Original article
Clinical and epidemiological characteristics of intestinal parasite infection by Blastocystis hominis
Características clínicas y epidemiológicas de la parasitación intestinal por Blastocystis hominis
C. Ocaña-Losadaa,
, J.A. Cuenca-Gómeza,b, M.T. Cabezas-Fernándeza,b,c, J. Vázquez-Villegasb,d, M.J. Soriano-Péreza,b, I. Cabeza-Barreraa,b, J. Salas-Coronasa,b,c
Corresponding author
a Unidad de Medicina Tropical, Hospital de Poniente, El Ejido, Almería, Spain
b RICET (Red de Investigación Cooperativa en Enfermedades Tropicales), Spain
c CEMyRI (Centro de Estudios de las Migraciones y Relaciones Interculturales), Universidad de Almería, Almería, Spain
d Unidad de Medicina Tropical, Distrito Poniente, Almería, Spain
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The disease usually manifests in humans through gastrointestinal symptoms and occasionally causes extraintestinal manifestations.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> This is an emerging parasitosis, whose incidence is increasing in many countries.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2,3</span></a> In the study by El Safadi et al.,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> the prevalence was 24% in Denmark and The Netherlands and 7% in Italy and the United Kingdom. The parasite is more common in economically depressed populations of tropical and subtropical regions with inferior hygienic-healthcare conditions, which facilitate its transmission.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are numerous unknowns concerning this parasite, the most controversial of which is its actual pathogenicity and, as a consequence, the need for specific treatment.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> The findings that cast doubt on its pathogenic character include its nonspecific symptoms, which could be due to the presence of other parasitic co-infections, as well as isolates of the parasite in the feces of individuals without symptoms. However, an increasing number of studies have supported the pathogenicity of this parasite based on clinical, phenotypic and genotypic data.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> These data include the verification that the frequency of symptoms increases as the parasite burden increases, the disappearance of symptoms after antiparasitic therapy, the morphological differences between the forms of <span class="elsevierStyleItalic">B. hominis</span> isolated in symptomatic and asymptomatic patients and the presence of various subtypes of the parasite according to the symptoms produced.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to report the clinical, epidemiological and analytical characteristics of patients with parasitosis by <span class="elsevierStyleItalic">B. hominis</span> in a tropical medicine unit (TMU) located in one of the areas of Spain with the largest immigrant population.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">An observational retrospective study was conducted on all patients diagnosed with parasitosis by <span class="elsevierStyleItalic">B. hominis</span> from October 2004 to March 2016 in the TMU of Hospital de Poniente in El Ejido (Almeria, Spain). The TMU is a reference unit for a population of 287,000 inhabitants, 30% of whom are foreigners, mostly immigrants (50% from Africa). To conduct the study, we collected demographic, epidemiological, clinical and analytical data from each patient. We performed an initial statistical analysis of all patients in whom this parasite was isolated. A second analysis was then performed of only those with parasitosis by <span class="elsevierStyleItalic">B. hominis</span> with no other parasitic co-infections, which was defined as the presence of <span class="elsevierStyleItalic">B. hominis</span> along with 1 or more distinct pathogenic parasites.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A complete case history review that included epidemiological aspects was performed for all patients. During the initial visit, laboratory tests were requested that included a full blood count and biochemistry with a hepatic and renal profile and IgE readings. If not available beforehand, serology was requested for the hepatitis B virus, hepatitis <span class="elsevierStyleSmallCaps">C</span> virus, human immunodeficiency virus, syphilis, <span class="elsevierStyleItalic">Schistosoma</span> infection (NovaLisa™ Schistosoma mansoni IgG ELISA Kit, NovaTec Immunodiagnostica GmbH, Dietzenbach, Germany) and, depending on the patient's origin, <span class="elsevierStyleItalic">Strongyloides</span> infection (ELISA kit PALEX Medical SA™, Ref. EIA-4208, DRG Diagnostics, Germany). To study the parasites in feces, we employed the Ritchie concentration technique on 3 samples collected on alternate days, repeating up to 3 sets of 3 samples for the patients without an initial diagnosis. The study of parasites in urine was performed for the patients from endemic areas of urinary schistosomiasis. The diagnosis of schistosomiasis was performed when the parasite's eggs were isolated in feces, urine or biopsy material. For the patients from areas of high prevalence, we performed a microfilariae study in blood using the Knott test.