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      Molecular Epidemiology and Risk Factors of Blastocystis sp. Infections Among General Populations in Yunnan Province, Southwestern China

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          Abstract

          Background

          Blastocystis is a common enteric parasite of controversial pathogenic roles in human diseases. Although the prevalence of Blastocystis infections has been investigated in a diverse range of populations, there is little knowledge on the molecular epidemiology and risk factors of Blastocystis infections among general populations in southeastern China.

          Materials and Methods

          A total of 507 individuals were randomly selected in Yunnan province, China from July 2016 to March 2017. Stool specimens were sampled for detection of Blastocystis sp. using PCR assay, and the risk factors of Blastocystis infections were identified. Blastocystis isolates were subtyped, and the associations of Blastocystis infections and subtypes with clinical manifestations were examined.

          Results

          The overall detection rate of Blastocystis sp. was 9.47% (95% CI: 7.13–12.44%). Toilet type ( OR = 3.248, 95% CI: 1.245–8.473), anemia ( OR = 2.601, 95% CI: 1.245–8.473) and type of daily drinking water ( OR = 3.11, 95% CI: 1.557–6.213) were identified as risk factors of Blastocystis infections; however, Blastocystis infections showed no associations with clinical symptoms. Four subtypes (ST1 to ST4) were characterized in Blastocystis isolates, in which ST3 was predominant (4.73%, 95% CI: 3.2–6.94%), followed by ST1 (3.16%, 95% CI: 1.95–5.07%), ST4 (1.38%, 95% CI: 0.07–2.82%) and ST2 (0.2%, 95% CI: 0–1.11%). In addition, ST1 subtype infection was found to correlate with anemia ( OR = 4.66, 95% CI: 1.631–14.314).

          Conclusions

          There is a high prevalence of Blastocystis infections among general populations in Yunnan province, southwestern China, and toilet type, anemia and type of daily drinking water are risk factors of Blastocystis infections. ST3 is the dominant subtype of Blastocystis sp. characterized, and ST1 correlates with anemia. Improving hygiene conditions, developing healthy lifestyles and intensifying health education programs are strongly recommended to reduce the prevalence and transmission potential of Blastocystis infections.

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          Blastocystis in Health and Disease: Are We Moving from a Clinical to a Public Health Perspective?

          Lee Andersen, Christen Stensvold (2016)
          Blastocystis is a genus of common single-celled intestinal parasitic protists with an unsettled role in human health and disease. Being a stable component of intestinal microbiota, once established, the Blastocystis parasite appears more common in healthy individuals than in patients with infectious, functional, or inflammatory bowel disease. Recent data suggest that the parasite is associated with certain gut microbiota profiles and health indices. Convincing data and tools differentiating asymptomatic colonization from infection are yet to be demonstrated. Although the parasite may elicit disease under certain circumstances, the focus on Blastocystis may be shifting from a clinical to a public health perspective.
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            Recent developments in Blastocystis research.

            Kaitlin C Clark, Mohammed A Alfellani, Mark I van Berge Henegouwen … (2012)
            Blastocystis is a common parasite of the human large intestine but has an uncertain role in disease. In this review, we appraise the published evidence addressing this and its weaknesses. Genetic diversity studies have led to the identification of numerous subtypes (STs) within the genus Blastocystis and, recently, methods for studying variation within STs have been developed, with implications for our understanding of host specificity. The geographic distribution of STs is summarised and the impact this may have on investigations into the role of the organism in disease is discussed. Finally, we describe the organelle and nuclear genome characteristics and look to future developments in the field. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Prevalence, risk factors for infection and subtype distribution of the intestinal parasite Blastocystis sp. from a large-scale multi-center study in France

