Balantidiasis: everything about the disease, clinical recommendations

By balantidiasis is meant a protozoal infectious intestinal disease, the causative agent of which is ciliate infusoria - balantidia. Balantidiasis is accompanied by ulcerative-inflammatory changes in the walls of the large intestine, which is clinically manifested by abdominal pain, diarrhea, emaciation, signs of intoxication damage. The disease often progresses heavily, with a high probability of death of the patient during late medical measures.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Epidemiology

Balantidiasis is registered mainly in rural areas. The disease has become particularly common in African, Latin American regions and Asian countries. According to statistics, it is the representatives of these regions who suffer from balantidiasis most often: today, about 200 million people are considered infected.

The disease spreads primarily due to the lack of adequate methods of rehabilitation of patients carrying a pathogenic microorganism.

The degree of lethality of balantidiasis is quite high - about 10-30%. This high rate is due to the frequent development of complications and the rapid depletion of the patient.

In our country, the disease is also found relatively often: this is promoted by a massive disregard for sanitary and hygienic norms, an insufficient social level of the population, and a lack of necessary attention from medicine (poor educational and preventive activities).

[11], [12], [13], [14]

Causes of the balance

The causative agent of a zoonotic intestinal disease called "balantidiasis" is a single-celled organism Balantidia if existing in the vegetative and cystic variant. Balantidia if it is the largest pathogenic protozoa. The vegetative variant is represented by an ovoid shape with an oral cavity gap at the anterior margin. The body is covered with longitudinally localized cilia (the microorganism needs them to move). The diameter of the cysts is approximately 50 microns.

Balantidiasis is infected by people who are in direct contact with pigs, or with plant products or water that are infected with cysts.

The immediate causes are:

• neglect of sanitary and hygienic standards;
• non-compliance with sanitary conditions for the care of pigs;
• non-compliance with personal hygiene;
• use of infected drinking water, unwashed vegetables, etc.

[15], [16], [17], [18]

Risk factors

The incidence is higher in rural areas: about 5% of villagers suffer from balantidiasis. Employees of pig farms and pig farms are particularly at risk, since pigs are the creatures most often affected by the causative agent of the disease. People are infected by the fecal-oral method, by using unwashed hands, as well as by drinking contaminated water or food.

[19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30]

Pathogenesis

Human infection can occur after contact with the causative agent of balantidiasis (mainly cysts) in the digestive system. Balantidia are able to exist in the intestinal cavity of a person for a long time, without the development of pathology. The infectious agent habitually settles in the lower segment of the small intestine. Introduction to intestinal tissues does not occur in all cases, and the exact cause of such selectivity is unknown.

Balantidia tissue damage mainly affects the cecum, sigmoid and rectum. At the initial stage of balantidiasis, puffiness and reddening zones are formed in the folded structure of the mucous membranes. Next, an erosive focus is formed. Pathogens are introduced into the tissues, hemorrhages appear, necrotic processes occur. Necrotic masses are rejected, in their place a cavity is formed, leaving into the intestinal lumen. The ulcers are characterized by irregularly shaped borders, thick and excised edges, a heterogeneous bottom, covered with a purulent-bloody secretion. There is a high likelihood of ulcerative perforation, with a further inflammatory process in the form of peritonitis.

Stages of balantidiasis according to pathogenetic data:

1. The stage of infection (balantidia enter the human digestive system, as a result of which it becomes a carrier, or a disease develops).
2. The stage of introduction of an infectious agent into the intestinal wall with the further development of the inflammatory process (the enzyme hyaluronidase facilitates the penetration of the agent into the intestinal wall, inflammation develops, the composition of the intestinal flora changes, the large intestine is affected).
3. Stage of intoxication (due to the inflammatory process, toxic components are absorbed into the bloodstream and the development of intoxication syndrome, which is manifested by fatigue, pain in the head, insomnia).
4. Diarrheal stage (intestine is affected, there is rapid fluid stool with mucous and bloody particles and a "rotten" smell, symptoms of dehydration appear, the patient rapidly loses weight).
5. Abdominal stage (pain in the lower abdomen, tenesmus, pain when probing the intestinal projection area appear).
6. The stage of distribution of balantidia (the pathogen spreads through the bloodstream to the system of mesenteric lymph nodes, to the liver, urogenital system, lungs).
7. The stage of development of complications (there is ulcerative perforation, peritonitis, internal bleeding, the addition of a secondary infection).

