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Table 1 Case reports of Blastocystis infection

From: Update on the pathogenic potential and treatment options for Blastocystis sp

Patient

Clinical history

Diagnosis

Treatment

Outcome

Study

One 11 y.o male and one 12 y.o male

Both presented with right lower quadrant tenderness, anorexia, abdominal pain, nausea, vomiting

Initially diagnosed with appendicitis. Stool examination showed Blastocystis and patients were then diagnosed with Blastocystis infection

Metronidazole and co-trimoxazole

Complete recovery

[15]

24 y.o female

Nine week history of urticaria, hives, chronic diarrhoea, IBS

Initially diagnosed with cellulitis. Treated with non-steroidal cream with no recovery of symptoms. Presented with hives and diagnosed as urticaria. Extensive investigation showed 4 + Blastocystis in her stool.

Metronidazole

All urticarial and IBS symptoms cleared

[24]

45 y.o female

Four month history of erythematous and pruriginous lesions on trunk and limbs, mild gastoenteric complaints

Diagnosed with urticaria. Extensive investigation showed the stool postive for Blastoycstis.

Paromomycin and metronidazole

All urticarial and gastrointestinal symproms cleared

[25]

32 y.o female

Four year history of allegic rhinitis and chronic urticaria, swelling in pressure sites

Diagnosed with delayed pressure urticaria. Treated with systemic corticosteroids with only partial clearance of symptoms. Stool examination positive for Blastocystis

Metronidazole

All urticarial symptoms cleared

[26]

60 y.o female

Four year history of anaphylactoid reactions, severe asthma and generalised urticaria

Diagnosed with chronic urticaria. Extensive investigation identified Blastocystis in the stool

Paromomycin

All urticaria symptoms cleared

[27]

74 y.o male

Diarrhoea, abdominal pain, nausea, fatigue and fever

Hospitalised. Stool were positive for Blastocystis

Metronidazole

Clearence of symptoms after 10days

[18]

29 y.o female

Six month history of morning stiffness, pain and swelling of joints, elbows, ankles, knees, diarrhoea, abdominal pain and vomiting

Treated for presumed infectious arthritis of the knee. No improvement. Microscopy of the synovial fluid and stools both showed the presence of Blastocystis.

Metronidazole

After two weeks knee inflammation subsided and all abdominal pain and diarrhoea were cleared

[28]

24 y.o male

Six week history of diffuse abdominal pain and diarrhoea

Stool examination was positive for Blastocystis and Endolimax nana.

Metronidazole

Complete resolution of symptoms 10days later

[29]

19 y.o male

Three week history of hives, abdominal pain for 2.5months

Diagnosed with acute urticaria. Routine testing showed the presence of Blastocystis in the stool ST3

Metronidazole

10days after treatment both urticaria and abdominal discomfort were cleared

[21]

20 y.o male

Urticaria and flatulence

Treated with antihistamines with no success. Further investigation showed Blastocystis ST2 in the stool. Initially treated with metronidazole but treatment failure appears to have occured. Then treated with co-trimoxazole with no success and finally treated with combination metronidazole and paramomycin

Metronidazole then co-trimoxazole followed by paromomycin

All symptoms cleared 10 days later

[22]

40 y.o female

Hospitalised due to severe diarrhoea and fever

Blastocystis ST8 infection diagnosed from stool cultures. Treated with metronidazole. Symptoms persisted and the patient also noted bloating, flatulence and abdominal pain. Further treated with co-trimoxazole

Metronidazole then co-trimoxazole

All symptoms cleared

[30]