Gut Pathogens | |
Update on the pathogenic potential and treatment options for Blastocystis sp | |
John Ellis2  John Harkness1  Damien Stark1  Tamalee Roberts2  | |
[1] Department of Microbiology, St. Vincent’s Hospital, Victoria St, Darlinghurst 2010, NSW, Australia;School of Medical and Molecular Biosciences, University of Technology, Sydney, Ultimo, NSW 2007, Australia | |
关键词: Parasitology; Subtypes; Treatment failure; Pathogenicity; Blastocystis; | |
Others : 817455 DOI : 10.1186/1757-4749-6-17 |
|
received in 2014-04-21, accepted in 2014-05-15, 发布年份 2014 | |
【 摘 要 】
Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole.
【 授权许可】
2014 Roberts et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140711003710951.pdf | 595KB | download | |
Figure 1. | 50KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Zierdt CH: Blastocystis hominis–past and future. Clin Microbiol Rev 1991, 4(1):61-79.
- [2]Zierdt CH, Donnolley CT, Muller J, Constantopoulos G: Biochemical and ultrastructural study of Blastocystis hominis. J Clin Microbiol 1988, 26(5):965-970.
- [3]Arisue N, Hashimoto T, Yoshikawa H, Nakamura Y, Nakamura G, Nakamura F, Yano TA, Hasegawa M: Phylogenetic position of Blastocystis hominis and of stramenopiles inferred from multiple molecular sequence data. J Eukaryot Microbiol 2002, 49(1):42-53.
- [4]Tan KS: New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 2008, 21(4):639-665.
- [5]Silberman JD, Sogin ML, Leipe DD, Clark CG: Human parasite finds taxonomic home. Nature 1996, 380(6573):398.
- [6]Graczyk TK, Shiff CK, Tamang L, Munsaka F, Beitin AM, Moss WJ: The association of Blastocystis hominis and Endolimax nana with diarrheal stools in Zambian school-age children. Parasitol Res 2005, 98(1):38-43.
- [7]Parkar U, Traub RJ, Vitali S, Elliot A, Levecke B, Robertson I, Geurden T, Steele J, Drake B, Thompson RC: Molecular characterization of Blastocystis isolates from zoo animals and their animal-keepers. Vet Parasitol 2010, 169(1–2):8-17.
- [8]Roberts T, Stark D, Harkness J, Ellis J: Subtype distribution of Blastocystis isolates identified in a Sydney population and pathogenic potential of Blastocystis. Eur J Clin Microbiol Infect Dis 2013, 32(3):335-343.
- [9]Alfellani MA, Taner-Mulla D, Jacob AS, Imeede CA, Yoshikawa H, Stensvold CR, Clark CG: Genetic diversity of Blastocystis in livestock and zoo animals. Protist 2013, 164(4):497-509.
- [10]El Safadi D, Gaayeb L, Meloni D, Cian A, Poirier P, Wawrzyniak I, Delbac F, Dabboussi F, Delhaes L, Seck M, Hamze M, Riveau G, Viscogliosi E: Children of Senegal River Basin show the highest prevalence of Blastocystis sp. ever observed worldwide. BMC Infect Dis 2014, 14(1):164. BioMed Central Full Text
- [11]Ithoi I, Jali A, Mak JW, Wan Sulaiman WY, Mahmud R: Occurrence of Blastocystis in water of two rivers from recreational areas in malaysia. J Parasitol Res 2011, 2011:123916.
- [12]Banaticla JE, Rivera WL: Detection and subtype identification of Blastocystis isolates from wastewater samples in the Philippines. J Water Health 2011, 9(1):128-137.
- [13]Anuar TS, Ghani MK, Azreen SN, Salleh FM, Moktar N: Blastocystis infection in Malaysia: evidence of waterborne and human-to-human transmissions among the Proto-Malay: Negrito and Senoi tribes of Orang Asli. Parasit Vectors 2013, 6:40. BioMed Central Full Text
- [14]Roberts T, Barratt J, Harkness J, Ellis J, Stark D: Comparison of microscopy, culture, and conventional polymerase chain reaction for detection of Blastocystis sp. in clinical stool samples. Am J Trop Med Hyg 2011, 84(2):308-312.
- [15]Andiran N, Acikgoz ZC, Turkay S, Andiran F: Blastocystis hominis–an emerging and imitating cause of acute abdomen in children. J Pediatr Surg 2006, 41(8):1489-1491.
