Balantidium coli infection occurs in areas with poor public sanitation. Swine are the main reservoir. Healthy people are resistant to infection. Like amebiasis, the infecting organism is a protozoa with an estimated incubation period of a few days.
CASES/YEAR
16,000 (US); 300,000 (Global)
OTHER NAMES
Balantidiasis;
INCUBATION
A few days (estimated); [CCDM]
INITIAL SYMPTOMS
Most patients are asymptomatic. Symptomatic patients have intermittent diarrhea. [PPID, p. 3426]
PRECAUTIONS
Person-to-person transmission can occur, but healthy people are resistant to infection. [PPID, p. 3426]
COMMENTS
Balantidium coli are large ciliated protozoa that can cause infections similar to amebiasis. Extraintestinal infections of the peritoneum and urogenital tissues are rare. Swine are the main reservoir, and infections occur in areas with poor public sanitation. Other possible reservoirs are rats and primates. Patients may have bloody stools with mucous, but relatively little pus. Cysts are not destroyed by water chlorination. [CCDM, p. 64-5] Cysts in feces of pigs (domestic or wild) transmit infection by direct handling or by ingestion of water or contaminated produce. Most infections are asymptomatic. Some patients have weight loss. In rare cases of fulminant dysentery, stools contain mucous and blood. A bladder infection case (hematuria) and a case with pneumonia have been reported. [PPID, p. 3426] Ingestion of cysts in pig feces are sources of infection while slaughtering or spreading fertilizer containing pig manure. Balantidium coli rarely spreads to other organs by the hematogenous route. [Harrison ID, p. 1122]
DIAGNOSTIC
Identify trophozoite or cysts in stool sample; [CCDM]
SCOPE
Global; Most common in Latin America, Southeast Asia , and the Middle East; [Gorbach, p. 419]
SIGNS & SYMPTOMS
-
G abdominal pain
-
G blood in stool
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G diarrhea
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G fecal leukocytes
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G nausea, vomiting
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N headache
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U hematuria
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*pneumonia
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*weight loss
SOURCE
Human Fecal-Oral, Eating Contaminated Food, Eating Contaminated Produce, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Monkeys, Rodents, Swine, Human, Wild Animals
RISK FACTORS
- Handle animal carcasses or placentas
- Handle domestic animals
- Ingest infectious agents in food/water
TREATMENT
Treat with tetracycline for 10 days. Metronidazole and iodoquinol are also effective. [CCDM]
REFERENCES FOR CASES/YEAR
1. (US) No data found; Assume same cases/yr as Cyclospora;
2. (Global) No data found; Assume same cases/yr as Cyclospora;