CILIATES: BALANTIDIUM COLI

Balantidium coli
 Identified as Paramecium coli by Malmsten in 1857, was later placed under a separate
genus in 1863
 Causes zoonotic diseases- Balantidiasis, Balantidiosis, and Balantidial dysentery
 Largest protozoan affecting humans
 Only ciliate known to cause disease in humans
 Attacks intestinal epithelium→ ulcer formation→ bloody diarrhea
 Host: pigs
 Stages:
1. Trophozoite
o 30-150 μm long, 25-120 μm wide
o Cilia for locomotion- arranged in longitudinal pattern from oral to caudal region
o Cytostome- oral apparatus at the tapered anterior end, responsible for acquiring
food
o Cytopage- at rounded posterior end, responsible for excreting waste
o Macronucleus- bean shaped
o Micronucleus- round, lies in concavity of macronucleus
o 2 contractile vacuoles- act as osmoregulatory organelles
o Mucocysts- extrusive organelles located beneath the cell membrane
2. Cyst
o Spherical to slightly ovoid
o 40-60μm diameter
o Thick cell walls (double walled)
o Encystation does not increase number of nuclei found in cyst
o Cilia are completely retracted
 Infective stage: Cyst
 Diagnostic stage: Trophozoites and Cysts
 Mode of Transmission: contaminated food and water
 Incubation period: 4-5 days
 Reproduction: asexually, asymmetric binary fission
 Life Cycle:
o Ingested cysts excyst in small intestines→ producing trophozoites stage→ inhabit
the lumen, mucosa and submucosa of large intestine, primarily the cecum→ cause
pathologic changes within intestine→ trophozoite encyst during intestinal
transport or after evacuation of semi-formed stools (cyst survive outside the
host)→ cysts shed in formed stools and cycle repeats itself if proper prevention
and control is not practiced.
 Pathogenesis and Clinical Manifestation
o B. coli trophozoites are capable of attacking intestinal epithelium and creating a
characteristic ulcer can differentiate in contrast with the flat-shaped, narrow neck
ulcers of amebiasis
o Ulcer- rounded base, wide neck
o Caused by lytic enzyme: hyaluronidase (secreted by trophozoite)
o Trophozoites abundant in exudates on mucosal surfaces and invade the
submucosa and the muscular coat including the blood vessels and lymphatics.
o Inflammatory cells and trophozoites numerous in base of ulcers
o Intrinsic Host Factors:
 Nutritional status, intestinal bacterial flora, achlorhydia, alcoholism, chronic disease, co-infection (Salmonella)
 Contribute to co-susceptibility and severity
o Forms:
 Asymptomatic
 People who do not present diarrhea or dysentery but may serve as parasite reservoir in the community
 Capable of infecting others
 Carriers of the parasite, could contaminate food and water
 Fulminant balantidiasis / Balantidial dysentery
  Diarrhea with bloody and mucoid stools
 Acute stages: 6-15 episodes diarrhea per day
 Abdominal pain, nausea, vomiting
 Associated with immunocompromised and malnourished states
 Chronic form
 Diarrhea alternate with constipation
 Abdominal pain, anemia and cachexia
 May spread to extraintestinal sites:
 Mesenteric nodes  Genitourinary sites
 Appendix  Pleura
 Liver  Lungs
 Complications:
 Intestinal perforation
 Acute appendicitis
 Diagnosis
o First: Microscopic demonstration of trophozoites and cysts in feces using direct examination or concentration (floatation
or sedimentation) techniques
 NOTE: Repeated stool examinations may be done to increase sensitivity in detecting trophozoites and cysts
o Biopsy- demonstrates presence of trophozoites-from lesions obtained from sigmoidoscopy
o Bronchoalveolar washings- trophozoites in cases of pulmonary involvement (extraintestinal spreads)
 Treatment
o Treatment of Choice:
 Tetracycline- contraindicated in children in less than 8 years old and pregnant women
 Metronidazole
o Others:
 Iodoquinol
 Doxycycline
 Nitazoxanide
 Epidemiology
o Distribution is cosmopolitan
o More prevalent in areas with poor sanitation, areas close contact with pigs or pig feces, overcrowded areas (orphanage
and prisons), warm and humid climates = survival of cysts
o 1% worldwide prevalence
 Prevention and Control
o Proper sanitation, safe water supply, good personal hygiene, protection of food from contamination
o Measures to limit contact of pigs with food and water
o Avoid using pig feces as fertilizer
o Cysts are easily inactivated by heat and 1% sodium hypochlorite
o Cysts resistant to environmental conditions and may survive for a long time
o Ordinary chlorination of water is not effective against B. coli cysts