Do not forget the stool examination!—cutaneous and gastrointestinal manifestations of Blastocystis sp. infection

Abstract

Blastocystis sp. is one of the most common parasites in the human intestinal tract. This infection commonly is accompanied by diarrhoea and abdominal pain, but extraintestinal symptoms, such as skin lesions, may also accompany the disease. In this study, our aim was to assess the frequency, clinical symptoms and skin manifestations of confirmed positive Blastocystis sp. infections. Data of 80 patients with confirmed positive Blastocystis sp. infections were assessed retrospectively. The average age of the patients was 46.3 years of age (with a range between 13 and 85 years of age). The number of female patients was higher than the number of males (48 vs. 32; 60 vs. 40%). Gastrointestinal and dermatological symptoms and the results of routine biochemical and haematological blood tests of enrolled patients were collected and analyzed. The skin manifestations were analyzed using the data available (including descriptions, photos and histologies). We discovered that 11.25% of our enrolled patients exhibited skin manifestations associated to Blastocystis sp., mainly on the females. The occurrence of Blastocystis sp. was 6% in symptomatic patients who required medical attendance in the time period between 2005 and 2013. Of the 80 patients, 73.75% indicated that they had gastrointestinal symptoms: 40 patients complained of abdominal pain and 17 with blood in their stool, while other symptoms, such as meteorism (15 subjects), weigh loss (8 subjects), perianal pain or itching (6 subjects), passing stool with mucus (5 subjects), vomiting (2 subjects) and fever (2 subjects) were less frequent. The prevalence of abdominal pain in the cohort without skin lesions was higher compared to those patients with skin problems (p = 0.007). The mean value of C-reactive protein showed elevated levels, but eosinophils were within a normal range. In addition, we did not find significant difference in eosinophilia between patients with vs. without skin manifestations. Thus, we suggest that eosinophilia is not an obligatory laboratory finding in protozoon infections, such as Blastocystis sp. In the light of our results, we suggest a stool parasite examination for patients with skin lesions of unknown origin.

Update on the pathogenic potential and treatment options for Blastocystis sp

“…Symptoms persisted after initial antibiotic therapy but were finally eradicated after combined metronidazole and paromomycin treatment [22]. A recent retrospective study reported 8/80 (11%) Blastocystis infected patients to have skin manifestations as well as gastrointestinal symptoms [23]. Unfortunately this study relied solely on microscopy, so no information on ST related to cutaneous lesions can be gathered; however all of these studies do show the potential for Blastocystis to cause cutaneous symptoms.…”

Mysterious chronic urticaria caused by Blastocystis spp.?

“…There was a four‐fold increase in total serum IgE levels in urticaria patients with protozoa in comparison with those without protozoa. A recent retrospective study reported that 11.25% of enrolled patients, mainly women, exhibited skin manifestations associated with Blastocystis spp . However, by contrast with helminth infestations, the association between chronic urticaria and protozoa appears to be less clear.…”

“…Species of the genus Blastocystis are unusual, unicellular, enteric protozoan parasites present in humans throughout the world. In the healthy population, prevalences of this parasite have been reported at 30–50% in developing countries and 1.5–10.0% in developed countries . The prevalence of Blastocystis spp.…”

“…In the healthy population, prevalences of this parasite have been reported at 30-50% in developing countries and 1.5-10.0% in developed countries. 1 The prevalence of Blastocystis spp. infestation is higher than that of other intestinal protozoan parasites such as those of the genera Giardia, Entamoeba, and Cryptosporidium.…”

The role of Blastocystis sp. as an etiology of irritable bowel syndrome

“…1 In a healthy population, the prevalence has been reported to be between 30%-50% and 1.5%-10.0%, in developing and developed countries, respectively. 2 People in the age range of years are mostly infected by Blastocystis. [3][4][5] In immunecompromised individuals, the prevalence of Blastocystis is about 30%-40% in developed countries.…”