Frequency and Subtypes of Blastocystis in Patients with Diarrhea in Van, Türkiye 2022–2023
,
Abstract
Background: We sought to determine how often Blastocystis. occurs and which subtypes predominate in patients suffering from diarrhea in Van, Türkiye.
Methods: We enrolled 200 volunteers—100 with diarrhea and 100 healthy controls—and examined their stool samples both by light microscopy and by PCR amplification of the 18S SSU rRNA gene. DNA sequences from 14 positive PCR amplicons were analyzed for the 18S SSU rDNA gene, and the subtypes were identified by sequence analysis of the PCR amplicons.
Results: Blastocystis was identified in 20 of 100 diarrheal patients (20%) and in 16 of 100 controls (16%). Among patients, the highest carriage rate was seen in females (21.6%), whereas in the control group it was males who showed the greatest prevalence (20.7%). When stratified by age, individuals aged 11–18 years exhibited the highest positivity: 40% in the patient cohort and 21.4% among controls. No significant differences emerged between patient and control groups with respect to age or sex overall, although the comparison of under-18s (23%) versus those 19 and older (10.3%) reached statistical significance (P = 0.013). Statistical analysis did not reveal any link between Blastocystis carriage and gastrointestinal symptoms. Sequencing of positive diarrheal samples showed that subtype 1 (ST1) accounted for 71.4% and subtype 2 (ST2) for 28.6% of cases.
Conclusion: The dominance of ST1 in diarrheal patients supports the subtype-pathogenicity relationship; however, further studies involving a large number of symptomatic and asymptomatic individuals are required to elucidate this relationship more precisely.
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3. Malatyalı E, Ertabaklar H, Ertuğ S. Subtype distribution of Blastocystis in Türkiye. Turkiye Parazitol Derg. 2023;47(3): 184-189.
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5. Zierdt CH. Blastocystis hominis-past and future. Clinical Microbiol Rev. 1991;4(1):61-79.
6. 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(8):803-807.
7. Stensvold CR, Clark CG. Current status of Blastocystis: A personal view. Parasitol Int. 2016;65:763-771.
8. Alfellani MA, Jacob AS, Perea NO, et al. Diversity and distribution of Blastocystis sp. subtypes in non-human primates. Parasitology. 2013; 140:966-71.
9. Popruk S, Adao DEV, Rivera WL. Epidemiology and subtype distribution of Blastocystis in humans: a review. Infect Genet Evol. 2021;95:105085.
10. Stensvold CR, Smith HV, Nagel R, et al. Eradication of Blastocystis carriage with antimicrobials: reality or delusion? J Clin Gastroenterol. 2010;44:85-90.
11. Dinleyici EC, Eren M, Dogan N, et al. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res. 2011;108:541-545.
12. Roberts T, Stark D, Harkness J, Ellis J. Update on the pathogenic potential and treatment options for Blastocystis sp.. Gut Pathog. 2014;6:17.
13. Şahin M, Cengiz ZT, Halidi AG, Aydemir S. Investigation of Blastocystis hominis Frequency in Patients with Diabetes by Microscopy and Conventional PCR Methods. Iran J Parasitol, 2023;18(2): 202-210.
14. Tamura K, Stecher G, Kumar S. MEGA11: Molecular Evolutionary Genetics Analysis version 11. Mol Biol Evol. 2021;38:3022-3027.
15. Alfellani MA, Stensvold CR, Vidal-Lapiedra A, et al. Variable geographic distribution of Blastocystis subtypes and its potential implications. Acta Trop. 2013;126(1):11-18.
16. El-Shazly AM, Abdel-Magied AA, El-Beshbishi SN, et al. Blastocystis hominis among symptomatic and asymptomatic individuals in Talkha Center, Dakahlia Governorate, Egypt. J Egypt Soc Parasitol. 2005;35:653-666.
17. Logar J, Andlovic A, Polj M. Incidence of Blastocystis hominis in patients with diarrhea. J Infect. 1994;28(2):151-154.
