Balantidiasis Clinical Presentation

Updated: Oct 18, 2019
  • Author: Subhash Chandra Parija, MD, MBBS, PhD, DSc, FRCPath; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Balantidium mostly causes asymptomatic and self-limiting infections. Clinical presentations of balantidiasis range from mild to severe symptoms. Asymptomatic hosts serve as reservoirs of infection in the community. Individuals with chronic infection usually present with diarrhea, cramping, abdominal pain, and halitosis. [15, 16]

Ciliate dysentery

B coli infection causes ciliate dysentery. Intermittent diarrhea alternating with constipation is the typical symptom in mild infections.

Individuals with fulminating balantidiasis present with frequent mucoid, bloody stools.

The clinical presentations of ciliate dysentery are similar to those of amoebic dysentery. Such a fulminant infection has a high case fatality rate, especially in immunocompromised and malnourished patients.

The most severe presentation of B coli infection consists of weight loss, tenesmus, and bloody stools. [15] Intestinal hemorrhage and perforation can also occur and are mediated by the production of B coli proteolytic enzymes. Hemorrhage and perforation were reported in fatal cases of B coli infection. [17]

Extraintestinal infections, although rare, have been reported to affect the appendix, liver, and lungs. [17, 18]



Patients with balantidiasis may present with abdominal tenderness, fever, and prolonged diarrhea, which may result in signs of dehydration.



Balantidiasis is caused by ingestion of food or water that has been contaminated with fecal matter from humans or animals. The fecal matter can contaminate food or water with B coli cysts.

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.



Intestinal perforation and peritonitis are the most common causes of death associated with balantidiasis. [19]

Intestinal perforation and extraintestinal spread to liver and mesenteric lymph nodes are rare.

Pulmonary involvement has been reported and appears to be more common in patients with underlying illnesses such as diabetes, cancer, or impaired lymphocyte function.