History

Fact Explanation
History of contact with pigs Balantidiasis (or balantidiosis) is a large-intestinal infection caused by Balantidium coli. Pigs are the primary reservoir. [1,2]
Asymptomatic Most of the infected patients do not manifest symptoms. These people can act as reservoirs and may transmit the disease to others. [1,2]
Diarrhea [1] Diarrhea can be watery, bloody, or mucoid. Diarrhea is often explosive and frequent. Chronic diarrhea results due to chronic infection. [2,3]
Abdominal pain [1] Due to trophozoite invasion of the large bowel. Often patients complain of cramping abdominal pain. [4] Some patients complain of associated anorexia [7], nausea and vomiting. [6]
Fever [7] A non-specific finding seen in some patients.
Tenesmus [2,5] This is an unproductive urge to defecate.
Symptoms of dehydration [8] Severe and frequent diarrhea can result in significant fluid loss and dehydration. Patients present with increased thirst, reduced urine output, postural dizziness, weakness and fatigue.
Headache [7] Some patients have headache.
Weight loss Occurs secondary to chronic diarrhea. [2,7]
References
  1. Parasites - Balantidiasis (also known as Balantidium coli Infection). Centers for Disease Control and Prevention. [online] [viewed 15 May 2014] Available from: http://www.cdc.gov/parasites/balantidium/
  2. SCHUSTER FL, RAMIREZ-AVILA L. Current World Status of Balantidium coli Clin Microbiol Rev [online] 2008 Oct, 21(4):626-638 [viewed 15 May 2014] Available from: doi:10.1128/CMR.00021-08
  3. LERMAN RH, HALL WT, BARRETT O J. Balantidium coli infection in a Vietnam returnee. Calif Med [online] 1970 Jun, 112(6):17-8 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/5429130
  4. YAZAR S, ALTUNTAS F, SAHIN I, ATAMBAY M. Dysentery caused by Balantidium coli in a patient with non-Hodgkin's lymphoma from Turkey. World J Gastroenterol [online] 2004 Feb 1, 10(3):458-9 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14760781
  5. ZINK CD. [Important forms of depression. A report of experiences from the practice for the practice. (II)]. Med Welt [online] 1979 Oct 19, 30(42):1553-6 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/43452
  6. KARUNA T, KHADANGA S. A rare case of urinary balantidiasis in an elderly renal failure patient Trop Parasitol [online] 2014, 4(1):47-49 [viewed 15 May 2014] Available from: doi:10.4103/2229-5070.129165
  7. SHARMA S, HARDING G. Necrotizing lung infection caused by the protozoan Balantidium coli Can J Infect Dis [online] 2003, 14(3):163-166 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094932
  8. DONGYOU LIU. Molecular Detection of Human Parasitic Pathogens. CRC Press, Jul 5, 2012, pp. 163.

Examination

Fact Explanation
Fever [1] Patients can have a febrile reaction due to the parasitemia.
Abdominal tenderness [2] Tenderness is poorly localized. Sometimes tenderness in the McBurney’s point is noted if appendicitis is associated with Balantidiasis. [3]
Signs of dehydration Patients present with increased thirst, reduced urine output, postural dizziness, weakness and fatigue. [4]
References
  1. SHARMA S, HARDING G. Necrotizing lung infection caused by the protozoan Balantidium coli Can J Infect Dis [online] 2003, 14(3):163-166 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094932
  2. Parasites - Balantidiasis (also known as Balantidium coli Infection). Centers for Disease Control and Prevention. [online] [viewed 15 May 2014] Available from: http://www.cdc.gov/parasites/balantidium/
  3. WARRELL D.A., TIMOTHY M. COX, JOHN D. FIRTH. Oxford Textbook of Medicine, Oxford University Press, 2003, Volume 1, pp. 761.
  4. AMY CANAVAN, BILLY S. ARANT JR. Diagnosis and Management of Dehydration in Children. Am Fam Physician. [online] 2009 Oct 1;80(7):692-696. [viewed 15 May 2014] Available from: http://www.aafp.org/afp/2009/1001/p692.html

Differential Diagnoses

Fact Explanation
Amebic dysentery Patients present with fever, chills, blood and mucous diarrhea, and abdominal discomfort. Amebic dysentery is also transmitted via the feco oral route. Stool smear will demonstrate the presence of organism. [1]
Pneumonia Pneumonia can be caused by other protozoa, like Toxoplasma, Babesia, Cryptosporidium, Leishmania, and Microsporidia speices. [2]
Appendicitis Appendicitis can be caused by Balantidiasis as well. [3]
References
  1. MACKEY-LAWRENCE NM, PETRI JR. WA. Amoebic dysentery Clin Evid [online] :0918 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275292
  2. SHARMA S, HARDING G. Necrotizing lung infection caused by the protozoan Balantidium coli Can J Infect Dis [online] 2003, 14(3):163-166 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094932
  3. WARRELL D.A., TIMOTHY M. COX, JOHN D. FIRTH. Oxford Textbook of Medicine, Oxford University Press, 2003, Volume 1, pp. 761.

