Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection (original) (raw)

Abstract

Although many Blastocystis infections remain asymptomatic, recent data suggest it also causes frequent symptoms. Therapy should be limited to patients with persistent symptoms and a complete workup for alternative etiologies. The goal of this study was to compare the natural evolution (no treatment) to the efficacy of Saccharomyces boulardii (S. boulardii) or metronidazole for the duration of diarrhea and the duration of colonization in children with gastrointestinal symptoms and positive stool examination for Blastocystis hominis. This randomized single-blinded clinical trial included children presenting with gastrointestinal symptoms (abdominal pain, diarrhea, nausea–vomiting, flatulence) more than 2 weeks and confirmed B. hominis by stool examination (B. hominis cysts in the stool with microscopic examination of the fresh stool). The primary end points were clinical evaluation and result of microscopic stool examination at day 15. Secondary end points were the same end points at day 30. Randomization was performed by alternating inclusion: group A, S. boulardii (250 mg twice a day, Reflor®) during 10 days; group B, metronidazole (30 mg/kg twice daily) for 10 days; group C, no treatment. At day 15 and 30 after inclusion, the patients were re-evaluated, and stool samples were examined microscopically. On day 15, children that were still symptomatic and/or were still _B. hominis_-infected in group C were treated with metronidazole for 10 days. There was no statistically significant difference between the three study groups for age, gender, and the presence of diarrhea and abdominal pain. On day 15, clinical cure was observed in 77.7% in group A (n, 18); in 66.6% in group B (n, 15); and 40% in group C (n:15) (p < 0.031, between groups A and C). Disappearance of the cysts from the stools on day 15 was 80% in group B, 72.2% in group A, and 26.6% in group C (p = 0.011, between group B and group C; p = 0.013, between group A and group C). At the end of the first month after inclusion, clinical cure rate was 94.4% in group A and 73.3% in group B (p = 0.11). Parasitological cure rate for B. hominis was very comparable between both groups (94.4% vs. 93.3%, p = 0.43). Metronidazole or S. boulardii has potential beneficial effects in B. hominis infection (symptoms, presence of parasites). These findings challenge the actual guidelines.

Access this article

Log in via an institution

Subscribe and save

• Starting from 10 chapters or articles per month
• Access and download chapters and articles from more than 300k books and 2,500 journals
• Cancel anytime View plans