- [16]Leelayoova S, Rangsin R, Taamasri P, Naaglor T, Thathaisong U, Mungthin M: Evidence of waterborne transmission of Blastocystis hominis. Am J Trop Med Hyg 2004, 70(6):658-662.
- [17]Carrascosa M, Martinez J, Perez-Castrillon JL: Hemorrhagic proctosigmoiditis and Blastocystis hominis infection. Ann Intern Med 1996, 124(2):278-279.
- [18]Levy Y, George J, Shoenfeld Y: Severe Blastocystis hominis in an elderly man. Journal of Infect 1996, 33(1):57-59.
- [19]Leder K, Hellard ME, Sinclair MI, Fairley CK, Wolfe R: No correlation between clinical symptoms and Blastocystis hominis in immunocompetent individuals. J Gastroenterol Hepatol 2005, 20(9):1390-1394.
- [20]Tungtrongchitr A, Manatsathit S, Kositchaiwat C, Ongrotchanakun J, Munkong N, Chinabutr P, Leelakusolvong S, Chaicumpa W: Blastocystis hominis infection in irritable bowel syndrome patients. Southeast Asian J Trop Med Public Health 2004, 35(3):705-710.
- [21]Katsarou-Katsari A, Vassalos CM, Tzanetou K, Spanakos G, Papadopoulou C, Vakalis N: Acute urticaria associated with amoeboid forms of Blastocystis sp. subtype 3. Acta Derm Venereol 2008, 88(1):80-81.
- [22]Vogelberg C, Stensvold CR, Monecke S, Ditzen A, Stopsack K, Heinrich-Grafe U, Pohlmann C: Blastocystis sp. subtype 2 detection during recurrence of gastrointestinal and urticarial symptoms. Parasitol Int 2010, 59(3):469-471.
- [23]Balint A, Doczi I, Bereczki L, Gyulai R, Szucs M, Farkas K, Urban E, Nagy F, Szepes Z, Wittmann T, Molnar T: Do not forget the stool examination!-cutaneous and gastrointestinal manifestations of Blastocystis sp. infection. Parasitol Res 2014, 113(4):1585-1590.
- [24]Gupta R, Parsi K: Chronic urticaria due to Blastocystis hominis. Australas J Dermatol 2006, 47(2):117-119.
- [25]Pasqui AL, Savini E, Saletti M, Guzzo C, Puccetti L, Auteri A: Chronic urticaria and blastocystis hominis infection: a case report. Eur Rev Med Pharmacol Sci 2004, 8(3):117-120.
- [26]Cassano N, Scoppio BM, Loviglio MC, Vena GA: Remission of delayed pressure urticaria after eradication of Blastocystis hominis. Acta Derm Venereol 2005, 85(4):357-358.
- [27]Biedermann T, Hartmann K, Sing A, Przybilla B: Hypersensitivity to non-steroidal anti-inflammatory drugs and chronic urticaria cured by treatment of Blastocystis hominis infection. Br J Dermatol 2002, 146(6):1113-1114.
- [28]Lee MG, Rawlins SC, Didier M, DeCeulaer K: Infective arthritis due to Blastocystis hominis. Ann Rheum Dis 1990, 49(3):192-193.
- [29]Shah M, Tan CB, Rajan D, Ahmed S, Subramani K, Rizvon K, Mustacchia P: Blastocystis hominis and Endolimax nana Co-Infection Resulting in Chronic Diarrhea in an Immunocompetent Male. Case Rep Gastroenterol 2012, 6(2):358-364.
- [30]Stensvold CR, Arendrup MC, Nielsen HV, Bada A, Thorsen S: Symptomatic infection with Blastocystis sp. subtype 8 successfully treated with trimethoprim-sulfamethoxazole. Ann Trop Med Parasitol 2008, 102(3):271-274.
- [31]Bohm-Gloning B, Knobloch J, Walderich B: Five subgroups of Blastocystis hominis from symptomatic and asymptomatic patients revealed by restriction site analysis of PCR-amplified 16S-like rDNA. Trop Med Int Health 1997, 2(8):771-778.
- [32]Kaneda Y, Horiki N, Cheng XJ, Fujita Y, Maruyama M, Tachibana H: Ribodemes of Blastocystis hominis isolated in Japan. Am J Trop Med Hyg 2001, 65(4):393-396.
