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Clinical Aspects of Blastocystis Infections: Advancements Amidst Controversies

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Blastocystis: Pathogen or Passenger?

Part of the book series: Parasitology Research Monographs ((Parasitology Res. Monogr.,volume 4))

Abstract

Blastocystis is a noninvasive, luminal parasite commonly reported in human stool samples. Its clinical presentation is diverse ranging between acute diarrhea and mild chronic abdominal discomfort. Clinical manifestations of Blastocystis also include urticaria and irritable bowel syndrome. Similar to other luminal parasites such as Giardia and Entamoeba, asymptomatic carriage of Blastocystis is common. The parasite is zoonotic and animal contact often leads to infections. The Blastocystis is also opportunistic with higher frequency in immunocompromised populations including pediatric and cancer patients as well as HIV-infected individuals. Although parasite is noninvasive it might complicate pathogenicity of other invasive pathogens. Metronidazole is the treatment of choice, but clinical management of Blastocystis is difficult owing to frequent reports of treatment failure. It also exhibits extensive phenotypic and genotypic diversity, not efficiently captured by classical diagnostic techniques, leading to under-reporting of Blastocystis infections. Diversity in pathobiology between variant parasite subtypes is suspected to be responsible for diverse clinical presentations of Blastocystis infections. Treatment outcomes are also suspected to be dependent on parasite subtype and phenotype. Despite a number of controversies surrounding the pathogenic potential of Blastocystis, several advances have been made in recent years in the areas of parasite virulence as well as molecular and cellular biology. These advances have also fueled improvements in clinical diagnostic tools as well identification of novel treatment options. This chapter highlights some of these recent developments.

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References

  • Armentia A, Méndez J, Gómez A, Sanchís E, Fernández A, de la Fuente R, Sánchez P (1993) Urticaria by Blastocystis hominis. Successful treatment with paromomycin. Allergol Immunopathol (Madr) 21:149–151

    CAS  Google Scholar 

  • Boorom K, Smith H, Nimri L, Viscogliosi E, Spanakos G, Parkar U, Li L-H, Zhou X-N, Ok U, Leelayoova S, Jones M (2008) Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection. Parasit Vectors 1:40

    Article  PubMed  Google Scholar 

  • Bueno L, Fioramonti J (2008) Protease-activated receptor 2 and gut permeability: a review. Neurogastroenterol Motil 20:580–587

    Article  PubMed  CAS  Google Scholar 

  • Cassano N, Scoppio BM, Loviglio MC, Vena GA (2005) Remission of delayed pressure urticaria after eradication of Blastocystis hominis. Acta Derm Venereol 85:357–358

    PubMed  Google Scholar 

  • Chandramathi S, Suresh K, Anita ZB, Kuppusamy UR (2012) Infections of Blastocystis hominis and microsporidia in cancer patients: are they opportunistic? Trans R Soc Trop Med Hyg 106:267–269

    Article  PubMed  Google Scholar 

  • Chandramathi S, Suresh K, Kuppusamy UR (2010a) Elevated levels of urinary hyaluronidase in humans infected with intestinal parasites. Ann Trop Med Parasitol 104:449–452

    Article  PubMed  CAS  Google Scholar 

  • Chandramathi S, Suresh KG, Mahmood AA, Kuppusamy UR (2010b) Urinary hyaluronidase activity in rats infected with Blastocystis hominis—evidence for invasion? Parasitol Res 106:1459–1463

    Article  PubMed  CAS  Google Scholar 

  • Chen TL, Chan CC, Chen HP, Fung CP, Lin CP, Chan WL, Liu CY (2003) Clinical characteristics and endoscopic findings associated with Blastocystis hominis in healthy adults. Am J Trop Med Hyg 69:213–216

    PubMed  Google Scholar 

  • Chen W, Pendyala S, Natarajan V, Garcia JG, Jacobson JR (2008) Endothelial cell barrier protection by simvastatin: GTPase regulation and NADPH oxidase inhibition. Am J Physiol Lung Cell Mol Physiol 295:L575–L583

    Article  PubMed  CAS  Google Scholar 

  • Coyle CM, Varughese J, Weiss LM, Tanowitz HB (2012) Blastocystis: to treat or not to treat. Clin Infect Dis 54:105–110

