title: Diagnosis and subtype analysis of Blastocystis sp. in 442 patients in a hospital setting in the Netherlands.
abstract: BACKGROUND
  Blastocystis sp. are among the most commonly observed intestinal parasites in routine clinical parasitology. Blastocystis in humans consists of at least 9 genetic subtypes. Different subtypes of Blastocystis may be associated with differences in pathogenicity and symptomatology.
  
  
  METHODS
  Advanced microscopy on two samples and sequence-confirmed PCR on a third sample from the same individual were used for Blastocystis diagnosis and subtype analyses on routine clinical samples in a university hospital.
  
  
  RESULTS
  With a combined gold standard of sequence-confirmed PCR and positive advanced microscopy, 107 out of 442 (24.2%) patients were diagnosed with Blastocystis. infection, which is a high frequency of detection in comparison to previous reports from industrialized countries. The sensitivity of microscopy and sequence-confirmed PCR was 99.1% (106/107) and 96.3% (103/107), respectively.Among 103 typable samples, subtype 3 was most abundant (n = 43, 42%), followed by subtypes 1 and 2 (both n = 23, 22%), subtype 4 (n = 12, 12%), and single samples with subtypes 6 (1%) and subtype 7 (1%). The prevalence of Blastocystis infection was 38% in patients from the Department of Tropical Medicine and 18% in patients from other departments.
  
  
  CONCLUSIONS
  A high prevalence of Blastocystis infection was found with both advanced microscopy and sequence-confirmed PCR in our patient population. Most cases were caused by subtypes ST1, ST2, ST3 and ST4. A significantly higher prevalence was found among patients with a history of recent travel to tropical countries.
authors: Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands. a.bart@amc.uva.nl
authors: Aldert
authors: A
authors: Bart
authors: Ellen M S
authors: EM
authors: Wentink-Bonnema
authors: Henk
authors: H
authors: Gilis
authors: Nienke
authors: N
authors: Verhaar
authors: Carla J A
authors: CJ
authors: Wassenaar
authors: Michèle
authors: M
authors: van Vugt
authors: Abraham
authors: A
authors: Goorhuis
authors: Tom
authors: T
authors: van Gool
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016844:Blastocystis / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D016776:Blastocystis Infections / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D017720:Molecular Epidemiology; D009426:Netherlands / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence
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