18. Stenzel DJ, Boreham PF. Blastocystis hominis revisited. Clin Microbiol Rev. 1996;9(4):563-584.
19. Stensvold CR. Blastocystis: Genetic diversity and molecular methods for diagnosis and epidemiology. Trop Parasitol. 2013;3(1):26-34.
20. Jalallou N, Iravani S, Rezaeian M, et al. Subtypes distribution and frequency of Blastocystis sp. isolated from diarrheic and non-diarrheic patients. Iran J Parasitol. 2017;12(1):63-68.
21. Kim MJ, Won EJ, Kim SH, et al. Molecular detection and subtyping of human Blastocystis and the clinical implications: Comparisons between diarrheal and non-diarrheal groups in Korean populations. Korean J Parasitol. 2020;58(3):321-326.
22. Cañete R, Jimenez PR, Sounouve KM, et al. Blastocystis sp. infection in patients with gastrointestinal complaints: a Cuban study. Turk Hij Den Biyol Derg. 2014;71(4):165-170.
23. Güreser AS, Karasartova D, Sarzhanov F, et al. Prevalence of Blastocystis and Dientamoeba fragilis in diarrheal patients in Corum, Türkiye. Parasitol Res. 2023;122(12):2977-2987.
24. Bugis AA, Mallah BA, Mallah BA, Zakai HA. Blastocystis hominis: Is it a cause of diarrhea?. Jour Adv Lab Res Biol. 2017;8(1):1-5.
25. El Safadi D, Cian A, Nourrisson C, et al. Prevalence, risk factors for infection and subtype distribution of the intestinal parasite Blastocystis sp. from a large-scale multi-centre study in France. BMC Infect Dis. 2016;16:451.
26. Beyhan YE, Gorgisen G. The molecular prevalence of Blastocystis spp. in patients with diarrhea. Gazi Med J. 2023;34;133-136.
27. Lu CT, Sung YJ. Epidemiology of Blastocystis hominis and other intestinal parasites among the immigrant population in northeastern Taiwan by routine physical examination for residence approval. J Microbiol Immunol Infect. 2009; 42:505-509.
28. Khoshnood S, Rafiei A, Saki J, Alizadeh K. Prevalence and genotype characterization of Blastocystis hominis among the Baghmalek people in southwestern Iran in 2013–2014. Jundishapur J Microbiol. 2015;8(10):e23930.
29. Abdulsalam AM, Ithoi I, Al-Mekhlafi HM, et al. Subtype distribution of Blastocystis isolates in Sebha, Libya. PLoS One. 2013;8(12):e84372.
30. Bart A, Wentink-Bonnema EM, Gilis H, et al. Diagnosis and subtype analysis of Blastocystis sp. in 442 patients in a hospital setting in the Netherlands. BMC Infect Dis. 2013;13:389.
31. Sheehan DJ, Raucher BG, McKitrick JC. Association of Blastocystis hominis with signs and symptoms of human disease. J Clin Microbiol. 1986;24:548-550.
32. Jha S, Gupta P, Bhatia M. Blastocystis spp. infection in cases of diarrhea: A pilot study from a tertiary care teaching hospital in Rishikesh, Uttarakhand, with a brief review of the literature. Trop Parasitol. 2021;11(2):113-121.
33. Kaya S, Çetin ES, Arıdoğan BC, et al. Pathogenicity of Blastocystis hominis, a clinical reevaluation. Türkiye Parazitol Derg. 2007;31(3):184-187.
34. Zulfa F, Sari IP, Kurniawan A. Association of Blastocystis subtypes with diarrhea in children. J Physics Conference Ser. 2017;884:012031.
35. Adıyaman Korkmaz G, Doğruman Al F, Mumcuoğlu İ. Investigation of the presence of Blastocystis spp. in stool samples with microscopic, culture and molecular methods. Mikrobiyol Bul. 2015;49(1):85-97.
