Balantidiasis: Difference between revisions

Balantidiasis
Balantidiasis
	Balantidium coli as seen in a wet mount of a stool specimen. The organism is surrounded by cilia.
Specialty	Infectious disease

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Balantidiasis is a protozoan infection caused by infection with Balantidium coli.^[1]

Symptoms and signs

Usually asymptomatic in immunocompetent individuals, but the symptoms of balantidiasis include:^{[citation needed]}

Intermittent diarrhea
Constipation
Vomiting
Abdominal pain
Anorexia
Weight loss
Headache
Colitis
Marked fluid loss

The most common ones are intermittent diarrhea and constipation or inflammation of the colon combined with abdominal cramps and bloody stools.^{[citation needed]}

Transmission

Balantidium is the only ciliated protozoan known to infect humans. Balantidiasis is a zoonotic disease and is acquired by humans via the feco-oral route from the normal host, the pig, where it is asymptomatic. Fecally contaminated food and water are the common sources of infection in humans.^[2]

Morphology

Balantidium coli exists in either of two developmental stages: trophozoites and cysts.^[3] In the trophozoite form, they can be oblong or spherical, and are typically 30 to 150 μm in length and 25 to 120 μm in width.^[4] It is its size at this stage that allows Balantidium coli to be characterized as the largest protozoan parasite of humans.^[3] Trophozoites possess both a macronucleus and a micronucleus, and both are usually visible.^[3] The macronucleus is large and sausage-shaped while the micronucleus is less prominent.^[4] At this stage, the organism is not infective but it can replicate by transverse binary fission.^[3]

In its cyst stage, the parasite takes on a smaller, more spherical shape, with a diameter of around 40 to 60 μm.^[4] Unlike the trophozoite, whose surface is covered only with cilia, the cyst form has a tough wall made of one or more layers. The cyst form also differs from the trophozoite form in being non-motile and does not undergo reproduction. The parasite must be ingested as a cyst in order to cause infection.^[3]

Diagnosis

The diagnosis of balantidiasis can be an intricate process, partly because the related symptoms may or may not all be present at once. However, the diagnosis of balantidiasis can be considered when a patient has diarrhea combined with a probable history of current exposure to pigs (as pigs are the primary reservoir), contact with infected persons, or anal sexual contact.^[5] The diagnosis of balantidiasis can be made by microscopic examination of stools in search of trophozoites or cysts,^[6] or colonoscopy or sigmoidoscopy to obtain a biopsy specimen from the large intestine, which may provide evidence for the presence of trophozoites.^{[citation needed]}

Prevention

Preventative measures require effective personal and community hygiene. Some specific safeguards include the following:^{[citation needed]}

Purification of drinking water.
Proper handling of food.
Careful disposal of human feces.
Monitoring the contacts of balantidiasis patients.

Treatment

Balantidiasis can be treated with tetracycline, metronidazole or iodoquinol.^[7]

History

The first study to generate balantidiasis in humans was undertaken by Cassagrandi and Barnagallo in 1896.^[8] However, this experiment was not successful in creating an infection and it was unclear whether Balantidium coli was the actual parasite used.^[8] The first case of balantidiasis in the Philippines, where it is the most common, was reported in 1904.^[9]^[4] Currently, Balantidium coli is distributed worldwide but less than 1% of the human population is infected.^[10]^[4] Pigs are a major reservoir of the parasite, and infection of humans occurs more frequently in areas where pigs commingle with people.^[10] This includes places like the Philippines, as previously mentioned, but also includes countries such as Bolivia and Papua New Guinea.^[10]^[11] Pigs are not the sole species capable of hosting B. coli. For example, the parasite also has a high rate of occurrence in rats.^[12] In a Japanese study that analyzed the fecal samples in 56 mammalian species, Balantidium coli was found to be present not just in all the wild boars tested (with wild boars and pigs being considered the same species), it was also found in five species of non human primate: Chimpanzee (Pan troglodytes), White-handed gibbon (Hylobates lar), Squirrel monkey (Saimiri sciurea), Sacred baboon (Comopithecus hamadryas), and Japanese macaque (Macaca fuscata).^[13] In other studies, Balantidium coli has also been found in species from the order Carnivora.^[13]

