Two cases of Blastocystis hominis infection and literature review

doi:10.3877/cma.j.issn.2095-5820.2024.03.009

Abstract

Abstract:

Objective

Analyzing and comparing 2 abnormal fecal specimens suspected of Blastocystis hominis infection, which were identified during routine laboratory work, to provide clinicians with diagnostic evidence for the disease and assist in formulating diagnosis and treatment plans.

Methods

The laboratory physician analyzed 2 abnormal stool samples suspected of being infected with Blastocystis hominis by observing the characteristics of the stool specimens with the naked eye, using the WWT /FA160 for automatic microscopy, manual microscopy, and multi person reading.

Results

By visually observing the characteristics of the stool specimen, it was found that its characteristics were abnormal, and abnormal tangible components were visible through FA160 automatic microscopy. After Wright's staining, through precise manual microscopy, multi person review of the images, and comparison with the atlas, it was ultimately determined that these 2 patients were infected with Blastocystis hominis.

Conclusion

Both patients had weakened immune systems and experienced diarrhea during hospitalization, with abnormal stool characteristics noted. Through laboratory analysis, Blastocystis hominis infection was confirmed. After consultation with clinicians, both patients received oral metronidazole treatment. Subsequent stool routine tests showed no significant abnormalities. Digestive symptoms in the patients markedly improved, leading to an enhanced quality of life.

Key words: parasites, Blastocystis hominis, cavity type, diarrhea

Tingyi Pu, Man Cui, Yizhi Qin, Yangyang Zhang, Dinghua Liu. Two cases of Blastocystis hominis infection and literature review[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2024, 12(03): 175-178.

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References 30

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项目	病例1	病例2
主诉	患者，女性，55岁，因“下腹胀痛不适13 d”入院。	患者，男性，67岁，因“肾功能异常11 d”入院。
现病史	13 d前无明显诱因出现下腹胀痛，伴排尿、排便困难，无发热畏寒，无腹泻、黑便等症状。	11天前，患者于外院诊疗时，发现肾功能异常，于重庆医科大学附属大学城医院肾内科就诊，无发热畏寒，无腹胀、腹泻、黑便等症状。
入院查体	心肺腹查体未见明显异常。	心肺腹查体未见明显异常。
辅助检查	实验室检查结果：（1）WBC 11.55×10⁹ /L（参考区间：3.50~9.50×10⁹ /L）；（2）中性粒细胞计数7.85×10⁹ /L（参考区间：1.80~6.30×10⁹ /L）；（3）嗜酸性粒细胞计数0.80×10⁹ /L（参考区间：0.02~0.52×10⁹ /L）；（4）白蛋白36.78 g/L（参考区间：40.00~55.00 g/L）。妇科彩超：盆腔内见范围约112 mm×38 mm不规则无回声区及低回声，内透声差，另见少许团状稍强回声，CDFI：稍强回声可见少许血流信号。	实验室检查结果：（1）WBC 24.27×10⁹ /L（参考区间：3.50~9.50×10⁹ /L）；（2）血红蛋白79 g/L（参考区间：115~150 g/L）；（3）白蛋白21.82 g/L（参考区间：40.00~55.00 g/L）；（4）肌酐548.80 μmol/L（参考区间：57.00~97.00 g/L）。
入院诊断	（1）盆腔包块待查：盆腔脓肿？卵巢肿瘤？其他来源肿瘤？（2）2型糖尿病；（3）高血压病3级（极高危）；（4）尿潴留。	（1）慢性肾衰竭急性加重；（2）肺部感染；（3）甲型流行性感冒；（4）高血压病3级（极高危）；（5）2型糖尿病。
入院后病情变化	排除相关手术禁忌症后患者行盆腔包块探查术，术后第7天患者出现腹泻，每天4~5次，便不成形，伴有发热。	入院第4天，患者诉腹泻，每天5~6次，稀便，不伴发热，自诉平时有饮生水习惯。

项目	病例1	病例2
主诉	患者，女性，55岁，因“下腹胀痛不适13 d”入院。	患者，男性，67岁，因“肾功能异常11 d”入院。
现病史	13 d前无明显诱因出现下腹胀痛，伴排尿、排便困难，无发热畏寒，无腹泻、黑便等症状。	11天前，患者于外院诊疗时，发现肾功能异常，于重庆医科大学附属大学城医院肾内科就诊，无发热畏寒，无腹胀、腹泻、黑便等症状。
入院查体	心肺腹查体未见明显异常。	心肺腹查体未见明显异常。
辅助检查	实验室检查结果：（1）WBC 11.55×10⁹ /L（参考区间：3.50~9.50×10⁹ /L）；（2）中性粒细胞计数7.85×10⁹ /L（参考区间：1.80~6.30×10⁹ /L）；（3）嗜酸性粒细胞计数0.80×10⁹ /L（参考区间：0.02~0.52×10⁹ /L）；（4）白蛋白36.78 g/L（参考区间：40.00~55.00 g/L）。妇科彩超：盆腔内见范围约112 mm×38 mm不规则无回声区及低回声，内透声差，另见少许团状稍强回声，CDFI：稍强回声可见少许血流信号。	实验室检查结果：（1）WBC 24.27×10⁹ /L（参考区间：3.50~9.50×10⁹ /L）；（2）血红蛋白79 g/L（参考区间：115~150 g/L）；（3）白蛋白21.82 g/L（参考区间：40.00~55.00 g/L）；（4）肌酐548.80 μmol/L（参考区间：57.00~97.00 g/L）。
入院诊断	（1）盆腔包块待查：盆腔脓肿？卵巢肿瘤？其他来源肿瘤？（2）2型糖尿病；（3）高血压病3级（极高危）；（4）尿潴留。	（1）慢性肾衰竭急性加重；（2）肺部感染；（3）甲型流行性感冒；（4）高血压病3级（极高危）；（5）2型糖尿病。
入院后病情变化	排除相关手术禁忌症后患者行盆腔包块探查术，术后第7天患者出现腹泻，每天4~5次，便不成形，伴有发热。	入院第4天，患者诉腹泻，每天5~6次，稀便，不伴发热，自诉平时有饮生水习惯。

项目	人芽囊原虫（空泡型）	WBC
大小	2~200 μm，平均直径4~15 μm	7~20 μm
折光性	比真菌折光性弱，比WBC、RBC折光性强	略带折光性
胞质	较清澈，内含空泡	可见颗粒
胞核	核挤于边缘（瑞氏染色后明显）	可有单个/多个核，核呈分叶状/杆状

项目	人芽囊原虫（空泡型）	WBC
大小	2~200 μm，平均直径4~15 μm	7~20 μm
折光性	比真菌折光性弱，比WBC、RBC折光性强	略带折光性
胞质	较清澈，内含空泡	可见颗粒
胞核	核挤于边缘（瑞氏染色后明显）	可有单个/多个核，核呈分叶状/杆状

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