On the state of laboratory diagnostics of travelers’ diarrhea of protozoal etiology in Ukraine and worldwide

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Assoc. prof. Bodnia I.P. 1, PhD Pokhil S.I. 2

1 Kharkiv National Medical University

2 Institute of Microbiology and Immunology, I.I. Mechnikov, Ukraine

Traveler’s diarrhea is an invasive disease associated with travel. The morbidity rate ranges from 30 to 70% and depends on the destination and seasonality. The epidemiology and clinical features of traveler’s diarrhea were first described in 1963. Among the etiological diversity of pathogens, protozoa come to the fore. A significant part is accounted for by Blastocystis spp., D. fragilis, Giardia spp. Other rare causes can be Cryptosporidium parvum, Entamoeba histolytica, Microsporidia and Cystoisospora. Parasitic infestation is most often diagnosed in returning travelers, due to the longer incubation period and the prescription of antibiotics. The diagnosis of traveler’s diarrhea in humans is established taking into account epidemiological, clinical data and the results of special laboratory studies. The latter play a leading role in the evidentiary verification of the protozoan etiology of travelers’ diarrhea, which directly affects the effectiveness of the therapy of patients and the prevention of the development of chronic forms of protozoa and delayed post-infectious complications. Due to technical availability, traditional microscopic methods remain the most popular in the laboratory diagnosis of protozoan intestinal diseases and are based on the detection of «diagnostic forms» of parasites — trophozoites, cysts, oocysts and/or others depending from the features of the life cycle of a specific species of protozoan parasites. However, microscopic methods of diagnosing intestinal protozoan parasitosis have a number of significant limitations: the means and procedures of microscopic examination of faecal smears (coproscopy) are considered satisfactory for the detection of Giardia spp., only to a certain extent (partially) suitable for the detection/identification of Blastocystis spp. and completely unsuitable for performing research aimed at the detection/identification of D. fragilis.

Keywords: traveler’s diarrhea, laboratory diagnostics, intestinal protozoa, coproscopy, Giardia spp., Blastocystis sp., D. fragilis.

https://doi.org/10.15407/internalmed2023.01.056

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Бодня, І.П. Про стан лабораторної діагностики діареї мандрівників протозойної етіології в Україні та в світі / І.П. Бодня, С.І. Похил // Східноєвропейський журнал внутрішньої та сімейної медицини. – 2023. – № 1. – С. 56-66. doi: 10.15407/internalmed2023.01.056

Bodnia IP, Pokhil SI. Pro stan laboratornoi diahnostyky diarei mandrivnykiv protozoinoi etiolohii v Ukraini ta v sviti [On the state of laboratory diagnostics of travelers’ diarrhea of protozoal etiology in Ukraine and worldwide]. Shidnoevr. z. vnutr. simejnoi med. 2023;1:56-66. Ukrainian. doi: 10.15407/internalmed2023.01.056

