Research Article
EVALUATION OF BLASTOCYSTIS SPP. AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH DIFFERENT DIAGNOSTIC METHODS AND SUBTYPE ANALYSES
Abstract
Objective: Blastocystis spp; is a protozoon that
can be seen worldwide. Fecal-oral transmission is the most accepted pathway for Blastocystis spp.
infection. Most infected patients show no symptoms of infection, however it can
cause abdominal pain, acute or chronic diarrhea, vomiting, flatulence and nausea.
It is suggested that Blastocystis spp. may cause several pathologies in gut causing an inflammatory response
that may lead to Inflammatory Bowel Diseases.
Materials
and Methods: Our study included 60 IBH patients diagnosed as ulcerative colitis (30)
and Crohn’s Disease (30) in Division of Gastroenterology and 40 healty controls
with no gastrointestinal disease. Stool samples of all patients were examined
for presence of any parasites. Presenceof Blastocystis
spp. was evaluated with microscopy, culture with two different media, ELISA
and PCR methods. For subtype analyses sequencing was performed.
Results: Blastocystis spp. was detected in 6 (10%) IBD patients, 2 (5%) in
controls. Blastocystis spp. antigen
detected in 12 (20%) IBD patients and 3 (7.5%) in controls. Blastocystis spp. DNA was detected in 8
(13.3%) IBD patients and 6 (15%) controls. No statistical significance was
detected between IBD patients and control group in terms of Blastocystis spp positivity. ST3 was the
predominant subtype and abdominal pain was the most common clinical symptom.
Conclusion: These results
suggested that using two different media increases the sensitivity. PCR was the
most sensitive method. ELISA results showed high sensitivity and specificity,
suggested that ELISA method could be an alternative to the microscopy and
culture. No significant relationship between IBD and Blastocystis spp. was determined. Also, no significance was
detected between subtypes and clinical symptoms. Although we could not
determine a relationship between subtypes and IBD or clinical symptoms, further
investigations are needed to clarify this issue.
Key words: Blastocystis spp.; inflammatory bowel disease; IBD; subtype;
clinical symptoms
References
- 1. Popruk P, Pintong A, Radomyos P. Diversity of Blastocystis subtypes in humans. J Trop Med Parasitol 2013; 36:88-97.
- 2. Dağcı.H: Blastocystis: Türkiye’deki Son Gelişmeler. 18. Ulusal Parazitoloji Kongresi Kitapçığı, 29 Eylül - 5 Ekim 2013, Denizli, 2013;30-4.
- 3. Wawrzyniak I, Poirier P, Viscogliosi E, Dionigia M, Texier C, Delbac F, El-Alaoui H. Blastocystis, an unrecognized parasite:an overview of pathogenesis and diagnosis. Ther Adv Infect Dis 2013; 1:167-78.
- 4. Koltas IS, Özcan K, Tanriverdi S, Paydas S, Paydas S, Baslamisli F. The prevalence of Blastocystis hominis in immunosupressed patients. Ann Med Sci 1999; 8:117- 9.
- 5. Tasova Y., Sahin B., Koltas S., Paydas S.: Clinical significance and frequency of Blastocystis hominis in Turkish patients with hematological malignancy. Acta Med Okayama 2000; 54:133-6.
- 6. Zoglool DAM., Khodari YAW., Frooq MU.: Blastocystis hominis and allergic skin diseases; a single center experience. Journal Of Health Sciences 2012; 2 : 66
- 7. Horiki N, Kaneda Y, Maruyama M, Fujita Y, Tachibana H. Intestinal blockage by carcinoma and Blastocystis hominis infection. Am J Trop Med Hyg 1999; 60:400-2.
- 8. Yakoob J., Jafri W., Jafri N., Khan R., Islam M., Beg MA., Zaman V.: Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis. Am J Trop Med Hyg 2004; 70: 383-5.
- 9. Nagler J.,Brown M., Soave R.: Blastocystis hominis in inflammatory bowel disease. J Clin Gastroenterol 1992; 16:109-12.
- 10. Giacometti A., Cirioni O., Fiorentini A., Fortuna M., Scalise G.: Irritable bowel syndrome in patients with Blastocystis hominis infection. Eur J Clin Microbiol Infect Dis 1999;18:436-9.
- 11. Yakoob J., Jafri W., Beg MA., Abbas Z., Naz S., Islam M., Khan R.: Irrıtable Bowl Sendrome: It is associated with genotypes of Blastocystis hominis. Parasitol Res 2010; 106:1033-8.
- 12. Phillips BP, Zierdt CH.: Blastocystis hominis: Pathogenic potential in human patients and in gnotobiotics. Exp Parasitol 1976;39: 358-64.
- 13. Long HY., Handschack A., Konig W., Ambrosch A.: Blastocytis hominis modulates immune responses and cytokine release in colonic epithelial cells. Parasitol Res 2001; 87:1029-30.
- 14. Alfellani MA, Mulla DT, Jacob AS, Imeede CA, Yoshikawa H, Stensvold CR, Clark CG. Genetic diversity of Blastocystis in livestock and zoo animals. Protist 2013;164:497-509.
- 15. Noël C, Dufernez F, Gerbod D, Edgcomb VP, Delgado-Viscogliosi P, Ho L.C, Singh M, Wintjens R, Sogin ML, Capron M, Pierce R, Zenner L, Viscogliosi E. Molecular phylogenies of Blastocystis isolates from different hosts: implications for genetic diversity, identification of species, and zoonosis. J Clin Microbiol 2005; 43: 348-55.
- 16. Tan KS. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 2008; 21:639-65.
- 17. Scanlan PD, Marchesi JR. Micro-eukaryotic diversity of the human distal gut microbiota: quantitative assessment using culture-dependent and independent analysis of faeces. ISME J 2008; 2:1183-93
- 18. Dominguez-Marquez M, Guna R, Munoz C, Gomez-Munoz M, Borras R. High prevalence of subtip 4 among isolates of Blastocystis hominis from symptomatic patients of health district of Valencia (Spain). Parasitol Res 2009; 105:949-55.
- 19. Stendsvolt C, Christiansen D, Olsen K, Nielsen H. Blastocystis sp. subtype 4 is common in Danish Blastocystis-positive patients presenting with acute diarrhea. Am J Trop Med Hyg 2011; 84:883-5.
- 20. Zaman V, Ng GC, Suresh K, Yap EH, Singh M. Isolation of Blastocystis from the cockroach (Dictyoptera, Blattidae). Parasitol Res 1993;79:73-4.
- 21. Jones, WR. The experimental infection of rats with Entamoeba histolytica; with a method for evaluating the anti-amoebic properties of new compounds. Annals of Tropical Medicine and Parasitology 1946; 40: 130-40.
- 22. Grecu (Mătiut) DS, Neagu AN, Hărmănescu EA, Moglan I, In vitro division modalities developed by Blastocystis hominis examined with the acridine orange stain. Analele Stiintifice ale Universitătii Alexandru Ioan Cuza” din Iaşi, s. Biologie animală, Tom LIX 2013;13-8
- 23. Stensvold CR. Comparison of sequencing (barcode region) and sequence-tagged-site PCR for Blastocystis subtyping. J. Clin. Microbiol 2013, 51: 190–4.
- 24. Böhm-Gloning B, Knobloch J, Walderich B. Five subgroups of Blastocystis hominis isolates from symptomatic and asymptomatic patients revealed by restriction site analysis of PCR-amplified 16S-like rDNA. Trop Med In Health 1997;2 (8):771–8.
- 25. Santín M, Gómez-Muñoz MT, Solano-Aguilar G, Fayer R. Development of a new PCR protocol to detect and subtype Blastocystis spp. from humans and animals. Parasitol Res. 2011;109(1):205-12.
- 26. Roberts T, Barrat 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 Hy.g 2011; 84:308-12.
- 27. Zaman V, Khan KZ. A comparison of direct microscopy with culture for the diagnosis of Blastocysis hominis.Southeast Asian J Trop Med Public Health 1994; 25:792-3.
- 28. Kukoschke KG, Necker A, Muller HE. Detection of Blastocystis hominis by direct microscopy and culture. Eur J Clin Microbiol Infec Dis 1990; 9:305-7.
- 29. Boeck, W. C., and J. Drbohlav. The cultivation of Endamoeba histolytica. Am. J. Hyg 1925; 5:371-407.
- 30. Leelayoova S, Taamasri P, Rangsin R, Naaglor T, Thathaisong U, Mungthin M. In-vitro cultivation: a sensitive method for detecting Blastocystis hominis. Ann Trop Med Parasitol 2002; 96:803–7.
- 31. Stensvold CR, Arendrup MC, Jespersgaard C, Molbak K, Nielsen HV. Detecting Blastocystis using parasitologic and DNA-based methods: a comparative study. Diagn Microbiol Infect Dis 2007;59:303–7.
- 32. Dogruman-Al F, Turk S, Adiyaman-Korkmaz G, Hananel A, Levi L, Kopelowitz J,et al. A novel ELISA test for laboratory diagnosis of Blastocystis spp. in human stool spesimens. Parasitol Res 2015; 114:495-500.
- 33. Termmathurapoj S , Leelayoova S , Aimpun P , Thathaisong U ,Nimmanon T , Taamasri P , Mungthin M. The usefulness of short-term in vitro cultivation for the detection and molecular study of Blastocystis hominis in stool specimens . Parasitol Res 2004; 93: 445 – 7 .
- 34. Hanauer SB. Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflamm Bowel Dis 2006;1:3-9.
- 35. Cenac N, Andrews CN, Holzhausen M, Chapman K, Cottrell G, Andrade-Gordon P, Steinhoff M, Barbara G, Beck P, Bunnet NW, Sharkey KA, Ferraz JG, Shaffer E, Vergnolle N. Role for protease activity in visceral pain in irritable bowel syndrome. J Clin Invest 2007; 117: 636-47.
- 36. Gecse K, Roka R, Ferrier R, Leveque M, Eutamene H, Cartier C, Ait-Belgnaoui A, Rosztoczy A, Izbeki F, Fiaramonti J, Wittmann T, Bueno L. Increased feacal serine protease activity in diarrhoeic IBS patients: a colonic luminal factor impairing colonic permeability and sensitivity 2008;57:591-9.
- 37. Puthia M., Vaithilingam A., Lu J., Tan K. Degradation of human secretory immunoglobulin a by Blastocystis. Parasitol Res 2005;97:386-9.
- 38. Mahmoud MS, Saleh WA. Secretory and humoral antibody responses to Blastocystis hominis in symptomatic and asymptomatic human infections. J Egypt Soc Parasitol. 2003; 33:13-30.
- 39. Markell EK, Udkow MP. Blastocystis hominis: pathogen or fellow traveler?. Am Trop Med Hyg 1986; 35:1023-26.
- 40. Petersen AM, Stensvold CR, Mirsepasi H, Engberg J, Friis-Møller A, Porsbo LJ, Hammerum AM, Nordgaard-Lassen I, Nielsen HV, Krogfelt KA. Active ulcerative colitis associated with low prevalence of Blastocystis and Dientamoeba fragilis infection. Scand J Gastroenterol 2013; 48:638-9.
- 41. Rossen NG, Bart A, Verhaar N, van Nood E, Kootte R, de Groot PF, D'Haens GR, Ponsioen CY, van Gool T. Low prevalence of Blastocystis sp. in active ulcerative colitis patients. Eur J Clin Microbiol Infect Dis 2015; 34:1039-44. 42. Cekin AH, Cekin Y, Adakan Y, Tasdemir E, Koclar FG, Yolcular BO. Blastocystosis in patients with gastrointestinal symptoms: a case–control study. BMC Gastroenterol 2012; 12:122.
- 43. Yamamoto-Furusho JK, Torijano-Carrera E. Intestinal protozoa infections among patients with ulcerative colitis: prevalence and impact on clinical disease course. Digestion 2010;82:18–23.
- 44. Tai WP, Hu PJ, Wu J, Lin XC: Six ulcerative colitis patients with refractory symptoms co-infective with Blastocystis hominis in China. Parasitol Res 2011;108:1207–10.
- 45. Dogruman-Al F, Kustimur S, Yoshikawa H, Tuncer C, Simsek Z, Tanyuksel M, et al. Blastocystis subtypes in irritable bowel syndrome and inflammatory bowel disease in Ankara, Turkey. Mem Inst Oswaldo Cruz, Rio de Janeiro 2009;104:724-7.
İNFLAMATUAR BARSAK HASTALIĞI OLAN HASTALARDA BLASTOCYSTIS SPP.'NİN FARKLI TANI YÖNTEMLERİ İLE ARAŞTIRILMASI VE GENOTİPLENDİRİLMESİ
Abstract
Amaç: Blastocystis spp; fekal-oral yolla
özellikle kötü hijyen koşullarında bulaşan, tüm dünyada yaygın bir
protozoondur. Enfeksiyon asemptomatik seyredebildiği gibi karın ağrısı,
kabızlık, bulantı gibi gastrointestinal semptomlara neden olabilmektedir. Blastocystis spp.’nin barsakta çeşitli
patolojilere neden olabileceği, inflamatuar yanıtı uyararak İnflamatuar Barsak
Hastalıkları (IBH)’nın gelişmesi ile ilişkisi olabileceği öne sürülmektedir.
Gereç-Yöntem: Çalışmamıza İ.Ü.
İstanbul Tıp Fakültesi Gastroenteroloji Bilim Dalı’nda 30 Crohn hastalığı (CH),
30 ülseratif kolit (UK) tanısı alan hasta ve 40 gastrointestinal system
hastalığı bulunmayan sağlıklı kontrol grubu dahil edilmiştir. Bu hastaların
dışkı örnekleri tüm parazitler yönünden incelenmiş, mikroskopi, kültür, ELISA
ve PCR ile Blastocystis spp. varlığı
araştırılmıştır. Blastocystis spp.
saptanan örneklerde subtip dağılımı sekanslama yöntemi ile araştırılmıştır.
Bulgular: İBH grubunda
mikroskopi ve kültür yöntemleri ile 6 (%10)’sında, kontrol grubunun 2
(%5)’sinde Blastocystis spp. varlığı
saptanmıştır. ELISA ile Blastocystis spp.
antijeni IBH grubunun 12 (%20)’sinde, kontrol grubunun 3 (%7,5)’ünde
saptanmıştır. Blastocystis spp.
DNA’sı PCR ile IBH grubunun 8 (%13,3)’inde, kontrol grubunun 6 (15%)’sında
bulunmuştur. Gruplar arasında Blastocystis
spp. varlığı yönünden anlamlı bir sonuç saptanamamıştır. Suptipler arasında
ST3 en sık olarak saptanmış, bunlarda en yaygın klinik semptomun karın ağrısı
olduğu gözlenmiştir.
Sonuç: İki farklı besiyeri
kullanılması tanı duyarlılığını arttırmıştır. En duyarlı tanı yöntemi PCR
olarak saptanmış, ELISA yöntemi de oldukça yüksek duyarlılık ve özgüllükte
sonuç vermiş, mikroskopi ve kültüre alternatif bir yöntem olabileceği
gözlenmiştir. Sonuçlarımız subtipler ile klinik bulgular arasında bir bağlantı
olduğunu göstermese de konuyu aydınlatmak için çalışmalara ihtiyaç olduğuna işaret
etmektedir.
Anahtar kelimeler: Blastocystis spp.; inflamatuar barsak hastalığı; IBH; subtip;
klinik semptomlar.
References
- 1. Popruk P, Pintong A, Radomyos P. Diversity of Blastocystis subtypes in humans. J Trop Med Parasitol 2013; 36:88-97.
- 2. Dağcı.H: Blastocystis: Türkiye’deki Son Gelişmeler. 18. Ulusal Parazitoloji Kongresi Kitapçığı, 29 Eylül - 5 Ekim 2013, Denizli, 2013;30-4.
- 3. Wawrzyniak I, Poirier P, Viscogliosi E, Dionigia M, Texier C, Delbac F, El-Alaoui H. Blastocystis, an unrecognized parasite:an overview of pathogenesis and diagnosis. Ther Adv Infect Dis 2013; 1:167-78.
- 4. Koltas IS, Özcan K, Tanriverdi S, Paydas S, Paydas S, Baslamisli F. The prevalence of Blastocystis hominis in immunosupressed patients. Ann Med Sci 1999; 8:117- 9.
- 5. Tasova Y., Sahin B., Koltas S., Paydas S.: Clinical significance and frequency of Blastocystis hominis in Turkish patients with hematological malignancy. Acta Med Okayama 2000; 54:133-6.
- 6. Zoglool DAM., Khodari YAW., Frooq MU.: Blastocystis hominis and allergic skin diseases; a single center experience. Journal Of Health Sciences 2012; 2 : 66
- 7. Horiki N, Kaneda Y, Maruyama M, Fujita Y, Tachibana H. Intestinal blockage by carcinoma and Blastocystis hominis infection. Am J Trop Med Hyg 1999; 60:400-2.
- 8. Yakoob J., Jafri W., Jafri N., Khan R., Islam M., Beg MA., Zaman V.: Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis. Am J Trop Med Hyg 2004; 70: 383-5.
- 9. Nagler J.,Brown M., Soave R.: Blastocystis hominis in inflammatory bowel disease. J Clin Gastroenterol 1992; 16:109-12.
- 10. Giacometti A., Cirioni O., Fiorentini A., Fortuna M., Scalise G.: Irritable bowel syndrome in patients with Blastocystis hominis infection. Eur J Clin Microbiol Infect Dis 1999;18:436-9.
- 11. Yakoob J., Jafri W., Beg MA., Abbas Z., Naz S., Islam M., Khan R.: Irrıtable Bowl Sendrome: It is associated with genotypes of Blastocystis hominis. Parasitol Res 2010; 106:1033-8.
- 12. Phillips BP, Zierdt CH.: Blastocystis hominis: Pathogenic potential in human patients and in gnotobiotics. Exp Parasitol 1976;39: 358-64.
- 13. Long HY., Handschack A., Konig W., Ambrosch A.: Blastocytis hominis modulates immune responses and cytokine release in colonic epithelial cells. Parasitol Res 2001; 87:1029-30.
- 14. Alfellani MA, Mulla DT, Jacob AS, Imeede CA, Yoshikawa H, Stensvold CR, Clark CG. Genetic diversity of Blastocystis in livestock and zoo animals. Protist 2013;164:497-509.
- 15. Noël C, Dufernez F, Gerbod D, Edgcomb VP, Delgado-Viscogliosi P, Ho L.C, Singh M, Wintjens R, Sogin ML, Capron M, Pierce R, Zenner L, Viscogliosi E. Molecular phylogenies of Blastocystis isolates from different hosts: implications for genetic diversity, identification of species, and zoonosis. J Clin Microbiol 2005; 43: 348-55.
- 16. Tan KS. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 2008; 21:639-65.
- 17. Scanlan PD, Marchesi JR. Micro-eukaryotic diversity of the human distal gut microbiota: quantitative assessment using culture-dependent and independent analysis of faeces. ISME J 2008; 2:1183-93
- 18. Dominguez-Marquez M, Guna R, Munoz C, Gomez-Munoz M, Borras R. High prevalence of subtip 4 among isolates of Blastocystis hominis from symptomatic patients of health district of Valencia (Spain). Parasitol Res 2009; 105:949-55.
- 19. Stendsvolt C, Christiansen D, Olsen K, Nielsen H. Blastocystis sp. subtype 4 is common in Danish Blastocystis-positive patients presenting with acute diarrhea. Am J Trop Med Hyg 2011; 84:883-5.
- 20. Zaman V, Ng GC, Suresh K, Yap EH, Singh M. Isolation of Blastocystis from the cockroach (Dictyoptera, Blattidae). Parasitol Res 1993;79:73-4.
- 21. Jones, WR. The experimental infection of rats with Entamoeba histolytica; with a method for evaluating the anti-amoebic properties of new compounds. Annals of Tropical Medicine and Parasitology 1946; 40: 130-40.
- 22. Grecu (Mătiut) DS, Neagu AN, Hărmănescu EA, Moglan I, In vitro division modalities developed by Blastocystis hominis examined with the acridine orange stain. Analele Stiintifice ale Universitătii Alexandru Ioan Cuza” din Iaşi, s. Biologie animală, Tom LIX 2013;13-8
- 23. Stensvold CR. Comparison of sequencing (barcode region) and sequence-tagged-site PCR for Blastocystis subtyping. J. Clin. Microbiol 2013, 51: 190–4.
- 24. Böhm-Gloning B, Knobloch J, Walderich B. Five subgroups of Blastocystis hominis isolates from symptomatic and asymptomatic patients revealed by restriction site analysis of PCR-amplified 16S-like rDNA. Trop Med In Health 1997;2 (8):771–8.
- 25. Santín M, Gómez-Muñoz MT, Solano-Aguilar G, Fayer R. Development of a new PCR protocol to detect and subtype Blastocystis spp. from humans and animals. Parasitol Res. 2011;109(1):205-12.
- 26. Roberts T, Barrat 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 Hy.g 2011; 84:308-12.
- 27. Zaman V, Khan KZ. A comparison of direct microscopy with culture for the diagnosis of Blastocysis hominis.Southeast Asian J Trop Med Public Health 1994; 25:792-3.
- 28. Kukoschke KG, Necker A, Muller HE. Detection of Blastocystis hominis by direct microscopy and culture. Eur J Clin Microbiol Infec Dis 1990; 9:305-7.
- 29. Boeck, W. C., and J. Drbohlav. The cultivation of Endamoeba histolytica. Am. J. Hyg 1925; 5:371-407.
- 30. Leelayoova S, Taamasri P, Rangsin R, Naaglor T, Thathaisong U, Mungthin M. In-vitro cultivation: a sensitive method for detecting Blastocystis hominis. Ann Trop Med Parasitol 2002; 96:803–7.
- 31. Stensvold CR, Arendrup MC, Jespersgaard C, Molbak K, Nielsen HV. Detecting Blastocystis using parasitologic and DNA-based methods: a comparative study. Diagn Microbiol Infect Dis 2007;59:303–7.
- 32. Dogruman-Al F, Turk S, Adiyaman-Korkmaz G, Hananel A, Levi L, Kopelowitz J,et al. A novel ELISA test for laboratory diagnosis of Blastocystis spp. in human stool spesimens. Parasitol Res 2015; 114:495-500.
- 33. Termmathurapoj S , Leelayoova S , Aimpun P , Thathaisong U ,Nimmanon T , Taamasri P , Mungthin M. The usefulness of short-term in vitro cultivation for the detection and molecular study of Blastocystis hominis in stool specimens . Parasitol Res 2004; 93: 445 – 7 .
- 34. Hanauer SB. Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflamm Bowel Dis 2006;1:3-9.
- 35. Cenac N, Andrews CN, Holzhausen M, Chapman K, Cottrell G, Andrade-Gordon P, Steinhoff M, Barbara G, Beck P, Bunnet NW, Sharkey KA, Ferraz JG, Shaffer E, Vergnolle N. Role for protease activity in visceral pain in irritable bowel syndrome. J Clin Invest 2007; 117: 636-47.
- 36. Gecse K, Roka R, Ferrier R, Leveque M, Eutamene H, Cartier C, Ait-Belgnaoui A, Rosztoczy A, Izbeki F, Fiaramonti J, Wittmann T, Bueno L. Increased feacal serine protease activity in diarrhoeic IBS patients: a colonic luminal factor impairing colonic permeability and sensitivity 2008;57:591-9.
- 37. Puthia M., Vaithilingam A., Lu J., Tan K. Degradation of human secretory immunoglobulin a by Blastocystis. Parasitol Res 2005;97:386-9.
- 38. Mahmoud MS, Saleh WA. Secretory and humoral antibody responses to Blastocystis hominis in symptomatic and asymptomatic human infections. J Egypt Soc Parasitol. 2003; 33:13-30.
- 39. Markell EK, Udkow MP. Blastocystis hominis: pathogen or fellow traveler?. Am Trop Med Hyg 1986; 35:1023-26.
- 40. Petersen AM, Stensvold CR, Mirsepasi H, Engberg J, Friis-Møller A, Porsbo LJ, Hammerum AM, Nordgaard-Lassen I, Nielsen HV, Krogfelt KA. Active ulcerative colitis associated with low prevalence of Blastocystis and Dientamoeba fragilis infection. Scand J Gastroenterol 2013; 48:638-9.
- 41. Rossen NG, Bart A, Verhaar N, van Nood E, Kootte R, de Groot PF, D'Haens GR, Ponsioen CY, van Gool T. Low prevalence of Blastocystis sp. in active ulcerative colitis patients. Eur J Clin Microbiol Infect Dis 2015; 34:1039-44. 42. Cekin AH, Cekin Y, Adakan Y, Tasdemir E, Koclar FG, Yolcular BO. Blastocystosis in patients with gastrointestinal symptoms: a case–control study. BMC Gastroenterol 2012; 12:122.
- 43. Yamamoto-Furusho JK, Torijano-Carrera E. Intestinal protozoa infections among patients with ulcerative colitis: prevalence and impact on clinical disease course. Digestion 2010;82:18–23.
- 44. Tai WP, Hu PJ, Wu J, Lin XC: Six ulcerative colitis patients with refractory symptoms co-infective with Blastocystis hominis in China. Parasitol Res 2011;108:1207–10.
- 45. Dogruman-Al F, Kustimur S, Yoshikawa H, Tuncer C, Simsek Z, Tanyuksel M, et al. Blastocystis subtypes in irritable bowel syndrome and inflammatory bowel disease in Ankara, Turkey. Mem Inst Oswaldo Cruz, Rio de Janeiro 2009;104:724-7.
There are 44 citations in total.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Clinical Research |
| Authors | |
| Publication Date | March 31, 2017 |
| Submission Date | October 30, 2016 |
| Published in Issue | Year 2017 Volume: 80 Issue: 1 |
Cite
Contact information and address
Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE
Email: itfdergisi@istanbul.edu.tr
Phone: +90 212 414 21 61