36. Ramirez JD, Sanchez LV, Bautista DC, et al. Blastocystis subtypes detected in humans and animals from Colombia. Infect Genet Evol. 2014;22:223-238.
37. Alinaghizade A, Mirjalali H, Mohebali M, et al. Inter-and intra subtype variation of Blastocystis subtypes isolated from diarrheic and non-diarrheic patients in Iran. Infect Genet Evol. 2017;50:77-82.
38. Stensvold CR, Christiansen DB, Olsen KEP, Nielsen HV. Blastocystis sp. subtype 4 is common in Danish Blastocystis-positive patients presenting with acute diarrhea. Am J Trop Med Hyg. 2011; 84(6):883-885.
39. Dağcı H, Kurt O, Demirel M, et al. Epidemiological and diagnostic features of Blastocystis infection in symptomatic patients in Izmir Province, Turkey. Iran J Parasitol. 2014;9(4):519-529.
40. Büyükbaba BÖ, Çelik PDG, Akgül A, İşsever H. Blastocystis spp. saptanan 50 semptomatik hastada subtip dağılımın saptanması. Kocaeli Üniv. Sağlık Bilimleri Derg. 2017;3:6-10.
41. Mohamed FAM, Khalıl KA. Blastocystis subtype 3 among adolescents with gastrointestınal symptoms in Fayoum Governorate, Egypt. J Egypt Soc Parasitol. 2023;53(3):467-474.
42. Aykur M, Çalıskan Kurt C, Dirim Erdogan D, et al. Distribution and phylogenetic analysis of subtypes and alleles of Blastocystis sp. in the stool samples collected from patients with gastrointestinal complaints in İzmir, Turkey. Acta Parasitol. 2023;68(2):304-316.
43. Yan Y, Su S, Lai R, et al. Genetic variability of Blastocystis hominis isolates in China. Parasitol Res. 2006;99:597-601.
44. Eroğlu F, Genc A, Elgun G, Koltas IS. Identification of Blastocystis hominis isolates from asymptomatic and symptomatic patients by PCR. Parasitol Res. 2009;105(6):1589-1592.
45. El Safadi D, Osman M, Mallat H, et al. Molecular epidemiology of Blastocystis in Lebanon and correlation between subtype 1 and gastrointestinal symptoms. Am J Trop Med Hyg. 2013;88:1203-1206.
2. Lhotská Z, Jirků M, Hlŏzková O, et al. A study on the prevalence and subtype diversity of the intestinal protist Blastocystis sp. in a gut-healthy human population in the Czech Republic. Front Cell Infect Microbiol. 2020;10:544335.
3. Malatyalı E, Ertabaklar H, Ertuğ S. Subtype distribution of Blastocystis in Türkiye. Turkiye Parazitol Derg. 2023;47(3): 184-189.
4. Tan KS. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev. 2008;21(4):639-665.
5. Zierdt CH. Blastocystis hominis-past and future. Clinical Microbiol Rev. 1991;4(1):61-79.
6. 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(8):803-807.
7. Stensvold CR, Clark CG. Current status of Blastocystis: A personal view. Parasitol Int. 2016;65:763-771.
8. Alfellani MA, Jacob AS, Perea NO, et al. Diversity and distribution of Blastocystis sp. subtypes in non-human primates. Parasitology. 2013; 140:966-71.
9. Popruk S, Adao DEV, Rivera WL. Epidemiology and subtype distribution of Blastocystis in humans: a review. Infect Genet Evol. 2021;95:105085.
10. Stensvold CR, Smith HV, Nagel R, et al. Eradication of Blastocystis carriage with antimicrobials: reality or delusion? J Clin Gastroenterol. 2010;44:85-90.
11. Dinleyici EC, Eren M, Dogan N, et al. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res. 2011;108:541-545.
12. Roberts T, Stark D, Harkness J, Ellis J. Update on the pathogenic potential and treatment options for Blastocystis sp.. Gut Pathog. 2014;6:17.
