Abstract

In this study we characterized the presence and subtype (ST1-ST4) of Blastocystis in patients attended at a referral center for tropical diseases in Northern Italy. We also, evaluated the organism’s association with other intestinal parasites. Parasite screening was performed on 756 patients, from different geographical origins (namely, Italians, Africans, South Americans, Asian and non-Italian Europeans) in which Italians represented the largest group. Blastocystis was seen to be the most prevalent parasite in the study. Subtype 3 and 1 were the most frequently found in the Italians and Africans. Our data confirmed previous studies performed in Italy, in which ST3 proved to be the most prevalent subtype, but we highlighted also a high frequency of mixed subtypes, which were probably underestimated in former analyses. Interestingly, the mixed subtypes group was the most prevalent in all the analysed geographical areas. About half of our cases showed other co-infecting parasites and the most frequent was Dientamoeba fragilis. Our study confirms that, in Blastocystis infection, multiple subtypes and co-infecting parasites are very frequently present, in particular Dientamoeba fragilis.

Highlights

  • Blastocystis is a common enteric protist, belonging to the heterogeneous infrakindom of Stramenopiles [1]

  • We found a higher prevalence of Blastocystis infection in males than in females (38.5% and 28.8% respectively)

  • Dientamoeba fragilis (D. fragilis) was the most frequent co-infecting parasite in all the geographical areas (Fig 2), with 24% (53/221) of analyzed cases harboring this parasite. Considering this result, we further explored the possible correlation between Blastocystis and D. fragilis, finding a statistically significant association between the two parasites (OR: 1.86, 95% CI: 1.27 to 2.73)

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Summary

Introduction

Blastocystis is a common enteric protist, belonging to the heterogeneous infrakindom of Stramenopiles [1]. It has a worldwide distribution and is transmitted by fecal-oral direct contact or waterborne transmission [2, 3]. Several publications suggest an association with gastrointestinal (GI) symptoms such as diarrhea, abdominal pain, nausea, vomiting, fatigue, flatulence, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) [4,5,6,7,8]. An association with cutaneous symptoms and urticaria is suggested [9, 10]. Subtype determination can be obtained by the molecular analysis of a particular

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