Balantidium Coli

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 Classification

• Kingdom : Protista
• Phylum: Protozoa
• Sub phylum: Cilliophora
• Class: Cilliata
• Order Vestibuliferida
• Family: Balantidiidae
• Genus: Balantidium
• Species: Balantidium coli
 Introduction

• Balantidium is a genus of
ciliates.
• Balantidium coli, is the only
member of the ciliate phylum
known to be pathogenic to
humans

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 Introduction

• Balantidium has two species :-

 Balantidium suis - infect the pigs.
 Balantidium coli - infect the human.
• Balantidium coli is the largest protozoan and the only
ciliate known to parasitize humans causing Balantidiasis
• but naturally it is a parasite of pigs in which it causes no
serious disease.

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 Introduction cont…

• Balantidium coli most commonly infects

humans, other primates, and pigs, which are
reservoirs of the parasite.
• It resides in the large intestine of man, pig
(main reservoir) and other animals.

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 Distribution

• It occurs worldwide(cosmopolitan).
• Because pigs are the primary reservoir, human
infections occur more frequently in areas where pigs
are raised and sanitation is inadequate.

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 Distribution cont…
• Infection is rare, but is likely to occur in places where
humans live closely with swine and where water
sanitation is poor.
• In addition to humans, pigs and other animals carry
the disease.
• People who raise pigs have bigger risk of getting
infected with Balantidiasis.

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 Transmission
• Balantidiasis is a zoonotic disease and is acquired by
humans via the feco-oral route from the normal host,
the domestic pig, where it is asymptomatic.
• Contaminated water is the most common mechanism of
transmission
• Human infection is usually acquired from swine through
ingestion of cysts from hands, in food or water
contaminated with pig’s feces. 8
 Life cycle of B.coli
• Host: Life cycle is completed in a single host.
 Pig is the natural host
 Man is the accidental host.

• Infective form: Cyst

• Mode of transmission: Man gets infection by ingestion
of food and water contaminated with cysts.
• Balantidium coli has two developmental stages, a
trophozoite/ciliate stage and a cyst stage. 9
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 The life cycle cont.

• The life cycle begins when a human ingest food or

water that has been contaminated with infective cysts.
• After ingestion, the cysts excyst in small intestines and
develops in large intestines into ciliates each producing
a single ciliate/trophozoites
• Trophozoites are the feeding stage of the parasite; they
multiply either in the gut lumen or enter the sub
mucosa of the large intestine
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 Life cycle cont…

• Trophozoites divide by both sexual and asexual

methods:
 Asexual reproduction: Trophozoites divide by binary
fission.
• Micronucleus divides first followed by the
macronucleus and finally a transverse septum is formed
that separates the cytoplasm into two halves

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 Life cycle cont…
 Sexual reproduction: Trophozoites also replicate
sexually (syngamy) by conjugation
• Some trophozoites invade the wall of the colon and
multiply, causing ulcerative pathology in the colon wall
• Some return to the lumen and disintegrate or undergo
encystation.
• Encystation is triggered by dehydration of the intestinal
contents and usually occurs in the distal large intestine,
but may also occur outside of the host in feces. 13
 Life cycle cont…

• They mature and are released into the external

environment through stool.
• The cysts are infective when passed out
• The cycle repeats itself if humans ingest them in water,
food or hands

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 SYMPTOMS

• Balantidium coli infection is most often asymptomatic,

but if the parasite/ciliates invade the large intestine
wall,
• then there is inflammation, and ulceration of intestinal
wall leading to dysentery (bloody diarrhea)
• characterized by passing out of stool containing blood
and pus, colitis, headache, abdominal pain, fever,
vomiting, nausea, loss of appetite and weight loss.
• Untreated dysentery cases can be fatal. 15
 Symptoms cont…

• Extra-intestinal infection is rare but potentially serious

and typically occurs secondary to intestinal infection.
• Peritonitis and liver abscesses have been noted following
intestinal perforation or rupture of fulminant colonic
ulcers.
• Invasion of urogenital tract may be caused by
contamination from the anal region or through fistulae
caused by severe infection
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 Symptoms cont…
• Perforation of the intestine can occur but it is rare
• Fluid loss through diarrhoea can be traumatic
• The organisms can invade the intestinal sub mucosa of
large intestines causing ulcerative abscesses and
haemorrhagic lesions

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 Laboratory diagnosis
 Stool Examination

• Repeated stool examination should be done as the

parasite is excreted intermittently.
 Laboratory diagnosis of Balantidiasis is by:

• Finding the motile ciliates or trophozoites of B. coli in a

fresh bloody faecal specimen(dysenteric faecal stool).
• Finding B. coli cysts in formed or semi-formed feces.