13. Şahin M, Cengiz ZT, Halidi AG, Aydemir S. Investigation of Blastocystis hominis Frequency in Patients with Diabetes by Microscopy and Conventional PCR Methods. Iran J Parasitol, 2023;18(2): 202-210.
14. Tamura K, Stecher G, Kumar S. MEGA11: Molecular Evolutionary Genetics Analysis version 11. Mol Biol Evol. 2021;38:3022-3027.
15. Alfellani MA, Stensvold CR, Vidal-Lapiedra A, et al. Variable geographic distribution of Blastocystis subtypes and its potential implications. Acta Trop. 2013;126(1):11-18.
16. El-Shazly AM, Abdel-Magied AA, El-Beshbishi SN, et al. Blastocystis hominis among symptomatic and asymptomatic individuals in Talkha Center, Dakahlia Governorate, Egypt. J Egypt Soc Parasitol. 2005;35:653-666.
17. Logar J, Andlovic A, Polj M. Incidence of Blastocystis hominis in patients with diarrhea. J Infect. 1994;28(2):151-154.
18. Stenzel DJ, Boreham PF. Blastocystis hominis revisited. Clin Microbiol Rev. 1996;9(4):563-584.
19. Stensvold CR. Blastocystis: Genetic diversity and molecular methods for diagnosis and epidemiology. Trop Parasitol. 2013;3(1):26-34.
20. Jalallou N, Iravani S, Rezaeian M, et al. Subtypes distribution and frequency of Blastocystis sp. isolated from diarrheic and non-diarrheic patients. Iran J Parasitol. 2017;12(1):63-68.
21. Kim MJ, Won EJ, Kim SH, et al. Molecular detection and subtyping of human Blastocystis and the clinical implications: Comparisons between diarrheal and non-diarrheal groups in Korean populations. Korean J Parasitol. 2020;58(3):321-326.
22. Cañete R, Jimenez PR, Sounouve KM, et al. Blastocystis sp. infection in patients with gastrointestinal complaints: a Cuban study. Turk Hij Den Biyol Derg. 2014;71(4):165-170.
23. Güreser AS, Karasartova D, Sarzhanov F, et al. Prevalence of Blastocystis and Dientamoeba fragilis in diarrheal patients in Corum, Türkiye. Parasitol Res. 2023;122(12):2977-2987.
24. Bugis AA, Mallah BA, Mallah BA, Zakai HA. Blastocystis hominis: Is it a cause of diarrhea?. Jour Adv Lab Res Biol. 2017;8(1):1-5.
25. El Safadi D, Cian A, Nourrisson C, et al. Prevalence, risk factors for infection and subtype distribution of the intestinal parasite Blastocystis sp. from a large-scale multi-centre study in France. BMC Infect Dis. 2016;16:451.
26. Beyhan YE, Gorgisen G. The molecular prevalence of Blastocystis spp. in patients with diarrhea. Gazi Med J. 2023;34;133-136.
27. Lu CT, Sung YJ. Epidemiology of Blastocystis hominis and other intestinal parasites among the immigrant population in northeastern Taiwan by routine physical examination for residence approval. J Microbiol Immunol Infect. 2009; 42:505-509.
28. Khoshnood S, Rafiei A, Saki J, Alizadeh K. Prevalence and genotype characterization of Blastocystis hominis among the Baghmalek people in southwestern Iran in 2013–2014. Jundishapur J Microbiol. 2015;8(10):e23930.
29. Abdulsalam AM, Ithoi I, Al-Mekhlafi HM, et al. Subtype distribution of Blastocystis isolates in Sebha, Libya. PLoS One. 2013;8(12):e84372.
30. Bart A, Wentink-Bonnema EM, Gilis H, et al. Diagnosis and subtype analysis of Blastocystis sp. in 442 patients in a hospital setting in the Netherlands. BMC Infect Dis. 2013;13:389.
