantidiasis, which is widespread throughout the world, urinary balantidiasis is uncommon. It often affects people with underlying diseases, and acute infections may be fatal. Even though urine is not typical for this parasite, specific morphologic characteristics can aid in accurate diagnosis. Abstract: Balantidium coli is a ciliated protozoan which can infect intestinal system. Urinary balantidiasis is an extremely rare infection that may cause serious issues in patients with underlying diseases. Herein, we present a case of urinary balantidiasis in a patient with bladder cancer.

Intestinal Perforation and Perianal Ulcer Due to Parasitic Infection / Perforación intestinal y úlcera perianal por infección parasitaria

Abstract Balantidium coli is the largest protozoan and the only ciliated parasite that infects humans. It causes balantidiasis, a disease humans acquire by fecal-oral transmission from its usual host: the pig. We report the case of an immunocompetent schoolgirl who presented with peritonitis due to intestinal perforation, with perianal ulceration secondary to polyparasitism caused by Balantidium coli, Enterobius vermicularis, and Trichuris trichiura. It is a rare, potentially preventable complication with extremely high mortality rates. The patient required eight surgical interventions.

Resumen Balantidium coli es el protozoario más grande y el único parásito ciliado que infecta a los seres humanos. Es el causante de la balantidiasis, enfermedad adquirida por los humanos por transmisión fecal-oral desde su hospedero habitual: el cerdo. Reportamos el caso de una escolar inmunocompetente, que presentó peritonitis por perforación intestinal, con ulceración perianal secundaria a poliparasitismo por Balantidium coli, Enterobius vermicularis y Trichuris trichiura. Esta es una complicación poco frecuente, potencialmente prevenible y con tasas de mortalidad extremadamente altas. La paciente requirió 8 intervenciones quirúrgicas.

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 apendicular como hallazgo incidental. Reporte de un caso / Apendicular balantidium coli as incidental finding during surgery. Report of a case

Resumen Balantidium coli es el único miembro de la familia Balantidiidae capaz de producir infección en seres humanos. Presentamos un caso en un hombre de 43 años que ingresa para corrección quirúrgica de hernia ventral durante la cual se realizó apendicetomía profiláctica. En el estudio histopatológico se observó apéndice cecal con arquitectura conservada, sin la presencia de apendicitis ni periapendicitis. En la luz se reconocieron estructuras grandes (aproximado de 50 μm) redondas con citoplasma amplio con vacuolas grandes, cilias periféricas y núcleos densos, los cuales correspondieron a trofozoitos de Balantidium coli.

Abstract Balantidium coli is the only member of the Balantidiiae family capable of infecting human beings. We present one in a 43 years-old male admitted for a surgical co rrection of an incisional hernia with prophylactic appendicectomy. Histopathological findings reported the cecal appendix within normal architecture, appendicitis and peri-appendicitis free. At the lumen big, rounded shape structures (aprox. 50 mm) were visible with broad cytoplasm, big vacuoles, peripheral cilia and dense nucleus, corresponding to Balantidium coli trophozoites.

Urinary balantidiasis in a patient with systemic lupus erythematosus and lupus nephritis: a case report.

BACKGROUND: Balantidium coli, a parasitic unicellular ciliate, often causes asymptomatic balantidiasis of the colon, but extraintestinal disease may occur rarely in immunosuppressed individuals. Renal balantidiasis associated with systemic lupus erythematosus has not been reported before. CASE PRESENTATION: We present a case of a 48-year-old Thai woman who presented with nephrotic syndrome due to systemic lupus erythematosus-related nephritis. Initially, few B. coli cysts were found in urine sediment, but these increased substantially following treatment with prednisolone. She made an uneventful recovery with 10 days of oral tetracycline therapy. No B. coli cysts were found in her stool. CONCLUSION: The route of infection in our patient was unclear but is likely to have been orofecal. Neither her infection nor its treatment caused a deterioration in her renal function.

Balantidiasis in an Asiatic elephant and its therapeutic management.