References

^ Schuster FL, Ramirez-Avila L (October 2008). "Current World Status of Balantidium coli". Clin. Microbiol. Rev. 21 (4): 626–38. doi:10.1128/CMR.00021-08. PMC 2570149. PMID 18854484.
^ Dwight D., Bowman (December 9, 2013). Georgi's Parasitology For Veterinarians. St. Louis, MO: Elsevier Saunders.: Saunders; 10 edition.
^ ^a ^b ^c ^d ^e Ramachandran, Ambili. "Morphology." The Parasite: Balantidium coli The Disease: Balantidiasis. 23 May 2003. Stanford University. 16 May 2009 <http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Morphology.htm Archived 2013-04-14 at the Wayback Machine>.
^ ^a ^b ^c ^d ^e Roberts, Larry S., and John Janovy Jr. Gerald D. Schmidt & Larry S. Roberts' Foundations of Parasitology. 8th ed. New York: McGraw-Hill, 2009.
^ Ferry T, Bouhour D, De Monbrison F, et al. (May 2004). "Severe peritonitis due to Balantidium coli acquired in France". Eur. J. Clin. Microbiol. Infect. Dis. 23 (5): 393–5. doi:10.1007/s10096-004-1126-4. PMID 15112068. S2CID 20552666.
^ Walzer PD, Judson FN, Murphy KB, Healy GR, English DK, Schultz MG (January 1973). "Balantidiasis outbreak in Truk". Am. J. Trop. Med. Hyg. 22 (1): 33–41. doi:10.4269/ajtmh.1973.22.33. PMID 4684887.
^ "Balantidiasis: Treatment & Medication - eMedicine Infectious Diseases". Archived from the original on 25 February 2009. Retrieved 2009-02-24.
^ ^a ^b McCarey AG (March 1952). "Balantidiasis in South Persia". Br Med J. 1 (4759): 629–31. doi:10.1136/bmj.1.4759.629. PMC 2023172. PMID 14905008.
^ Mason CW (1919). "A Case of Balantidium coli Dysentery". Journal of Parasitology. 5 (3): 137–138. doi:10.2307/3271167. JSTOR 3271167.
^ ^a ^b ^c Parasites and Health: Balantidiasis Balantidium coli. Archived 2013-12-03 at the Wayback Machine DPDx - Balantidiasis. 5 Dec. 2008. CDC Division of Parasitic Diseases. 16 May 2009 >.
^ Ramachandran, Ambili (23 May 2003). "Epidemiology of Balantidiasis". The Parasite: Balantidium coli The Disease: Balantidiasis. Stanford University. Archived from the original on 14 June 2009. Retrieved 16 May 2009.
^ Prevention, CDC - Centers for Disease Control and. "CDC - Balatidiasis - Biology". www.cdc.gov. Retrieved 2018-04-27.
^ ^a ^b Nakauchi, Kiyoshi. "The Prevalence of Balantidium coli Infection in Fifty-Six Mammalian Species." Journal of Veterinary Medical Science 61 (1999): 63-65.

External links

[pmid18854484-1] Schuster FL, Ramirez-Avila L (October 2008). "Current World Status of Balantidium coli". Clin. Microbiol. Rev. 21 (4): 626–38. doi:10.1128/CMR.00021-08. PMC 2570149. PMID 18854484.

[2] Dwight D., Bowman (December 9, 2013). Georgi's Parasitology For Veterinarians. St. Louis, MO: Elsevier Saunders.: Saunders; 10 edition.

[Ramachandran_Morphology-3] Ramachandran, Ambili. "Morphology." The Parasite: Balantidium coli The Disease: Balantidiasis. 23 May 2003. Stanford University. 16 May 2009 <http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Morphology.htm Archived 2013-04-14 at the Wayback Machine>.

[Roberts-4] Roberts, Larry S., and John Janovy Jr. Gerald D. Schmidt & Larry S. Roberts' Foundations of Parasitology. 8th ed. New York: McGraw-Hill, 2009.

