#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
CS
proLékaře.cz / Journals / Epidemiology, Microbiology, Immunology / 2025 - 2

Blastocystis in the human gastrointestinal tract – commensal or “silent” pathogen?

Czech version

Authors: S. Kühnelová 1;  L. Rožnovský 2;  J. Doležílková 3;  R. Maďar 1
Authors‘ workplace: Ústav epidemiologie a ochrany veřejného zdraví LF OU 1;  Klinika infekčního lékařství FNO a Katedra interních oborů LF OU 2;  Oddělení parazitologie a lékařské zoologie Zdravotního ústavu se sídlem v Ostravě 3
Published in: Epidemiol. Mikrobiol. Imunol. 74, 2025, č. 2, s. 118-125
Category:
doi: https://doi.org/10.61568/emi/11-6492/20250428/140419

Overview

Blastocystis is a unicellular anaerobic microorganism inhabiting the human and animal gastrointestinal tract (GIT). It is the most abundant representative of eukaryotes reported in human feces and found in approx. a billion people worldwide. Despite the common occurrence, its direct pathogenicity and status among other, more significant, GIT parasites remain unclear. Blastocystis colonization is associated with various non-specific clusters of symptoms, such as diarrhea, abdominal pain, flatulence, or nausea and is often diagnosed in patients with irritable bowel syndrome, ulcerative colitis, or urticaria. Controversy persists mainly because of the detection of Blastocystis even in asymptomatic patients and the unclear mechanism of its potential pathogenicity. Also, for the reasons mentioned above, no treatment guidelines are available.

Keywords:

infection – pathogen – Blastocystis – commensal

Sources
  1. Vielma JR. Blastocystosis: Epidemiological, clinical, pathogenic, diagnostic, and therapeutic aspects. Invest Clin, 2019,60(1):53–78. doi: 10.22209/IC.v60n1a06.
  2. Wawrzyniak I, Poirier P, Viscoglisi E, Dionigia M., et al. Blastocystis, an unrecognized parasite: an overview of pathogenesis and diagnosis. Ther Adv Infect Dis, 2013,1(5):167–178. doi: 10.1177/2049936113504754.
  3. Andersen LO, Stensvold CR. Blastocystis in health and disease: are we moving from a clinical to a public health perspective? J Clin Microbiol., 2016,54(3):524–528. doi: 10.1128/JCM.0252015.
  4. Audebert C, Even G, Cian A, et al. Colonization with the enteric protozoa Blastocystis is associated with increased diversity of human gut bacterial microbiota. Sci Rep., 2016, 6:25255. doi: 10.1038/srep25255.
  5. Záhonová K, Low RS, Warren CJ, et al. Evolutionary analysis of cellular reduction and anaerobicity in the hyper-prevalent gut microbe Blastocystis. Curr Biol., 2023,33(12):2449– 442, 4.e8. doi: 10.1016/j.cub.2023.05.025.
  6. Stensvold CR, Suresh GK, Tan KSW, et al. Terminology for Blastocystis subtypes – a consensus. Trends Parasitol., 2007,23(3):93– 96. doi: 10.1016/j.pt.2007.01.004.
  7. Tan KSW. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev., 2008,21(4):639–665. doi: 10.1128/CMR.00022-08.
  8. Adl SM, Bass D, Lane CE, et al. Revision to the Classification, Nomenclature, and Diversity of Eukaryotes. Journal of Eukaryotic Microbiology, 2019,66(1):4–119. doi: 10.1111/jeu.12691.
  9. Gentekaki E Curtis BA, Stairs CW, et al. Extreme genome diversity in the hyper-prevalent parasitic eukaryote Blastocystis. PLoS Biol, 2017,15(9):e2003769.
  10. Shirvani G, Fasihi-Harandi, M., Raiesi, O, et al. Prevalence and Molecular Subtyping of Blastocystis from Patients with Irritable Bowel Syndrome, Inflammatory Bowel Disease and Chronic Urticaria in Iran. Acta Parasitologica, 2020,65(1):90–96. doi: 10.2478/s11686-019-00131-y.
  11. Melo GB, Roldan W, Malta F de M, et al. Culture isolation and molecular identification of Blastocystis sp. in Brazilian human isolates: preliminary results. Rev Inst Med Trop Sao Paulo, 2020,62:e51. doi: 10.1590/s1678-9946202062051.
  12. Mandell JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases: 2. svazek. 8. vydání. Saunders; 2015. 3960 s. ISBN-13: 978-1-4557-4801-3. doi: 10.1016/C2012-1-00075-6.
  13. Yason JA, Tan KSW. Seeing the Whole Elephant: Imaging Flow Cytometry Reveals Extensive Morphological Diversity within Blastocystis Isolates. PLoS ONE, 2015,10(11): e0143974.
  14. Centers for Disease Control and Prevention [online]. 2019-1021 [cit. 2024-04-17]. Blastocystis. Dostupné na www: <https:// www.cdc.gov/dpdx/blastocystis/index.html>
  15. Eroglu F, Koltas IS. Evaluation of the transmission mode of B. hominis by using PCR method. Parasitol Res, 2010,107(4):841–845. doi: 10.1007/s00436-010-1937-4.
  16. Melo GB, Bosqui LR, Costa IND, et al. Current status of research regarding Blastocystis sp., an enigmatic protist, in Brazil. Clinics (Sao Paulo), 2021,76:e2489.
  17. Stensvold CR, Tan KSW, Clark CG. Blastocystis. Trends in Parasitology, 2020, 36(3):315– 316. doi: 10.1016/j.pt.2019.12.008.
  18. Beneš J. Infekční lékařství. Praha: Galén, 2009. ISBN-13: 978-807262-644-1.
  19. Centers for Disease Control and Prevention [online]. 2019-05-20 [cit. 2024-04-22]. Cryptosporidiosis. Dostupné na www: <https:// www.cdc.gov/dpdx/cryptosporidiosis/index.html>
  20. Bouzid M, Hunter PR, Chalmers RM, et al. Cryptosporidium pathogenicity and virulence. Clin Microbiol Rev., 2013,26(1):115–134. doi: 10.1128/CMR.00076-12.
  21. Augendre L, Costa D, Escotte-Binet S, et al. Surrogates of foodborne and waterborne protozoan parasites: A review. Food Waterborne Parasitol., 2023,33:e00212. doi: 10.1016/j.fawpar.2023. e00212.
  22. Roche K, Dalle F, Capelli N, et al. From modern-day parasitology to paleoparasitology: the elusive past record and evolution of Cryptosporidium. Front Microbiol., 2023, 14:1249884. doi: 10.3389/fmicb.2023.1249884.
  23. Wetzel DM, Schmidt J, Kuhlenschmidt MS, et al. Gliding motility leads to active cellular invasion by Cryptosporidium parvum sporozoites. Infect Immun., 2005,73(9):5379– 5387. doi: 10.1128/ IAI.73.9.5379-5387.2005.
  24. Current WL, Reese NC. A Comparison of Endogenous Development of Three Isolates of Cryptosporidiumin Suckling Mice1. The Journal of Protozoology, 1986,33(1):98–108. doi: 10.1111/j.15507408.1986.tb05567.x.
  25. Guidelnes for drinking-water quality: Fourth edition incorporating the first and second addenda [Internet]. Geneva: World Health Organization; 2022. PMID: 35417116.