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis of parasitosis by <span class="elsevierStyleItalic">B. hominis</span> was performed when the parasite was observed in feces. In the subgroup without parasitic co-infection, all patients with isolates of other parasites in blood, feces or urine were excluded, except those with parasites considered nonpathogenic such as <span class="elsevierStyleItalic">Entamoeba coli</span>, <span class="elsevierStyleItalic">Endolimax nana</span> or <span class="elsevierStyleItalic">Dicrocoelium dendriticum</span>. In terms of its pathogenicity, <span class="elsevierStyleItalic">Dicrocoelium</span> is known to produce spurious or false parasitoses in which the human is invaded but not colonized, because the eggs in feces disappear after the individual stops eating the contaminated food, without producing symptoms. In our series, we showed that all were false parasitoses, and therefore the patients with <span class="elsevierStyleItalic">Dicrocoelium</span> isolates were not excluded from this subgroup.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the symptomatic patients (abdominal pain, diarrhea or pruritus) in whom no other parasitosis was found or for whom the symptoms persisted after treating other parasitoses, we assumed that <span class="elsevierStyleItalic">B. hominis</span> was the causal agent for the symptoms. As first-line antiparasitic therapy, we used 500–750<span class="elsevierStyleHsp" style=""></span>mg of metronidazole every 8<span class="elsevierStyleHsp" style=""></span>h for 7–10 days. The second-line therapy was 160<span class="elsevierStyleHsp" style=""></span>mg/800<span class="elsevierStyleHsp" style=""></span>mg of trimethoprim-sulfamethoxazole every 12<span class="elsevierStyleHsp" style=""></span>h for 7 days. A subsequent check-up was performed at 6–12 weeks. The cure criterion was the disappearance of the parasite in feces or symptom resolution in the cases in which a parasite check could not be performed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">For the data analysis, we employed the Statistical Package for the Social Sciences (SPSS), version 15.0 (SPSS Inc., Chicago, IL, USA), using the mean as the measure of central tendency; we used the range and standard deviation as the measure of dispersion.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This study was approved by the Clinical Research Ethics Committee of Almeria (code 3/2018).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 3070 patients treated in the Tropical Medicine office, 570 (18%) were diagnosed with <span class="elsevierStyleItalic">B. hominis</span> infection; of these, 477 (83.7%) were male patients. The mean age of the patients was 31 years (range, 6–77). For the immigrants, the mean length of stay in Spain was 52 months (range, 0–348). The main countries of origin were the following: Senegal (159, 28%), Mali (103, 18%), Guinea-Bissau (68, 12%), Morocco (61, 11%), Mauritania (37, 6%) and Gambia (21, 4%).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Among the 570 patients with <span class="elsevierStyleItalic">B. hominis</span> colonization, there were 18 Spaniards (3.1%), 2 of whom were expats (residents of Mexico and the Democratic Republic of Congo) and 7 of whom were travelers with different destination countries. The remaining 9 had not recently traveled internationally (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The patients were referred from primary care (429; 75.3%) and internal medicine (42; 7.4%) and gastroenterology (38; 6.7%) departments. Among the 245 patients (43%) with exclusively <span class="elsevierStyleItalic">B. hominis</span> isolates, the main reasons for the referral were very similar to those of the group with parasitic co-infections (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Of the 325 (57%) patients with parasitic co-infections, the most common parasites were <span class="elsevierStyleItalic">Entamoeba histolytica</span> (<span class="elsevierStyleItalic">E. histolytica</span>)/<span class="elsevierStyleItalic">dispar</span> (144; 25.3%), <span class="elsevierStyleItalic">Strongyloides stercoralis</span> (<span class="elsevierStyleItalic">S. stercoralis</span>) (99; 17.4%), hookworm (66; 11.6%) and schistosomiasis (48; 8.4%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the first visit, the group of 570 patients with <span class="elsevierStyleItalic">B. hominis</span> infection had a mean eosinophil blood count of 374.6<span class="elsevierStyleHsp" style=""></span>cells/μL (range, 5–3202) and a mean IgE level of 17.11<span class="elsevierStyleHsp" style=""></span>IU/mL (range, 3.6–11,860.9). In the first visit, the patients with no parasitic co-infection had a mean total eosinophil blood count of 271.2<span class="elsevierStyleHsp" style=""></span>cells/μL (range, 5–3202) and a mean IgE level of 458<span class="elsevierStyleHsp" style=""></span>IU/mL (range, 3.6–7816). <span class="elsevierStyleItalic">B. hominis</span> was isolated in the first batch of feces from 215 (87.7%) of these patients. Of the 30 remaining patients, 26 (10.6%) were diagnosed in the second batch, and 4 (1.6%) were diagnosed in the third.