Balantidiasis - Causes, Symptoms, Diagnosis And Treatment

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Balantidiasis - Causes, Symptoms, Diagnosis And Treatment
Balantidiasis - Causes, Symptoms, Diagnosis And Treatment

Video: Balantidiasis - Causes, Symptoms, Diagnosis And Treatment

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Video: Parasitic Diseases Lectures #17: Balantidiasis 2023, February
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Balantidiasis (ciliated dysentery) is a zoonotic protozoal infection occurring with symptoms of ulcerative hemorrhagic colitis and general intoxication. Outbreaks of balantidiasis are more common in the southern regions, but sporadic cases of infection are also recorded in rural areas with developed pig breeding. Balantidiasis is characterized by a severe course, and with a late start of treatment - high mortality due to intestinal complications, cachexia, and sepsis. The spread of balantidiasis is facilitated by the lack of alertness on the part of medical specialists to this pathology, a low level of sanitary culture of the population, and a high invasion of the rural population (4-5%).

The content of the article:

  • 1 General information
  • 2 Epidemiology
  • 3 Signs
  • 4 Development of the disease
  • 5 Description
  • 6 Clinical picture
  • 7 Symptoms of balantidiasis
  • 8 Ways of transmission of balantidiasis
  • 9 Diagnostics
  • 10 Complications of balantidiasis
  • 11 Treatment
  • 12 Prevention

general information

Balantidiasis
Balantidiasis

The causative agent of the disease is the simplest Balantidium coli. The parasite is the largest among the pathogenic intestinal protozoa. Cysts remain viable in the external environment for 3-4 weeks.

The disease is relatively rare. In rural areas, about 4-5% of the population is infected with balantidia. As a rule, these are people in contact with pigs, which are natural carriers of balantidia. Infestation occurs through contact with infected persons.

A person becomes infected when a pathogen, and more often cysts, enters the digestive tract. Balantidia can live for a long time in the human intestine without showing any signs of presence. The parasite lives usually in the lower parts of the small intestine. Lesions are observed mainly in the blind, sigmoid, and rectum. Initially, swelling and redness appear on the folds of the mucous membrane, then erosion, then balantidia penetrate the tissues, causing foci of hemorrhage and necrosis.

Diagnosis is carried out by analyzing native swabs from feces or scrapings from the affected areas of the intestinal mucosa. Balantidia are easily recognized.

Epidemiology

Human balantidiasis occurs throughout the world, but is more common in tropical and subtropical regions, developing countries.

Balantidium coli infections tend to occur in domestic and wild animals, especially pigs in warm climates and monkeys in the tropics.

Consequently, balantidiasis in people is more common in these areas, especially in areas where hygiene requirements are not followed. Pig faeces getting into water or food used by humans is the main route of human infection.

Signs

Balantidiasis
Balantidiasis

Balantidium coli infections tend to occur in domestic and wild animals, especially pigs in warm climates and monkeys in the tropics

The incubation period of the disease lasts from 5 to 30 days, but more often 10-15 days. In acute balantidiasis, the patient complains of high fever, abdominal pain, bloating, diarrhea, in which blood and mucus are found, tenesmus (false urge to defecate). It is also characterized by drastic weight loss. All this is accompanied by weakness, nausea, vomiting, headache and dizziness. Tongue with acute balantidiasis is coated with white bloom. Acute balantidiasis lasts about two months. Without treatment, it becomes chronic.

In chronic recurrent balantidiasis, the body temperature is normal, the stool is liquid, mixed with mucus, and sometimes blood, 2-3 times a day. The abdomen is painful on palpation. The periods of exacerbation in chronic balantidiasis are replaced by remissions. This form of the disease can last up to 10 years.

In chronic continuous balantidiasis, the course of the disease is monotonous, without remission, the symptoms are moderate.

A subclinical form is also possible, in which the disease does not manifest itself in any way, and it can only be detected during sigmoidoscopy.

With the carriage of balantidia, the disease does not manifest itself in any way. It is possible to establish the fact of carriage only by the results of the analysis of feces.

Disease development

Balantidia enter the human body through the fecal-oral route in the form of cysts, from which adult forms - trophozoites - are formed in the lumen of the digestive tract.

Trophozoites exist in the patient's colon, sometimes penetrating its walls and causing ulcers to form on the mucous membrane.

The fact is that balantidia secrete the enzyme hyaluronidase, which destroys the tissues of the intestinal walls and helps parasites to penetrate the mucous membrane. Sometimes these ulcers become infected with other bacteria, leading to secondary infections.