    Article  PubMed  Google Scholar 

  • Dagci H, Ustun S, Taner MS, Ersoz G, Karacasu F, Budak S (2002) Protozoon infections and intestinal permeability. Acta Trop 81:1–5

    Article  PubMed  CAS  Google Scholar 

  • Denoeud F, Roussel M, Noel B, Wawrzyniak I, Da Silva C, Diogon M, Viscogliosi E, Brochier-Armanet C, Couloux A, Poulain J, Segurens B, Anthouard V, Texier C, Blot N, Poirier P, Ng GC, Tan KS, Artiguenave F, Jaillon O, Aury JM, Delbac F, Wincker P, Vivarès CP, El Alaoui H (2011) Genome sequence of the stramenopile Blastocystis, a human anaerobic parasite. Genome Biol 12:R29

    Article  PubMed  CAS  Google Scholar 

  • Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y (2011) Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res 108:541–545

    Article  PubMed  Google Scholar 

  • Dogruman-Al F, Simsek Z, Boorom K, Ekici E, Sahin M, Tuncer C, Kustimur S, Altinbas A (2010) Comparison of methods for detection of Blastocystis infection in routinely submitted stool samples, and also in IBS/IBD Patients in Ankara, Turkey. PLoS One 5:e15484

    Article  PubMed  Google Scholar 

  • Domínguez-Márquez MV, Guna R, Muñoz C, Gómez-Muñoz MT, Borrás R (2009) High prevalence of subtype 4 among isolates of Blastocystis hominis from symptomatic patients of a health district of Valencia (Spain). Parasitol Res 105:949–955

    Article  PubMed  Google Scholar 

  • Dunn LA, Boreham PF (1991) The in-vitro activity of drugs against Blastocystis hominis. J Antimicrob Chemother 27:507–516

    Article  PubMed  CAS  Google Scholar 

  • Dunn LA, Tan KS, Vanelle P, Juspin T, Crozet MD, Terme T, Upcroft P, Upcroft JA (2012) Development of metronidazole-resistant lines of Blastocystis sp. Parasitol Res 111(1):441–450

    Article  PubMed  CAS  Google Scholar 

  • Eckmann L, Laurent F, Langford TD, Hetsko ML, Smith JR, Kagnoff MF, Gillin FD (2000) Nitric oxide production by human intestinal epithelial cells and competition for arginine as potential determinants of host defense against the lumen-dwelling pathogen Giardia lamblia. J Immunol 164:1478–1487

    PubMed  CAS  Google Scholar 

  • Eida OM, Hussein EM, Eida AM, El-Moamly AA, Salem AM (2008) Evaluation of the nitric oxide activity against Blastocystis hominis in vitro and in vivo. J Egypt Soc Parasitol 38:521–536

    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 105:1589–1592

    Article  PubMed  Google Scholar 

  • Gecse K, Róka R, Ferrier L, Leveque M, Eutamene H, Cartier C, Ait-Belgnaoui A, Rosztóczy A, Izbéki F, Fioramonti J, Wittmann T, Bueno L (2008) Increased faecal serine protease activity in diarrhoeic IBS patients: a colonic lumenal factor impairing colonic permeability and sensitivity. Gut 57:591–599

    Article  PubMed  CAS  Google Scholar 

  • Hameed DM, Hassanin OM, Zuel-Fakkar NM (2011) Association of Blastocystis hominis genetic subtypes with urticaria. Parasitol Res 108:553–560

    Article  PubMed  Google Scholar 

  • Herbinger KH, Fleischmann E, Weber C, Perona P, Löscher T, Bretzel G (2011) Epidemiological, clinical, and diagnostic data on intestinal infections with Entamoeba histolytica and Entamoeba dispar among returning travelers. Infection 39:527–535

    Article  PubMed  Google Scholar 

  • Horiki N, Kaneda Y, Maruyama M, Fujita Y, Tachibana H (1999) Intestinal blockage by carcinoma and Blastocystis hominis infection. Am J Trop Med Hyg 60:400–402

    PubMed  CAS  Google Scholar 

  • Hu KC, Lin CC, Wang TE, Liu CY, Chen MJ, Chang WH (2008) Amoebic liver abscess or is it? Gut 57(627):683