[5] Ferry T, Bouhour D, De Monbrison F, et al. (May 2004). "Severe peritonitis due to Balantidium coli acquired in France". Eur. J. Clin. Microbiol. Infect. Dis. 23 (5): 393–5. doi:10.1007/s10096-004-1126-4. PMID 15112068. S2CID 20552666.

[6] Walzer PD, Judson FN, Murphy KB, Healy GR, English DK, Schultz MG (January 1973). "Balantidiasis outbreak in Truk". Am. J. Trop. Med. Hyg. 22 (1): 33–41. doi:10.4269/ajtmh.1973.22.33. PMID 4684887.

[urlBalantidiasis:_Treatment_&_Medication_-_eMedicine_Infectious_Diseases-7] "Balantidiasis: Treatment & Medication - eMedicine Infectious Diseases". Archived from the original on 25 February 2009. Retrieved 2009-02-24.

[McCarey-8] McCarey AG (March 1952). "Balantidiasis in South Persia". Br Med J. 1 (4759): 629–31. doi:10.1136/bmj.1.4759.629. PMC 2023172. PMID 14905008.

[Mason-9] Mason CW (1919). "A Case of Balantidium coli Dysentery". Journal of Parasitology. 5 (3): 137–138. doi:10.2307/3271167. JSTOR 3271167.

[CDC-10] Parasites and Health: Balantidiasis Balantidium coli. Archived 2013-12-03 at the Wayback Machine DPDx - Balantidiasis. 5 Dec. 2008. CDC Division of Parasitic Diseases. 16 May 2009 >.

[11] Ramachandran, Ambili (23 May 2003). "Epidemiology of Balantidiasis". The Parasite: Balantidium coli The Disease: Balantidiasis. Stanford University. Archived from the original on 14 June 2009. Retrieved 16 May 2009.

[12] Prevention, CDC - Centers for Disease Control and. "CDC - Balatidiasis - Biology". www.cdc.gov. Retrieved 2018-04-27.

[Nakauchi-13] Nakauchi, Kiyoshi. "The Prevalence of Balantidium coli Infection in Fifty-Six Mammalian Species." Journal of Veterinary Medical Science 61 (1999): 63-65.

