Ertuğ Sema, Malatyalı Erdoğan, Ertabaklar Hatice, Özlem Çalışkan Serçin, Bozdoğan Bülent
Adnan Menderes University Faculty of Medicine, Department of Medical Parasitology, Aydin, Turkey.
Mikrobiyol Bul. 2015 Jan;49(1):98-104. doi: 10.5578/mb.8532.
The pathogenic potential and genetic diversity of Blastocystis are poorly understood despite being one of the most frequent intestinal parasites in routine fecal examination all around the world as well as Turkey. There are numerous defined subtypes (ST) of Blastocystis which infect animals and nine of them were isolated from human fecal samples. Blastocystis is an anaerobic parasite and generally recognized as nonpathogenic microorganism that colonizes the colon. However recent studies have indicated that the genotypes may be related with the pathogenicity and clinical symptoms of the infection. The aims of this study were to investigate the subtypes of Blastocystis isolates obtained from stool samples submitted to the parasitology laboratory of Adnan Menderes University, Faculty of Medicine, and to evaluate the clinical symptoms of infected cases. A total of 61 cases (40 male, 21 female; age range: 5-69 years, mean age: 35 ± 19.1 years) were included in the study. Stool samples that were positive for Blastocystis cysts in direct microscopic examination, were inoculated in Jones medium and incubated at 37°C for 72 hours for the growth of parasite. Genomic DNAs were isolated from Jones medium directly or frozen samples with a commercial kit (DNAzol, Invitrogen, USA). The subtypes of Blastocystis were detected by polymerase chain reaction (PCR) using ST-specific primers and the symptoms of patients were evaluated retrospectively. Forty-four (72.1%) out of 61 isolates were subtyped by PCR, while 17 (27.9%) could not be typed. The distribution of Blastocystis subtypes were found as follows; ST3 in 17 (38.6%), ST2 in 13 (29.5%), ST1 in 9 (20.5%), ST1 + ST3 in 4 (9.1%), and ST1 + ST2 in one (2.3%) of the samples. The most common symptoms among Blastocystis infected cases were abdominal pain (n= 24, 39.4%), pruritus (n= 22, 36.1%), diarrhea (n= 4, 6.6%) and constipation (n= 2, 3.3%), respectively. This is the first study investigating the genotypes of Blastocystis in Aydin province (located at Aegean region of Turkey), and the findings were consistent with those reported from other regions. The predominant subtype was found as ST3, like other studies in our country and this data supports that ST3 is a human originated genotype of Blastocystis. Additionally, the higher rate of pruritus detected among our patients infected with Blastocystis compared with the other studies was considered remarkable. In conclusion, multicenter and large-scaled molecular and clinical studies are needed to elucidate the pathogenicity and the epidemiology of Blastocystis infections.
尽管芽囊原虫是全球以及土耳其常规粪便检查中最常见的肠道寄生虫之一,但其致病潜力和遗传多样性仍知之甚少。芽囊原虫有许多已定义的亚型(ST)可感染动物,其中9种是从人类粪便样本中分离出来的。芽囊原虫是一种厌氧寄生虫,通常被认为是定植于结肠的非致病微生物。然而,最近的研究表明,这些基因型可能与感染的致病性和临床症状有关。本研究的目的是调查从阿德南·曼德雷斯大学医学院寄生虫学实验室送检的粪便样本中分离出的芽囊原虫亚型,并评估感染病例的临床症状。本研究共纳入61例患者(40例男性,21例女性;年龄范围:5 - 69岁,平均年龄:35±19.1岁)。直接显微镜检查中芽囊原虫囊肿呈阳性的粪便样本,接种于琼斯培养基中,在37°C孵育72小时以促进寄生虫生长。使用商业试剂盒(DNAzol,美国英杰公司)从琼斯培养基直接或冷冻样本中分离基因组DNA。使用ST特异性引物通过聚合酶链反应(PCR)检测芽囊原虫的亚型,并回顾性评估患者的症状。61株分离株中有44株(72.1%)通过PCR进行了亚型分型,而17株(27.9%)无法分型。芽囊原虫亚型的分布如下:ST3占17株(38.6%),ST2占13株(29.5%),ST1占9株(20.5%),ST1 + ST3占4株(9.1%),ST1 + ST2占1株(2.3%)。芽囊原虫感染病例中最常见的症状分别为腹痛(n = 24,39.4%)、瘙痒(n = 22,36.1%)、腹泻(n = 4,6.6%)和便秘(n = 2,3.3%)。这是第一项在艾登省(位于土耳其爱琴海地区)调查芽囊原虫基因型的研究,研究结果与其他地区报道的结果一致。与我国其他研究一样,主要亚型为ST3,这一数据支持ST3是芽囊原虫的一种人类起源基因型。此外,与其他研究相比,我们的芽囊原虫感染患者中检测到的瘙痒发生率较高,这一点值得关注。总之,需要开展多中心、大规模的分子和临床研究来阐明芽囊原虫感染的致病性和流行病学。