Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Sep 18, 2024; 12(3): 95631
Published online Sep 18, 2024. doi: 10.13105/wjma.v12.i3.95631
Blastocystis hominis as a cause of chronic diarrhea in low-resource settings: A systematic review
Stephen Amoak, Jonathan Soldera
Stephen Amoak, Presbyterian Hospital Bawku, Bawku, UA0010, Ghana
Jonathan Soldera, Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: Soldera J, Amoak S participated in the concept and design research, drafted the manuscript and contributed to data acquisition, analysis and interpretation; Soldera J contributed to study supervision; all authors contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest pertaining to the subject matter discussed in this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, PhD, Tutor, Acute Medicine and Gastroenterology, University of South Wales, Llantwit Rd, Pontypridd, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Received: April 14, 2024
Revised: August 24, 2024
Accepted: September 4, 2024
Published online: September 18, 2024
Processing time: 151 Days and 14.1 Hours
Abstract
BACKGROUND

Blastocystis hominis (B. hominis), an anaerobic unicellular protist parasite, is known for its diverse clinical manifestations upon infecting the human gastrointestinal tract. Although globally distributed, it is particularly prevalent in developing nations. Examining the symptoms and treatment outcomes of B. hominis infection in low-resource settings holds immense significance, providing healthcare practitioners with valuable insights to enhance patient care.

AIM

To synthesize existing evidence on the symptomatology and treatment outcomes of B. hominis infection in low-resource settings.

METHODS

Following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a systematic review was conducted. The search spanned electronic databases including PubMed, Scopus, and Google Scholar. After a comprehensive screening process, a thorough examination of the papers, adhering to inclusion and exclusion criteria, and data extraction from eligible studies was conducted. The findings underwent summarization through simple descriptive analysis.

RESULTS

The search yielded 1200 papers, with 17 meeting inclusion criteria. Chronic diarrhea due to B. hominis infection was reported in only two studies, while abdominal pain, diarrhea, flatulence, constipation, and nausea/vomiting emerged as the most commonly documented symptoms. Recovery rates after one week of treatment ranged from 71.8% to 100%, and after two weeks, from 60% to 100%.

CONCLUSION

In low-resource settings, chronic diarrhea resulting from B. hominis infection is infrequent. Common symptoms include abdominal pain, diarrhea, flatulence, constipation, and nausea/vomiting. Post-treatment, clinical outcomes are notably favorable, supporting the recommendation for treatment. Metronidazole is advocated as the first-line agent, with consideration for switching to a second-line option in cases of treatment failure or poor response.

Keywords: Blastocystis infections; Gastrointestinal diseases; Treatment outcome; Developing countries; Metronidazole/therapeutic use

Core Tip: This systematic review highlights the symptomatology and treatment outcomes of Blastocystis hominis (B. hominis) infection in low-resource settings. Notably, chronic diarrhea due to B. hominis is rare in these contexts. Abdominal pain, diarrhea, flatulence, constipation, and nausea/vomiting are the predominant symptoms reported. Post-treatment recovery rates are promising, ranging from 60% to 100% after two weeks of treatment. Metronidazole is recommended as the initial treatment, with consideration for alternative options if needed. These findings provide valuable insights for healthcare practitioners managing B. hominis infections in resource-limited settings.