- [33]Ozyurt M, Kurt O, Molbak K, Nielsen HV, Haznedaroglu T, Stensvold CR: Molecular epidemiology of Blastocystis infections in Turkey. Parasitol Int 2008, 57(3):300-306.
- [34]Yan Y, Su S, Lai R, Liao H, Ye J, Li X, Luo X, Chen G: Genetic variability of Blastocystis hominis isolates in China. Parasitol Res 2006, 99(5):597-601.
- [35]Yoshikawa H, Wu Z, Kimata I, Iseki M, Ali IK, Hossain MB, Zaman V, Haque R, Takahashi Y: Polymerase chain reaction-based genotype classification among human Blastocystis hominis populations isolated from different countries. Parasitol Res 2004, 92(1):22-29.
- [36]Dogruman-Al F, Dagci H, Yoshikawa H, Kurt O, Demirel M: A possible link between subtype 2 and asymptomatic infections of Blastocystis hominis. Parasitol Res 2008, 103(3):685-689.
- [37]Ramirez JD, Sanchez LV, Bautista DC, Corredor AF, Florez AC, Stensvold CR: Blastocystis subtypes detected in humans and animals from Colombia. Infect Genet Evol 2013, 22:223-228.
- [38]Dominguez-Marquez MV, Guna R, Munoz C, Gomez-Munoz MT, Borras R: High prevalence of subtype 4 among isolates of Blastocystis hominis from symptomatic patients of a health district of Valencia (Spain). Parasitol Res 2009, 105(4):949-955.
- [39]Stensvold CR, Christiansen DB, Olsen KE, Nielsen HV: Blastocystis sp. subtype 4 is common in Danish Blastocystis-positive patients presenting with acute diarrhea. Am J Trop Med Hyg 2011, 84(6):883-885.
- [40]Hussein EM, Hussein AM, Eida MM, Atwa MM: Pathophysiological variability of different genotypes of human Blastocystis hominis Egyptian isolates in experimentally infected rats. Parasitol Res 2008, 102(5):853-860.
- [41]Denoeud F, Roussel M, Noel B, Wawrzyniak I, Da Silva C, Diogon M, Viscogliosi E, Brochier-Armanet C, Couloux A, Poulain J, Segurans B, Anthouard V, Texier C, Blot N, Poirier P, Choo NG, Tan KS, Artiguenave F, Jaillon O, Aury JM, Delbac F, Wincker P, Vivares CP, El Alaoui H: Genome sequence of the stramenopile Blastocystis, a human anaerobic parasite. Genome Biol 2011, 12(3):R29. BioMed Central Full Text
- [42]Parija SC, Jeremiah S: Blastocystis: Taxonomy, biology and virulence. Tropical Parasitol 2013, 3(1):17-25.
- [43]Puthia MK, Lu J, Tan KS: Blastocystis ratti contains cysteine proteases that mediate interleukin-8 response from human intestinal epithelial cells in an NF-kappaB-dependent manner. Eukaryot Cell 2008, 7(3):435-443.
- [44]Puthia MK, Vaithilingam A, Lu J, Tan KS: Degradation of human secretory immunoglobulin A by Blastocystis. Parasitol Res 2005, 97(5):386-389.
- [45]Puthia MK, Sio SW, Lu J, Tan KS: Blastocystis ratti induces contact-independent apoptosis, F-actin rearrangement, and barrier function disruption in IEC-6 cells. Infect Immun 2006, 74(7):4114-4123.
- [46]Mirza H, Tan KS: Blastocystis exhibits inter- and intra-subtype variation in cysteine protease activity. Parasitol Res 2008, 104(2):355-361.
- [47]Wawrzyniak I, Texier C, Poirier P, Viscogliosi E, Tan KS, Delbac F, El Alaoui H: Characterization of two cysteine proteases secreted by Blastocystis ST7, a human intestinal parasite. Parasitol Int 2012, 61(3):437-442.
- [48]Abdel-Hameed DM, Hassanin OM: Proteaese activity of Blastocystis hominis subtype3 in symptomatic and asymptomatic patients. Parasitol Res 2011, 109:321-327.
- [49]Abou Gamra MM, Elwakil HS, El Deeb HK, Khalifa KE, Abd Elhafiz HE: The potential use of 29 kDa protein as a marker of pathogenicity and diagnosis of symptomatic infections with Blastocystis hominis. Parasitol Res 2011, 108(5):1139-1146.