Source of balantidiasis

The main source of spread of the causative agent of balantidiasis are pigs: their invasion is determined by 60-80 percent. In some cases, the carrier may be a person, but infection from it is practically excluded: in the human body, the formation of cysts occurs rarely and in small numbers.

Infection with a vegetative variant is considered impossible, since such forms die quickly, both outside the living organism and in the acidic gastric contents.

The cystous variant can remain viable in the pig-breeding environment for up to 14 days, and in the ground for up to 244 days. When processing disinfectant fluids cysts die for several hours.

[31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44]

Ways of infection

The route of infection is fecal-oral. Infection occurs through dirty hands, infected drinking water, unwashed vegetables or fruits (water, food and contact).

Symptoms of the balance

The duration of the incubation period for balantidiasis was determined by an average of 2 weeks (the minimum recorded period was five days, and the maximum - 30 days).

Balantidiasis is not always manifested by any symptoms, as it can occur in a latent form and in the form of carriage. In other cases, acute and chronic forms of pathology are diagnosed, often in combination with other inflammatory and parasitic processes (for example, amebiasis, shigellosis, etc.).

• The acute version of balantidiasis is characterized by an acute onset. The first signs of a problem are general fatigue, pain in the head, loss of appetite, nausea, pronounced fever. Soon the symptoms of intestinal lesions are added: abdominal pain, cramps, frequent and ineffectual urge to defecate, diarrhea. Fecal fluid, with blood and pus particles, fetid; defecation is observed from 3-4 to 18-20 times a day. The patient is very quickly and exhausted, losing weight; the surface of the tongue is covered with "dirty" bloom, palpation of the abdomen is painful along the intestines. An enlarged liver is possible. Endoscopically, catarrhal hemorrhagic inflammation and ulceration can be detected. Analysis of the biopsy indicates an accumulation of balantidia in submucosal tissues, as well as at the borders of the ulcers and in the abscesses. If untreated for 6-8 weeks, the acute course of balantidiasis transforms into chronic.
• Chronic balantidiasis often has a relapsing ability: exacerbations last from one week to a month, and the period of calm of the disease varies from three months to six months. Signs of intoxication are not fully manifested, the temperature does not always increase. The main clinical picture is manifested by local signs: frequent loose stools with inclusions of mucus, pus, and blood. Inspection allows you to pay attention to the "coated" surface of the tongue, pain when probing the large intestine. It is also possible not recurrent, but the continuous course of chronic balantidiasis. This option is always manifested by the increasing emaciation and cachexia of the patient.

[45], [46]

Balantidiasis in men

Cases of balantidiasis can be recorded in homosexuals, during anal sex with a carrier who is suffering from a chronic form of the disease. A sick man develops a combined inflammatory process of the skin of the head and the inner leaflet of the foreskin of the penis. Perhaps the formation of painful ulcers, covered with granulations, with purulent fetid secretion, inflammation and an increase in the inguinal lymph nodes. Sometimes representatives of non-traditional sexual orientation found wart ulceration in the genital area and the anus. Complications in this case are prostatitis, epididymitis.

[47], [48], [49]

Balantidiasis in children

Children may become infected with balantidiasis by drinking infected water or unwashed vegetables. Death among sick children is often the result of improper treatment: the disease is taken for ordinary diarrhea or food poisoning, therefore, treatment is fundamentally wrong. In addition, the latent form of balantidiasis is often registered.

Balantidiasis in childhood is manifested by bloody diarrhea of dysenteric type. Common symptoms are complemented by damage to other internal organs (liver, lungs). As a rule, the disease begins with "indigestion," with general weakness, loss of appetite, and frequent loose stools. For several days, the child is worried about tenesmus: he may ask to go to the toilet, but there will be no excrement. Perhaps the release of mucus mixed with pus and blood. The clinical picture is complemented by vomiting, pain in the lower abdomen, fever. The children's body is quickly dehydrated.

[50], [51], [52]

Forms

Balantidiasis can proceed typically (with full clinical manifestations) and atypically (in the form of a latent form, or carriage).

Balantidiasis is characterized by the following flow variants:

• mono-disease;
• combined disease (most often combined with lesions of amoebas, shigella, etc.).