  26. Andersen LO, Bonde I, Nielsen HB, et al. A retrospective metagenomics approach to studying Blastocystis. FEMS Microbiol Ecol., 2015,91(7):fiv072. doi: 10.1093/femsec/fiv072.
  27. Skotarczak B. Genetic diversity and pathogenicity of Blastocystis. Annals of Agricultural and Environmental Medicine, 2018,25(3):411–416. doi: 10.26444/aaem/81315.
  28. Lhotská Z, Jirků M, Hložková O, et al. A Study on the Prevalence and Subtype Diversity of the Intestinal Protist Blastocystis sp. in a Gut-Healthy Human Population in the Czech Republic. Front. Cell. Infect. Microbiol., 2020,10:544335. doi: 10.3389/ fcimb.2020.544335
  29. Cinek O, Polackova K, Odeh R, et al. Blastocystis in the faeces of children from six distant countries: prevalence, quantity, subtypes, and the relation to the gut bacteriome. Parasites Vectors, 2021,14(1):399. doi: 10.1186/s13071-021-04859-3.
  30. Hublin JSY, Maloney JG, Santin M. Blastocystis in domesticated and wild mammals and birds. Res Vet Sci., 2021,135:260–282. doi: 10.1016/j.rvsc.2020.09.031.
  31. An D, Jiang T, Zhang C, et al. Epidemiology and Molecular Characterization of Zoonotic Gastrointestinal Protozoal Infection in Zoo Animals in China. Animals (Basel). 2024, 14(6):853. doi: 10.3390/ani14060853.
  32. Shams M, Shamsi L, Sadrebazzaz A, et al. A systematic review and meta-analysis on the global prevalence and subtypes distribution of Blastocystis sp. infection in cattle: A zoonotic concern. Comparative Immunology, Microbiology and Infectious Diseases, 2021,76:101650. doi: 10.1016/j.cimid.2021.101650.
  33. Deng L, Wojciech L, Png CW, et al. Experimental colonization with Blastocystis ST4 is associated with protective immune responses and modulation of gut microbiome in a DSS-induced colitis mouse model. PLoS Pathog, 2022,79(5):245. doi: 10.1007/ s00018-022-04271-9.
  34. Yason JA, Liang, YR, Png, CW, et al. Interactions between a pathogenic Blastocystis subtype and gut microbiota: in vitro and in vivo studies. Microbiome, 2019,7(1):30. doi: 10.1186/ s40168-019-0644-3.
  35. Matiut DS, Hritcu L. The pathogenic role of Blastocystis isolated from patients with irritable bowel syndrome and colitis from Iasi, Romania. Acta Parasitologica, 2014, 60(1):116–123. doi: 10.1515/ap-2015-0015.
  36. Poirier P, Wawrzyniak I, Vivarqs CP, et al. New insights into Blastocystis spp. – A potential link with irritable bowel syndrome. PLoS Pathog, 2012,8(3):e1002545.
  37. Valsecchi R, Leghissa P, Greco V. Cutaneous lesions in Blastocystis hominis infection. Acta Derm Venereol, 2004,84(4):322– 323. doi: 10.1080/00015550410025949.
  38. Deng L, Wojciech L, Gascoigne NRJ, et al. New insights into the interactions between Blastocystis, the gut microbiota, and host immunity. PLoS Pathog, 2021,17(2):e1009253.
  39. Betts EL, Newton JM, Thompson GS, et al. Metabolic Fluctuations in the Human Stool Obtained from Blastocystis Carriers and Non-Carriers. Metabolites., 2021,11(12):883. doi: 10.3390/ metabo11120883.
  40. Viesy S, Rezaei Z, Pouladi I, et al. The Prevalence of Blastocystis sp. and Its Relationship with Gastrointestinal Disorders and Risk factors. Iran J Parasitol, 2022,17(1):90–95. doi: 10.18502/ijpa. v17i1.9029.
  41. Jiménez P, Muñoz M, Ramírez JD. An update on the distribution of Blastocystis subtypes in the Americas. Heliyon, 2023,8(12):e12592.
  42. Popruk S, Adao DEV, Rivera WL. Epidemiology and subtype distribution of Blastocystis in humans: A review. Infect Genet Evol, 2021,95:105085. doi: 10.1016/j.meegid.2021.105085.
  43. Rajamanikam A, Isa MNM, Samudi C, et al. Gut bacteria influence Blastocystis sp. phenotypes and may trigger pathogenicity. PLoS Negl Trop Dis., 2023,17(3):e0011170.
  44. Stensvold CR, Smith HV, Nagel R, et al. Eradication of Blastocystis carriage with antimicrobials: reality or delusion? J Clin Gastroenterol., 2010,44(2):85-90. doi: 10.1097/MCG.0b013e3181bb86ba.
  45. Backhaus J, Frickmann H, Hagen RM, et al. Gastrointestinal Pathogens in Multi-Infected Individuals: A Cluster Analysis of Interaction. Microorganisms, 2023,11(11):2642. doi: 10.3390/ microorganisms11112642.
  46. Khorshidvand Z, Khazaei S, Amiri M, et al. Worldwide prevalence of emerging parasite Blastocystis in immunocompromised patients: A systematic review and meta-analysis. Microbial Pathogenesis, 2020,152:104615. doi: 10.1016/j.micpath.2020.104615.
  47. Alqarni AS, Wakid MH, Gattan SH. Prevalence, type of infections and comparative analysis of detection techniques of intestinal parasites in the province of Belgarn, Saudi Arabia. PeerJ, 2022; 10:e13889.
