Exacerbated symptoms in Blastocystis sp.-infected patients treated with metronidazole: two case studies

Rajamanikam, Arutchelvan; Kumar, Suresh; Samudi, Chandramathi; Kudva, M V

doi:10.1007/s00436-018-5948-x

Cited by 8 publications

(10 citation statements)

References 31 publications

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“…Recently, Blastocystis’ resistance to the most commonly used drugs has become a topic of discussion for researchers [21,22]. Herbal medicine has many potential benefits as it may be safer, healthier and cheaper.…”

Section: Introductionmentioning

confidence: 99%

Anti-Blastocystis Activity In Vitro of Egyptian Herbal Extracts (Family: Asteraceae) with Emphasis on Artemisia judaica

Mokhtar

Ahmed

Eltamany

et al. 2019

IJERPH

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Achillea fragrantissima (Forssk.) Sch. Bip. (known as Qaysoom), Echinops spinosus L. (known as Shoak Elgamal) and Artemisia judaica L. (known Shih Baladi) are members of the Asteraceae family known for their traditional medical use in Egypt. The ethanol extracts of these plants were evaluated for their efficacy against a protozoan parasite (Blastocystis). Two different molecular subtypes of Blastocystis were used (ST1 and ST3). Significant growth inhibition of Blastocystis was observed when exposed to both A. judaica (99.3%) and A. fragrantissima (95.6%) with minimal inhibitory concentration (MIC90) at 2000 µg/mL. Under the effect of the extracts, changes in Blastocystis morphology were noted, with the complete destruction of Blastocystis forms after 72 h with the dose of 4000 µg/mL. Different subtypes displayed different responses to the herbal extracts tested. ST1 exhibited significantly different responses to the herbal extracts compared to ST3. A. judaica was selected as the herb of choice considering all of its variables and because of its effective action against Blastocystis. It was then exposed to further fractionation and observation of its effect on ST1 and ST3. Solvent portioned fractions (dichloromethane (DCM), ethyl acetate (EtOAc) and n-hexane) in A. judaica were found to be the potent active fractions against both of the Blastocystis subtypes used.

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Section: Introductionmentioning

confidence: 99%

Anti-Blastocystis Activity In Vitro of Egyptian Herbal Extracts (Family: Asteraceae) with Emphasis on Artemisia judaica

Mokhtar

Ahmed

Eltamany

et al. 2019

IJERPH

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“… 7 However, side effects, treatment failure, and resistance to metronidazole had been reported since 1976 and similar cases of treatment failure were reported later on. 8 Therefore, a great need to develop newer and safer antiparasitic agents has emerged.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, the regimen of treatment requires a long duration consumption of the drug which may cause headache, vertigo, dizziness, and syncope and sometimes may lead to convulsive seizures, peripheral neuropathy, neutropenia, and leucopenia. Resistance to metronidazole treatment had been also reported since 1976; 8 thus, there was a great need to develop a new, safer, and more effective alternative drug.…”

Section: Introductionmentioning

confidence: 99%

In vitro Effect of Silver Nanoparticles on Blastocystis hominis

Younis¹,

Abououf²,

Ali³

et al. 2020

IJN

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“…GI symptoms have been shown to persist in patients even after treatment with metronidazole [44]. Recently, we have reported 2 cases of patients experiencing exacerbation of gastrointestinal symptoms when treated with metronidazole[45]. The continued exacerbation and worsening of symptoms could be directly linked to increase in the cysteine protease levels in both Blastocystis sp.…”

Section: Discussionmentioning

confidence: 99%

Resistance towards metronidazole in Blastocystis sp.: A pathogenic consequence

et al. 2019

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Blastocsytis sp. is a protozoan parasite that has been linked to common gastrointestinal illnesses. Metronidazole, the first line therapy, was reported to show frequent inefficacy. Previously, Blastocystis sp. isolated from different population showed varying metronidazole resistance. However, the effect of metronidazole treatment on pathogenic potentials of Blastocystis sp. isolated from different populations, which is known to have different gut environment, is unclear. This study investigates the in vitro effect of metronidazole on the pathogenic potentials of Blastocystis sp. isolated from urban and orang asli individuals. Blastocystis sp. ST 3 isolated from symptomatic and asymptomatic individuals were treated with a range of metronidazole concentration. The parasites’ growth characteristics, apoptotic rate, specific protease activity and the ability to proliferate cancer cells were analyzed upon treatment with 0.001 mg/l metronidazole. The study demonstrates that Blastocystis sp. isolates showed increase in the parasite numbers especially the amoebic forms (only in urban isolates) after treating with metronidazole at the concentration of 0.001 mg/ml. High number of cells in post-treated isolates coincided with increase of apoptosis. There was a significant increase in cysteine protease of Blastocystis sp. isolates upon treatment despite the initial predominance of serine protease in asymptomatic isolates. Metronidazole resistant Blastocystis sp. also showed significant increase in cancer cell proliferation. Resistance to metronidazole did not show significant different influence on the pathogenicity between Blastocystis sp. isolated from urban and orang asli individual. However, an increase in parasite numbers, higher amoebic forms, cysteine protease and ability to proliferate cancer cells implicates a pathogenic role. The study provides evidence for the first time, the effect of metronidazole towards enhancing pathogenic potentials in Blastocystis sp. when isolated from different gut environment. This necessitates the need for reassessment of metronidazole treatment modalities.

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Exacerbated symptoms in Blastocystis sp.-infected patients treated with metronidazole: two case studies

Cited by 8 publications

References 31 publications

Anti-Blastocystis Activity In Vitro of Egyptian Herbal Extracts (Family: Asteraceae) with Emphasis on Artemisia judaica

Anti-Blastocystis Activity In Vitro of Egyptian Herbal Extracts (Family: Asteraceae) with Emphasis on Artemisia judaica

In vitro Effect of Silver Nanoparticles on Blastocystis hominis

Resistance towards metronidazole in Blastocystis sp.: A pathogenic consequence

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