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@@ Line 1: / Line 1: @@
 {{Infobox medical condition (new)
 | name            = Balantidiasis
 | synonyms        =
 | image           = Balantidium coli wet mount.jpg
 | caption         = ''Balantidium coli'' as seen in a wet mount of a stool specimen. The organism is surrounded by cilia.
 | pronounce       =
 | field           = [[Infectious disease (medical specialty)|Infectious disease]]
 | symptoms        =
 | complications   =
 | onset           =
 | duration        =
 | types           =
 | causes          =
 | risks           =
 | diagnosis       =
 | differential    =
 | prevention      =
 | treatment       =
 | medication      =
 | prognosis       =
 | frequency       =
 | deaths          =
 }}
 '''Balantidiasis''' is a [[protozoan infection]] caused by infection with ''[[Balantidium coli]]''.<ref name="pmid18854484">{{cite journal |vauthors=Schuster FL, Ramirez-Avila L |title=Current World Status of Balantidium coli |journal=Clin. Microbiol. Rev. |volume=21 |issue=4 |pages=626–38 |date=October 2008 |pmid=18854484 |doi=10.1128/CMR.00021-08 |pmc=2570149}}</ref>
 ==Symptoms and signs==
-Usually asymptomatic in immunocompetent individuals, but the symptoms of balantidiasis include:
+Usually asymptomatic in immunocompetent individuals, but the symptoms of balantidiasis include:{{citation needed|date=May 2021}}
 * Intermittent diarrhea
 * Constipation
@@ Line 35: / Line 36: @@
 * Colitis
 * Marked fluid loss
-The most common ones are '''intermittent diarrhea''' and '''constipation''' or inflammation of the colon combined with abdominal cramps and bloody stools.
+The most common ones are '''intermittent diarrhea''' and '''constipation''' or inflammation of the colon combined with abdominal cramps and bloody stools.{{citation needed|date=May 2021}}
 ==Transmission==
-''Balantidium'' is the only ciliated protozoan known to infect humans. Balantidiasis is a zoonotic disease and is acquired by humans via the feco-oral route from the normal host, the pig, where it is asymptomatic. “Contaminated water is the most common mechanism of transmission. Equally dangerous, however, is the ingestion of contaminated food.” <ref>{{Cite book|title=Georgi's Parasitology For Veterinarians|last=Dwight D.|first=Bowman|publisher=Saunders; 10 edition|date=December 9, 2013|location=St. Louis, MO: Elsevier Saunders.}}</ref>
+''Balantidium'' is the only ciliated protozoan known to infect humans. Balantidiasis is a zoonotic disease and is acquired by humans via the feco-oral route from the normal host, the pig, where it is asymptomatic. Fecally contaminated food and water are the common sources of infection in humans.<ref>{{Cite book|title=Georgi's Parasitology For Veterinarians|last=Dwight D.|first=Bowman|publisher=Saunders; 10 edition|date=December 9, 2013|location=St. Louis, MO: Elsevier Saunders.}}</ref>
 ==Morphology==
-''Balantidium coli'' exists in either of two developmental stages: [[trophozoite]]s and [[Microbial cyst|cyst]]s.<ref name="Ramachandran_Morphology">Ramachandran, Ambili. "Morphology." The Parasite: Balantidium coli The Disease: Balantidiasis. 23 May 2003. Stanford University. 16 May 2009 <http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Morphology.htm>.</ref> In the trophozoite form, they can be oblong or spherical, and are typically 30 to 150&nbsp;[[micrometre|µm]] in length and 25 to 120&nbsp;µm in width.<ref name="Roberts" /> It is its size at this stage that allows ''Balantidium coli'' to be characterized as the largest protozoan parasite of humans.<ref name="Ramachandran_Morphology" />
+''Balantidium coli'' exists in either of two developmental stages: [[trophozoite]]s and [[Microbial cyst|cyst]]s.<ref name="Ramachandran_Morphology">Ramachandran, Ambili. "Morphology." The Parasite: Balantidium coli The Disease: Balantidiasis. 23 May 2003. Stanford University. 16 May 2009 <http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Morphology.htm {{Webarchive|url=https://web.archive.org/web/20130414013812/http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Morphology.htm |date=2013-04-14 }}>.</ref> In the trophozoite form, they can be oblong or spherical, and are typically 30 to 150&nbsp;[[micrometre|μm]] in length and 25 to 120&nbsp;μm in width.<ref name="Roberts" /> It is its size at this stage that allows ''Balantidium coli'' to be characterized as the largest protozoan parasite of humans.<ref name="Ramachandran_Morphology" />