- [50]Mahmoud MS, Saleh WA: Secretory and humoral antibody responses to Blastocystis hominis in symptomatic and asymptomatic human infections. J Egypt Soc Parasitol 2003, 33(1):13-30.
- [51]Iguchi A, Yoshikawa H, Yamada M, Kimata I, Arizono N: Expression of interferon gamma and proinflammatory cytokines in the cecal mucosa of rats experimentally infected with Blastocystis sp. strain RN94-9. Parasitol Res 2009, 105(1):135-140.
- [52]Moe KT, Singh M, Howe J, Ho LC, Tan SW, Chen XQ, Ng GC, Yap EH: Experimental Blastocystis hominis infection in laboratory mice. Parasitol Res 1997, 83(4):319-325.
- [53]Yao FR, Qiao JY, Zhao Y, Zhang X, Yang JH, Li XQ: [Experimental infection of mice with Blastocystis hominis]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2005, 23(6):444-448.
- [54]Zhang HW, Li W, Yan QY, He LJ, Su YP: [Impact of blastocystis hominis infection on ultrastructure of intestinal mucosa in mice]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2006, 24(3):187-191.
- [55]Elwakil HS, Hewedi IH: Pathogenic potential of Blastocystis hominis in laboratory mice. Parasitol Res 2010, 107(3):685-689.
- [56]Chandramathi S, Suresh KG, Mahmood AA, Kuppusamy UR: Urinary hyaluronidase activity in rats infected with Blastocystis hominis–evidence for invasion? Parasitol Res 2010, 106(6):1459-1463.
- [57]Li J, Deng T, Li X, Cao G, Li X, Yan Y: A rat model to study Blastocytis subtype 1 infections. Parasitol Res 2013, 112(10):3537-3541.
- [58]Stark D, Fotedar R, van Hal S, Beebe N, Marriott D, Ellis JT, Harkness J: Prevalence of enteric protozoa in human immunodeficiency virus (HIV)-positive and HIV-negative men who have sex with men from Sydney, Australia. Am J Trop Med Hyg 2007, 76(3):549-552.
- [59]Cimerman S, Cimerman B, Lewi DS: Prevalence of intestinal parasitic infections in patients with acquired immunodeficiency syndrome in Brazil. Int J Infect Dis 1999, 3(4):203-206.
- [60]Prasad KN, Nag VL, Dhole TN, Ayyagari A: Identification of enteric pathogens in HIV-positive patients with diarrhoea in northern India. J Health Popul Nutr 2000, 18(1):23-26.
- [61]Gassama A, Sow PS, Fall F, Camara P, Gueye-N'diaye A, Seng R, Samb B, M'Boup S, Aidara-Kane A: Ordinary and opportunistic enteropathogens associated with diarrhea in Senegalese adults in relation to human immunodeficiency virus serostatus. Int J Infect Dis 2001, 5(4):192-198.
- [62]Hailemariam G, Kassu A, Abebe G, Abate E, Damte D, Mekonnen E, Ota F: Intestinal parasitic infections in HIV/AIDS and HIV seronegative individuals in a teaching hospital, Ethiopia. Jpn J Infect Dis 2004, 57(2):41-43.
- [63]Alemu A, Shiferaw Y, Getnet G, Yalew A, Addis Z: Opportunistic and other intestinal parasites among HIV/AIDS patients attending Gambi higher clinic in Bahir Dar city, North West Ethiopia. Asian Pac J Trop Med 2011, 4(8):661-665.
- [64]Adamu H, Wegayehu T, Petros B: High prevalence of diarrhoegenic intestinal parasite infections among non-ART HIV patients in Fitche Hospital, Ethiopia. PLoS One 2013, 8(8):e72634.
- [65]Zali MR, Mehr AJ, Rezaian M, Meamar AR, Vaziri S, Mohraz M: Prevalence of intestinal parasitic pathogens among HIV-positive individuals in Iran. Jpn J Infect Dis 2004, 57(6):268-270.
- [66]Kurniawan A, Karyadi T, Dwintasari SW, Sari IP, Yunihastuti E, Djauzi S, Smith HV: Intestinal parasitic infections in HIV/AIDS patients presenting with diarrhoea in Jakarta, Indonesia. Trans R Soc Trop Med Hyg 2009, 103(9):892-898.