  48. Gong B, Liu X, Wu Y, et al. Prevalence and subtype distribution of Blastocystis in ethnic minority groups on both sides of the China – Myanmar border, and assessment of risk factors. Parasite, 2019,26:46. doi: 10.1051/parasite/2019046.
  49. Salehi M, Mardaneh J, Niazkar RH, et al. Prevalence and Subtype Analysis of Blastocystis hominis Isolated from Patients in the Northeast of Iran. Journal of Parasitology Research, 2021,8821885. doi: 10.1155/2021/8821885.
  50. Verma R, Delfanian K. Blastocystis hominis Associated Acute Urticaria. The American Journal of the Medical Sciences, 2013,346(1):80–81. doi: 10.1097/MAJ.0b013e3182801478.
  51. Aghazadeh M, Jones M, Perera S, et al. The Application of 3base™ Technology to Diagnose Eight of the Most Clinically Important Gastrointestinal Protozoan Infections. Int. J. Mol. Sci., 2023,24(17):13387. doi: 10.3390/ijms241713387.
  52. Lamp KC, Freeman CD, Klutman, NE, et al. Pharmacokinetics and Pharmacodynamics of the Nitroimidazole Antimicrobials. Clinical Pharmacokinetics, 1999,36(5):353–373. doi: 10.2165/00003088-199936050-00004.
  53. Kurt Ö, Doğruman Al F, Tanyüksel M. Eradication of Blastocystis in humans – Really necessary for all? Parasitol Int., 2016,65(6):797– 801. doi: 10.1016/j.parint.2016.01.010.
  54. Coyle CM, Varughese J, Weiss LM, et al. Blastocystis: To Treat or Not to Treat... Clinical Infectious Diseases, 2012,54(1):105–110. doi: 10.1093/cid/cir810.
  55. Cohen J, Powderly WG, Opal SM. Infectious Diseases, 2. svazek. 3. vydání. Saunders; 2010. ISBN-13: 978-0-323-04579-7.
  56. Abdo SM, Ghallab MMI, Zaghloul MS, et al. Efficacy of Nitazoxanide, Nitazoxanide-Garlic Combination and Tinidazole in Treatment of Giardia duodenalis and Blastocystis hominis: Coproscopic Assessment. Iran J Parasitol, 2023,18(1):48– 55. doi: 10.18502/ijpa.v18i1.12379.
  57. Roberts T, Stark D, Harkness J, et al. Update on the pathogenic potential and treatment options for Blastocystis sp. Gut Pathogens, 2014,6:17. doi: 10.1186/1757-4749-6-17.
  58. Dudlová A, Juriš P, Jurišová S, et al. Epidemiology and geographical distribution of gastrointestinal parasitic infection in humans in Slovakia. Helminthologia, 2016,53(4):309– 317. doi: 10.1515/helmin-2016-0035.
  59. Piperni E, Nguyen LH, Manghi P, et al. Intestinal Blastocystis is linked to healthier diets and more favorable cardiometabolic outcomes in 56,989 individuals from 32 countries. Cell, 2024,187(17):4554– 4570.e18. doi: 10.1016/j.cell.2024.06.018.
  60. Lepczyńska M, Dzika E, Chen W. Prevalence of Blastocystis Subtypes in Healthy Volunteers in Northeastern Poland. Journal of Parasitology, 2021,107(5):684– 688. doi: doi.org/10.1645/20-170.
  61. Yoshikawa H, Wu Z, Kimata I, et al. Polymerase chain reaction--based genotype classification among human Blastocystis hominis populations isolated from different countries. Parasitology research, 2004,92(1):22–29. doi: 10.1007/s00436-003-0995-2.
  62. World Health Organization [online]. 2023 [cit. 2024-02-10]. Developing capacity to monitor parasitic NTDs through Kato-Katz in Cambodia. Dostupné na www: <https://www.who.int/news--room/feature-stories/detail/developing-capacity-to-monitor--parasitic-ntds-through-kato-katz-in-cambodia>
  63. Centers for Disease Control and Prevention [online]. [cit. 2024-02-11]. Stool Specimen Processing. Dostupné na www:<https://www.cdc.gov/dpdx/diagnosticprocedures/stool/spe- cimenproc.html>
  64. Becker SL, Lohourignon LK, Speich B, et al. Comparison of the Flotac-400 dual technique and the formalin-ether concentration technique for diagnosis of human intestinal protozoon infection. J Clin Microbiol., 2011, 49(6):2183–2190. doi: 10.1128/ JCM.01035-10.

Poděkování

Tento článek vznikl s podporou Studentské grantové soutěže Lékařské fakulty Ostravské univerzity v rámci projektu SGS12/LF/2025 „Prevalence Blastocystis sp. u vybraných skupin osob v České republice“.

Do redakce došlo dne 4. 1. 2025.

Adresa pro korespondenci:
Mgr. Sabina Kühnelová
Ústav epidemiologie a ochrany veřejného zdraví LF OU
Syllabova 1264/19 703 00 Ostrava – Vítkovice
e-mail: kuhnsa99@osu.cz

Labels
Hygiene and epidemiology Medical virology Clinical microbiology
How the epidemiology of rotavirus infections is changing with vaccination in the Czech Republic
Results of microbiological surveillance in patients with high-voltage eletrical injuries: A 10-year single center experience
Microbial contamination of air filters of air conditioning system of urban buses
Corynebacterium durum and possibilities of its identification
A lethal tick-borne encephalitis from an active endemic area in Slovakia
-
Article was published in

Epidemiology, Microbiology, Immunology

Issue 2
2025 Issue 2
Download issue PDF
Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#