Balantidium coli: Difference between revisions
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==Background== | ==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%<ref>Schuster FL and Ramirez-Avila L. Current World Status of Balantidium coli. Clin. Microbiol. 2008; 21(4):626–638.</ref> 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== | ==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== | ==Differential Diagnosis== | ||
*[[Entamoeba histolytica]] | |||
*[[Shigella]] | |||
*[[Salmonella]] | |||
*[[Campylobacter]] | |||
*[[E. coli]] | |||
*IBD | |||
== | ==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== | ==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== | ==Disposition== | ||
*Discharge in well-hydrated patient with uncomplicated disease | |||
*Admit if needing fluid hydration, fulminant balantidiasis, or any complication | |||
==See Also== | ==See Also== | ||
*[[Parasitic diseases]] | |||
==External Links== | ==External Links== | ||
*[http://www.cdc.gov/parasites/balantidium/ CDC - Parasites - Balantidiasis] | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: ID]] | [[Category:ID]] | ||
Latest revision as of 11:48, 7 July 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.