    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

    PubMed  CAS  Google Scholar 

  • Hussein EM, Hussein AM, Eida MM, Atwa MM (2008) Pathophysiological variability of different genotypes of human Blastocystis hominis Egyptian isolates in experimentally infected rats. Parasitol Res 102:853–860

    Article  PubMed  Google Scholar 

  • Idris NS, Dwipoerwantoro PG, Kurniawan A, Said M (2010) Intestinal parasitic infection of immunocompromised children with diarrhoea: clinical profile and therapeutic response. J Infect Dev Ctries 4:309–317

    Article  PubMed  CAS  Google Scholar 

  • Jimenez-Gonzalez DE, Martinez-Flores WA, Reyes-Gordillo J, Ramirez-Miranda ME, Arroyo-Escalante S, Romero-Valdovinos M, Stark D, Souza-Saldivar V, Martinez-Hernandez F, Flisser A, Olivo-Diaz A, Maravilla P (2012) Blastocystis infection is associated with irritable bowel syndrome in a Mexican patient population. Parasitol Res 110:1269–1275

    Article  PubMed  Google Scholar 

  • Katsarou-Katsari A, Vassalos CM, Tzanetou K, Spanakos G, Papadopoulou C, Vakalis N (2008) Acute urticaria associated with amoeboid forms of Blastocystis sp. subtype 3. Acta Derm Venereol 88:80–81

    Article  PubMed  Google Scholar 

  • Kaya S, Cetin E, AridoÄŸan B, Arikan S, Demirci M (2007) Pathogenicity of Blastocystis hominis, a clinical reevaluation. Turkiye Parazitol Derg 31:184–187

    PubMed  Google Scholar 

  • Kurniawan A, Karyadi T, Dwintasari SW, Sari IP, Yunihastuti E, Djauzi S, Smith HV (2009) Intestinal parasitic infections in HIV/AIDS patients presenting with diarrhoea in Jakarta, Indonesia. Trans R Soc Trop Med Hyg 103:892–898

    Article  PubMed  CAS  Google Scholar 

  • Londoño AL, Mejía S, Gómez-Marín JE (2009) Prevalence and risk factors associated with intestinal parasitism in preschool children from the urban area of Calarcá, Colombia. Rev Salud Publica (Bogota) 11:72–81

    Article  Google Scholar 

  • Mahmoud MS, Saleh WA (2003) Secretory and humoral antibody responses to Blastocystis hominis in symptomatic and asymptomatic human infections. J Egypt Soc Parasitol 33:13–30

    PubMed  Google Scholar 

  • Mehraj V, Hatcher J, Akhtar S, Rafique G, Beg MA (2008) Prevalence and factors associated with intestinal parasitic infection among children in an urban slum of Karachi. PLoS ONE 3:e3680

    Article  PubMed  Google Scholar 

  • Mirza H, Tan KS (2009) Blastocystis exhibits inter- and intra-subtype variation in cysteine protease activity. Parasitol Res 104:355–361

    Article  PubMed  Google Scholar 

  • Mirza H, Teo JD, Upcroft J, Tan KS (2011a) A rapid, high-throughput viability assay for Blastocystis spp. reveals metronidazole resistance and extensive subtype-dependent variations in drug susceptibilities. Antimicrob Agents Chemother 55:637–648

    Article  PubMed  CAS  Google Scholar 

  • Mirza H, Wu Z, Kidwai F, Tan KS (2011b) A metronidazole-resistant isolate of Blastocystis spp. is susceptible to nitric oxide and downregulates intestinal epithelial inducible nitric oxide synthase by a novel parasite survival mechanism. Infect Immun 79:5019–5026

    Article  PubMed  CAS  Google Scholar 

  • Mirza H, Wu Z, Teo JD, Tan KS (2012) Statin-pleiotropy prevents rho kinase-mediated intestinal epithelial barrier compromise induced by Blastocystis cysteine proteases. Cell Microbiol 14(9):1474–1484

