Balantidiasis is an infectious disease produced by a single-celled microorganism (protozoan) called Balantidium coli that infects the digestive tract. It is primarily a disease of the tropics, although it is also found in cooler, temperate climates. Most persons with balantidiasis do not exhibit any noticeable symptoms (asymptomatic), but a few individuals will develop diarrhea with blood and mucus and an inflamed colon (colitis).
Description
Balantidiasis is caused by Balantidium coli, a parasitic protozoan that infects the large intestine. B. coli is the largest and only protozoan, having cilia or hair-like structures, that is capable of causing disease in humans. Balantidiasis occurs most commonly in areas with poor sanitation and in settings where humans live in close contact with pigs, sheep, or goats.
Causes and symptoms
Balantidiasis is transmitted primarily by eating food or drinking water that has been contaminated by human or animal feces containing B. colicysts. During its life cycle, this organism exists in two very different forms: the infective cyst or capsuled form, which cannot move but can survive outside the human body because of its thick, protective covering; and the disease-producing form, the trophozoite, which although capable of moving, cannot survive once excreted in the feces and, therefore, cannot infect others. In the digestive tract, the cysts are transported to the intestine where the walls of the cysts are broken open by digestive secretions, releasing the mobile trophozoites. Once released within the intestine, the trophozoites multiply by feeding on intestinal bacteria or by invading the lining of the large intestine. Within the lining of the large intestine, the trophozoites secrete a substance that destroys intestinal tissue and creates sores (ulcers) or abscesses. Trophozoites eventually form new cysts that are carried through the digestive tract and excreted in the feces. Under favorable temperature and humidity conditions, the cysts can survive in soil or water for weeks to months, ready to begin the cycle again.
Most individuals with balantidiasis have no noticeable symptoms. Even though these individuals may not feel ill, they are still capable of infecting others by person-to-person contact or by contaminating food or water with cysts that others may ingest, for example, by preparing food with unwashed hands.
The most common symptoms of balantidiasis are chronic diarrhea or severe colitis with abdominal cramps, pain, and bloody stools. Complications may include intestinal perforation in which the intestinal wall becomes torn, but the organisms do not spread to other parts of the body in the blood stream.
Diagnosis
Diagnosis of balantidiasis, as with other similar diseases, can be complicated, partly because symptoms may or may not be present. A diagnosis of balantidiasis may be considered when a patient has diarrhea combined with a possible history of recent exposure to amebiasis through travel, contact with infected persons, or anal intercourse.
Specifically, a diagnosis of balantidiasis is made by finding B. colicysts or trophozoites in the patient's stools or by finding trophozoites in tissue samples (biopsy) taken from the large bowel. A diagnostic blood test has not yet been developed.
Stool examination
This test involves microscopically examining a stool sample for the presence of cysts and/or trophozoites of B. coli.
Sigmoidoscopy
To take a tissue sample from the large intestine, a procedure called a sigmoidoscopy is performed. During a sigmoidoscopy, a thin, flexible instrument is used to visually examine the intestinal lining and obtain small tissue specimens.
Treatment
Patients with balantidiasis are treated with prescription medication, typically consisting of a ten day course of either tetracycline or metronidazole. Alternative drugs that have proven effective in treating balantidiasis include iodoquinol or paromomycin.
Prognosis
Although somewhat dependent on the patient's over-all health, in general, the prognosis for most patients with balantidiasis is good. Severely infected patients occasionally die as a result of a tear in the intestinal wall (intestinal perforation) and consequent loss of blood.
Prevention
There are no immunization procedures or medications that can be taken prior to potential exposure to prevent balantidiasis. Moreover, people who have had the disease can become reinfected. Prevention requires effective personal and community hygiene. Specific safeguards include the following:
Purification of drinking water. Water can be purified by filtering, boiling, or treatment with iodine.
Proper food handling. Measures include protecting food from contamination by flies, cooking food properly, washing one's hands after using the bathroom and before cooking or eating, and avoiding foods that cannot be cooked or peeled when traveling in countries with high rates of balantidiasis.
Careful disposal of human feces.
Monitoring the contacts of balantidiasis patients. The stools of family members and sexual partners of infected persons should be tested for the presence of cysts or trophozoites.
BOOKS
Goldsmith, Robert S. "Infectious Diseases: Protozoal & Helminthic." In Current Medical Diagnosis and Treatment, 1998. 37th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1997.
Gumprecht, Jeffrey P., and Murray Wittner. "Other Intestinal Parasites." In Current Diagnosis. Vol. 9. Ed. Rex B. Conn, et al. Philadelphia: W. B. Saunders Co., 1997.
Weinberg, Adriana, and Myron J. Levin. "Infections: Parasitic & Mycotic." In Current Pediatric Diagnosis & Treatment,ed. William W. Hay Jr., et al. Stamford: Appleton & Lange, 1997.
Rebecca J. Frey
KEY TERMS
Asymptomatic—Persons who carry a disease and are usually capable of transmitting the disease but who do not exhibit symptoms of the disease are said to be asymptomatic.
Biopsy—The removal of a tissue sample for diagnostic purposes.
Ciliated—Covered with short, hair-like protrusions, like B. coli and certain other protozoa. The cilia or hairs help the organism to move.
Colitis—An inflammation of the large intestine that occurs in some cases of balantidiasis. It is marked by cramping pain and the passing of bloody mucus.
Protozoan—A single-celled, usually microscopic organism, such as B. coli, that is eukaryotic and, therefore, different from bacteria (prokaryotic).
Sigmoidoscopy—A procedure in which a thin, flexible, lighted instrument, called a sigmoidoscope, is used to visually examine the lower part of the large intestine.