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Among the 23 patients with exclusively <span class="elsevierStyleItalic">B. hominis</span> isolates and eosinophilia (total eosinophil count >450<span class="elsevierStyleHsp" style=""></span>cells/μL), possible alternative causes for the eosinophilia were found: 3 of the patients had vasculitis with positive antineutrophil cytoplasmic antibodies, bronchial asthma and primary biliary cirrhosis/primary sclerosing cholangitis; IgG serology results showed <span class="elsevierStyleItalic">Schistosoma</span> in 4 patients, although the eosinophilia persisted despite treatment with praziquantel; in 5 cases, the eosinophilia was transient; 6 patients underwent empiric treatment with albendazole, praziquantel and ivermectin, after a negative parasitological study, and the eosinophilia disappeared in 4 of them; finally, 5 cases were lost during the follow-up.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 245 patients with exclusive <span class="elsevierStyleItalic">B. hominis</span> isolates, antiparasitic therapy was prescribed for 42 symptomatic patients. Nineteen cases were lost during the follow-up. Of the remaining 23 patients, 18 (78.2%) improved clinically, and the parasites in feces were neutralized in 19 (82.6%).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Parasitosis by <span class="elsevierStyleItalic">B. hominis</span> is highly prevalent in patients treated in a TMU. The infection mainly affects immigrants, and many of the cases are asymptomatic. In the symptomatic patients, the clinical manifestations can be attributed in most cases to other concomitant parasitoses. However, when there is no other cause that explains the symptoms, treatment with metronidazole resolves or improves the symptoms and eliminates the parasite in a significant number of patients.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Parasitosis by <span class="elsevierStyleItalic">B. hominis</span> is especially frequent in economically depressed populations of tropical and subtropical regions. Among the patients treated in our unit, the prevalence of parasitosis by <span class="elsevierStyleItalic">B. hominis</span> was 18%, a rate very similar to that measured in the multicenter study by El Safadi et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> on a French population (18.1%) of mostly sub-Saharan immigrants. These readings vary substantially in other regions. For example, in the study by Scanlan et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> in the United States, the prevalence was 7% due to the smaller immigrant population.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Although most of the patients included in our series came from countries with low levels of development, 18 patients (3.2%) were Spanish, 40% of whom had traveled to various countries with deficient hygiene-sanitary conditions.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Blastocystosis is a zoonosis transmitted from animals to humans, although intraindividual contagion is possible. In both cases, this transmission involves a fecal-oral mechanism, through water or food contaminated with the parasite's cysts.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> In native cases, the transmission mechanism is difficult to establish, although a number of patients in the present study had consumed water from untreated natural springs.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The most common symptoms related to <span class="elsevierStyleItalic">B. hominis</span> infection are abdominal pain, diarrhea, flatulence, asthenia and weight loss.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4,6</span></a> As with other studies,<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7,8</span></a> the main referral symptoms in our study were abdominal pain and diarrhea. Less common were urticarial symptoms (acute and chronic),<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9,10</span></a> with no other cause that could explain them and that resolved after the start of antiparasitic therapy.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10,11</span></a> In our study, 18 patients (7.3%) presented pruritus, and 6 (2.4%) presented urticarial manifestations.</p><p id="par0110" class="elsevierStylePara elsevierViewall">There are studies that have indicated a relationship between the infectious <span class="elsevierStyleItalic">B. hominis</span> subtype and the clinical expression, such that subtypes 1 and 3 are related to gastrointestinal manifestations, with subtype 3 prevalent in humans, while subtypes 2 and 4 are related to urticarial conditions.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4,12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Another frequent reason for referral was eosinophilia, which was present in 73 patients (12.8%) with parasitic co-infections and in 23 (9.4%) with exclusively <span class="elsevierStyleItalic">B. hominis</span> parasitosis, as reflected in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Among the patients with parasitic co-infections, eosinophilia could be explained by the presence of the other parasites, mainly helminths such as <span class="elsevierStyleItalic">Schistosoma</span>, <span class="elsevierStyleItalic">S. stercoralis</span>, hookworm, <span class="elsevierStyleItalic">Ascaris lumbricoides</span> and <span class="elsevierStyleItalic">Trichuris trichiura</span>. In the patients with exclusively <span class="elsevierStyleItalic">B. hominis</span> isolates, the eosinophilia could be due to the presence of undiagnosed helminthiasis, after reasonably ruling out the other causes (medication, allergic processes, <span class="elsevierStyleItalic">etc.