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 Laboratory diagnosis cont.

• Trophozoites are passed irregularly and quickly

destroyed outside the colon.
• It is found in the active stage of the disease and
considered as the invasive form.
 Trophozoites are detected in acute disease (dysenteric
stool)

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 Laboratory diagnosis cont.

 Trophozoites are easy to identify by its rotatory motility,

large size, kidney shaped macronucleus and presence of
cilia
 Cysts are seen in chronic cases or carriers
 Cyst is round, measures 40–60 μm in size, surrounded by
a cyst wall and has two nuclei.

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 Examination of feacal specimens for B. coli
ciliates
• Trophozoites degenerate rapidly in feces and therefore
specimens need to be examined while fresh
• Transfer a drop of fresh specimen to a slide and cover
with a cover slip
• Examine the preparation microscopically using the 10x
objective with the condenser iris closed sufficiently to
give good contrast
• Look for large oval shaped ciliates which have a rapid
revolving motility 21
Identification features of B. coli ciliates/ trophozoites

• Large, easily seen oval shaped ciliate

• Measure 50–200 x 40-70µm.
• They are actively motile rapidly revolving or rolling
across the microscopic field

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Morphology of Balantidium coli (schematic
diagram) (A) trophozoite; (B) cyst

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 Identification features of B. Coli ciliates cont…
• It possess a cytostome (peristome) – funnel shaped at the
narrow end of the organism.
• The body surface of this organism is covered by cilium
which is important in movement and nutrition .
• With careful focusing, the beating cilia can be seen
particularly at cytostome region.
• Often contains ingested red cells.
• There is a contractile vacuole near the blunt posterior end
of the body & another near the centre 25
 Identification features of B. Coli ciliates ….
• It has two nuclei namely the macronucleus which is kidney
shaped and a micronucleus that lies in the notch of
macronucleus which both are normally visible in stained
preparations.
• One of two contractile vacuoles may be visible.
• The cytoplasm contains numerous food particles
• Anterior end is narrow and the posterior end is broad

• Anterior end bears a groove (peristome) that leads to a mouth

(cytostome) followed by a short funnel shaped gullet

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Identification features of B. Coli
trophozoites

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 Examination of feces for B. coli cysts
• Mix small amount of feces in physiological saline on
one end of a slide and
• mix a small amount of feces in Dobell’s iodine on the
other end of the slide
• Cover the preparation with the cover glass
• Examine the preparations using the 10x objective
with the condenser iris closed sufficiently to give
good contrast 29
 Identification features of B. coli cysts

• They are round to oval in shape

• Large measuring 40–60µm in diameter.
• It is surrounded by a thick and transparent cyst wall.
• Cilia (inside wall) can sometimes be seen in younger cysts
just below the wall.
• It also contains two nuclei (macronucleus and
micronucleus) and vacuoles visible in stained
preparations
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Identification features of B. coli cysts

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 Histopathology

• Histopathological staining of the biopsy tissue or

scrapping of the ulcers taken by sigmoidoscopy reveals
cluster of trophozoites, cysts and lymphocytic infiltration
found in submucosa

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 Culture

• The culture media like Boeck and Drbohlav egg serum

media and Balamuth’s media that support the growth of
Entamoeba histolytica can be used for cultivation of B.
coli.
• Culture is rarely necessary as the parasite is easily
detected by stool microscopy or histopathology.

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 Prevention and control of Balantidiasis

• Following proper personal hygienic practices

• Do not use human feces as fertilizer in agriculture.
• Washing hands after going to the toilet and before
meal.
• Protecting water supplies from faecal contamination
• Wash vegetables and cook meat properly as infective
Balantidium coli cysts are killed by heat.

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Prevention and control of Balantidiasis
• Teach children the importance of washing hands to
prevent infection.
• Proper disposal of human and pig feces ·
• Ensuring clean water supply and proper hygienic
living conditions
• Treat those infected

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 Treatment

• Balantidiasis is treated with tetracycline according to

the instructions of your health care provider.
• Tetracycline is not recommended for pregnant women
or children under 8 years old.
• If the drug is not available, then iodoquinol and
metronidazole can be used.

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 Summary
• Multiplication :- occur by two method
1- Asexual type by binary fission .
2- Sexual type by conjugation .
• Life cycle :- direct life cycle or simple life cycle that mean the
parasite do not need intermediate host .
• Mature cysts are passed with feces.
• Transmission :- by ingestion of contaminated food or water
with feces containing the mature cyst .
• Excystation occurs in the small intestine, and the trophozoites
colonize large intestine.
• Trophozoites undergo encystation to produce infective cysts.
• Cysts are the infective stage of this parasite.

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