Description

Balantidiasis is caused by Balantidium coli, class Ciliata, subtype Ciliophora, type of protozoa (Protozoa), class of ciliates. This is the largest pathogenic protozoan. It moves with the help of cilia. Balantidia are quite stable in the external environment. In feces at room temperature, they can last up to 30 hours, in waste water - up to 7 days, in dry, shaded places - up to 2 weeks.

This ciliate was first described by the Swedish scientist Malmsten back in 1857. In 1901, N.S. Soloviev proved that it is dangerous to humans.

The disease develops when balantidial cysts enter the human digestive tract. Moreover, for a long time they are in the intestines, not manifesting in any way. Why they suddenly acquire pathogenic properties is still not clear. It is known that with the help of the hyaluronidase enzyme, they penetrate first into the mucous membrane of the ileum, and then into the mucous membrane of the remaining parts of the large intestine.

There they multiply intensively. And in places where parasites are introduced, deep ulcers of an irregular shape are formed with a diameter of 1 mm to several centimeters. Their bottom is covered with pus, in which balantidia are found. At the same time, the mucous membrane of the intestine is red and edematous; not only ulcers, but also hemorrhages and areas of necrosis are found on its surface.

In severe cases, ulcers may perforate and peritonitis may develop. With balantidiasis, other complications are possible:

  • intestinal bleeding;
  • appendicitis (balantidia often affects the cecum);
  • pararectal abscess;
  • prolapse of the rectum;
  • dehydration.

These complications are often fatal.

Clinical picture

Clinically, balantidiasis can manifest itself in three ways:

  • An asymptomatic course in which patients are carriers of the parasite and serve as a reservoir of infection in society.
  • A chronic infection that causes diarrhea, cramps, and abdominal pain.
  • Malignant balantidiasis.
Balantidiasis
Balantidiasis

Most patients infected with balantidia develop the asymptomatic form of the disease. They can excrete trophozoites and cysts in the feces, without any complaints and signs of balantidiasis.

In the chronic form of balantidiasis, patients develop persistent diarrhea, blood or mucus in loose stools, nausea, bad breath, colitis, abdominal pain, weight loss, poor appetite, a slight increase in body temperature, symptoms of dehydration, headaches, general weakness.

Most of these symptoms are nonspecific and are common in other conditions, such as amoebic dysentery.

The malignant form of balantidiasis is characterized by weight loss, tenesmus, bloody diarrhea. Intestinal bleeding and perforation may also develop.

Malignant balantidiasis has a very high mortality rate - without appropriate treatment, about 30% of patients die from it.

Symptoms of balantidiasis

For the acute form of the disease, characteristic violent, detailed symptoms. After infection, the symptoms of balantidiasis are absent for 5-30 days (latent incubation period).

Getting into the gastrointestinal tract, the microorganism affects the intestinal wall, causing at the initial stage edema and hyperemia of the mucous membrane, which are replaced as the process progresses with hemorrhages and foci of necrosis, accompanied by powerful intoxication, which manifests itself:

  • cramping abdominal pain;
  • frequent false urge to defecate;
  • weakness, deterioration in general health;
  • an increase in body temperature to 38.5–39 ° С;
  • headache, dizziness;
  • decreased or complete lack of appetite;
  • liquid fetid stools mixed with blood, pus, mucus (10-15 times a day).

Objective signs: the tongue is dry, coated with a white coating, the liver and spleen are enlarged, the abdomen is sharply painful when pressed in the umbilical region and in the lower sections. There is a rapid loss of body weight, depletion develops over several days (up to a week).

An increase in body temperature may be against the background of an attached bacterial infection. Without it, the temperature may be normal.

Acute forms of balantidiasis resemble enterocolitis or colitis in their manifestations. Characterized by signs of general intoxication: weakness, headache, decreased appetite, moderate fever, and sometimes chills. There are also signs of intestinal damage: abdominal pain, diarrhea, flatulence. Sometimes a dry coated tongue is observed, the liver is enlarged and painful. Stool up to 20 times a day, has a putrid smell. Patients lose weight quickly. When sigmoidoscopy reveals extensive ulcerative changes.

Ways of transmission of balantidiasis

Balantidiasis
Balantidiasis

Balantidium coli is transmitted by the faecal-oral route. People can become infected by drinking contaminated water or food that has come into contact with the feces of infected animals or people. Infection can occur in several ways, including the following examples:

  • Eating meat, fruits and vegetables that have been contaminated by an infected person or the faeces of an infected animal.
  • Drinking water or washing food in water contaminated with the faeces of infected people or animals.
  • Failure to comply with the rules of personal hygiene.