</span>).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleItalic">B. hominis</span> does not produce eosinophilia but rather acts by increasing interleukin production (4, 5 and 13, among others), resulting in IgE-mediated reactions, with the participation of mast cells and basophils but not eosinophils.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> In a study conducted by Zaki et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> on children with parasitosis by <span class="elsevierStyleItalic">B. hominis</span>, an association between this parasite and the presence of eosinophilia could not be demonstrated.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The screening of imported diseases in the immigrant population, implemented in primary care, helps identify parasitosis by <span class="elsevierStyleItalic">B. hominis</span> in a considerable proportion of patients.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">15,16</span></a> In our study, 75.3% of the patients were referred from primary care, and parasitosis by <span class="elsevierStyleItalic">B. hominis</span> was diagnosed in 31% of the patients.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In terms of the antiparasitic therapy for patients with <span class="elsevierStyleItalic">B. hominis</span> isolates, most studies conclude that it is not necessary for asymptomatic patients. For symptomatic patients, the recommendation is to rule out other possible etiologies. Therapy is warranted when the patient is symptomatic and there are no other causes that explain the symptoms.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">17–19</span></a> In this study, a high percentage of the 42 treated patients showed cure criteria, with symptoms disappearing in 78% of the cases and neutralization of the parasite in feces in 83%.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The efficacy of treatment against <span class="elsevierStyleItalic">B. hominis</span> is debatable. In the series by Nigro et al.,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> symptoms disappeared in 88% of the patients treated with metronidazole compared with only 14% of the placebo group. In contrast, in a study with 18 patients treated with metronidazole, iodoquinol or triple therapy (nitazoxanide, furazolidone and secnidazole), the symptoms and the parasite isolates in feces persisted.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> A subsequent study observed a low susceptibility of the parasite to metronidazole, suggesting trimethoprim-sulfamethoxazole or ivermectin as possible alternatives.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Silva-Díaz et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> found a good response to treatment with metronidazole and nitazoxanide but resistance to treatment with trimethoprim-sulfamethoxazole and erythromycin. These conflicting results could be partly explained by the parasite's varying susceptibility depending on the selective antimicrobial pressure in each population. New studies are therefore needed to determine the efficacy of the various antimicrobials against <span class="elsevierStyleItalic">B. hominis</span>, more <span class="elsevierStyleItalic">in vivo</span> than <span class="elsevierStyleItalic">in vitro</span>.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our study's limitations include our laboratory's inability to differentiate <span class="elsevierStyleItalic">E. histolytica</span> from <span class="elsevierStyleItalic">E. dispar</span> and the significant number of patients who were lost during the subsequent follow-up (45%), which impedes the assessment of the efficacy of the antiparasitic therapy. Lastly, given our study's retrospective character, we only included patients referred to a reference unit. The actual prevalence of this parasitosis could have therefore been overestimated.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion, <span class="elsevierStyleItalic">B. hominis</span> is one of the most common intestinal parasites diagnosed in sub-Saharan immigrants in our community. The implementation of specific protocols in the initial care of immigrant patients helps detect a high number of asymptomatic patients and treat those patients in whom <span class="elsevierStyleItalic">B. hominis</span> could be causing the symptoms. Treatment with metronidazole appears to be effective, both in eradicating the parasite and in the disappearance of the symptoms. We need to develop techniques that help us determine the parasite's pathogenicity and identify the pathogenic strains, the various subtypes and their geographical distribution, their hosts and their relationship with the resulting clinical conditions.