Balanthidiasis

Balanthidiasis - the protozoal illness characterised by the general intoxication and a canker of a colon, is inclined to fixing and chronic flow, at late begun etiotropic treatment can end is lethal.

Aetiology. The originator (Balantidium coli) concerns a type of the elementary (Protozoa), to subtype Ciliophora, class Ciliata. This infusorian Swedish scientist Malmsten in 1857 for the first time has described its Ability to cause disease of the human has proved Nightingales in 1901 the Originator is the largest among the pathogenic intestinal elementary. The dimensions of the vegetative form 50-80 microns at length and 35-60 microns at width, diameter of a cyst about 50 microns, a surface of the vegetative form it is covered by cilia with which help locomotion is carried out. In a cyst external environment keep vitality within 3-4 weeks. It is considered, that at the human and a pig one kind of balantidiums parasitizes.

Epidemiology. Disease is taped was rather rarely. However the population contamination can be enough high. So, in rural districts it is infested by balantidiums of 4-5 % of the population. The persons contacting to pigs, being natural carriers balantidium are especially often infected. In the locuses infestation can descend at contact with sick of a balanthidiasis. Diseases meet, as a rule, in the form of sporadic cases.

Pathogenesis. Infestation of the human descends at hit of balantidiums, more often cysts, in a digestive tube. The originator can is long to exist in an intestine of the human, not showing pathogenic action. Dwells usually in the inferior parts of small bowels. The causes of introduction of balantidiums in an intestine tissue that is observed only at a small part infested, remain not studied. The lesions caused by balantidiums, are localised mainly in blind, sigmoid and direct intestines. In the beginning in mucosa cords there are edema and hyperemia fields, then erosions are formed, balantidiums inpour into a depth of tissues, causing the locuses of hemorrhages and a necrosis. After a sloughing there is the lumen intercommunicating with a lumen of an intestine. Ulcers have irregular lineaments, edges cut up and thickened, a bottom rough, is covered by krovjanisto-purulent scurf. There can be a perforation of ulcers to development of a diffuse peritonitis.

Symptoms and flow. The incubation interval lasts 10-15 days (from 5 to 30) is more often. Clinically the balanthidiasis can proceed in acute and chronic forms. Excrete also a latent balanthidiasis (carriage) and associated forms of a balanthidiasis (with an amebiasis, a shigellosis, etc.) . On gravity of flow average and serious forms prevail. Acute forms of a balanthidiasis remind a coloenteritis or a colitis on the implications. There are symptoms of the general intoxication: delicacy, a headache, appetite dropping, at half of patients a moderate fever, sometimes with a fever. Signs of a lesion of an intestine are simultaneously observed: abdominal pains, diarrhoeia, a meteorism, at involving in rectum process are possible tenesmuses. In a feces there can be slime and blood admixings. Quite often note a dry coated tongue, a spastic stricture and morbidity of a colon, the liver is enlarged and painful. At a proctosigmoidoscope tap focal infiltrative-ulcerative process. At a blood analysis - the moderate anaemia, an eosinophilia, depression of total of protein and albumins, an ESR is moderately enlarged. At serious flow of an acute balanthidiasis the high fever becomes perceptible, intoxication symptoms are expressed sharply (a fever, a nausea, vomiting, a headache). Chair to 20 times a day with a slime and blood admixing, with a putrefactive odour. Patients quickly grow thin, in a week the cachexia can already educe. There can be signs of a boring of a peritoneum. At a proctosigmoidoscope extensive ulcerative changes are taped. In blood a hypochromia anaemia, neutrophilic a leukocytosis.

At a chronic balanthidiasis intoxication symptoms are expressed weakly, a body temperature usually normal, a chair 2-3 times a day, liquid, with a slime admixing, are is rare - bloods. At objective inspection the abdominal distention, morbidity of blind and ascending intestines becomes perceptible. At a proctosigmoidoscope typical ulcerative changes can be taped. Exacerbations are replaced by remissions during which time patients feel well, objectively special changes to tap it is not possible.

Complications. Punching of an intestine, a diffuse peritonitis.

Diagnosis and the differential diagnosis. Balanthidiasis recognition is based on data of the anamnesis, epidemiological preconditions, character of clinical implications. In diagnostics results of a proctosigmoidoscope matter. Detection of parasites in a feces confirms the diagnosis. To investigate excrements it is necessary not later than 20 mines after a defecation. More often the balantidium manages to find in the smears prepared from a scraping of struck fields of an intestine (a stuff take at a proctosigmoidoscope). To differentiate it is necessary from an amebiasis, a nonspecific ulcerative colitis, intestine neoplasms.