    Article  PubMed  CAS  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 

  • Motzkus-Feagans CA, Pakyz A, Polk R, Gambassi G, Lapane KL (2012) Statin use and the risk of Clostridium difficile in academic medical centres. Gut. 2012 Mar 22. [Epub ahead of print]

    Google Scholar 

  • Nagel R, Cuttell L, Stensvold CR, Mills PC, Bielefeldt-Ohmann H, Traub RJ (2011) Blastocystis subtypes in symptomatic and asymptomatic family members and pets and response to therapy. Intern Med J

    Google Scholar 

  • Navarro C, Domínguez-Márquez M, Garijo-Toledo M, Vega-García S, Fernández-Barredo S, Pérez-Gracia M, García A, Borrás R, Gómez-Muñoz M (2008) High prevalence of Blastocystis sp. in pigs reared under intensive growing systems: frequency of ribotypes and associated risk factors. Vet Parasitol 153:347–358

    Article  PubMed  CAS  Google Scholar 

  • Noureldin MS, Shaltout AA, El Hamshary EM, Ali ME (1999) Opportunistic intestinal protozoal infections in immunocompromised children. J Egypt Soc Parasitol 29:951–961

    PubMed  CAS  Google Scholar 

  • Pasqui AL, Savini E, Saletti M, Guzzo C, Puccetti L, Auteri A (2004) Chronic urticaria and Blastocystis hominis infection: a case report. Eur Rev Med Pharmacol Sci 8:117–120

    PubMed  CAS  Google Scholar 

  • Patino WD, Cavuoti D, Banerjee SK, Swartz K, Ashfaq R, Gokaslan T (2008) Cytologic diagnosis of Blastocystis hominis in peritoneal fluid: a case report. Acta Cytol 52:718–720

    Article  PubMed  Google Scholar 

  • Piche T, Barbara G, Aubert P, Bruley des Varannes S, Dainese R, Nano JL, Cremon C, Stanghellini V, De Giorgio R, Galmiche JP, Neunlist M (2009) Impaired intestinal barrier integrity in the colon of patients with irritable bowel syndrome: involvement of soluble mediators. Gut 58:196–201

    Article  PubMed  CAS  Google Scholar 

  • Poirier P, Wawrzyniak I, Albert A, El Alaoui H, Delbac F, Livrelli V (2011) Development and evaluation of a real-time PCR assay for detection and quantification of Blastocystis parasites in human stool samples: prospective study of patients with hematological malignancies. J Clin Microbiol 49:975–983

    Article  PubMed  CAS  Google Scholar 

  • Puthia M, Vaithilingam A, Lu J, Tan K (2005) Degradation of human secretory immunoglobulin A by Blastocystis. Parasitol Res 97:386–389

    Article  PubMed  Google Scholar 

  • Puthia MK, Sio SW, Lu J, Tan KS (2006) Blastocystis ratti induces contact-independent apoptosis, F-actin rearrangement, and barrier function disruption in IEC-6 cells. Infect Immun 74:4114–4123

    Article  PubMed  CAS  Google Scholar 

  • Quiros-Buelna E (1989) Furazolidone and metronidazole for treatment of giardiasis in children. Scand J Gastroenterol Suppl 169:65–69

    Article  PubMed  CAS  Google Scholar 

  • Rene BA, Stensvold CR, Badsberg JH, Nielsen HV (2009) Subtype analysis of Blastocystis isolates from Blastocystis cyst excreting patients. Am J Trop Med Hyg 80:588–592

    PubMed  Google Scholar 

  • Salvi PF, Virgilio E, Bocchetti T, Costa G, Pascarella G, Balducci G (2012) Blastocystis hominis and recurrent megacolon: a causative or fortuitous association? Am Surg 78:198–199

    Google Scholar 

  • Stark D, van Hal S, Marriott D, Ellis J, Harkness J (2007) Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis. Int J Parasitol 37:11–20

    Article  PubMed  CAS  Google Scholar 

  • Stensvold CR, Ahmed UN, Andersen LO, Nielsen HV (2012a) Development and evaluation of a genus-specific, probe-based, internal process controlled real-time PCR assay for sensitive and specific detection of Blastocystis. J Clin Microbiol 50(6):1847–1851