-Trophozoites possess both a macronucleus and a micronucleus, and both are usually visible.<ref name="Ramachandran_Morphology" />  The macronucleus is large and sausage-shaped while the micronucleus is less prominent.<ref name="Roberts" /> At this stage, the organism is not infective but it can replicate by [[transverse binary fission]].<ref name="Ramachandran_Morphology" />
+Trophozoites possess both a macronucleus and a micronucleus, and both are usually visible.<ref name="Ramachandran_Morphology" />  The macronucleus is large and sausage-shaped while the micronucleus is less prominent.<ref name="Roberts" /> At this stage, the organism is not infective but it can replicate by transverse [[binary fission]].<ref name="Ramachandran_Morphology" />
-In its cyst stage, the parasite takes on a smaller, more spherical shape, with a diameter of around 40 to 60&nbsp;µm.<ref name="Roberts" /> Unlike the trophozoite, whose surface is covered only with cilia, the cyst form has a tough wall made of one or more layers.<ref name="Ramachandran_Morphology" /> The cyst form also differs from the trophozoite form because it is non-motile and does not undergo reproduction.<ref name="Ramachandran_Morphology" /> Instead, the cyst is the form that the parasite takes when it causes infection.<ref name="Ramachandran_Morphology" />
+In its cyst stage, the parasite takes on a smaller, more spherical shape, with a diameter of around 40 to 60&nbsp;μm.<ref name="Roberts" /> Unlike the trophozoite, whose surface is covered only with cilia, the cyst form has a tough wall made of one or more layers. The cyst form also differs from the trophozoite form in being non-[[motility|motile]] and does not undergo reproduction. The parasite must be ingested as a cyst in order to cause infection.<ref name="Ramachandran_Morphology" />
 ==Diagnosis==
+The diagnosis of balantidiasis can be an intricate process, partly because the related symptoms may or may not all be present at once. However, the diagnosis of balantidiasis can be considered when a patient has diarrhea combined with a probable history of current exposure to '''pigs''' (as pigs are the primary reservoir), contact with infected persons, or anal sexual contact.<ref>{{cite journal |vauthors=Ferry T, Bouhour D, De Monbrison F |s2cid=20552666 |title=Severe peritonitis due to Balantidium coli acquired in France |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=23 |issue=5 |pages=393–5 |date=May 2004 |pmid=15112068 |doi=10.1007/s10096-004-1126-4|display-authors=etal}}</ref> The diagnosis of balantidiasis can be made by '''microscopic examination of stools''' in search of [[trophozoites]] or cysts,<ref>{{cite journal |vauthors=Walzer PD, Judson FN, Murphy KB, Healy GR, English DK, Schultz MG |title=Balantidiasis outbreak in Truk |journal=Am. J. Trop. Med. Hyg. |volume=22 |issue=1 |pages=33–41 |date=January 1973 |pmid=4684887 |doi=10.4269/ajtmh.1973.22.33 }}</ref> or '''colonoscopy or sigmoidoscopy''' to obtain a [[biopsy]] specimen from the large intestine, which may provide evidence for the presence of [[trophozoites]].{{Citation needed|date=February 2021}}
-The diagnosis of balantidiasis can be an intricate process, partly because the related symptoms may or may not be present. However, the diagnosis of balantidiasis can be considered when a patient has diarrhea combined with a probable history of current exposure to '''pigs''' (since pigs are the primary reservoir), contact with infected persons, or anal intercourse.<ref>{{cite journal |vauthors=Ferry T, Bouhour D, De Monbrison F |s2cid=20552666 |title=Severe peritonitis due to Balantidium coli acquired in France |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=23 |issue=5 |pages=393–5 |date=May 2004 |pmid=15112068 |doi=10.1007/s10096-004-1126-4|display-authors=etal}}</ref> In addition, the diagnosis of balantidiasis can be made by '''microscopic examination of stools''' in search of [[trophozoites]] or cysts,<ref>{{cite journal |vauthors=Walzer PD, Judson FN, Murphy KB, Healy GR, English DK, Schultz MG |title=Balantidiasis outbreak in Truk |journal=Am. J. Trop. Med. Hyg. |volume=22 |issue=1 |pages=33–41 |date=January 1973 |pmid=4684887 |doi=10.4269/ajtmh.1973.22.33 }}</ref> or '''colonoscopy or sigmoidoscopy''' to obtain a biopsy from the large intestines which may provide evidence for the presence of [[trophozoites]].