Investigations - for Diagnosis

Fact Explanation
Microscopic examination Either a smear of stool sample or scrapings from the periphery of ulcers obtained during an endoscopic examination can be used to demonstrate the presence of organisms or cysts. [1]
Chest X-ray Chest X-ray may show pulmonary parenchymal involvement. [2]
Computed tomography (CT) CT shows the involvement of pulmonary parenchyma, lymph nodes and other organs and also confirms the findings seen in chest X-ray. [2]
Colonoscopy Allows obtaining tissue specimens for the diagnosis of colonic involvement. [3]
Bronchoalveolar lavage Used in diagnosing pulmonary parenchymal involvement. [2]
References
  1. Parasites - Balantidiasis (also known as Balantidium coli Infection). Centers for Disease Control and Prevention. [online] [viewed 15 May 2014] Available from: http://www.cdc.gov/parasites/balantidium/
  2. SHARMA S, HARDING G. Necrotizing lung infection caused by the protozoan Balantidium coli Can J Infect Dis [online] 2003, 14(3):163-166 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094932
  3. SCHUSTER FL, RAMIREZ-AVILA L. Current World Status of Balantidium coli Clin Microbiol Rev [online] 2008 Oct, 21(4):626-638 [viewed 15 May 2014] Available from: doi:10.1128/CMR.00021-08

Management - General Measures

Fact Explanation
Health education Disease is transmitted via the feco oral route. Health education should address hygienic measures to prevent the disease transmission and include washing hands with soap and water before cooking or eating and after using toilets. Raw vegetables and fruits should be washed before consumption. [1,2]
Fluid replacement Oral or intravenous fluid replacement is necessary to treat dehydration. [3]
Electrolyte replacement Electrolyte homeostasis should be maintained. [3]
Appendectomy If appendicitis is present patients may benefit from appendectomy. [4]
References
  1. Parasites - Balantidiasis (also known as Balantidium coli Infection). Centers for Disease Control and Prevention. [online] [viewed 15 May 2014] Available from: http://www.cdc.gov/parasites/balantidium/
  2. LERMAN RH, HALL WT, BARRETT O J. Balantidium coli infection in a Vietnam returnee. Calif Med [online] 1970 Jun, 112(6):17-8 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/5429130
  3. AMY CANAVAN, BILLY S. ARANT JR. Diagnosis and Management of Dehydration in Children. Am Fam Physician. [online] 2009 Oct 1;80(7):692-696. [viewed 15 May 2014] Available from: http://www.aafp.org/afp/2009/1001/p692.html
  4. WARRELL D.A., TIMOTHY M. COX, JOHN D. FIRTH. Oxford Textbook of Medicine, Oxford University Press, 2003, Volume 1, pp. 761.

Management - Specific Treatments

Fact Explanation
Antibiotics Antibiotics that are frequently used are tetracycline (500 mg orally four times daily for 10 days), metronidazole (500-750 mg orally three times daily for 5 days) and iodoquinol (650 mg orally three times daily for 20 days). [1,2]
Nitazoxanide Nitazoxanide (500 mg orally twice daily for 3 days) is a broad-spectrum antiparasitic and antihelminthic drug used in treatment of balantidiasis. [3]
References
  1. Parasites - Balantidiasis (also known as Balantidium coli Infection). Centers for Disease Control and Prevention. http://www.cdc.gov/parasites/balantidium/
  2. LERMAN RH, HALL WT, BARRETT O J. Balantidium coli infection in a Vietnam returnee. Calif Med [online] 1970 Jun, 112(6):17-8 [viewed 15 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/5429130
  3. SCHUSTER FL, RAMIREZ-AVILA L. Current World Status of Balantidium coli Clin Microbiol Rev [online] 2008 Oct, 21(4):626-638 [viewed 15 May 2014] Available from: doi:10.1128/CMR.00021-08