- [67]Tian LG, Wang TP, Lv S, Wang FF, Guo J, Yin XM, Cai YC, Dickey MK, Steinmann P, Chen JX: HIV and intestinal parasite co-infections among a Chinese population: an immunological profile. Infect Dis Proverty 2013, 2(1):18. BioMed Central Full Text
- [68]Tan TC, Ong SC, Suresh KG: Genetic variability of Blastocystis sp. isolates obtained from cancer and HIV/AIDS patients. Parasitol Res 2009, 105(5):1283-1286.
- [69]Chandramathi S, Suresh K, Anita ZB, Kuppusamy UR: Infections of Blastocystis hominis and microsporidia in cancer patients: are they opportunistic? Trans R Soc Trop Med Hyg 2012, 106(4):267-269.
- [70]Poirier P, Wawrzyniak I, Albert A, El Alaoui H, Delbac F, Livrelli V: Development and evaluation of a real-time PCR assay for detection and quantification of blastocystis parasites in human stool samples: prospective study of patients with hematological malignancies. J Clin Microbiol 2011, 49(3):975-983.
- [71]Stark D, van Hal S, Marriott D, Ellis J, Harkness J: Irritable bowel syndrome: A review on the role of intestinal protozoa and the importance of their detection and diagnosis. Int J Parasitol 2007, 37(1):11-20.
- [72]Olivo-Diaz A, Romero-Valdovinos M, Gudino-Ramirez A, Reyes-Gordillo J, Jimenez-Gonzalez DE, Ramirez-Miranda ME, Martinez-Flores WA, Martinez-Hernandez F, Flisser A, Maravilla P: Findings related to IL-8 and IL-10 gene polymorphisms in a Mexican patient population with irritable bowel syndrome infected with Blastocystis. Parasitol Res 2012, 111(1):487-491.
- [73]Yakoob J, Jafri W, Jafri N, Khan R, Baig MA, Zaman V: Irritable bowel syndrome: search of an etiology: role of Blastocystis hominis. Am J Gastroenterol 2003, 98(9, Supplement 1):S264-S265.
- [74]Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R: Irritable bowel syndrome: is it associated with genotypes of Blastocystis hominis. Parasitol Res 2010, 106(5):1033-1038.
- [75]Dogruman-Al F, Simsek Z, Boorom K, Ekici E, Sahin M, Tuncer C, Kustimur S, Altinbas A: Comparison of Methods for Detection of Blastocystis Infection in Routinely Submitted Stool Samples, and also in IBS/IBD Patients in Ankara, Turkey. PLoS One 2010, 5(11):e15484.
- [76]Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R: Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria. Parasitol Res 2010, 107(3):679-684.
- [77]Jimenez-Gonzalez DE, Martinez-Flores WA, Reyes-Gordillo J, Ramirez-Miranda ME, Arroyo-Escalante S, Romero-Valdovinos M, Stark D, Souza-Saldivar V, Martinez-Hernandez F, Flisser A, Olivo-Diaz A, Maravilla P: Blastocystis infection is associated with irritable bowel syndrome in a Mexican patient population. Parasitol Res 2011, 110(3):1269-1275.
- [78]Ahmadian A, Ehn M, Hober S: Pyrosequencing: history, biochemistry and future. Clin Chim Acta 2006, 363(1–2):83-94.
- [79]Lucia JF, Aguilar C, Betran A: Blastocystis hominis colitis in a haemophilic patient as a cause of lower gastrointestinal bleeding. Haemophilia 2007, 13(2):224-225.
- [80]Moghaddam DD, Ghadirian E, Azami M: Blastocystis hominis and the evaluation of efficacy of metronidazole and trimethoprim/sulfamethoxazole. Parasitol Res 2005, 96(4):273-275.
- [81]Nassir E, Awad J, Abel AB, Khoury J, Shay M, Lejbkowicz F: Blastocystis hominis as a cause of hypoalbuminemia and anasarca. Eur J Clin Microbiol Infect Dis 2004, 23(5):399-402.
- [82]Valsecchi R, Leghissa P, Greco V: Cutaneous lesions in Blastocystis hominis infection. Acta Derm Venereol 2004, 84(4):322-323.