References

  1. Kamata K, Birrer R, Tokuda Y. Travel medicine: Part 1-The basics. Journal of General and Family Medicine. 2017;18(2):52-55. http://dx.doi.org/10.1002/jgf2.39
  2. Kamata K, Birrer R, Tokuda Y. Travel medicine: Part 2-Special situations. Journal of General and Family Medicine. 2017;18(3):114-117. http://dx.doi.org/10.1002/jgf2.40
  3. Boraston B, Botten D. Travel medicine: what’s involved ? When to refer? Can. Fam. Physician. 2014;60:1091–1103.
  4. Shah N, Ramsey D, DuPont H. Global Etiology of Travelers’ Diarrhea: Systematic Review from 1973 to the Present. The American Journal of Tropical Medicine and Hygiene. 2009;80(4):609-614. http://dx.doi.org/10.4269/ajtmh.2009.80.609
  5. Kendall M, Crim S, Fullerton K, Han P, Cronquist A, Shiferaw B, Ingram L, Rounds J, Mintz E, Mahon B. Travel-Associated Enteric Infections Diagnosed After Return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004–2009. Clinical Infectious Diseases. 2012;54(suppl_5):S480-S487. http://dx.doi.org/10.1093/cid/cis052
  6. Masyeni S, Sukmawati H, Paramasatiari L, Aryastuti S, Somia K, Kambayana G, Astika N, Duarsa R, Merati T. Diarrhea Among International Travelers in BaliIndonesia: Clinical and Microbiological Finding. International Journal of Travel Medicine and Global Health. 2017;5(3):84-88. http://dx.doi.org/10.15171/ijtmgh.2017.18
  7. Dunn N, Okafor C. Travelers Diarrhea. Treasure Island (FL) : StatPearls Publishing. Creighton University. Last Update: February 8, 2019. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK459348/.
  8. Rose S, Keystone J, Connor B, Hackett P, Kozarsky P, Quarry D. Travelers’ Diarrhea. International Travel Health Guide 2006-2007. 2006;:89-103. http://dx.doi.org/10.1016/b978-0-323-04050-1.50011-0
  9. Leung A, Leung A, Wong A, Hon K. Travelers’ Diarrhea: A Clinical Review. Recent Patents on Inflammation & Allergy Drug Discovery. 2019;13(1):38-48. http://dx.doi.org/10.2174/1872213×13666190514105054
  10. Riddle M, Connor B, Beeching N. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J. Travel. Med. 2017;24:63–80. https://doi.org/10.1093/jtm/tax026
  11. McFarland L, Goh S. Are probiotics and prebiotics effective in the prevention of travellers’ diarrhea: A systematic review and meta-analysis. Travel Medicine and Infectious Disease. 2019;27:11-19. http://dx.doi.org/10.1016/j.tmaid.2018.09.007
  12. Ng Q, Ho C, Shin D, Venkatanarayanan N, Chan H. A meta-analysis of the use of rifaximin to prevent travellers’ diarrhoea. Journal of Travel Medicine. 2017;24(5):. http://dx.doi.org/10.1093/jtm/tax025
  13. Shkurba AV. Diareja puteshestvennikov. Klin. infektol. i parazitol. 2012;3–4:132–143. Russian. Available from: https:// rucont.ru/efd/457397.
  14. Riabova OO., Kashuta VYe. Diareia mandrivnykiv: ratsionalna farmakoterapiia. Suchasna farmatsiia. 2018. liutyi. P 70–71. Ukrainian. Available from: http://dspace.nuph.edu.ua/ bitstream/123456789/15736/1/Stattia_Diareia.pdf.
  15. Zaidi D, Wine E. An update on travelers’ diarrhea. Current Opinion in Gastroenterology. 2015;31(1):7-13. http://dx.doi.org/10.1097/mog.0000000000000133
  16. Porter C, Olson S, Hall A, Riddle M. Travelers’ Diarrhea: An Update on the Incidence, Etiology, and Risk in Military Deployments and Similar Travel Populations. Military Medicine. 2017;182(S2):4-10. http://dx.doi.org/10.7205/milmed-d-17-00064
  17. Steffen R. Emerging Options for the Management of Travelers’ Diarrhea. Gastroenterology & Hepatology. 2018;14:1–12.
  18. Lalani T, Maguire J, Grant E, Fraser J, Ganesan A, Johnson M, Deiss R, Riddle M, Burgess T, Tribble D. Epidemiology and Self‐Treatment of Travelers’ Diarrhea in a Large, Prospective Cohort of Department of Defense Beneficiaries. Journal of Travel Medicine. 2015;22(3):152-160. http://dx.doi.org/10.1111/jtm.12179