 ==Prevention==
@@ Line 60: / Line 60: @@
 ==Treatment==
-Balantidiasis can be treated with [[tetracycline]],<ref name="urlBalantidiasis: Treatment & Medication - eMedicine Infectious Diseases">{{cite web |url=http://emedicine.medscape.com/article/213077-treatment |title=Balantidiasis: Treatment & Medication - eMedicine Infectious Diseases |access-date=2009-02-24| archive-url= https://web.archive.org/web/20090225203748/http://emedicine.medscape.com/article/213077-treatment| archive-date= 25 February 2009 | url-status= live}}</ref> [[carbarsone]], [[metronidazole]], or [[diiodohydroxyquin]].
+Balantidiasis can be treated with [[tetracycline]], [[metronidazole]] or [[iodoquinol]].<ref name="urlBalantidiasis: Treatment & Medication - eMedicine Infectious Diseases">{{cite web |url=http://emedicine.medscape.com/article/213077-treatment |title=Balantidiasis: Treatment & Medication - eMedicine Infectious Diseases |access-date=2009-02-24| archive-url= https://web.archive.org/web/20090225203748/http://emedicine.medscape.com/article/213077-treatment| archive-date= 25 February 2009 | url-status= live}}</ref>
-==History ==
+==History==
 [[Image:Balantidium trophB.JPG|left|frame|A trophozoite of ''Balantidium coli'']]
-The first study to generate balantidiasis in humans was undertaken by Cassagrandi and Barnagallo in 1896.<ref name="McCarey">{{cite journal |author=McCarey AG |title=Balantidiasis in South Persia |journal=Br Med J |volume=1 |issue=4759 |pages=629–31 |date=March 1952 |pmid=14905008 |pmc=2023172 |doi=10.1136/bmj.1.4759.629 }}</ref> However, this experiment was not successful in creating an infection and it was unclear whether ''Balantidium coli'' was the actual parasite used.<ref name="McCarey" /> The first case of balantidiasis in the Philippines, where it is the most common, was reported in 1904.<ref name="Mason">{{cite journal |author=Mason CW |title=A Case of Balantidium coli Dysentery |journal=Journal of Parasitology  |volume=5 |pages=137–8 |year=1919 |doi=10.2307/3271167 |jstor=3271167 |issue=3}}</ref><ref name="Roberts">Roberts, Larry S., and John Janovy Jr. Gerald D. Schmidt & Larry S. Roberts' Foundations of Parasitology. 8th ed. New York: McGraw-Hill, 2009.</ref> Currently, ''Balantidium coli'' is distributed worldwide but less than 1% of the human population is infected.<ref name="CDC">[http://www.dpd.cdc.gov/dpdx/HTML/Balantidiasis.htm Parasites and Health: Balantidiasis ''Balantidium coli''.] {{Webarchive|url=https://web.archive.org/web/20131203202628/http://www.dpd.cdc.gov/dpdx/HTML/Balantidiasis.htm |date=2013-12-03 }} DPDx - Balantidiasis. 5 Dec. 2008. CDC Division of Parasitic Diseases. 16 May 2009 >.</ref><ref name="Roberts" />
+The first study to generate balantidiasis in humans was undertaken by Cassagrandi and Barnagallo in 1896.<ref name="McCarey">{{cite journal |author=McCarey AG |title=Balantidiasis in South Persia |journal=Br Med J |volume=1 |issue=4759 |pages=629–31 |date=March 1952 |pmid=14905008 |pmc=2023172 |doi=10.1136/bmj.1.4759.629 }}</ref> However, this experiment was not successful in creating an infection and it was unclear whether ''Balantidium coli'' was the actual parasite used.<ref name="McCarey" /> The first case of balantidiasis in the Philippines, where it is the most common, was reported in 1904.<ref name="Mason">{{cite journal |author=Mason CW |title=A Case of Balantidium coli Dysentery |journal=Journal of Parasitology  |volume=5 |pages=137–138 |year=1919 |doi=10.2307/3271167 |jstor=3271167 |issue=3|url=https://www.biodiversitylibrary.org/part/316265 }}</ref><ref name="Roberts">Roberts, Larry S., and John Janovy Jr. Gerald D. Schmidt & Larry S. Roberts' Foundations of Parasitology. 8th ed. New York: McGraw-Hill, 2009.</ref> Currently, ''Balantidium coli'' is distributed worldwide but less than 1% of the human population is infected.<ref name="CDC">[http://www.dpd.cdc.gov/dpdx/HTML/Balantidiasis.htm Parasites and Health: Balantidiasis ''Balantidium coli''.] {{Webarchive|url=https://web.archive.org/web/20131203202628/http://www.dpd.cdc.gov/dpdx/HTML/Balantidiasis.htm |date=2013-12-03 }} DPDx - Balantidiasis. 5 Dec. 2008. CDC Division of Parasitic Diseases. 16 May 2009 >.</ref><ref name="Roberts" />