There are balantidiasis depending on the severity:

• light type;
• moderate type;
• severe type of pathology.

The nature of the disease can be:

• uncomplicated;
• complicated.

[53], [54], [55], [56]

Complications and consequences

The main complications of balantidiasis are such diseases:

• Ulcer perforation is the formation of a through hole in the intestinal wall. The contents of the intestine enters the abdominal cavity, as a result - peritonitis develops.
• Intra intestinal bleeding is the exit of blood into the intestinal cavity with a further shortage of circulating blood volume. This complication is rather formidable and requires immediate medical attention.
• General exhaustion, weight loss, cachexia are critical conditions that include deep metabolic disorders with an increasing shortage of fats and carbohydrates, with increased protein catabolism and slower synthesis.
• The accession of a secondary infection is the infection of another type of microorganisms, against the background of the existing balantidiasis.

Resistance to balantidiasis

Acquired immunity for balantidiasis is usually unstable and non-sterile, so the person who has recovered is not protected from relapse or reinfection.

[57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68]

Diagnostics of the balance

Diagnosis begins with a physical examination:

• the general condition of the patient is assessed;
• checks for dehydration symptoms;
• heart and vascular network functionality is assessed (blood pressure is measured, heart tones are heard);
• palpable abdomen, checked signs of peritoneal irritation, is determined by the state of the liver.

It is important to visually examine the fecal feces of the patient. Only after that proceed to laboratory research methods.

A blood test with balantidiasis can detect hypochromic anemia, neutrophilic leukocytosis, small eosinophilia, accelerated ESR.

Blood biochemistry demonstrates hypoalbuminemia and hypoproteinemia.

Laboratory tests reveal vegetative variants and balantidial cysts; leukocytes, erythrocytes, mucus in fecal masses (coprogram) are also determined. In addition, in the feces found the genetic material balantidii.

Instrumental diagnostics consists of the following procedures:

• complex ultrasound examination of internal organs (helps to identify the complications of balantidiasis);
• endoscopy (fibrocolonoscopy, helps to detect ulcerative erosive changes in the mucous membrane of the large intestine);
• general radiography of the internal organs (it helps to detect free gas in the abdominal cavity, provoked by intraintestinal perforations).

[69]

Differential diagnosis

Differential diagnosis should be carried out with acute bacterial lesions of the intestine, occurring with signs of bleeding intestinal inflammation: it can be a lesion of shigella, campylobacter, salmonella. Important differentiation with other parasitic pathologies in which there is gastrointestinal inflammation (this is possible with amebiasis, schistosomiasis, ankilostomidoze), as well as ulcerative colitis, Crohn's disease, acute appendicitis, intestinal obstruction, intestinal tuberculosis.

To clarify the diagnosis, one should take into account the epidemiological, symptomatic, laboratory and instrumental information, as well as the results of additional diagnostic methods.

Treatment of the balance

The use of drugs for balantidiasis includes the inclusion of antiparasitic, symptomatic drugs, as well as means to stabilize the balance of intestinal flora and immune protection.

A sick person is subject to isolation - at home or in a hospital (placed in a separate ward-box, or in a ward with other patients with similar nosology).

The infectious focus (the place of residence, the work of the patient) is treated according to the prophylactic recommendations used to prevent infectious diseases with a fecal-oral route of infection. The patient allocate individual dishes, household items. People who have been in contact with a sick person are tested for feces for the presence of balantidia: they do not need quarantine isolation. Possible statement on dispensary accounting during the year.

Asymptomatic carriers may end in spontaneous convalescence, but in some cases, treatment with metronidazole or iodoquinol is prescribed.

Clinical guidelines for the treatment of balantidiasis

Under the clinical recommendations refers to the regulatory and standard health document, which defines the requirements for the provision of medical care to patients with balantidiasis. Such assistance is provided in stages:

1. Patients with suspected balantidiasis undergo laboratory diagnostics.
2. After receiving laboratory confirmation of balantidiasis, additional studies are included to assess the likelihood of complications.
3. Prescribed treatment corresponding to the severity of the disease. If necessary, the therapy is adjusted depending on the appearance of new symptoms, or in the case of the ineffectiveness of certain medications.
4. After recovery, the patient is determined to dispensary registration.

