Name: Rosheen Mikko B.

Anisco

BLASTOCYSTIS HOMINIS

CHARACTERISTICS Blastocystis Hominis is a protozoan intestinal parasite belonging to the Blastocystis genus of Stramenopiles a vast array of organisms including brown algae, water molds, and diatoms. It has a widespread geographic distribution and is found in countries of all income levels across the world. It's status as a true pathogen is controversial - while it has been found in patients with gastrointestinal symptoms it is not proven to be the cause, and many carriers are asymptomatic. Research on Blastocystis Hominis is limited, with large gaps remaining in our understanding of its life cycle, transmission mechanisms, incubation period, epidemiology, and treatment options. Like most aspects of Blastocystis Hominis, the parasites taxonomy and classification is rather unclear. For many years opinion on the matter varied widely, placing the parasite alternatively as a yeast, fungus, or cyst stage of another organism. Only recently was it classified as a protozoa after an analysis of small-subunit rRNA sequences placed it firmly as a member of the Stramenopiles. Different sources currently provide slightly different phylogenetic trees for Blastocystis Hominis

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PATHOLOGY AND SIGNS AND SYMPTOMS Due to the uncertain infective nature and transmission pathways of the parasite, there are no widespread public health or prevention strategies directly aimed at Blastocystis Hominis. The CDC does list the following, however, as potentially useful preventative and control measures: -Handwash with soap and water before handling food and after using the toilet. If employed in a childcare center, also wash after each diaper change even if gloves were used. -Avoid potentially infected water and food -Wash and peel all raw fruits and vegetables -Avoid untreated water in countries with less established water-safety standards It does not appear as if there are any vaccines for Blastocystis Hominis on the horizon. The most commonly reported symptoms of infection with this parasite according to medical literature (below) are similar to Dientamoeba fragilis: watery diarrhea, constipation & abdominal pain. Fever, rectal bleeding, weight loss, flatus, dizziness, vomiting, dehydration, rectal itching and chronic fatigue are also commonly described in the literature. Other symptoms commonly described by Blasto. Sufferers who contact this site are:

Cravings for sweets foods and carbohydrates Thick white/greenish coating on tongue Depression Inability to concentrate Green stools Undigested foods particles in stool PHATOGENESIS Pathogenesis refers to the mechanism by which an organism causes disease. The following disease-causing mechanisms have been reported in studies of Blastocystis infection: Barrier Disruption: In isolates from Blastocystis sp. subtype 4, study has demonstrated that Blastocystis has the ability to alter the arrangement of F-actin in intestinal epithelial cells. Actin filaments are important in stabilizing tight junctions; they in turn stabilize the barrier, which is a layer of cells, between the intestinal epithelial cells and the intestinal content. The parasite causes the actin filaments to rearrange, and so compromising barrier function. This has been suggested to contribute to the diarrheal symptoms sometimes observed in Blastocystis patients. Invasiveness: Invasive infection has been reported in humans and animal studies. Immune Modulation: Blastocystis has been shown to provoke cells from the human colon to produce inflammatory cytokinesInterleukin-8 and GM-CSF. Interleukin-8 plays a role in rheumatoid arthritis. Protease Secretion: Blastocystis secretes a protease that breaks up antibodies produced and secreted into the gastrointestinal tractlumen. These antibodies, known as immunoglobulin A (IgA), make up the immune defense system of human by preventing the growth of harmful microorganisms in the body and by neutralizing toxins secreted by these microorganisms. By breaking up the antibodies, it allows the persistence of Blastocystis in the human gut. Another more recent study has also shown and proposed that, in response to the proteases secreted by Blastocystis, the intestinal host cells would signal a series of events to be carried out, eventually leading to the self-destruction of the host cells a phenomenon known as apoptosis Other secretory mechanism: A study of a different protozoan which produces similar symptoms, Entamoeba histolytica, found that organism secretes several neurologically active chemicals, such as serotonin and Substance P. Serum levels of serotonin have been found to be elevated in patients with Entamoeba histolytica. One paper noted the diffuse symptoms of Blastocystis infection correlate with serotonin's role in the body, and suggested a similar mechanism may be present in Blastocystis infection. TREATMENT, PREVENTION and CONTROL There is a lack of scientific study to support the efficacy of any particular treatment. An additional review published in 2009 made a similar conclusion, noting that because the diagnostics in use have been unreliable, it has been impossible to determine whether a drug has eradicated the infection, or just made the patient feel better. Historical reports, such as one from 1916, note difficulty associated with eradication of Blastocystis from patients, describing it as "an infection that is hard to get rid of." A 1999 in vitro from Pakistan study found 40% of isolates are resistant to common antiprotozoal drugs. A study of isolates from patients diagnosed with IBS found 40% of isolates resistant to Metronidazole and 32% resistant to furazolidone. Drugs reported in studies have included Metronidazole, TMP-SMX , Doxycycline, NitazoxanideIodoquinol and Paromomycin. Iodoquinol has been found to be less effective in practice and in-vitro. Miconazole has been reported as an agent against Blastocystis growth in-vitro.