              Dima El Safadi, Amandine Cian, Céline Nourrisson … (2016)
              Background Blastocystis sp. is the most common intestinal parasite of humans. Despite its potential public health impact, epidemiological data regarding the prevalence and molecular subtype distribution of Blastocystis sp. in Europe are rarely reported. Therefore, the first multi-center epidemiological survey performed in Europe was conducted in France to diagnose and subtype Blastocystis sp. and to identify risk factors for infection. Methods Stool samples from 788 patients were collected either in summer or winter in 11 hospitals throughout France together with patient data. All stool samples were tested for the presence of Blastocystis sp. by quantitative PCR targeting the SSU rDNA gene. Positive samples were sequenced to determine the distribution of the subtypes in our cohort. Statistical analyses were performed to identify potential risk factors for infection. Results Using quantitative PCR, the overall prevalence of Blastocystis sp. was shown to reach 18.1 %. The prevalence was significantly higher in summer (23.2 %) than in winter (13.7 %). Travellers or subjects infected with other enteric parasites were significantly more infected by Blastocystis sp. than non-travellers or subjects free of other enteric parasites, respectively. Different age-related epidemiological patterns were also highlighted from our data. The prevalence of Blastocystis sp. was not significantly higher in patients with digestive symptoms or diagnosed with chronic bowel diseases. Among symptomatic patients, Blastocystis sp. infection was significantly associated with abdominal pain. Gender, socioeconomic status, and immune status were not identified as potential risk factors associated with infection. Among a total of 141 subtyped isolates, subtype 3 was predominant (43.3 %), followed by subtype 1 and subtype 4 (20 %), subtype 2 (12.8 %), subtype 6 and subtype 7 (2.1 %). No association between ST and clinical symptoms was statistically evidenced. Conclusions A high prevalence of Blastocystis sp. infection was found in our French patient population. Seasonal impact on the prevalence of Blastocystis sp. was highlighted and recent travels and age were identified as main risk factors for infection. Most cases were caused by subtypes 1 to 4, with a predominance of subtype 3. Large variations in both prevalence and ST distribution between hospitals were also observed, suggesting distinct reservoirs and transmission sources of the parasite. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1776-8) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Risk Manag Healthc Policy
                Journal ID (publisher-id): rmhp
                Journal ID (pmc): rmhp
                Title: Risk Management and Healthcare Policy
                Publisher: Dove
                ISSN (Electronic): 1179-1594
                Publication date (Electronic): 29 September 2020
                Publication date Collection: 2020
                Volume: 13
                Pages: 1791-1801
                Affiliations
                [1 ]Key Laboratory of National Health Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases , Wuxi 214064, Jiangsu Province, People’s Republic of China
                [2 ]National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of National Health Commission on Parasites and Vector Biology, WHO Collaborating Center for Tropical Diseases, Chinese Center for Tropical Diseases Research , Shanghai 200025, People’s Republic of China
                [3 ]The First Clinical Medical College of Lanzhou University , Lanzhou 730000, Gansu Province, People’s Republic of China
                Author notes
                Correspondence: Liguang Tian National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of National Health Commission on Parasites and Vector Biology, WHO Collaborating Center for Tropical Diseases, Chinese Center for Tropical Diseases Research , Shanghai City200025, People’s Republic of China Email jztlg@126.com
                Wei Wang Key Laboratory of National Health Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases , Wuxi City, Jiangsu Province214064, People’s Republic of China Email wangwei@jipd.com
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0000-0002-5709-981X
                Article
                Publisher ID: 269664
                DOI: 10.2147/RMHP.S269664
                PMC ID: 7532910
                PubMed ID: 33061712
                SO-VID: 91f80718-8978-4f7e-bd67-b08ba886746f
                Copyright © © 2020 Deng et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 27 June 2020
                Date accepted : 03 September 2020
                Page count
                Figures: 1, Tables: 9, References: 51, Pages: 11
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Social policy & Welfare
                Keywords: blastocystis sp.,molecular epidemiology,risk factor,subtype,clinical manifestation,southwestern china
                Data availability:
                ScienceOpen disciplines: Social policy & Welfare
                Keywords: blastocystis sp., molecular epidemiology, risk factor, subtype, clinical manifestation, southwestern china

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