[70], [71], [72], [73], [74], [75]

Medicines: what can a doctor prescribe when balantidiasis?

Tetracycline	The course of reception is designed for 10 days. Adults take 500 mg 4 times a day, children (from the age of seven) - at the rate of 10 mg / kg 4 times a day (the maximum daily amount for a child is 2 g).
Monomicin	Monomitsin is taken orally at 0.6-1.5 g / day, for two cycles of five days, with an interval between cycles of also five days.
Metrics	Metronidazole is prescribed in the form of two or three five-day cycles, 500 mg three times a day. The time interval between cycles is 5 days.
Dextrose	It is used for dehydration according to indications.
Sodium chloride	It is used for dehydration according to indications.
Enerol	Take 1-2 sachets twice a day, for 10-14 days. Rarely, but the drug can cause allergic reactions.
Lineks	Adults take two capsules Linex three times a day. Side effects are practically absent, only rarely can we talk about hypersensitivity reactions.
Dioctahedral Smectite	It is appointed according to individual indications. In large doses or long-term use can cause constipation.
Ibuprofen	Assign at the rate of 20-30 mg per kilogram of body weight per day. The average amount of the drug is 200-400 mg every 4-6 hours. You should not take more than 1200 mg per day. Side effects: stomach pain, allergies.
Paracetamol	Take 500-1000 mg every five hours, not exceeding the daily dosage of 4000 mg. Do not use the drug for more than 3-4 days.
But-snap	Assign 120-240 mg / day, divided into 2-3 doses. Side effects: pain in the head, lowering blood pressure, sleep disorders.
Papaverine	Enter intramuscularly in 0.5-2 ml of 2% solution. The duration of the treatment course is determined individually. During treatment, the patient may experience a headache, dry mouth.
Cetirizine	Prescribe the drug in the amount of 10 mg once a day. Side effects of cetirizine are thrombocytopenia, dizziness, and hypersensitivity reactions.
Azoximar bromide	Immunostimulant, which is administered subcutaneously at 6-12 mg daily for 5-10 days. It is also possible intramuscular, sublingual and rectal use of the drug. Contraindications - children under 12 years of age, pregnancy.

Vitamins with balantidiasis

In addition to antibacterial treatment, when balantidiasis prescribed drugs that enhance the immune defense of the body: it is a tincture of Eleutherococcus, Schizandra, ginseng. Vitamin therapy is also shown.

To support immunity, you can use most of the existing vitamins, but with balantidiasis, their dosage must be increased at least twice. This is due to increased consumption of nutrients during infection, as well as their enhanced elimination as a result of dehydration.

Lack of vitamins should be compensated by the use of multivitamin drugs - both during the entire period of treatment, and at the stage of recovery of the body.

In the fight against infection need to focus on vitamins such as ascorbic acid, riboflavin (vitamin B ₂ ), retinol (vitamin A), tocopherol (vitamin E). These vitamins take part in the work of the immune system, increase the protective functions of the skin and mucous integuments, activate the reaction of leukocytes, accelerate the regenerative processes.

Vitamins with balantidiasis are an integral part of complex treatment. According to research results, enhanced vitamin therapy in combination with a balanced vitaminized diet can shorten the period of the disease and reduce the risk of complications.

Physiotherapy treatment for balantidiasis

There are a large number of methods of physiotherapy, with which it is possible to accelerate the recovery of the body after the end of the acute period of balantidiasis. These are, first of all, thermal procedures (ozokerite, therapeutic mud, peat and paraffin baths, UHF-therapy), hydrotherapy, electrophoresis with novocaine and papaverine.

After calming down the main symptoms are shown:

• bathing (coniferous, radon, pearl, oxygen);
• the effect of heat on the epigastric zone (ozokerite, therapeutic mud, paraffin).

These methods are used only in stationary or polyclinic conditions.

Outside the acute period at home it is allowed to carry out treatment with baths and applications. After 8-12 weeks, during the recovery phase, spa treatment, peat and mud therapy, sea and pine baths, hydrotherapy, etc., are shown. Patients are especially recommended to visit such resorts as Yessentuki, Zheleznovodsk, Dorokhovo, etc.

