EVALUATION OF BLASTOCYSTIS SPP. AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH DIFFERENT DIAGNOSTIC METHODS AND SUBTYPE ANALYSES

Öz

Objective: Blastocystis spp; is a protozoon that can be seen worldwide. Fecal-oral transmission is the most accepted pathway for Blastocystis spp. infection. Most infected patients show no symptoms of infection, however it can cause abdominal pain, acute or chronic diarrhea, vomiting, flatulence and nausea. It is suggested that Blastocystis spp. may cause several pathologies in gut causing an inflammatory response that may lead to Inflammatory Bowel Diseases.

Materials and Methods: Our study included 60 IBH patients diagnosed as ulcerative colitis (30) and Crohn’s Disease (30) in Division of Gastroenterology and 40 healty controls with no gastrointestinal disease. Stool samples of all patients were examined for presence of any parasites. Presenceof Blastocystis spp. was evaluated with microscopy, culture with two different media, ELISA and PCR methods. For subtype analyses sequencing was performed.

Results: Blastocystis spp. was detected in 6 (10%) IBD patients, 2 (5%) in controls. Blastocystis spp. antigen detected in 12 (20%) IBD patients and 3 (7.5%) in controls. Blastocystis spp. DNA was detected in 8 (13.3%) IBD patients and 6 (15%) controls. No statistical significance was detected between IBD patients and control group in terms of Blastocystis spp positivity. ST3 was the predominant subtype and abdominal pain was the most common clinical symptom.

Conclusion: These results suggested that using two different media increases the sensitivity. PCR was the most sensitive method. ELISA results showed high sensitivity and specificity, suggested that ELISA method could be an alternative to the microscopy and culture. No significant relationship between IBD and Blastocystis spp. was determined. Also, no significance was detected between subtypes and clinical symptoms. Although we could not determine a relationship between subtypes and IBD or clinical symptoms, further investigations are needed to clarify this issue.

Key words: Blastocystis spp.; inflammatory bowel disease; IBD; subtype; clinical symptoms

Anahtar Kelimeler

• Blastocystis spp,inflammatory bowel disease,IBD,subtype

İNFLAMATUAR BARSAK HASTALIĞI OLAN HASTALARDA BLASTOCYSTIS SPP.'NİN FARKLI TANI YÖNTEMLERİ İLE ARAŞTIRILMASI VE GENOTİPLENDİRİLMESİ

Öz

Amaç: Blastocystis spp; fekal-oral yolla özellikle kötü hijyen koşullarında bulaşan, tüm dünyada yaygın bir protozoondur. Enfeksiyon asemptomatik seyredebildiği gibi karın ağrısı, kabızlık, bulantı gibi gastrointestinal semptomlara neden olabilmektedir. Blastocystis spp.’nin barsakta çeşitli patolojilere neden olabileceği, inflamatuar yanıtı uyararak İnflamatuar Barsak Hastalıkları (IBH)’nın gelişmesi ile ilişkisi olabileceği öne sürülmektedir.

Gereç-Yöntem: Çalışmamıza İ.Ü. İstanbul Tıp Fakültesi Gastroenteroloji Bilim Dalı’nda 30 Crohn hastalığı (CH), 30 ülseratif kolit (UK) tanısı alan hasta ve 40 gastrointestinal system hastalığı bulunmayan sağlıklı kontrol grubu dahil edilmiştir. Bu hastaların dışkı örnekleri tüm parazitler yönünden incelenmiş, mikroskopi, kültür, ELISA ve PCR ile Blastocystis spp. varlığı araştırılmıştır. Blastocystis spp. saptanan örneklerde subtip dağılımı sekanslama yöntemi ile araştırılmıştır.

Bulgular: İBH grubunda mikroskopi ve kültür yöntemleri ile 6 (%10)’sında, kontrol grubunun 2 (%5)’sinde Blastocystis spp. varlığı saptanmıştır. ELISA ile Blastocystis spp. antijeni IBH grubunun 12 (%20)’sinde, kontrol grubunun 3 (%7,5)’ünde saptanmıştır. Blastocystis spp. DNA’sı PCR ile IBH grubunun 8 (%13,3)’inde, kontrol grubunun 6 (15%)’sında bulunmuştur. Gruplar arasında Blastocystis spp. varlığı yönünden anlamlı bir sonuç saptanamamıştır. Suptipler arasında ST3 en sık olarak saptanmış, bunlarda en yaygın klinik semptomun karın ağrısı olduğu gözlenmiştir.

Sonuç: İki farklı besiyeri kullanılması tanı duyarlılığını arttırmıştır. En duyarlı tanı yöntemi PCR olarak saptanmış, ELISA yöntemi de oldukça yüksek duyarlılık ve özgüllükte sonuç vermiş, mikroskopi ve kültüre alternatif bir yöntem olabileceği gözlenmiştir. Sonuçlarımız subtipler ile klinik bulgular arasında bir bağlantı olduğunu göstermese de konuyu aydınlatmak için çalışmalara ihtiyaç olduğuna işaret etmektedir.

Anahtar kelimeler: Blastocystis spp.; inflamatuar barsak hastalığı; IBH; subtip; klinik semptomlar.

Anahtar Kelimeler

• Blastocystis spp,inflamatuar barsak hastalığı,IBH,subtip,klinik semptomlar

Kaynakça

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