eMedicine Specialties > Infectious Diseases > Parasitic Infections

Balantidiasis

Author: Valda M Chijide, MD, Clinical Professor, Department of Medicine, University of Saskatchewan; Consultant in Infectious Diseases, Regina, Saskatchewan, Canada
Contributor Information and Disclosures

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.

More on Balantidiasis

Overview: Balantidiasis
Differential Diagnoses & Workup: Balantidiasis
Treatment & Medication: Balantidiasis
Follow-up: Balantidiasis
Multimedia: Balantidiasis
References
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References

  1. Walzer PD, Judson FN, Murphy KB, et al. Balantidiasis outbreak in Truk. Am J Trop Med Hyg. Jan 1973;22(1):33-41. [Medline].

  2. 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].

  3. Vasilakopoulou A, Dimarongona K, Samakovli A, et al. Balantidium coli pneumonia in an immunocompromised patient. Scand J Infect Dis. 2003;35(2):144-6. [Medline].

  4. Dodd LG. Balantidium coli infestation as a cause of acute appendicitis. J Infect Dis. Jun 1991;163(6):1392. [Medline].

  5. 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].

  6. Arean VM, Koppisch E. Balantidiasis; a review and report of cases. Am J Pathol. Nov-Dec 1956;32(6):1089-115. [Medline].

  7. Aucott JN, Ravdin JI. Amebiasis and "nonpathogenic" intestinal protozoa. Infect Dis Clin North Am. Sep 1993;7(3):467-85. [Medline].

  8. Canadian Pharmacists Association. Compendium of Pharmaceuticals and Specialties (CPS). 2006;2182-2183.

  9. Esteban JG, Aguirre C, Angles R, et al. Balantidiasis in Aymara children from the northern Bolivian Altiplano. Am J Trop Med Hyg. Dec 1998;59(6):922-7. [Medline].

  10. Fisk T, Keystone J, Kozarsky P. Cyclospora cayetanensis, Isospora belli, Sarcocystis Species, Balantidium coli, and Blastocystis hominis. In: Mandell GL, Bennet JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 2. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:3228-37.

  11. Garcia L, Bruckner D. Intestinal Protozoa: Flagellates and Ciliates. In: Diagnostic Medical Parasitology. 3rd ed. Washington, DC: ASM Press; 1997:34-53.

  12. Markell E. Lumen-Dwelling Protozoa. In: Markell and Voge's Medical Parasitology. 8th ed. Philadelphia, Pa: WB Saunders Co; 1999:24-89.

  13. Micromedex. Tetracycline. Drugdex Drug Evaluations. 2000. Available at: http://www.micromedex.com:Accessed 2000. [Medline].

  14. Neafie R. Balantidiasis. In: Pathology of Tropical and Extraordinary Diseases. Vol 1. Washington, DC: Armed Forces Institute of Pathology; 1976:325-7.

  15. PDR. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc; 2000.

  16. Rosenblatt JE. Antiparasitic agents. Mayo Clin Proc. Nov 1999;74(11):1161-75. [Medline].

  17. The Medical letter on drugs and therapeutics. Drugs for parasitic infections. Med Lett Drugs Ther. Jan 2 1998;40(1017):1-12. [Medline].

  18. 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].

  19. Young MD. Attempts to transmit human Balantidium coli. Am J Trop Med Hyg. Jan 1950;30(1):71. [Medline].

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Further Reading

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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

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Contributor Information and Disclosures

Author

Valda M Chijide, MD, Clinical Professor, Department of Medicine, University of Saskatchewan; Consultant in Infectious Diseases, Regina, Saskatchewan, Canada
Valda M Chijide, MD is a member of the following medical societies: American College of Physicians, HIV Medicine Association of America, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey D Band, MD, Clinical Professor of Medicine, Wayne State University School of Medicine; Director, Division of Infectious Diseases and International Medicine, William Beaumont Hospital Corporation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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