Alternative treatment for balantidiasis

For the quick relief of the unpleasant symptoms of balantidiasis, some prescription alternative medicine may be useful:

• 200 ml of boiling water take 2 tbsp. L blackberry leaves, boil for five minutes, then cover with a lid and towel, stand for half an hour, filtered. Drink the drug three times a day in one glass.
• In a glass of boiling water pour a quarter of a spoonful of ground cinnamon, a pinch of ground hot pepper. Cover with a lid, insist 20-30 minutes. Drink in the form of heat, at a time. The procedure can be repeated 2-3 times a day.
• Potato starch (1 tsp) poured 100 ml of water at room temperature, stirred and immediately drunk.
• Drink at once 100-150 ml of vodka tincture on the walls of a walnut.
• Mix a third of a teaspoon of salt and 75-85 ml of vodka, drink at a time.

Arsenal of alternative recipes can be successfully supplemented by the use of herbal and herbal fees. This will help herbal medicine.

[76], [77], [78], [79], [80]

Herbal medicine

To ease the course of balantidiasis and speed up recovery will help such herbal preparations:

• Take 2 tbsp. L Lapis rhizomes, alder cones, nettle rhizomes. Stand on a water bath in 500 ml of water for ten minutes, then insist about two hours under the lid. Take 100 ml 4 times daily before meals.
• Take equal amounts of Potentilla, rhizomes of the burnet and shepherd's bag. Insist 5 tbsp. L mixture in 1 liter of boiling water for several hours. Take 100 ml on an empty stomach 4 times a day.
• Take equal amounts of wormwood, cuffs and rhizomes of Althea. Steamed 2 tbsp. L mixture in 500 ml of boiling water, incubated for 2 hours. Take the infusion of 100 ml on an empty stomach 4 times a day.
• Take equal parts of the goose potentilla, ashberry, plantain and mountaineer. About 50 g of the mixture is poured 500 ml of boiling water, infused for 30 minutes. Take 50-60 ml three times a day.
• Prepare an equivalent mixture of highlander rhizome, blueberries and burnet. One teaspoon of the mixture is poured a glass of boiling water and infused for one hour. The infusion is taken during the day, 100 ml (about 5 times a day).

Homeopathy for Balantidiasis

Homeopathic treatment has many advantages: it is effective, safe, suitable for adults, children, and pregnant women. However, at the acute stage of balantidiasis, it is recommended to take homeopathy preparations only after consulting with the doctor, since additional medications can “smear” the clinical manifestations and make it difficult to determine the tactics of traditional treatment.

What drugs recommends homeopathy for balantidiasis:

• Colocin - can be prescribed to eliminate cramps, painful attacks;
• Lycopodium - helps eliminate flatulence and excess gas in the intestines;
• Nux vomica - normalizes digestive processes, removes toxic substances from the body;
• Hina is a drug that is usually prescribed during the recovery of the body after balantidiasis. The course of taking funds is designed for five days;
• Baptisia - helps to alleviate the main manifestations of the disease (digestive disorders, weakness, muscle pain);
• Veratrum Album - helps with severe vomiting and diarrhea, with general weakness and a drop in blood pressure.

Prevention

Preventive measures include personal safety (compliance with the rules of hygiene, boiling water, washing plant products), preventing fecal contamination of water and soil (controlling zoological hygiene on farms and cattle breeding bases, neutralizing manure masses, etc.).

Specific prevention of the development of balantidiasis does not exist.

Additionally, you need to pay attention to the holding of such events:

• sanitary and hygienic rules, sanitary inspection of places of breeding and keeping of pigs;
• control of meat processing plants, food processing plants, water supply systems;
• compliance with regular disinfection;
• unquestioning observance of individual hygienic standards, washing hands with soap, using only thoroughly washed vegetables and fruits;
• observance of food hygiene (use of fresh, high-quality food, eating in adequate conditions);
• strengthening immune defenses;
• denial of common use of things and dishes in everyday life.

[81], [82], [83]

Forecast

If the treatment of the disease was started in a timely manner, and the therapeutic scheme included complex and competent appointments, then the prognosis can be considered as favorable. If untreated, the degree of mortality is 10-30%.

Most often balantidiasis is treated in a hospital. The patient is discharged at the end of the acute period of the disease, after normalization of the general condition and elimination of the underlying pathological signs (after about three weeks). After recovery, the patient may return to the former rhythm of life (go to work or study) if the results of fecal tests for the presence of balantidia were negative (three times during the week).

[84]