    Article  PubMed  CAS  Google Scholar 

  • Stensvold CR, Alfellani M, Clark CG (2012b) Levels of genetic diversity vary dramatically between Blastocystis subtypes. Infect Genet Evol 12:263–273

    Article  PubMed  Google Scholar 

  • Stensvold CR, Alfellani MA, Nørskov-Lauritsen S, Prip K, Victory EL, Maddox C, Nielsen HV, Clark CG (2009a) Subtype distribution of Blastocystis isolates from synanthropic and zoo animals and identification of a new subtype. Int J Parasitol 39:473–479

    Article  PubMed  CAS  Google Scholar 

  • Stensvold CR, Arendrup MC, Jespersgaard C, Mølbak K, Nielsen HV (2007) Detecting Blastocystis using parasitologic and DNA-based methods: a comparative study. Diagn Microbiol Infect Dis 59:303–307

    Article  PubMed  CAS  Google Scholar 

  • Stensvold CR, Arendrup MC, Nielsen HV, Bada A, Thorsen S (2008) Symptomatic infection with Blastocystis sp. subtype 8 successfully treated with trimethoprim-sulfamethoxazole. Ann Trop Med Parasitol 102:271–274

    Article  PubMed  CAS  Google Scholar 

  • Stensvold CR, Arendrup MC, Nielsen HV, Mølbak K (2009b) Blastocystis—an enigmatic parasite. Ugeskr Laeger 171:2388–2390

    PubMed  Google Scholar 

  • Stensvold CR, Lewis HC, Hammerum AM, Porsbo LJ, Nielsen SS, Olsen KE, Arendrup MC, Nielsen HV, Mølbak K (2009c) Blastocystis: unravelling potential risk factors and clinical significance of a common but neglected parasite. Epidemiol Infect 137:1655–1663

    Article  PubMed  CAS  Google Scholar 

  • Stensvold CR, Smith HV, Nagel R, Olsen KE, Traub RJ (2010) Eradication of Blastocystis carriage with antimicrobials: reality or delusion? J Clin Gastroenterol 44:85–90

    Article  PubMed  Google Scholar 

  • Stensvold R, Brillowska-Dabrowska A, Nielsen HV, Arendrup MC (2006) Detection of Blastocystis hominis in unpreserved stool specimens by using polymerase chain reaction. J Parasitol 92:1081–1087

    Article  PubMed  CAS  Google Scholar 

  • Suresh K, Smith H (2004) Comparison of methods for detecting Blastocystis hominis. Eur J Clin Microbiol Infect Dis 23:509–511

    Article  PubMed  CAS  Google Scholar 

  • Tan KS (2008) New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 21:639–665

    Article  PubMed  CAS  Google Scholar 

  • Tan KS, Mirza H, Teo JD, Wu B, Macary PA (2010) Current views on the clinical relevance of Blastocystis spp. Curr Infect Dis Rep 12:28–35

    Article  PubMed  Google Scholar 

  • Tan TC, Ong SC, Suresh KG (2009) Genetic variability of Blastocystis sp. isolates obtained from cancer and HIV/AIDS patients. Parasitol Res 105:1283–1286

    Article  PubMed  CAS  Google Scholar 

  • Taoufiq Z, Gay F, Balvanyos J, Ciceron L, Tefit M, Lechat P, Mazier D (2008) Rho kinase inhibition in severe malaria: thwarting parasite-induced collateral damage to endothelia. J Infect Dis 197:1062–1073

    Article  PubMed  Google Scholar 

  • TaÅŸova Y, Sahin B, KoltaÅŸ S, PaydaÅŸ S (2000) Clinical significance and frequency of Blastocystis hominis in Turkish patients with hematological malignancy. Acta Med Okayama 54:133–136

    PubMed  Google Scholar 

  • Tsuji E, Hiki N, Nomura S, Fukushima R, Kojima J, Ogawa T, Mafune K, Mimura Y, Kaminishi M (2003) Simultaneous onset of acute inflammatory response, sepsis-like symptoms and intestinal mucosal injury after cancer chemotherapy. Int J Cancer 107:303–308

    Article  PubMed  CAS  Google Scholar 

  • Upcroft JA, Upcroft P (2001) Drug susceptibility testing of anaerobic protozoa. Antimicrob Agents Chemother 45:1810–1814