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

• Besirbellioglu BA, Ulcay A, Can M, Erdem H, Tanyuksel M, Avci IY, Araz E, Pahsa A (2006) Saccharomyces boulardii and infection due to Giardia lamblia. Scand J Infect Dis 38:479–481
  Article PubMed Google Scholar
• Dagci H, Kurt O, Demirel M, Ostan I, Azizi NR, Mandiracioglu A, Yurdagül C, Tanyüksel M, Eroglu E, Ak M (2008) The prevalence of intestinal parasites in the province of Izmir, Turkey. Parasitol Res 103(4):839–845
  Article PubMed Google Scholar
• Dinleyici EC, Eren M, Yargic ZA, Dogan N, Vandenplas Y (2009) Clinical efficacy of Saccharomyces boulardii and metronidazole compared to metronidazole alone in children with acute bloody diarrhea caused by amebiasis: a prospective, randomized, open label study. Am J Trop Med Hyg 80:953–955
  CAS PubMed Google Scholar
• Eren M, Dinleyici EC, Vandenplas Y (2010) Clinical efficacy comparison of Saccharomyces boulardi and yoghurt fluid in acute non-bloody diarrhea in children: a randomized, controlled, open label study. Am J Trop Med Hyg 82(3):488–491
  Article PubMed Google Scholar
• Eroglu F, Genc A, Elgun G, Koltas IS (2009) Identification of Blastocystis hominis isolates from asymptomatic and symptomatic patients by PCR. Parasitol Res 105(6):1589–1592
  Article PubMed Google Scholar
• Htwe K, Yee KS, Tin M, Vandenplas Y (2008) Effect of Saccharomyces boulardii in the treatment of acute watery diarrhea in Myanmar children: a randomized controlled study. Am J Trop Med Hyg 78:214–216
  PubMed Google Scholar
• Hussain R, Jaferi W, Zuberi S, Baqai R, Abrar N, Ahmed A, Zaman V (1997) Significantly increased IgG2 subclass antibody levels to Blastocystis hominis in patients with irritable bowel syndrome. Am J Trop Med Hyg 56:301–306
  CAS PubMed Google Scholar
• Jones MS, Whipps CM, Ganac RD, Hudson NR, Boroom K (2009) Association of Blastocystis subtype 3 and 1 with patients from an Oregon community presenting with chronic gastrointestinal illness. Parasitol Res 104(2):341–345
  Article PubMed Google Scholar
• Kurugöl Z, Koturoğlu G (2005) Effects of Saccharomyces boulardii in children with acute diarrhoea. Acta Paediatr 94:44–47
  Article PubMed Google Scholar
• Mansour-Ghanaei F, Dehbashi N, Yazdanparast K, Shafaghi A (2003) Efficacy of Saccharomyces boulardii with antibiotics in acute amoebiasis. World J Gastroenterol 9:1832–1833
  PubMed Google Scholar
• Moghaddam DD, Ghadirian E, Azami M (2005) Blastocystis hominis and the evaluation of efficacy of metronidazole and trimethoprim/sulfamethoxazole. Parasitol Res 96:273–275
  Article PubMed Google Scholar
• Nigro L, Larocca L, Massarelli L, Patamia I, Minniti S, Palermo F, Cacopardo B (2003) A placebo-controlled treatment trial of Blastocystis hominis infection with metronidazole. J Travel Med 10(2):128–130
  Article PubMed Google Scholar
• Rossignol JF, Kabil SM, Said M, Samir H, Younis AM (2005) Effect of nitazoxanide in persistent diarrhea and enteritis associated with Blastocystis hominis. Clin Gastroenterol Hepatol 3:987–991
  Article CAS PubMed Google Scholar
• Szajewska H, Skórka A, Dylag M (2007) Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther 25:257–264
  Article CAS PubMed Google Scholar
• Tan KS, Singh M, Yap EH (2002) Recent advances in Blastocystis hominis research: hot spots in terra incognita. Int J Parasitol 32:789–804
  Article CAS PubMed Google Scholar
• Vandenplas Y, Benninga M (2009) Probiotics and functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr 48(Suppl 2):S107–S109
  Article PubMed Google Scholar
• Villarruel G, Rubio DM, Lopez F, Cintioni J, Gurevech R, Romero G, Vandenplas Y (2007) Saccharomyces boulardii in acute childhood diarrhoea: a randomized, placebo-controlled study. Acta Paediatr 96:538–541
  Article PubMed Google Scholar
• Yakoob J, Jafri W, Jafri N, Khan R, Islam M, Beg MA, Zaman V (2004) Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis. Am J Trop Med Hyg 70:383–385
  PubMed Google Scholar
• Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R (2010a) Irritable bowel syndrome: is it associated with genotypes of Blastocystis hominis. Parasitol Res 106(5):1033–1038
  Article PubMed Google Scholar
• Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R (2010b) Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria. Parasitol Res 107(3):679–684
  Article PubMed Google Scholar

Download references

Acknowledgement

This study presents as a poster presentation in the 43rd Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) in 9–12 June 2010 at Istanbul, and the abstract of this study was published in a supplemental issue in the Journal of Pediatric Gastroenterology and Nutrition.

Author information

Authors and Affiliations

1. Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
   Ener Cagri Dinleyici, Serap Reyhanioglu & Zeynel Abidin Yargic
2. Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
   Makbule Eren
3. Department of Parasitology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
   Nihal Dogan
4. Universitair Ziekenhuis Brussel Kinderen, Vrije Universiteit Brussel, Brussels, Belgium
   Yvan Vandenplas

Authors

1. Ener Cagri Dinleyici
2. Makbule Eren
3. Nihal Dogan
4. Serap Reyhanioglu
5. Zeynel Abidin Yargic
6. Yvan Vandenplas

Corresponding author

Correspondence toEner Cagri Dinleyici.

Rights and permissions

About this article

Cite this article

Dinleyici, E.C., Eren, M., Dogan, N. et al. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection.Parasitol Res 108, 541–545 (2011). https://doi.org/10.1007/s00436-010-2095-4

Download citation

• Received: 30 August 2010
• Accepted: 16 September 2010
• Published: 05 October 2010
• Issue date: March 2011
• DOI: https://doi.org/10.1007/s00436-010-2095-4

Keywords