  19. Brehm T, Lütgehetmann M, Tannich E, Addo M, Lohse A, Rolling T, Vinnemeier C. Risk factors for different intestinal pathogens among patients with traveler’s diarrhea: A retrospective analysis at a German travel clinic (2009–2017). Travel Medicine and Infectious Disease. 2020;37:101706. http://dx.doi.org/10.1016/j.tmaid.2020.101706
  20. Putri G, Nurdian Y. Traveler’s diarrhea caused by protozoa. projects: neglected urban diseases. Parasitol. 2017;:.
  21. Centers for Disease Control and Prevention (CDC). Encyclopedia of Public Health. 2008;:105-105. http://dx.doi.org/10.1007/978-1-4020-5614-7_343
  22. Garcia L, Arrowood M, Kokoskin E, Paltridge G, Pillai D, Procop G, Ryan N, Shimizu R, Visvesvara G. Practical Guidance for Clinical Microbiology Laboratories: Laboratory Diagnosis of Parasites from the Gastrointestinal Tract. Clinical Microbiology Reviews. 2018;31(1):. http://dx.doi.org/10.1128/cmr.00025-17
  23. Libman M, Gyorkos T, Kokoskin E, MacLean J. Detection of Pathogenic Protozoa in the Diagnostic Laboratory: Result Reproducibility, Specimen Pooling, and Competency Assessment. Journal of Clinical Microbiology. 2008;46(7):2200-2205. http://dx.doi.org/10.1128/jcm.01666-07
  24. Shahinian VR, Kharchenko NV, Danko OP, Kharchenko VV, Sopil HV. Parazytarna invaziia Blastocystis spp.: rol u somatychnii patolohii liudyny. Suchasna hastroenterolohiia. 2020;4:73–79. Ukrainian. Available from: http://doi.org / 10.30978/MG2020-4-73.
  25. Tan K. New Insights on Classification, Identification, and Clinical Relevance of Blastocystis spp. Clinical Microbiology Reviews. 2008;21(4):639-665. http://dx.doi.org/10.1128/cmr.00022-08
  26. Andersen L, Stensvold C. Blastocystis in Health and Disease: Are We Moving from a Clinical to a Public Health Perspective?. Journal of Clinical Microbiology. 2016;54(3):524-528. http://dx.doi.org/10.1128/jcm.02520-15
  27. Vielma J. Blastocystosis: Epidemiological, clinical, pathogenic, diagnostic, and therapeutic aspects. Investigación Clínica. 2019;60(1):53-78. http://dx.doi.org/10.22209/ic.v60n1a06
  28. Jeremiah S, Parija S. Blastocystis: Taxonomy, biology and virulence. Tropical Parasitology. 2013;3(1):17. http://dx.doi.org/10.4103/2229-5070.113894
  29. Coyle C, Varughese J, Weiss L, Tanowitz H. Blastocystis: To Treat or Not to Treat…. Clinical Infectious Diseases. 2011;54(1):105-110. http://dx.doi.org/10.1093/cid/cir810
  30. Lepczyńska M, Chen W, Dzika E. Mysterious chronic urticaria caused by Blastocystis spp. International Journal of Dermatology. 2015;55(3):259-266. http://dx.doi.org/10.1111/ijd.13064
  31. Shirvani G, Fasihi-Harandi M, Raiesi O, Bazargan N, Zahedi M, Sharifi I, Kalantari-Khandani B, Nooshadokht M, Shabandoust H, Mohammadi M, Ebrahimipour M, Babaei Z. Prevalence and Molecular Subtyping of Blastocystis from Patients with Irritable Bowel Syndrome, Inflammatory Bowel Disease and Chronic Urticaria in Iran. Acta Parasitologica. 2019;65(1):90-96. http://dx.doi.org/10.2478/s11686-019-00131-y
  32. Kurt Ö, Doğruman Al F, Tanyüksel M. Eradication of Blastocystis in humans: Really necessary for all?. Parasitology International. 2016;65(6):797-801. http://dx.doi.org/10.1016/j.parint.2016.01.010
  33. Lhotská Z, Jirků M, Hložková O, Brožová K, Jirsová D, Stensvold C, Kolísko M, Jirků Pomajbíková K. A Study on the Prevalence and Subtype Diversity of the Intestinal Protist Blastocystis sp. in a Gut-Healthy Human Population in the Czech Republic. Frontiers in Cellular and Infection Microbiology. 2020;10:. http://dx.doi.org/10.3389/fcimb.2020.544335
  34. Nemati S, Zali M, Johnson P, Mirjalali H, Karanis P. Molecular prevalence and subtype distribution of Blastocystis sp. in Asia and in Australia. Journal of Water and Health. 2021;19(5):687-704. http://dx.doi.org/10.2166/wh.2021.011
