Blastocystis hominis (B. hominis) and Dientamoeba fragilis (D. fragilis) are microscopic parasites sometimes found in the stools of people who have diarrhea, abdominal pain or other gastrointestinal signs and symptoms. However, it’s not clear whether blastocystis infection, as it’s called, is actually an infection or that it causes any abdominal signs and symptoms.
Many people who carry blastocystis hominis have no signs or symptoms. Some people who have this parasite have diarrhea and other symptoms. However, blastocystis hominis often appears with other organisms that may be the actual cause of the signs and symptoms commonly associated with blastocystis infection, also known as blastocystosis. So experts aren’t sure whether blastocystis hominis causes disease or merely serves as an indicator of other agents that might cause diarrheal symptoms.
Travelers who have visited developing countries often pick up blastocystis hominis, one of the most common parasites found in stool samples. However, it’s not known whether the organism causes traveler’s diarrhea. If you have blastocystis hominis in your stool but no signs or symptoms, you don’t need treatment. Even if you have symptoms, the blastocystis infection may clear up on its own. If you have signs and symptoms that don’t improve, you can take medications that may help, but the medication isn’t always effective.
The signs and symptoms that might be associated with blastocystosis include:
Once thought to be a harmless yeast, B. hominis is a parasite, a microscopic single-celled organism (protozoan). It behaves like a tiny animal — hunting and gathering other microbes for food. Many protozoa inhabit your gastrointestinal tract and are harmless; others cause disease.
Whether B. hominis causes disease is controversial. Some experts believe that the blastocystis parasite does cause diarrhea and other signs and symptoms. Others believe that’s not the case — that other organisms that may exist with B. hominis may be the true culprits.
Many types of protozoa get into the intestinal tract through oral-fecal contact, such as occurs when a person who doesn’t wash hands thoroughly after using the toilet prepares food. No one knows for certain how B. hominis is transmitted, but experts suspect it’s through oral-fecal contact. Experts do know that the incidence of blastocystosis increases in places with inadequate sanitation and poor personal hygiene.
The cause of your diarrhea may be difficult to diagnose. Your doctor likely will take your medical history, ask you about recent activities, such as traveling, and perform a physical exam. A number of lab tests help diagnose parasitic diseases:
If you have diarrhea associated with blastocystosis, it’s likely to be self-limiting. However, anytime you have diarrhea, you lose vital fluids, salts and minerals, which can lead to dehydration. Children are especially vulnerable to dehydration.
An oral rehydration solution (ORS) is the best way to replace lost fluids. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose or another carbohydrate, such as rice powder, to enhance absorption in the intestinal tract.
Bottled oral rehydration products are available in chemists or drugstores in developed areas, and many pharmacies carry their own brands. You can find packets of powdered oral rehydration solution recommended by the World Health Organization at stores, pharmacies and health agencies in most countries. Reconstitute the powder in bottled or boiled water according to the directions on the package.
If you have blastocystosis without signs or symptoms, then you don’t need treatment. Mild signs and symptoms may improve on their own within a few days.
Potential medications for treating blastocystosis include the antibiotic metronidazole (Flagyl), the combination medication sulfamethoxazole and trimethoprim (Bactrim, Septra, others) and the antiprotozoal medication iodoquinol (Yodoxin, others). However, keep in mind that response to medication for blastocystosis varies greatly from person to person, and that improvement may be due to the medication’s effect on another organism.
If oral therapy fails, then intra-colonic infusion of high dose triple therapy is used via a colonoscopy.
You may be able to prevent blastocystis or other gastrointestinal infection by taking the following precautions while traveling in high-risk countries.
The general rule of thumb is this: Boil it, cook it, peel it or forget it. Unfortunately, most travelers don’t stick to these guidelines 100 percent of the time. Remember these tips:
When visiting high-risk countries, keep the following tips in mind:
If you have blastocystosis, good personal hygiene will help keep you from spreading the infection to others: