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European Journal of Clinical Microbiology & Infectious Diseases

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01-06-2020 | Metronidazole | Review

Blastocystis, urticaria, and skin disorders: review of the current evidences

Authors: Fares Bahrami, Erfan Babaei, Alireza Badirzadeh, Tahereh Rezaei Riabi, Amir Abdoli

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 6/2020

Abstract

Blastocystis is one of the most common intestinal protozoan parasites worldwide, which is linked to cutaneous lesions and urticaria. In a setting of systematic review, the data on the association of Blastocystis infection with cutaneous lesions were searched in order to summarize the main clinical symptoms, diagnostic methods, treatment, and outcome of the patients. The search identified 28 eligible articles, including 12 cross-sectional studies and 16 case reports/case series (including 23 cases). A diverse spectrum of skin symptoms, mainly urticaria, rash, and itching, was reported from the studies. Of the 23 infected cases with the skin symptoms, gastrointestinal symptoms were reported from the 16 cases, whereas 7 cases with urticaria had asymptomatic infection. The most frequent subtypes were ST1, ST2, and ST3, respectively. Metronidazole, paromomycin, and tinidazole were the most prescribed drugs in patients with single Blastocystis infection. Notably, urticaria and other cutaneous symptoms of all treated patients were resolved after treatment. In conclusion, this study indicates that Blastocystis infection can be a neglected cause of urticaria and skin disorders. Since the treatment of Blastocystis infection is simple, screening and treatment of this infection should be considered in patients with urticaria and other skin disorders.

Clark CG, van der Giezen M, Alfellani MA, Stensvold CR (2013) Recent developments in Blastocystis research. In: Adv Parasitol, vol 82. Elsevier, Netherlands, pp 1–32

Alexeieff A (1911) Sur la nature des formations dites kystes de Trichomonas intestinalis. CR Soc Biol 71:296–298

Stensvold CR, Clark CG (2016) Current status of Blastocystis: a personal view. Parasitol Int 65(6):763–771PubMed

Ajjampur SS, Tan KS (2016) Pathogenic mechanisms in Blastocystis spp.—interpreting results from in vitro and in vivo studies. Parasitol Int 65(6):772–779PubMed

Tan KS, Singh M, Yap EH (2002) Recent advances in Blastocystis hominis research: hot spots in terra incognita. Int J Parasitol 32(7):789–804PubMed

Andersen LOB, Stensvold CR (2016) Blastocystis in health and disease: are we moving from a clinical to a public health perspective? J Clin Microbiol 54(3):524–528PubMedPubMedCentral

Coyle CM, Varughese J, Weiss LM, Tanowitz HB (2011) Blastocystis: to treat or not to treat. Clin Infect Dis 54(1):105–110PubMed

Cifre S, Gozalbo M, Ortiz V, Soriano JM, Merino JF, Trelis M (2018) Blastocystis subtypes and their association with irritable bowel syndrome. Med Hypotheses 116:4–9PubMed

Rasti S, Hassanzadeh M, Hooshyar H, Momen-Heravi M, Mousavi SGA, Abdoli A (2017) Intestinal parasitic infections in different groups of immunocompromised patients in Kashan and Qom cities, Central Iran. Scand J Gastroenterol 52(6–7):738–741PubMed

10.

Roberts T, Stark D, Harkness J, Ellis J (2014) Update on the pathogenic potential and treatment options for Blastocystis sp. Gut Pathogens 6(1):17. https://doi.org/10.1186/1757-4749-6-17 CrossRefPubMedPubMedCentral

11.

Lepczyńska M, Chen WC, Dzika E (2016) Mysterious chronic urticaria caused by Blastocystis spp.? Int J Dermatol 55(3):259–266PubMed

12.

Armentia A, Mendez J, Gomez A, Sanchis E, Fernandez A, Sánchez P (1993) Urticaria by Blastocystis hominis. Successful treatment with paromomycin. Allergol Immunopathol 21(4):149–151

13.

Biedermann T, Hartmann K, Sing A, Przybilla B (2002) Hypersensitivity to non-steroidal anti-inflammatory drugs and chronic urticaria cured by treatment of Blastocystis hominis infection. Brit J Dermatol 146(6):1113–1114

14.

Scanlan PD, Stensvold CR (2013) Blastocystis: getting to grips with our guileful guest. Trends Parasitol 29(11):523–529PubMed

15.

Stensvold CR, van der Giezen M (2018) Associations between gut microbiota and common luminal intestinal parasites. Trends Parasitol 34(5):369–377PubMed

16.

Lepczyńska M, Białkowska J, Dzika E, Piskorz-Ogórek K, Korycińska J (2017) Blastocystis: how do specific diets and human gut microbiota affect its development and pathogenicity? Eur J Clin Microbiol Infect Dis 36(9):1531–1540PubMedPubMedCentral

17.

Greaves M (2000) Chronic urticaria. J Allergy Clin Immunol 105(4):664–672PubMed

18.

Kaplan AP (2004) Chronic urticaria: pathogenesis and treatment. J Allergy Clin Immunol 114(3):465–474. https://doi.org/10.1016/j.jaci.2004.02.049 CrossRefPubMed

19.

Greaves MW (1995) Chronic urticaria. New Engl J Med 332(26):1767–1772. https://doi.org/10.1056/nejm199506293322608 CrossRefPubMed

20.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. System Rev 4(1):1

21.

Cakir F, Cicek M, Yildirim IH (2019) Determination the subtypes of Blastocystis sp. and evaluate the effect of these subtypes on pathogenicity. Acta Parasitol 64(1):7–12PubMed

22.

El Saftawy EA, Amin NM, Hamed DH, Elkazazz A, Adel S (2019) The hidden impact of different Blastocystis genotypes on C-3 and IgE serum levels: a matter of debate in asthmatic Egyptian children. J Parasit Dis 43(3):443451

23.

Tunalı V, Öztürk EA, Ünver A, Turgay N (2018) The prevalence of Blastocystosis among patients with gastrointestinal and dermatologic complaints and effects of Blastocystis spp. density on symptomatology. Türkiye Parazitolojii Dergisi 42(4):254–257PubMed

24.

Salvador F, Sulleiro E, Sánchez-Montalvá A, Alonso C, Santos J, Fuentes I, Molina I (2016) Epidemiological and clinical profile of adult patients with Blastocystis sp. infection in Barcelona, Spain. Parasit Vectors 9(1):548PubMedPubMedCentral

25.

Ertuğ S, Malatyalı E, Ertabaklar H, Özlem SÇ, Bozdoğan B (2015) Subtype distribution of Blastocystis isolates and evaluation of clinical symptoms detected in Aydin province, Turkey. Mikrobiyol Bul 49(1):98–104PubMed

26.

Beyhan YE, Yilmaz H, Cengiz ZT, Ekici A (2015) Clinical significance and prevalence of Blastocystis hominis in Van, Turkey. Saudi Med J 36(9):1118–1121PubMedPubMedCentral

27.

Bálint A, Dóczi I, Bereczki L, Gyulai R, Szűcs M, Farkas K, Urbán E, Nagy F, Szepes Z, Wittmann T (2014) Do not forget the stool examination!—cutaneous and gastrointestinal manifestations of Blastocystis sp. infection. Parasitol Res 113(4):1585–1590PubMed

28.

Giacometti A, Cirioni O, Antonicelli L, D'Amato G, Silvestri C, Del Prete MS, Scalise G (2003) Prevalence of intestinal parasites among individuals with allergic skin diseases. J Parasitol 89(3):490–493PubMed

29.

Casero RD, Mongi F, Sánchez A, Ramírez JD (2015) Blastocystis and urticaria: examination of subtypes and morphotypes in an unusual clinical manifestation. Acta Trop 148:156–161PubMed

30.

Yilmaz EA, Karaatmaca B, Sackesen C, Sahiner UM, Cavkaytar O, Sekerel BE, Soyer O (2016) Parasitic infections in children with chronic spontaneous urticaria. Int Arch Allergy Immunol 171(2):130–135

31.

Hameed DMA, Hassanin OM, Zuel-Fakkar NM (2011) Association of Blastocystis hominis genetic subtypes with urticaria. Parasitol Res 108(3):553–560PubMed

32.

Aydin M, Yazici M, Demirkazik M, Koltas IS, Cikman A, Gulhan B, Duran T, Yilmaz A, Kara M (2019) Molecular characterization and subtyping of Blastocystis in urticarial patients in Turkey. Asian Pac J Trop Med 12(10):450–456

33.

Pielok Ł, Frąckowiak K, Kłudkowska M (2019) Disseminated skin rash and blood eosinophilia in a polish traveler diagnosed Strongyloides stercoralis, Trichuris trichiura. Schistosoma sp and Blastocystis sp coinfection. Annals Parasitol 65(1):99–102

34.

Pawlowska J, Pawlowska-Iwanicka K, Stelmach I (2018) Blastocystis infection in a 5-year-old boy-a case report. Pediatr Med Rodz 14(3):324–326

35.

Verma R, Delfanian K (2013) Blastocystis hominis associated acute urticaria. Am J Med Sci 346(1):80–81PubMed

36.

Kick G, Rueff F, Przybilla B (2002) Palmoplantar pruritus subsiding after Blastocystis hominis eradication. Acta Derm Venereol 82(1):60–60PubMed

37.

Pasqui A, Savini E, Saletti M, Guzzo C, Puccetti L, Auteri A (2004) Chronic urticaria and Blastocystis hominis infection. A case report. Eur Rev Med Pharmacol Sci 8:117–120PubMed

38.

Cassano N, Scoppio BM, Loviglio MC, Vena G (2005) Remission of delayed pressure urticaria after eradication of Blastocystis hominis. Acta Derm Venerol 85(4):357–358PubMed

39.

Katsarou-Katsari A, Vassalos CM, Tzanetou K, Spanakos G, Papadopoulou C, Vakalis N (2008) Acute urticaria associated with amoeboid forms of Blastocystis sp. subtype 3. Acta Derm Venereol 88(1):80–81PubMed

40.

Valsecchi R, Leghissa P, Greco V (2004) Cutaneous lesions in Blastocystis hominis infection. Acta Derm Venereol 84(4):322–323PubMed

41.

Vogelberg C, Stensvold CR, Monecke S, Ditzen A, Stopsack K, Heinrich-Gräfe U, Pöhlmann C (2010) Blastocystis sp. subtype 2 detection during recurrence of gastrointestinal and urticarial symptoms. Parasitol Int 59(3):469–471PubMed

42.

Lee MG, Rawlins SC, Didier M, DeCeulaer K (1990) Infective arthritis due to Blastocystis hominis. Ann Rheum Dis 49(3):192PubMedPubMedCentral

43.

Rajič B, Arapović J, Raguž K, Bošković M, Babić SM, Maslać S (2015) Eradication of Blastocystis hominis prevents the development of symptomatic Hashimoto’s thyroiditis: a case report. J Infect Dev Ctries 9(07):788–791PubMed

44.

Gupta R, Parsi K (2006) Chronic urticaria due to Blastocystis hominis. Aust J Dermatol 47(2):117–119

45.

Shah M, Tan CB, Rajan D, Ahmed S, Subramani K, Rizvon K, Mustacchia P (2012) Blastocystis hominis and Endolimax nana co-infection resulting in chronic diarrhea in an immunocompetent male. Case Rep Gastroenterol 6(2):358–364PubMedPubMedCentral

46.

Stensvold C, Arendrup M, Nielsen H, Bada A, Thorsen S (2008) Symptomatic infection with Blastocystis sp. subtype 8 successfully treated with trimethoprim–sulfamethoxazole. Ann Trop Med Parasitol 102(3):271–274PubMed

47.

Kantardjiev V, Galev A, Broshtilova V (2019) Urticaria associated with amoeboid forms of Blastocystis spp. Asian J Res Infect Dis:1–4

48.

Hennino A, Bérard F, Guillot I, Saad N, Rozières A, Nicolas J-F (2006) Pathophysiology of urticaria. Clin Rev Allergy Immunol 30(1):3–11. https://doi.org/10.1385/criai:30:1:003 CrossRefPubMed

49.

Kolkhir P, Balakirski G, Merk HF, Olisova O, Maurer M (2016) Chronic spontaneous urticaria and internal parasites–a systematic review. Allergy 71(3):308–322PubMed

50.

Rostami A, Riahi SM, Haghighi A, Saber V, Armon B, Seyyedtabaei SJ (2017) The role of Blastocystis sp. and Dientamoeba fragilis in irritable bowel syndrome: a systematic review and meta-analysis. Parasitol Res 116(9):2361–2371. https://doi.org/10.1007/s00436-017-5535-6 CrossRefPubMed

51.

Kasperska-Zajac A, Grzanka A, Machura E, Misiolek M, Mazur B, Jochem J (2013) Increased serum complement C3 and C4 concentrations and their relation to severity of chronic spontaneous urticaria and CRP concentration. J Inflamm 10(1):22. https://doi.org/10.1186/1476-9255-10-22 CrossRef

52.

Hide M, Francis DM, Grattan C, Hakimi J, Kochan JP, Greaves MW (1993) Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic Urticaria. New Engl J Med 328(22):1599–1604. https://doi.org/10.1056/nejm199306033282204 CrossRefPubMed

53.

Tong LJ, Balakrishnan G, Kochan JP, Kinét J-P, Kaplan AP (1997) Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol 99(4):461–465. https://doi.org/10.1016/S0091-6749(97)70071-X CrossRefPubMed

54.

Grattan CE, Francis DM, Hide M, Greaves MW (1991) Detection of circulating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 21(6):695–704. https://doi.org/10.1111/j.1365-2222.1991.tb03198.x CrossRefPubMed

55.

Magen E, Mishal J, Feldman V, Zeldin Y, Schlesinger M, Kidon M, Sthoeger Z (2010) Increased mean platelet volume and C-reactive protein levels in patients with chronic urticaria with a positive autologous serum skin test. Am J Med Sci 339(6):504–508. https://doi.org/10.1097/MAJ.0b013e3181db6ed5 CrossRefPubMed

56.

Kasperska-Zajac A, Sztylc J, Machura E, Jop G (2011) Plasma IL-6 concentration correlates with clinical disease activity and serum C-reactive protein concentration in chronic urticaria patients. Clin Exp Allergy 41(10):1386–1391. https://doi.org/10.1111/j.1365-2222.2011.03789.x CrossRefPubMed

57.

Kasperska-Zajac A, Grzanka A, Machura E, Mazur B, Misiolek M, Czecior E, Kasperski J, Jochem J (2013) Analysis of procalcitonin and CRP concentrations in serum of patients with chronic spontaneous urticaria. Inflamm Res 62(3):309–312. https://doi.org/10.1007/s00011-012-0580-1 CrossRefPubMed

58.

Lynch SV, Pedersen O (2016) The human intestinal microbiome in health and disease. New Engl J Med 375(24):2369–2379. https://doi.org/10.1056/NEJMra1600266 CrossRefPubMed

59.

Nabizadeh E, Jazani NH, Bagheri M, Shahabi S (2017) Association of altered gut microbiota composition with chronic urticaria. Ann Allergy Asthma Immunol 119(1):48–53. https://doi.org/10.1016/j.anai.2017.05.006 CrossRefPubMed

60.

Lu T, Chen Y, Guo Y, Sun J, Shen W, Yuan M, Zhang S, He P, Jiao X (2019) Altered gut microbiota diversity and composition in chronic urticaria. Dis Markers 2019:11. https://doi.org/10.1155/2019/6417471 CrossRef

61.

Valerio I, Floriana S, Valentina T, Fabrizio P, Anatole M, Veronica DC, David DC, Serena S, Federica B, Rossella DA (2016) Gut microbiota related to Giardia duodenalis, Entamoeba spp. and Blastocystis hominis infections in humans from Côte d’Ivoire. J infect Dev Ctries 10 (09). https://doi.org/10.3855/jidc.8179

62.

O’Brien Andersen L, Karim AB, Roager HM, Vigsnæs LK, Krogfelt KA, Licht TR, Stensvold CR (2016) Associations between common intestinal parasites and bacteria in humans as revealed by qPCR. Eur J Clin Microbiol Infect Dis 35(9):1427–1431. https://doi.org/10.1007/s10096-016-2680-2 CrossRefPubMed

63.

Salem I, Ramser A, Isham N, Ghannoum MA (2018) The gut microbiome as a major regulator of the gut-skin axis. Front Microbiol 9(1459). https://doi.org/10.3389/fmicb.2018.01459

Title: Blastocystis, urticaria, and skin disorders: review of the current evidences
Authors: Fares Bahrami
Erfan Babaei
Alireza Badirzadeh
Tahereh Rezaei Riabi
Amir Abdoli
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Metronidazole
Urticaria
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 6/2020
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-019-03793-8

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