Abstract
Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole.
Highlights
Blastocystis is one of the most common intestinal protists of humans
Blastocystis was first described 100 years ago but surprisingly little is still known about the pathogenicity, genetic diversity, host range and treatment
Up to 17 subtypes have been described with subtype (ST) 1–9 being found in humans [7]
Summary
Blastocystis is one of the most common intestinal protists of humans. Blastocystis was first described 100 years ago but surprisingly little is still known about the pathogenicity, genetic diversity, host range and treatment. Though this is not a high incidence of the parasite in the population, it was shown that in these two patients there were 10 or more organisms seen per field of view and the presence of no other pathogens suggested that Blastocystis was the cause of diarrhoea in these patients This is in comparison to studies done in Africa which showed Blastocystis infection to be at a higher rate in HIV positive patients compared to a control group. There are some problems in relation to accuracy of these results with most studies relying on techniques such as the less sensitive microscopy and culture These studies give varying results in respect to Blastocystis infection in HIV/AIDS patients, this parasite should still be considered as a cause of diarrhoea in these cases and shows the significance of parasite infection in immunosuppressed patients. There may be a correlation between ST and sensitivity to drugs which is yet to be addressed in studies
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