Several factors can increase the risk of developing balantidiasis. These include:

  • Close contact with pigs.
  • Working with manure or fertilizers that contain pig excrement.
  • Living in regions with polluted water supply.
  • Poor nutrition.
  • Lack of stomach acid (achlorhydria).
  • Alcoholism.
  • Weakened immunity.

Diagnostics

Balantidiasis
Balantidiasis

Balantidiasis is a fairly rare disease, the symptoms of which can resemble many other diseases. The suspicion of the presence of balantidiag can cause close contact of a person with pigs or their excrement, residence or travel to regions with poor water purification, close contact with infected people.

Balantidiasis is diagnosed by examining feces under a microscope, during which spores or adult forms of the parasite can be detected.

Since balantidia appears in the stool periodically, the stool analysis must be taken several times, and the test itself must be carried out immediately after the delivery of the material.

Balantidia trophozoites can also be found in intestinal tissues. This requires a biopsy, which is performed during a colonoscopy or sigmoidoscopy. During these tests, the doctor may also notice inflammation, bleeding, and ulcers in the lining of the colon.

Complications of balantidiasis

Balantidiasis can be complicated by such pathological conditions as:

  • Severe dehydration of the patient.
  • A sharp decrease in body weight, up to cachexia (critical weight loss, when there is no subcutaneous fat in the body).
  • Bowel perforation.
  • Peritonitis.

Each of these complications can be fatal.

Treatment

Balantidiasis
Balantidiasis

The diagnosis is made by an infectious disease specialist or gastroenterologist, based on the clinical picture, history data and laboratory data. For analysis, feces are taken for microscopic examination and scraping from the affected areas of the intestinal mucosa. Be sure to do sigmoidoscopy. In this study, the intestinal walls with characteristic ulcers are clearly visible.

It is very important to start treatment in a timely manner, as its absence can be fatal. Antiparasitic drugs are used to treat balantidiasis. Take them in courses. On average, 2-3 five-day courses are enough for a cure.

To eliminate intoxication and dehydration, an isotonic sodium chloride solution, a glucose solution or protein solutions are administered intravenously to the sufferers.

The most commonly used tablet forms of the following drugs:

  • Tetracycline - 500 mg 4 times a day for 10 days (contraindicated in pregnant women and children under 8 years of age).
  • Metronidazole - 750 mg three times a day for 5 days.
  • Iodoquinol - 650 mg three times a day for 20 days.

Since balantidiasis causes diarrhea, patients need to eliminate fluid and electrolyte deficiencies.

In rare cases of complications (perforation, appendicitis), surgery may be necessary.

Prevention

Balantidiasis
Balantidiasis

Prevention of balantidiasis consists in the timely identification of people and animals suffering from this disease and their correct treatment.

It is important to be sure to wash vegetables and fruits before eating.

Those who work with pigs need to carefully observe personal hygiene, wash their hands thoroughly after working with animals.

It is important to protect water bodies from contamination from pig farms. In addition, you cannot use water from open reservoirs without first disinfecting it.

  • Drinking and using only pure water for domestic purposes.
  • Maintaining sanitary and hygienic living conditions.
  • Avoiding contact with pigs or fertilizers contaminated with their faeces.
  • Thorough hand washing after using the toilet and before preparing or eating food.
  • Washing all fruits and vegetables with clean water.

As for public prevention, balantidiasis, like many other diseases transmitted by the fecal-oral route, can be prevented by improving hygiene, water purification and disinfection, and wastewater treatment.

Specifically for balantidiasis, the following steps can be taken:

  • Firstly, since pigs are the main reservoir of infection, it is necessary to limit contact between them and people. The pigs' habitat should be separated from where people live, they should drink water from a separate source.
  • Secondly, clean water is a must. For the prevention of balantidiasis and other parasitic diseases, it is very important to create the ability to use purified water.
  • Thirdly, wastewater disposal and garbage disposal are important. Without this, the excrement of pigs and humans can pollute the environment and water.
  • Fourth, it is necessary to promote the observance of the rules of personal hygiene by the population.
  • And finally, people with asymptomatic balantidiasis need to be treated with antibiotics, as they still excrete cysts in the stool. This helps prevent further spread of the infection.

These community measures are sometimes difficult to implement, as the communities in which balantidiasis is prevalent are poorly educated, poor and do not have good living conditions. Nevertheless, it is important to strive for their implementation, since they prevent the development of not only balantidiasis, but also many other diseases.

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