    Article  PubMed  CAS  Google Scholar 

  • Utzinger J, Botero-Kleiven S, Castelli F, Chiodini PL, Edwards H, Köhler N, Gulletta M, Lebbad M, Manser M, Matthys B, N'Goran EK, Tannich E, Vounatsou P, Marti H (2010) Microscopic diagnosis of sodium acetate-acetic acid-formalin-fixed stool samples for helminths and intestinal protozoa: a comparison among European reference laboratories. Clin Microbiol Infect 16:267–273

    Article  PubMed  CAS  Google Scholar 

  • Vogelberg C, Stensvold CR, Monecke S, Ditzen A, Stopsack K, Heinrich-Gräfe U, Pöhlmann C (2010) Blastocystis sp. subtype 2 detection during recurrence of gastrointestinal and urticarial symptoms. Parasitol Int 59:469–471

    Article  PubMed  Google Scholar 

  • WHO (2008) Guideline for drinking water quality. Incorporated first and second addenda, Geneva, p 514

    Google Scholar 

  • Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R (2010) Irritable bowel syndrome: is it associated with genotypes of Blastocystis hominis. Parasitol Res 106:1033–1038

    Article  PubMed  Google Scholar 

  • Yakoob J, Jafri W, Jafri N, Islam M, Asim Beg M (2004a) In vitro susceptibility of Blastocystis hominis isolated from patients with irritable bowel syndrome. Br J Biomed Sci 61:75–77

    PubMed  CAS  Google Scholar 

  • Yakoob J, Jafri W, Jafri N, Khan R, Islam M, Beg MA, Zaman V (2004b) Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis. Am J Trop Med Hyg 70:383–385

    PubMed  Google Scholar 

  • Yoshikawa H, Nagano I, Wu Z, Yap EH, Singh M, Takahashi Y (1998) Genomic polymorphism among Blastocystis hominis strains and development of subtype-specific diagnostic primers. Mol Cell Probes 12:153–159

    Article  PubMed  CAS  Google Scholar 

  • Yoshikawa H, Wu Z, Pandey K, Pandey BD, Sherchand JB, Yanagi T, Kanbara H (2009) Molecular characterization of Blastocystis isolates from children and rhesus monkeys in Kathmandu, Nepal. Vet Parasitol 160:295–300

    Article  PubMed  CAS  Google Scholar 

  • Zaman V, Zaki M (1996) Resistance of Blastocystis hominis cysts to metronidazole. Trop Med Int Health 1:677–678

    Article  PubMed  CAS  Google Scholar 

  • Zierdt C, Swan J (1981) Generation time and growth rate of the human intestinal parasite Blastocystis hominis. J Protozool 28:483–485

    PubMed  CAS  Google Scholar 

  • Zierdt CH, Swan JC, Hosseini J (1983) In vitro response of Blastocystis hominis to antiprotozoal drugs. J Protozool 30:332–334

    PubMed  CAS  Google Scholar 

  • Zuel-Fakkar NM, Abdel Hameed DM, Hassanin OM (2011) Study of Blastocystis hominis isolates in urticaria: a case-control study. Clin Exp Dermatol 36:908–910

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    Haris Mirza

  2. Laboratory of Molecular and Cellular Parasitology, Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, Singapore, 117597, Singapore

    Kevin S. W. Tan

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  1. Haris Mirza
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Editors and Affiliations

  1. Department of Zoomorphology, Cell Biology and Parasitology,, Heinrich Heine University, Universitätsstr. 1, Düsseldorf, 40225, Germany

    Heinz Mehlhorn

  2. National University of Singapore, Singapore, Singapore

    Kevin S. W. Tan

  3. , Department of Biological Sciences, Nara Women's University, Kitauoya-Nishimachi, Kitauoya-Nishimachi, 630-8506, Nara, Japan

    Hisao Yoshikawa

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Mirza, H., Tan, K.S.W. (2012). Clinical Aspects of Blastocystis Infections: Advancements Amidst Controversies. In: Mehlhorn, H., Tan, K., Yoshikawa, H. (eds) Blastocystis: Pathogen or Passenger?. Parasitology Research Monographs, vol 4. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32738-4_5

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