  35. Gentekaki E, Curtis B, Stairs C, Klimeš V, Eliáš M, Salas-Leiva D, Herman E, Eme L, Arias M, Henrissat B, Hilliou F, Klute M, Suga H, Malik S, Pightling A, Kolisko M, Rachubinski R, Schlacht A, Soanes D, Tsaousis A, Archibald J, Ball S, Dacks J, Clark C, van der Giezen M, Roger A. Extreme genome diversity in the hyper-prevalent parasitic eukaryote Blastocystis. PLOS Biology. 2017;15(9):e2003769. http://dx.doi.org/10.1371/journal.pbio.2003769
  36. Robles-Cabrera M, Maguiña J, Gonzales-Huerta L, Panduro-Correa V, Dámaso-Mata B, Pecho-Silva S, Navarro-Solsol A, Rabaan A, Rodríguez-Morales A, Arteaga-Livias K. Blastocystis species and Gastrointestinal Symptoms in Peruvian Adults Attended in a Public Hospital. Infection & Chemotherapy. 2021;53(2):374. http://dx.doi.org/10.3947/ic.2021.0004
  37. Deng L, Wojciech L, Gascoigne N, Peng G, Tan K. New insights into the interactions between Blastocystis, the gut microbiota, and host immunity. PLOS Pathogens. 2021;17(2):e1009253. http://dx.doi.org/10.1371/journal.ppat.1009253
  38. Efstratiou A, Ongerth J, Karanis P. Waterborne transmission of protozoan parasites: Review of worldwide outbreaks – An update 2011–2016. Water Research. 2017;114:14-22. http://dx.doi.org/10.1016/j.watres.2017.01.036
  39. Hublin J, Maloney J, Santin M. Blastocystis in domesticated and wild mammals and birds. Research in Veterinary Science. 2021;135:260-282. http://dx.doi.org/10.1016/j.rvsc.2020.09.031
  40. Zanetti A, Malheiros A, de Matos T, Longhi F, Moreira L, Silva S, Castrillon S, Ferreira S, Ignotti E, Espinosa O. Prevalence of Blastocystis sp. infection in several hosts in Brazil: a systematic review and meta-analysis. Parasites amp; Vectors. 2020;13(1):. http://dx.doi.org/10.1186/s13071-020-3900-2
  41. Guidelines for drinking-water quality. Third edition. Incorporating First and Second Addenda. WHO Geneva. 2008. Available from: https: // www.who.int/water_sanitation_health/ publications/gdwq3rev/en/.
  42. de la Cruz C, Stensvold R. Global water pathogen project : Part three. Specific excreted pathogens: environmental and epidemiology aspects Blastocystis. Fayer and W. Jakubowski.2017;9:.
  43. Abdulsalam A. Drinking water is a significant predictor of Blastocystis infection among rural Malaysian primary schoolchildren. Parasitology. 2012;139(8):1014-1020. http://dx.doi.org/10.1017/s0031182012000340
  44. Skotarczak B. Genetic diversity and pathogenicity of Blastocystis. Annals of Agricultural and Environmental Medicine. 2018;25(3):411-416. http://dx.doi.org/10.26444/aaem/81315
  45. Sekar U, Shanthi M. Recent insights into the genetic diversity, epidemiology and clinical relevance of Blastocystis species.. The Journal of Medical Research. 2015;1(1):33-39. http://dx.doi.org/10.31254/jmr.2015.1110
  46. Tasić N, Milenković T, Bujić V, Zdravković D, Tasić A. BLASTOCYSTIS HOMINIS: A MYSTERIOUS AND COMMONLY DISREGARDED PARASITE. Facta Universitatis, Series: Medicine and Biology. 2017;:39. http://dx.doi.org/10.22190/fumb161027001t
  47. Mülayim S, Aykur M, Dağcı H, Dalkılıç S, Aksoy A, Kaplan M. Investigation of Isolated Blastocystis Subtypes from Cancer Patients in Turkey. Acta Parasitologica. 2021;66(2):584-592. http://dx.doi.org/10.1007/s11686-020-00322-y
  48. Forsell J. Genetic subtypes in unicellular intestinal parasites with special focus on Blastocystis. Department of Clinical Microbiology. Umeå, Sweden. 2017. Available from: https://www.divaportal.org/smash/get/diva 2:1081616/Fulltexto1.pdf.
  49. Sarzhanov F, Dogruman-Al F, Santin M, Maloney J, Gureser A, Karasartova D, Taylan-Ozkan A. Investigation of neglected protists Blastocystis sp. and Dientamoeba fragilis in immunocompetent and immunodeficient diarrheal patients using both conventional and molecular methods. PLOS Neglected Tropical Diseases. 2021;15(10):e0009779. http://dx.doi.org/10.1371/journal.pntd.0009779
