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Balantidium coli in the Urinse Sediment | OMICS International
ISSN: 2165-7920
Journal of Clinical Case Reports
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Balantidium coli in the Urinse Sediment

www.omicsonline.org/searchresult.phpJose Antonio Tesser Poloni1*, Elizete Keitel2, Patrícia Speroto Ceccon3, Carlos Franco Voegeli4, Istifanus Bala Bosan5, Giuseppe Garigali6 and Giovanni Battista Fogazzi6
1Central Laboratory of Clinical Analysis , Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA) Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
2Department of Nephrology - ISCMPA and UFCSPA, Brazil
3Central Laboratory of Clinical Analysis, ISCMPA, Brazil
4Central Laboratory of Clinical Analysis –-ISCMPA, Brazil
5Department of Medicine, Nephrology Unit, - Ahmadu Bello University, Zaria , Nigeria
6Divison of Nephrology and Dialysis, Ospedale Maggiore IRCCS , Via Commenda 15 , I- 20122 Milan, Italy
Corresponding Author : Jose Antonio Tesser Poloni
Rua Riveira 280/803, Porto Alegre-RS, 90670-160, Brazil
Tel: +55-51-99689730
Fax: +55-51-32148090
Email: [email protected]
Received April 08, 2015; Accepted April 20, 2015; Published April 22, 2015
Citation: Poloni JAT, Keitel E, Ceccon PS, Voegeli CF, Bosan IB, et al. (2015) Balantidium coli in the Urinse Sediment. J Clin Case Rep 5:i107. doi:10.4172/2165-7920.1000i107
Copyright: © 2015 Poloni JAT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Balantidium coli is a ciliated protozoa which can infect humans. Although the infection is uncommon, it tends to be more frequent in the tropics and subtropical regions. It is often asymptomatic but may present with gastrointestinal symptoms. Few cases of urinary balantidiasis have been reported but faecal contamination could cause diagnostic dilemma.

Keywords
Urinary balantidiasis; Dilemma; Urine Sediment; Uterine cervix
Introduction
Balantidium coli is a ciliated protozoa which can infect humans. Although the infection is uncommon, it tends to be more frequent in the tropics and subtropical regions. It is often asymptomatic but may present with gastrointestinal symptoms. Few cases of urinary balantidiasis have been reported [1,2] but faecal contamination could cause diagnostic dilemma.
Clinical Image
We report Balantidium coli in urine sediment from a 59-year-old woman who was seen in a Hospital at Porto Alegre (Rio Grande do Sul, Brazil), which serves a large rural and urban population. On March 20, 2009 the asymptomatic patient of low social class presented with a clinical history of uterine cervix carcinoma, obstructive uropathy (which required a permanent bilateral ureteric stenting) and recurrent urinary tract infection. She was admitted to our center for a general check-up.
The centrifuged urinary sediment (analyzed with a bright field microscope) contained many leukocytes and bacteria interminglexd with mites, yeasts, Fusarium fungi and a large number of a ciliated protozoa, whose morphology and rapid movements through the slide were all consistent with trophozoites and cysts of Balantidium coli (Figure 1). All these findings were confirmed in a new sample supplied in the afternoon of the same day. There was no specific treatment for Balantidium coli but a repeat urine sample was collected six days later after properly educating the patient on the methods of urine collection. This new urine sample revealed only bacteria and leukocytes but no Balantidium coli, no mites, yeasts or Fusarium. Urine culture was positive for Serratia sp. which was treated with i.v. amikacin.
Discussion
Stimulated by the unusual findings described above, we checked the patient and found that the first two urine samples had been obtained without proper procedures about urine collection and that the urine had been collected in a container which was kept under the bed of the patient for hours before being transferred to the sterile capped container supplied by the hospital laboratory. On the contrary, the third urine sample had been collected directly in the container supplied by the laboratory and after the patient had been instructed about the correct procedure for urine collection [3].
The finding of a large variety of microorganism in the first two samples, coupled with the incorrect urine collection procedures used and the low social class of the patient, strongly suggest that the urine was heavily contaminated by particles coming from both the environment (eg, Fusarium fungi, which may exist in the soil of potted plants in hospital) [4] and/or the patient herself (eg, mites from pubis or perianal area [5], Balantidium coli from feces).
Maino et al. [1] reported urinary balantidiasis in an immunocompromissed patient [1], while our case demonstrates just contamination. Various protozoa and helminthes can occasionally be found on urine sediment following contamination from faeces in the infested person or the environment [5]. Clear instructions must be given to patients on proper urine sample collection to avoid confusion on diagnosis.
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