-Pigs are a major reservoir of the parasite, and infection of humans occurs more frequently in areas where pigs comingle with people.<ref name="CDC" /> This includes places like the [[Philippines]], as previously mentioned, but also includes countries such as [[Bolivia]] and [[Papua New Guinea]].<ref name="CDC" /><ref name="Ramachandran_Epi">Ramachandran, Ambili. "Epidemiology of Balantidiasis." The Parasite: Balantidium coli The Disease: Balantidiasis. 23 May 2003. Stanford University. 16 May 2009 <http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Epidemiology.htm>.</ref> But pigs are not the only animal where the parasite is found. For example, Balantidium coli also has a high rate of incidence in rats.<ref>{{Cite web|url=https://www.cdc.gov/parasites/balantidium/biology.html|title=CDC - Balatidiasis - Biology|last=Prevention|first=CDC - Centers for Disease Control and|website=www.cdc.gov|language=en-us|access-date=2018-04-27}}</ref> In a Japanese study that analyzed the fecal samples in 56 mammalian species, ''Balantidium coli'' was found to be present not just in all the wild boars tested (with wild boars and pigs being considered the same species), it was also found in five species of non human primate: Chimpanzee (''Pan troglodytes''), White-handed gibbon (''Hylobates lar''), Squirrelmonkey (''Saimiri sciurea''), Sacred baboon (''Comopithecus hamadryas''), and Japanese macaque (''Macaca fuscata'').<ref name="Nakauchi">Nakauchi, Kiyoshi. "The Prevalence of Balantidium coli Infection in Fifty-Six Mammalian Species." Journal of Veterinary Medical Science 61 (1999): 63-65.</ref> In other studies, ''Balantidium coli'' was also found in species from the orders [[Rodent]]ia and [[Carnivora]].<ref name="Nakauchi" />
+Pigs are a major reservoir of the parasite, and infection of humans occurs more frequently in areas where pigs commingle with people.<ref name="CDC" /> This includes places like the [[Philippines]], as previously mentioned, but also includes countries such as [[Bolivia]] and [[Papua New Guinea]].<ref name="CDC" /><ref>{{cite web|last=Ramachandran|first=Ambili|title=Epidemiology of Balantidiasis|work=The Parasite: Balantidium coli The Disease: Balantidiasis|date=23 May 2003|accessdate=16 May 2009|publisher=Stanford University|url=http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Epidemiology.htm|archive-date=14 June 2009|archive-url=https://web.archive.org/web/20090614083019/http://www.stanford.edu/group/parasites/ParaSites2003/Balantidium/Epidemiology.htm|url-status=dead}}</ref> Pigs are not the sole species capable of hosting ''B. coli''. For example, the parasite also has a high rate of occurrence in rats.<ref>{{Cite web|url=https://www.cdc.gov/parasites/balantidium/biology.html|title=CDC - Balatidiasis - Biology|last=Prevention|first=CDC - Centers for Disease Control and|website=www.cdc.gov|language=en-us|access-date=2018-04-27}}</ref> In a Japanese study that analyzed the fecal samples in 56 mammalian species, ''Balantidium coli'' was found to be present not just in all the wild boars tested (with wild boars and pigs being considered the same species), it was also found in five species of non human primate: Chimpanzee (''Pan troglodytes''), White-handed gibbon (''Hylobates lar''), Squirrel monkey (''Saimiri sciurea''), Sacred baboon (''Comopithecus hamadryas''), and Japanese macaque (''Macaca fuscata'').<ref name="Nakauchi">Nakauchi, Kiyoshi. "The Prevalence of Balantidium coli Infection in Fifty-Six Mammalian Species." Journal of Veterinary Medical Science 61 (1999): 63-65.</ref> In other studies, ''Balantidium coli'' has also been found in species from the order [[Carnivora]].<ref name="Nakauchi" />
 ==References==
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 | ICD10           = {{ICD10|A|07|0|a|00}}
 | ICD9            = {{ICD9|007.0}}
 | ICDO            =
 | OMIM            =
 | MedlinePlus     =
 | eMedicineSubj   = med
 | eMedicineTopic  = 203
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 [[Category:Intestinal infectious diseases]]
-[[Category:Neglected tropical diseases]]
 [[Category:Tropical diseases]]

Classification	D ICD-10: A07.0 ICD-9-CM: 007.0 MeSH: D001447 DiseasesDB: 31216
External resources	eMedicine: med/203 Orphanet: 1223