  50. Maloney J, Molokin A, da Cunha M, Cury M, Santin M. Blastocystis subtype distribution in domestic and captive wild bird species from Brazil using next generation amplicon sequencing. Parasite Epidemiology and Control. 2020;9:e00138. http://dx.doi.org/10.1016/j.parepi.2020.e00138
  51. Deng L, Tay H, Peng G, Lee J, Tan K. Prevalence and molecular subtyping of Blastocystis in patients with Clostridium difficile infection, Singapore. Parasites & Vectors. 2021;14(1):. http://dx.doi.org/10.1186/s13071-021-04749-8
  52. Stensvold C, Clark C. Pre-empting Pandora’s Box: Blastocystis Subtypes Revisited. Trends in Parasitology. 2020;36(3):229-232. http://dx.doi.org/10.1016/j.pt.2019.12.009
  53. Ramírez J, Sánchez A, Hernández C, Flórez C, Bernal M, Giraldo J, Reyes P, López M, García L, Cooper P, Vicuña Y, Mongi F, Casero R. Geographic distribution of human Blastocystis  subtypes in South America. Infection, Genetics and Evolution. 2016;41:32-35. http://dx.doi.org/10.1016/j.meegid.2016.03.017
  54. Jiménez P, Jaimes J, Ramírez J. A summary of Blastocystis subtypes in North and South America. Parasites & Vectors. 2019;12(1):. http://dx.doi.org/10.1186/s13071-019-3641-2
  55. Hammood A, Ahmed B, Salman Y. Blastocystis hominis Detection among Gastrointestinal Disorders’ Patients in Kirkuk Province Using Three Different Laboratory Methods. International Journal of Current Microbiology and Applied Sciences. 2016;5(7):883-900. http://dx.doi.org/10.20546/ijcmas.2016.507.101
  56. Parija S, Padukone S, Mandal J, Rajkumari N, Bhat B, Swaminathan R. Detection of Blastocystis in clinical stool specimens using three different methods and morphological examination in Jones’ medium. Tropical Parasitology. 2018;8(1):33. http://dx.doi.org/10.4103/tp.tp_4_18
  57. Mohammad N, Mastuki M, AlMekhlafi H. Comparative study of Wheatley’s trichrome stain and in-vitro culture against PCR assay for the diagnosis of Blastocystis sp. in stool samples. Parasitol. 2018;13:127–136.
  58. Piekara-Stępińska A, Gorczykowski M, Piekarska J. Suitability of selected culture media for Blastocystis spp. Vet. Scien. 2018;2: 815–817. DOI: 10.24425/pjvs.2018.125593.
  59. Hegazy L, Salama M, Fawzy E. Evaluation of Jones’ medium culture versus locke egg medium in diagnosis of Blastocystis hominis. Annals of the Romanian Soc. Cell Biol. 2021;25:987–1001.
  60. Clark C, Diamond L. Methods for Cultivation of Luminal Parasitic Protists of Clinical Importance. Clinical Microbiology Reviews. 2002;15(3):329-341. http://dx.doi.org/10.1128/cmr.15.3.329-341.2002
  61. Tan S, Singh M, Yap E, Ho L, Moe K, Howe J, Ng G. Colony formation of Blastocystis hominis in soft agar. Parasitology Research. 1996;82(4):375-377. http://dx.doi.org/10.1007/s004360050130
  62. Tan K, Ng G, Quek E, Howe J, Ramachandran N, Yap E, Singh M. Blastocystis hominis: A Simplified, High-Efficiency Method for Clonal Growth on Solid Agar. Experimental Parasitology. 2000;96(1):9-15. http://dx.doi.org/10.1006/expr.2000.4544
  63. Karamati S. Comprehensive Study of Phenotypic and Growth Rate Features of Blastocystis Subtypes 1-3 and 6 in Symptomatic and Asymp-tomatic Subjects. Iranian Journal of Parasitology. 2019;:. http://dx.doi.org/10.18502/ijpa.v14i2.1132
  64. 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. http://dx.doi.org/10.1371/journal.pone.0015484
  65. Rudzińska M, Kowalewska B, Szostakowska B, Grzybek M, Sikorska K, Świątalska A. First Report on the Occurrence and Subtypes of Blastocystis in Pigs in Poland Using Sequence-Tagged-Site PCR and Barcode Region Sequencing. Pathogens. 2020;9(7):595. http://dx.doi.org/10.3390/pathogens9070595
  66. Jones II M, Ganac R, Hiser G, Hudson N, Le A, Whipps C. Detection of Blastocystis from stool samples using real-time PCR. Parasitology Research. 2008;103(3):551-557. http://dx.doi.org/10.1007/s00436-008-1006-4