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1009448" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec968986" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1009449" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec968985" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-09" "fechaAceptado" => "2018-01-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec968986" "palabras" => array:5 [ 0 => "<span class="elsevierStyleItalic">Blastocystis hominis</span>" 1 => "Intestinal parasitosis" 2 => "Parasitic co-infections" 3 => "Gastrointestinal disorders" 4 => "Metronidazole" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec968985" "palabras" => array:5 [ 0 => "<span class="elsevierStyleItalic">Blastocystis hominis</span>" 1 => "Parasitosis intestinales" 2 => "Coparasitaciones" 3 => "Alteraciones gastrointestinales" 4 => "Metronidazol" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Blastocystis hominis</span> (<span class="elsevierStyleItalic">B. hominis</span>) is one of the most common intestinal parasites isolated in humans. The parasite can cause gastrointestinal symptoms or, in most cases, remain asymptomatic. There are issues concerning the parasite's pathogenic character. The aim of this study was to analyze the clinical and epidemiological characteristics of the parasite infection by B. hominis, with or without other parasitic co-infections.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational retrospective study was conducted of <span class="elsevierStyleItalic">B. hominis</span> isolates in feces from October 2004 to March 2016 in a tropical medicine unit. We reviewed all patients with a parasite infection, exclusively or not by <span class="elsevierStyleItalic">B. hominis</span>.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied 3070 patients, 570 (18%) of whom were diagnosed with B. hominis infection, which was the only isolate in 245 (43%) of the 570 patients. A total of 325 (57%) patients presented other parasitic co-infections (<span class="elsevierStyleItalic">Entamoeba histolytic</span> or <span class="elsevierStyleItalic">Entamoeba dispar</span>, <span class="elsevierStyleItalic">Strongyloides stercoralis</span>, hookworm and <span class="elsevierStyleItalic">Schistosoma</span> spp.). The main symptom was abdominal pain (41.8%). In 31.2% of cases, the parasite was detected in the imported diseases screening of asymptomatic patients. Of those who underwent treatment with metronidazole, 78.2% improved. The parasite was neutralized in 82.6% of the patients.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Parasite infection by <span class="elsevierStyleItalic">B. hominis</span> is one of the most common diseases in our tropical medicine unit. Most patients are asymptomatic, or their symptoms can be attributed to other parasite infections. In those cases in which symptoms persist without being able to attribute them to other causes, a specific treatment is recommended.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Blastocystis hominis (B. hominis)</span> es uno de los parásitos intestinales más frecuentemente aislados en el ser humano. Puede producir sintomatología gastrointestinal o, en la mayoría de los casos, permanecer asintomático. Existen dudas sobre el carácter patógeno del parásito. El objetivo de este estudio fue analizar las características clínicas y epidemiológicas de la parasitación por <span class="elsevierStyleItalic">B. hominis</span>, con y sin otras coparasitaciones.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo de aislamientos de <span class="elsevierStyleItalic">B. hominis</span> en heces, desde octubre del 2004 hasta marzo del 2016 en una Unidad de Medicina Tropical. Se revisó a todos los pacientes con parasitación exclusiva, o no, por <span class="elsevierStyleItalic">B. hominis</span>.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudió a 3.070 pacientes. En 570 (18%) se diagnosticó infección por <span class="elsevierStyleItalic">B. hominis</span>, de los que en 245 (43%) representó el único aislamiento; 325 (57%) presentaron otras coparasitaciones <span class="elsevierStyleItalic">(Entamoeba hystolitica</span> o dispar, <span class="elsevierStyleItalic">Strongyloides stercoralis</span>, uncinarias y <span class="elsevierStyleItalic">Schistosoma</span> sp.). El síntoma principal fue dolor abdominal (41,8%). En un 31,2% el parásito se detectó en el cribado de enfermedades importadas en pacientes asintomáticos. De los que recibieron tratamiento con metronidazol, un 78,2% mejoró y en el 82,6% los parásitos se negativizaron.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La parasitación por <span class="elsevierStyleItalic">B. hominis</span> es una de las enfermedades más frecuentes en nuestra Unidad de Medicina Tropical. La mayoría de los pacientes están asintomáticos o bien la clínica puede ser atribuida a otras parasitaciones. En aquellos casos en los que persisten los síntomas sin poder ser atribuidos a otras causas, es recomendable un tratamiento específico.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ocaña-Losada C, Cuenca-Gómez JA, Cabezas-Fernández MT, Vázquez-Villegas J, Soriano-Pérez MJ, Cabeza-Barrera I, et al. Características clínicas y epidemiológicas de la parasitación intestinal por <span class="elsevierStyleItalic">Blastocystis hominis</span>. Rev Clin Esp. 2018;218:115-120.