Physicians have described the successful use of a variety of discontinued antiprotozoals in treatment of Blastocystis infection. Emetine was reported as successful in cases in early 20th century with British soldiers who contracted Blastocystis infection while serving in Egypt. In vitro testing showed emetine was more effective than Metronidazole or furazolidone. Emetine is available in the United States through special arrangement with the Center for Disease Control. Clioquinol (Enterovioform) was noted as successful in treatment of Blastocystisinfection but removed from the market following an adverse event in Japan. Stovarsol and Narsenol, two arsenic-based antiprotozoals, were reported to be effective against the infection. Carbarsone was available as an anti-infective compound in the United States as late as 1991, and was suggested as a possible treatment. The reduction in the availability of antiprotozoal drugs has been noted as a complicating factor in treatment of other protozoal infections. For example, in Australia, production of diloxanide furoate ended in 2003, paromomycin is available under special access provisions, and the availability of iodoquinol is limited.

PREVENTION You may be able to prevent blastocystis or other gastrointestinal infection by taking a number of precautions while traveling in high-risk countries. Watch what you eat. The general rule of thumb is this: If you can't boil it, cook it or peel it forget it. Unfortunately, most travelers don't stick to these guidelines all of the time. Remember these tips: Don't buy food from street vendors. Avoid unpasteurized milk and dairy products, including ice cream. Avoid raw or undercooked meat, fish and shellfish. Steer clear of moist food at room temperature, such as sauces and buffet offerings. Eat foods that are well cooked and served hot. Munch on dry foods like breads and foods high in sugar, such as jellies and syrups. Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and unpeelable fruits, such as grapes and berries. Don't drink the water When visiting high-risk countries, keep the following tips in mind: Avoid unsterilized water from tap, well or stream. If you need to consume local water, boil it for at least three minutes and then let it cool to room temperature. Avoid ice cubes or fruit juices made with tap water. Beware of sliced fruit that may have been washed in contaminated water. Don't swim in water that may be contaminated. Keep your mouth closed while showering. Feel free to drink canned or bottled drinks in their original containers including water, carbonated beverages, beer or wine as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring. Use bottled water to brush your teeth. Use bottled or boiled water to mix baby formula. Make sure hot beverages, such as coffee or tea, are steaming hot. If it's not possible to buy bottled water or boil your water, bring some means to purify water: Consider a water-filter pump with a microstrainer filter that can filter out small microorganisms. Look in camping stores for a filter that is certified by the National Science Foundation.

Another approach is to chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but reserve it for short trips, because too much iodine can be harmful to your body. You can purchase iodine tablets or crystals at camping stores and pharmacies. Be sure to carefully follow the directions. Take precautions against passing a parasite to others If you have blastocystis or another gastrointestinal infection, good personal hygiene will help keep you from spreading the infection to others: Wash hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren't available, use an alcohol-based hand sanitizer. Wash hands well after changing a diaper, especially if you work in a child care center, even if you wear gloves. MORPHOLOGY The vacuolated form (that is found in stool samples used for diagnostics) is the most common form found in the host. Unicellular, it is 5-30 microns in diameter, with the usual range being 8-10 microns. Blastocystis is usually spherical, oval, or ellipsoidal, with usually one, but sometimes two to four nuclei located in the rim of the cytoplasm. In bi-nucleated cells, the two nuclei might be at opposite poles. Cells contain a large central body, or vacuole, with a thin rim of cytoplasm around the periphery. Occasionally, a ring of granules can be found in the cytoplasm, and the cell appears to have a beaded rim. LEARNING INSIGHTS Blastocystis is an unusual enteric protozoan parasite of humans and many animals. It has a worldwide distribution and is often the most commonly isolated organism in parasitological surveys. The parasite has been described since the early 1900s, but only in the last decade or so have there been significant advances in our understanding ofBlastocystis biology. However, the pleomorphic nature of the parasite and the lack of standardization in techniques have led to confusion and, in some cases, misinterpretation of data. This has hindered laboratory diagnosis and efforts to understand its mode of reproduction, life cycle, prevalence, and pathogenesis. Accumulating epidemiological, in vivo, and in vitro data strongly suggest that Blastocystis is a pathogen. Many genotypes exist in nature, and recent observations indicate that humans are, in reality, hosts to numerous zoonotic genotypes. Such genetic diversity has led to a suggestion that previously conflicting observations on the pathogenesis of Blastocystis are due to pathogenic and nonpathogenic genotypes. Recent epidemiological, animal infection, and in vitro host-Blastocystis interactionstudies suggest that this may indeed be the case. This review focuses on such recent advances and also provides updates on laboratory and clinical aspects of Blastocystis spp. REFERENCE http://en.wikipedia.org/wiki/Blastocystis http://www.stanford.edu/group/parasites/ParaSites2010/Delamon_Alfredo_Rego/paraSITEfinalweb.ht m http://www.stanford.edu/class/humbio103/ParaSites2003/Blastocystis%20Hominis/Blastocystis%20Ho minis.htm