31. Sheehan DJ, Raucher BG, McKitrick JC. Association of Blastocystis hominis with signs and symptoms of human disease. J Clin Microbiol. 1986;24:548-550.
32. Jha S, Gupta P, Bhatia M. Blastocystis spp. infection in cases of diarrhea: A pilot study from a tertiary care teaching hospital in Rishikesh, Uttarakhand, with a brief review of the literature. Trop Parasitol. 2021;11(2):113-121.
33. Kaya S, Çetin ES, Arıdoğan BC, et al. Pathogenicity of Blastocystis hominis, a clinical reevaluation. Türkiye Parazitol Derg. 2007;31(3):184-187.
34. Zulfa F, Sari IP, Kurniawan A. Association of Blastocystis subtypes with diarrhea in children. J Physics Conference Ser. 2017;884:012031.
35. Adıyaman Korkmaz G, Doğruman Al F, Mumcuoğlu İ. Investigation of the presence of Blastocystis spp. in stool samples with microscopic, culture and molecular methods. Mikrobiyol Bul. 2015;49(1):85-97.
36. Ramirez JD, Sanchez LV, Bautista DC, et al. Blastocystis subtypes detected in humans and animals from Colombia. Infect Genet Evol. 2014;22:223-238.
37. Alinaghizade A, Mirjalali H, Mohebali M, et al. Inter-and intra subtype variation of Blastocystis subtypes isolated from diarrheic and non-diarrheic patients in Iran. Infect Genet Evol. 2017;50:77-82.
38. Stensvold CR, Christiansen DB, Olsen KEP, Nielsen HV. Blastocystis sp. subtype 4 is common in Danish Blastocystis-positive patients presenting with acute diarrhea. Am J Trop Med Hyg. 2011; 84(6):883-885.
39. Dağcı H, Kurt O, Demirel M, et al. Epidemiological and diagnostic features of Blastocystis infection in symptomatic patients in Izmir Province, Turkey. Iran J Parasitol. 2014;9(4):519-529.
40. Büyükbaba BÖ, Çelik PDG, Akgül A, İşsever H. Blastocystis spp. saptanan 50 semptomatik hastada subtip dağılımın saptanması. Kocaeli Üniv. Sağlık Bilimleri Derg. 2017;3:6-10.
41. Mohamed FAM, Khalıl KA. Blastocystis subtype 3 among adolescents with gastrointestınal symptoms in Fayoum Governorate, Egypt. J Egypt Soc Parasitol. 2023;53(3):467-474.
42. Aykur M, Çalıskan Kurt C, Dirim Erdogan D, et al. Distribution and phylogenetic analysis of subtypes and alleles of Blastocystis sp. in the stool samples collected from patients with gastrointestinal complaints in İzmir, Turkey. Acta Parasitol. 2023;68(2):304-316.
43. Yan Y, Su S, Lai R, et al. Genetic variability of Blastocystis hominis isolates in China. Parasitol Res. 2006;99:597-601.
44. Eroğlu F, Genc A, Elgun G, Koltas IS. Identification of Blastocystis hominis isolates from asymptomatic and symptomatic patients by PCR. Parasitol Res. 2009;105(6):1589-1592.
45. El Safadi D, Osman M, Mallat H, et al. Molecular epidemiology of Blastocystis in Lebanon and correlation between subtype 1 and gastrointestinal symptoms. Am J Trop Med Hyg. 2013;88:1203-1206.
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| Issue | Vol 21 No 1 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijpa.v21i1.21634 | |
| Keywords | ||
| Blastocystosis Diarrhea Microscopy Subtype1 Türkiye | ||
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How to Cite
1.
Gümüş M, Aydemir S, Taş Cengiz Z, Yılmaz H. Frequency and Subtypes of Blastocystis in Patients with Diarrhea in Van, Türkiye 2022–2023. Iran J Parasitol. 2026;21(1):57-66.