- [83]Yakoob J, Jafri W, Jafri N, Islam M, Asim Beg M: In vitro susceptibility of Blastocystis hominis isolated from patients with irritable bowel syndrome. Br J Biomed Sci 2004, 61(2):75-77.
- [84]Haresh K, Suresh K, Khairul Anus A, Saminathan S: Isolate resistance of Blastocystis hominis to metronidazole. Trop Med Int Health 1999, 4(4):274-277.
- [85]Zaman V, Zaki M: Resistance of Blastocystis hominis cysts to metronidazole. Trop Med Int Health 1996, 1(5):677-678.
- [86]Cimerman S, Ladeira MC, Ladeira MC, Iuliano WA: [Blastocystosis: nitazoxanide as a new therapeutic option]. Rev Soc Bras Med Trop 2003, 36(3):415-417.
- [87]Diaz E, Mondragon J, Ramirez E, Bernal R: Epidemiology and control of intestinal parasites with nitazoxanide in children in Mexico. Am J Trop Med Hyg 2003, 68(4):384-385.
- [88]Rossignol JF, Kabil SM, Said M, Samir H, Younis AM: Effect of nitazoxanide in persistent diarrhea and enteritis associated with Blastocystis hominis. Clin Gastroenterol Hepatol 2005, 3(10):987-991.
- [89]Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y: Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res 2010, 108(3):541-545.
- [90]Roberts T, Ellis J, Harkness J, Marriott D, Stark D: Treatment failure in patients with chronic Blastocystis infection. J Med Microbiol 2014, 63:252-257.
- [91]Markell EK, Udkow MP: Blastocystis hominis: pathogen or fellow traveler? Am J Trop Med Hyg 1986, 35(5):1023-1026.
- [92]Mirza H, Teo JD, Upcroft J, Tan KS: A Rapid, High-Throughput Viability Assay for Blastocystis spp. Reveals Metronidazole Resistance and Extensive Subtype-Dependent Variations in Drug Susceptibilities. Antimicrob Agents Chemother 2011, 55:637-648.
- [93]Armentia A, Mendez J, Gomez A, Sanchis E, Fernandez A, de la Fuente R, Sanchez P: Urticaria by Blastocystis hominis. Successful treatment with paromomycin. Allergol Immunopathol (Madr) 1993, 21(4):149-151.
- [94]Nigro L, Larocca L, Massarelli L, Patamia I, Minniti S, Palermo F, Cacopardo B: A placebo-controlled treatment trial of Blastocystis hominis infection with metronidazole. J Travel Med 2003, 10(2):128-130.
- [95]Romero Cabello R, Guerrero LR, Munoz Garcia MR, Geyne Cruz A: Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. Trans R Soc Trop Med Hyg 1997, 91(6):701-703.
- [96]Hahn P, Fleischer NFK: Blastocystis hominis- is it of clinical importance? Trop Med Parasitol 1985, 36:7-8.
- [97]Kick G, Rueff F, Przybilla B: Palmoplantar pruritus subsiding after Blastocystis hominis eradication. Acta Derm Venereol 2002, 82(1):60.
- [98]Ok UZ, Girginkardesler N, Balcioglu C, Ertan P, Pirildar T, Kilimcioglu AA: Effect of trimethoprim-sulfamethaxazole in Blastocystis hominis infection. Am J Gastroenterol 1999, 94(11):3245-3247.
- [99]Stensvold CR, Smith HV, Nagel R, Olsen KE, Traub RJ: Eradication of Blastocystis carriage with antimicrobials: reality or delusion? J Clin Gastroenterol 2010, 44(2):85-90.
- [100]Mirza H, Wu Z, Kidwai F, Tan KS: A Metronidazole-Resistant Isolate of Blastocystis spp. Is Susceptible to Nitric Oxide and Downregulates Intestinal Epithelial Inducible Nitric Oxide Synthase by a Novel Parasite Survival Mechanism. Infect Immun 2011, 79(12):5019-5026.
- [101]Dunn LA, Tan KS, Vanelle P, Juspin T, Crozet MD, Terme T, Upcroft P, Upcroft JA: Development of metronidazole-resistant lines of Blastocystis sp. Parasitol Res 2012, 111(1):441-450.
- [102]Dhurga DB, Suresh KG, Tan TC, Chandramathi S: Apoptosis in Blastocystis spp. is related to subtype. Trans R Soc Trop Med Hyg 2012, 106(12):725-730.