Balantidium coli: Difference between revisions
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Revision as of 15:38, 20 September 2014
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% . 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
Workup
- 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: 35-50 mg/kg/day in 3 doses x 5 days (max: 2g/day)
- Tetracycline or
- Adult: 500mg qid x 10 days
- Peds (>8yo): 40 mg/kg/day in 4 doses x 10 days (max: 2g/day)
- Iodoquinol
- Adults: 650mg tid x 20 days
- Peds: 30-40 mg/kg/day in 3 doses x 20 days (max: 2g/day)
Disposition
- Home if no complications in pt who is well-hydrated
- Admit if needing fluid hydration, fulminant balantidiasis, or any complication
See Also
External Links
Sources
- Schuster F, Ramires-Avila L. “Current world status of Balantidium coli.” Clinical Microbiology Reviews. Oct. 2008: 626-38.
- Rosen’s Emergency Medicine