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This study was conducted within the activities implemented by the research group CTS 582 of the Ministry of Health of the Government of Andalusia, the Cooperative Research Network on Tropical Diseases (RICET) and the Center for the Study of Migrations and Intercultural Relationships (CEMyRI) of the University of Almeria.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age, years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Traveler \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Countries visited \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parasitic co-infections \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytica</span>/<span class="elsevierStyleItalic">dispar</span>, <span class="elsevierStyleItalic">Giardia lamblia</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Costa Rica, Panama, United States, Peru \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Giardia lamblia</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Endolimax nana</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Expatriates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mexico (Veracruz) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Expatriates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Democratic Republic of Congo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arthromylagia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytica</span>/<span class="elsevierStyleItalic">dispar</span>, <span class="elsevierStyleItalic">Giardia lamblia</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Morocco (Casablanca) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytic</span>/<span class="elsevierStyleItalic">dispar</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ethiopia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Schistosoma</span> spp. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytic</span>/<span class="elsevierStyleItalic">dispar</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Uzbekistan, Egypt, Tunisia, Jordan, Brazil, Israel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Strongyloides stercoralis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mexico \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1709664.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Spanish patients infected by <span class="elsevierStyleItalic">Blastocystis hominis</span>.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With parasitic co-infections, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without parasitic co-infections, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">238 (41.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (36.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Screening of asymptomatic patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">178 (31.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Eosinophilia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (9.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatic disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (11.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (7.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Skin lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adenopathies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Macrohematuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arthromylagia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiological lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ophthalmologic abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Microhematuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other reasons \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (7.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1709665.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Reasons for referral of patients with <span class="elsevierStyleItalic">Blastocystis hominis</span> isolates, with or without parasitic co-infections.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parasite \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytic</span>/<span class="elsevierStyleItalic">dispar</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Strongyloides stercoralis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hookworm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Schistosoma</span> spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Endolimax nana</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Giardia lamblia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hymenolepis nana</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Trichuris trichiura</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cryptosporidium</span> spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ascaris lumbricoides</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enterobius vermicularis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Taenia</span> spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1709663.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Intestinal parasitic co-infections found in the study patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por <span class="elsevierStyleItalic">Blastocystis</span> sp., revisión de la literatura" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. 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| 2023 March | 7 | 6 | 13 |
| 2020 September | 0 | 1 | 1 |
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