Balantidiasis

Key Features

• Balantidium coli is a large intestinal protozoan found worldwide but particularly in the tropics

• Pigs are the reservoir host

• Disease is rare in humans and results from ingestion of cysts passed in stools of humans or swine

• Deaths have occurred from intestinal perforation and hemorrhage

Clinical Findings

• Many infections are asymptomatic

• Chronic infections may cause recurrent diarrhea or dysentery

• Abscesses and ulcerations result from trophozoite invading the intestinal mucosa

Diagnosis

• Established by finding trophozoites or cysts in stool or ulcer scrapings of large bowel

Treatment

• Tetracycline hydrochloride

  • Treatment of choice

  • 500 mg orally four times daily for 10 days

• Iodoquinol (diiodohydroxyquin)

  • Alternative drug

  • 650 mg orally three times daily for 21 days

• Occasional success has also been reported with

  • Metronidazole

  • Paromomycin

  • Nitazoxanide