Balantidium coli: Difference between revisions
No edit summary |
(Text replacement - "OR" to "'''OR'''") |
||
| Line 40: | Line 40: | ||
==Management== | ==Management== | ||
*[[Metronidazole]] ''OR'' | *[[Metronidazole]] '''''OR''''' | ||
**Adults: 500-750mg tid x 5 days | **Adults: 500-750mg tid x 5 days | ||
**Peds: 35-50mg/kg/day in 3 doses x 5 days (max: 2g/day) | **Peds: 35-50mg/kg/day in 3 doses x 5 days (max: 2g/day) | ||
*[[Tetracycline]] ''OR'' | *[[Tetracycline]] '''''OR''''' | ||
**Adult: 500mg qid x 10 days | **Adult: 500mg qid x 10 days | ||
**Peds (>8yo): 40mg/kg/day in 4 doses x 10 days (max: 2g/day) | **Peds (>8yo): 40mg/kg/day in 4 doses x 10 days (max: 2g/day) | ||
Revision as of 23:30, 30 May 2017
Background
- Infection of large intestine by parasite, Balantidium coli
- Large, ciliated protozoan
- Simple life cycle: dormant cyst to trophozoite to cyst
- Reservoir host is pig (asymptomatic)
- Pig sheds feces with cysts => contaminated water and food => ingested by humans => parasite resides in large intestine
- Parasite usually resides in lumen of intestine but can also penetrate mucosa
- Opportunistic infection
- Human-to-human transmission via fecal-oral route as well
- Worldwide prevalence 0.02-1%[1] and found wherever pigs are found
- Risk factors:
- Close contact between human and pigs
- Lack of appropriate waste disposal that can contaminate drinking water sources
- Subtropical/tropical climates (warmth and humidity favor survival of cyst)
- Compromised immune system, elderly, malnourished, alcoholics
Clinical Features
- Range of mild to severe disease
- Asymptomatic hosts (usually immunocompetent)
- Chronic infection: non-bloody diarrhea, cramping, abdominal pain
- Fulminant balantidiasis: mucoid, bloody stools
- Rarely, colonic perforation
- Extra-intestinal cases are rare
- Rarely infecting lungs causing pneumonia or pulmonary hemorrhage
- Mostly seen in elderly or immunocompromised
- Death is rare
Differential Diagnosis
Evaluation
- Stool samples over several days (excretion of parasites can be erratic)
- Wet mount slide preparation: large 150-200um ovoid shape with cilia, swimming aimlessly in circles
- If suspect infection of pulmonary system, perform BAL
Management
- Metronidazole OR
- Adults: 500-750mg tid x 5 days
- Peds: 35-50mg/kg/day in 3 doses x 5 days (max: 2g/day)
- Tetracycline OR
- Adult: 500mg qid x 10 days
- Peds (>8yo): 40mg/kg/day in 4 doses x 10 days (max: 2g/day)
- Iodoquinol
- Adults: 650mg tid x 20 days
- Peds: 30-40mg/kg/day in 3 doses x 20 days (max: 2g/day)
Disposition
- Discharge in well-hydrated patient with uncomplicated disease
- Admit if needing fluid hydration, fulminant balantidiasis, or any complication
See Also
External Links
References
- ↑ Schuster FL and Ramirez-Avila L. Current World Status of Balantidium coli. Clin. Microbiol. 2008; 21(4):626–638.