Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Gastroenteritis wikipedia , lookup
Hygiene hypothesis wikipedia , lookup
Neonatal infection wikipedia , lookup
Marburg virus disease wikipedia , lookup
Infection control wikipedia , lookup
Sociality and disease transmission wikipedia , lookup
Multiple sclerosis research wikipedia , lookup
African trypanosomiasis wikipedia , lookup
Schistosomiasis wikipedia , lookup
JMM Case Reports Letters template TITLE: Laboratory diagnosis of human ciliate protozoan parasites: Balantidium coli and beyond [REFERENCE CASE REPORT: Urinary infection due to Balantioides coli: a rare accidental zoonotic disease in an addicted and diabetic young female in Iran] Author Name: Alireza Abdolrasouli Address: Department of Medical Microbiology Charing Cross Hospital Imperial College Healthcare National Health Service Trust Fulham Palace Road London, W6 8RF United Kingdom Email: [email protected] The full names, institutional addresses and email addresses for all authors must be included on the title page. In order to assist us in choosing the correct editor to handle your paper, please choose one box in each of the following categories: Field: ☒Human ☐Dental Subject: ☐Bacteriology ☐Veterinary/Fisheries ☐Virology ☐ Mycology ☒ Parasitology Keywords: Please provide at least one keyword for each of the following categories: Disease/Indication: Balantidiosis Pathology/Symptoms: extra-intestinal infections Treatment: NA CORRESPONDENCE Up to 350 words To the Editor - I read with interest, an article recently published in the Journal of Medical Microbiology Case Reports describing a rare case of urinary tract infection due to Balantidium coli in a female patient from Iran (Soleimanpour et al. 2015). I agree with authors that balantidiasis is considered a neglected disease and extra-intestinal infections in particular, are uncommon in humans despite the high prevalence of B. coli in tropical and sub-tropical areas (Schuster and Ramirez-Avila, 2008). Recently, more extra-intestinal cases of “balantidiasis”, mainly in the urinary tract were reported in the medical literature (Bandyopadhyay et al. 2013; Karuna and Khadanga, 2014; Khanduri et al. 2014) perhaps reflecting on the role of ciliate protozoan parasites in immunocompromised host. One very important missing feature in almost all published cases is indeed molecular confirmation of B. coli. Identifications were solely based on the morphological characteristics of ciliate trophozoites seen in direct microscopic examination of urine samples (Bandyopadhyay et al. 2013; Karuna and Khadanga. 2014; Khanduri et al. 2014). Microscopic image provided in the published report demonstrates a high similarity to Balantidium species. However, careful examination of presented first photograph also provides another vital piece of information on the structure of observed trophozoites: length of cilia. Although lack of scale bar makes the precise measurement impossible, elongated and profound cilia with uneven distribution captured in Figure one (Soleimanpour et al. 2015) is in sharp contrast with the classic ‘short’ and ‘fine’ cilia ‘covering the entire body’ of Balantidium spp. (Garcia, 2007) and those clearly depicted in The 5th Edition of Atlas of Human Parasitology (Ash and Orihel, 2007). Notably, due to delegate nature of cilia in B. coli, they can even be missed on light microscopic examination and techniques like phase-contrast may be required to enhance their visualisation. Moreover, from taxonomy point of view, as nomenclature of ‘Balantioides coli’ was not either formally approved or commonly applied by parasitologists and hence, should be avoided to prevent further confusion. More importantly, a different ciliate soil protozoan with wide distribution in nature, namely Colpoda species has previously been observed in human urinary samples (Costache et al, 2011). In the absence of DNA-based confirmatory methods, morphological similarities between Balantidium and Colpoda in addition to their characteristic motility, make their accurate identification troublesome. Recently, an extensive evaluation of genetic diversity in B. coli based on the polymorphism of SSU rDNA sequences, confirmed the diversity of cyst-forming ciliates among non-human primates. Presence of novel Buxtonella-like ciliates in primates opens the question about the possible occurrence of these pathogens in human and highlights the need for application of broad molecularbased diagnostics for ciliate infections in man (Pomajbíková et al, 2013). Currently very few Balantidium sequences are available in GenBank, and most represent the SSU rDNA or Internal Transcribed Spacer regions of B. coli (Verweij and Stensvold, 2014). Application of general, broad-specificity primers targeting nonhuman eukaryotic SSU rDNA may be of significant utility in efforts to correctly identify ciliate protozoa detected in human and animal clinical samples. This in turn, provides a better understanding of epidemiology, pathophysiology and genetic diversity of these microorganisms. References: 1. Soleimanpour, S., Babaei, A., Movahhedi Roudi, A., Raeisalsadati, S. S. (2015). Urinary infection due to Balantioides coli: a rare accidental zoonotic disease in an addicted and diabetic young female in Iran. J Med Micobiol Case Reports. doi: 10.1099/jmmcr.0.000102 2. Schuster, F. L., and Ramirez-Avila, L. (2008). Current world status of Balantidium coli. Clin Microbiol Rev 21, 626-638. 3. Bandyoppadhyay, A., Majumder, K., Goswami, B. K. (2013). Balantidium coli in urine sediment: report of a rare case presenting with hematuria. J Parasit Dis 37, 283-285. 4. Karuna, T., and Khadanga S. (2014). A rare case of urinary balantidiasis in an elderly renal failure patient. Trop Parasitol 4, 47-49. 5. Kanduri, A., Chauhan, S., Chandola, Mahawal, B. S., Kataria, V. K. (2014). Balantidiosis: a rare accidental finding in the urine of a patient with acute renal failure. J Clin Diagnostic Res 8, 3-4. 6. Garcia, L. S. (2007). Diagnostic Medical Parasitology, 5th ed. American Society for Microbiology Press, Washington DC, USA. 7. Ash, L. R., Rrihel, T. C. Atlas of human parasitology, 5th ed. American Society for Clinical Pathology Press, Chicago, Illinois, USA. 8. Costache, C., Bursaşiu, S., Filipaş, C., Colosi, I. (2011). A case of ciliate protozoa Colpoda spp. (Ciliata: Colpodidae) detected in human urine. Iranian J Parasitol 6, 99-104. 9. Pomajbı´kova´ K, Obornı´k M, Hora´k A, Petrzˇelkova´ KJ, Grim JN, et al. (2013) Novel insights into the genetic diversity of Balantidium and Balantidium-like cyst-forming ciliates. PLoS Negl Trop Dis 7(3): e2140. doi:10.1371/journal.pntd.0002140 10. Verweij, J. J., Stensvold, C. R. (2014). Molecular testing for clinical diagnosis and epidemiological investigations of intestinal parasitic infections. Clin Microbiol Rev 27, 371– 418. Acknowledgements/Declaration of Interest Author declares he had no conflict of interest. Signature: Mr. A. Abdolrasouli Date: 06/02/2016 *Licence to Publish forms are provided during submission through Editorial Manager. **Authors are responsible for attaining patient consent and will be asked to confirm this during submission. Read our ethical guidelines here: http://jmmcr.sgmjournals.org/site/misc/ifora.xhtml#req-ethics.