A 14 years old female Asiatic elephant was presented to the hospital with a history of mucoid watery diarrhea, inappetence and lethargy. Clinical examination revealed normal body temperature (98.2 °F), tachycardia (42 bpm), eupnoea (14/min), congested mucous membrane and dehydration. Haemato-biochemical parameters are well within the range. Microscopic examination of faecal sample revealed presence of live, motile and pear shaped ciliated Balantidium coli protozoa. Based on clinical and laboratory examination, the condition was diagnosed as balantidiasis. The animal was treated with Tab. Metronidazole (10 mg/Kg, PO, BID) for 5 days. Supportive treatment was done with antacids, hepatoprotectants and multivitamin supplements. An uneventful recovery was noticed after 5 days of treatment.

Balantidiasis colónica: reporte de un caso fatal y revisión de la literatura

La balantidiasis es una zoonosis producida por el Balantidium coli, que habita el intestino grueso del cerdo y del hombre. La infección es infrecuente en humanos y afecta principalmente al colon. Se produce con mayor frecuencia en países en desarrollo, regiones tropicales y subtropicales. La balantidiasis colónica puede presentarse en la mayoría de los casos de forma asintomática y llegar en los casos más graves como diarrea disentérica que puede complicarse con hemorragia digestiva baja e incluso perforación. Presentamos el caso de un varón de 72 años, proveniente de la sierra peruana de ocupación agricultor y criador de ganado porcino y ovino, quién acude por 3 meses de enfermedad caracterizado inicialmente por deposiciones líquidas con moco sin sangre, dolor abdominal cólico, náuseas, vómitos y en el último mes de enfermedad presenta diarrea disentérica. Se ingresa a colonoscopía por sospecha de colitis infecciosa, encontrándose en la muestra en fresco y biopsia de tejido colónico trofozoitos de Balantidium coli. Paciente recibe tratamiento con amebicida y antibacteriano sin mejoría clínica, presentando como complicación múltiples perforaciones en colon sigmoides, tratado con resección y colostomía terminal. Finalmente, paciente fallece a pesar de recibir manejo médico y quirúrgico.

Balantidiasis is a zoonosis produced by Balantidium coli, which inhabits the large intestine of the pig and man. Infection is uncommon in humans and mainly affects the colon. It occurs more frequently in developing countries, tropical and subtropical regions. Colonic balantidiasis can occur in most cases asymptomatically and reach in the most severe cases such as dysenteric diarrhea that can be complicated by low digestive bleeding and even perforation. We present the case of a 72-year-old man, from the Peruvian highlands, who was a farmer and breeder of swine and sheep, who came for 3 months of illness, initially characterized by liquid stools with bloodless mucus, abdominal pain, nausea, vomiting and in the last month of illness he presents dysenteric diarrhea. Colonoscopy was performed due to suspicion of infectious colitis, Balantidium coli trophozoites were found in the fresh sample and colonic tissue biopsy. Patient receives treatment with amebicide and antibacterial without clinical improvement, presenting as a complication multiple perforation in the sigmoid colon, treated with resection and terminal colostomy. Finally, the patient died despite receiving medical and surgical treatment.

Urinary balantidiasis: A rare incidental finding in a patient with chronic obstructive pulmonary disease.

Balantidiasis is a rare zoonotic disease in humans. Balantidium coli is the causative ciliated protozoan. We present a case of urinary balantidiasis in a patient having chronic obstructive pulmonary disease (COPD) who was on steroids for a long time. He has no symptoms of bowel or urinary involvement. We are reporting this case because of its rarity in human urine and also for future references.

A case report of an uncommon parasitic infection of human balantidiasis.

Balantidium coli, a large, ciliated pathogen, is known to cause balantidiasis in humans. We report a case of B. coli infection in a 37-year-old male with tuberculosis and presenting with fever, anorexia, mild abdominal pain, and episodes of loose stools for 1 week.

A rare case of urinary balantidiasis in an elderly renal failure patient.

Balantidium coli is the largest ciliated protozoa infecting humans by the feco-oral transmission from pigs. Large gut is the most common site of involvement. Symptomatology varies from asymptomatic carrier to invasive dysentery. Extra-intestinal infections can occur in liver, lung and urogenital tract. There are very few case reports of urinary balantidiasis. We present a case of urinary balantidiasis in an elderly farmer having diabetes and chronic kidney disease. This case is reported for its rarity and future references.