eMedicine Specialties > Infectious Diseases > Parasitic Infections
Balantidiasis
Updated: Sep 18, 2008
Introduction
Background
Balantidiasis (also known as balantidiosis) is defined as large-intestinal infection with Balantidium coli, which is a ciliated protozoan (and the largest protozoan that infects humans). B coli is known to parasitize the colon, and pigs may be its primary reservoir.
Pathophysiology
B coli exists as a trophozoite and a cyst and usually affects the large intestine, from the caecum to the rectum. The trophozoites replicate by binary fission and conjugation, and they subsist on bacteria. Humans ingest infective cysts, which then migrate to the large intestine, cecum, and terminal ileum. The organisms primarily dwell in the lumen but can also penetrate the mucosa and cause ulcers. B coli produces hyaluronidase, potentially enhancing its ability to invade the mucosa.
Frequency
United States
Balantidiasis is found worldwide and has an overall estimated prevalence of 1%. Balantidiasis epidemics have occurred in psychiatric hospitals in the United States.
International
Balantidiasis tends to be more common among persons who handle pigs. The disease is reported most commonly in Latin America; Southeast Asia; and Papua, New Guinea. In 1971, a balantidiasis outbreak involving 100 people occurred in Truk following a typhoon.1 In France, a pork butcher with immunosuppression due to alcohol use developed occupational balantidiasis.2
Mortality/Morbidity
Most cases of balantidiasis in immunocompetent individuals are asymptomatic. Mortality rates associated with acute and fulminating types of balantidiasis were as high as 30% in untreated patients prior to the introduction of antibiotics. Pneumonia has been described in patients with cancer-related immunosuppression3 and has not always been associated with direct contact with pigs.
Clinical
History
Potential symptoms of balantidiasis include the following:
- Diarrhea (watery, bloody, mucoid)
- Nausea
- Vomiting
- Abdominal pain
- Anorexia
- Weight loss
- Headache
- Mild colitis
- Fever
- Severe and marked fluid loss (resembling amebic dysentery)
Physical
Patients with balantidiasis may present with abdominal tenderness, fever, and prolonged diarrhea, which may result in signs of dehydration.
Causes
Risk factors for balantidiasis include contact with pigs, handling fertilizer contaminated with pig excrement, and living in areas where the water supply may be contaminated by the excrement of infected animals. Poor nutrition, achlorhydria, alcoholism, and immunosuppression may also be contributing factors.
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References
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Ferry T, Bouhour D, De Monbrison F, et al. Severe peritonitis due to Balantidium coli acquired in France. Eur J Clin Microbiol Infect Dis. May 2004;23(5):393-5. [Medline].
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Dodd LG. Balantidium coli infestation as a cause of acute appendicitis. J Infect Dis. Jun 1991;163(6):1392. [Medline].
Anargyrou K, Petrikkos GL, Suller MT, et al. Pulmonary Balantidium coli infection in a leukemic patient. Am J Hematol. Jul 2003;73(3):180-3. [Medline].
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Garcia L, Bruckner D. Intestinal Protozoa: Flagellates and Ciliates. In: Diagnostic Medical Parasitology. 3rd ed. Washington, DC: ASM Press; 1997:34-53.
Markell E. Lumen-Dwelling Protozoa. In: Markell and Voge's Medical Parasitology. 8th ed. Philadelphia, Pa: WB Saunders Co; 1999:24-89.
Micromedex. Tetracycline. Drugdex Drug Evaluations. 2000. Available at: http://www.micromedex.com:Accessed 2000. [Medline].
Neafie R. Balantidiasis. In: Pathology of Tropical and Extraordinary Diseases. Vol 1. Washington, DC: Armed Forces Institute of Pathology; 1976:325-7.
PDR. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc; 2000.
Rosenblatt JE. Antiparasitic agents. Mayo Clin Proc. Nov 1999;74(11):1161-75. [Medline].
The Medical letter on drugs and therapeutics. Drugs for parasitic infections. Med Lett Drugs Ther. Jan 2 1998;40(1017):1-12. [Medline].
Yazar S, Altuntas F, Sahin I, et al. Dysentery caused by Balantidium coli in a patient with non-Hodgkin's lymphoma from Turkey. World J Gastroenterol. Feb 1 2004;10(3):458-9. [Medline].
Young MD. Attempts to transmit human Balantidium coli. Am J Trop Med Hyg. Jan 1950;30(1):71. [Medline].
Further Reading
Keywords
balantidiasis, balantidiosis, Balantidium coli, B coli, hyaluronidase, Balantidium coli infection, B coli infection, acute balantidiasis, fulminating balantidiasis, occupational balantidiasis, protozoa infection, protozoan infection, colon cyst, colonic cyst
Overview: Balantidiasis