Balantidiasis Workup

  • Author: Valda M Chijide, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Nov 22, 2011
 

Laboratory Studies

  • Wet smear stool specimens
    • B coli does not stain well on permanent stained smears, complicating diagnosis of balantidiasis; however, the diagnosis can be made by examining wet smears of stool specimens or scrapings from the periphery of ulcers during an endoscopic examination.
    • On unstained specimens, the trophozoite is recognized by its large size (approximately 50-100 µm in length and 40-70 µm in width), a short ciliary covering, and its spiraling motility. It is frequently observed under low power. On stained preparations, the trophozoite characteristically shows 2 nuclei: the macronucleus, which is kidney-shaped, and the micronucleus, which is spherical and lies close to the macronucleus.
    • Cysts may be spherical or ellipsoid and are approximately 50-70 µm long. Newly encysted organisms observed on unstained specimens may still have cilia, but cilia disappear after a longer period of encystment. Observation of a macronucleus and a micronucleus is diagnostic if observed in a cyst on a stained specimen. See the images below. Trophozoite of Balantidium coli in colon. This phoTrophozoite of Balantidium coli in colon. This photograph shows the large macronucleus and the thin cell membrane covered with cilia (X820). Courtesy of Armed Forces Institute of Pathology (AFIP 75-9300). Cyst of Balantidium coli in feces. This photographCyst of Balantidium coli in feces. This photograph demonstrates a thick cyst wall and a large macronucleus (X820). Courtesy Armed Forces Institute of Pathology (AFIP 75-9301).
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Imaging Studies

  • Chest radiography may show pulmonary parenchymal involvement in patients with balantidiasis.
  • Computed tomography (CT) scanning may reveal pulmonary parenchymal and lymph node involvement, as well as involvement of other organ systems.
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Procedures

  • Colonoscopy: Perform an endoscopic examination of the colon to obtain a biopsy of ulcers, thereby aiding in diagnosis of balantidiasis. Obtain the specimens from the periphery of ulcers.
  • Bronchoalveolar lavage (BAL) can identify organisms on wet mount of bronchial secretions.
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Histologic Findings

B coli can invade the mucosa and submucosa, causing ulceration and infiltration with polymorphonuclear cells, lymphocytes, and eosinophils. Trophozoites can be observed at the invading edge of ulcers or at the periphery of submucosal abscesses.

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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.

Specialty Editor Board

Jeffrey D Band, MD  Professor of Medicine, Oakland University William Beaumont School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, 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; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

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.

References

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Trophozoite of Balantidium coli in colon. This photograph shows the large macronucleus and the thin cell membrane covered with cilia (X820). Courtesy of Armed Forces Institute of Pathology (AFIP 75-9300).
Cyst of Balantidium coli in feces. This photograph demonstrates a thick cyst wall and a large macronucleus (X820). Courtesy Armed Forces Institute of Pathology (AFIP 75-9301).
 
 
 
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