What is the treatment for a positive stool test showing Entamoeba coli (E. coli) cysts and trophozoites with a few Blastocystis hominis?

From the Guidelines

Entamoeba coli and Blastocystis hominis found in stool typically do not require treatment as they are generally considered non-pathogenic organisms. Entamoeba coli is a commensal amoeba that lives in the human intestine without causing disease, unlike its pathogenic relative Entamoeba histolytica 1. Similarly, Blastocystis hominis is often present without causing symptoms in many individuals. If the patient is asymptomatic, observation without medication is the standard approach. However, if the patient is experiencing gastrointestinal symptoms like diarrhea, abdominal pain, or bloating that cannot be attributed to other causes, treatment may be considered.

In symptomatic cases, the treatment approach may vary, but metronidazole 500-750 mg three times daily for 7-10 days is commonly prescribed 1. Alternative options include tinidazole 2 grams once daily for 3 days or nitazoxanide 500 mg twice daily for 3 days. It's essential to note that treatment success for Blastocystis can be variable. The pathogenicity of Blastocystis hominis remains controversial, and in the absence of other pathogens, it may be clinically relevant if symptoms persist 1.

Good hygiene practices, including handwashing before meals and after using the bathroom, are recommended to prevent reinfection or transmission to others. The decision to treat should be based on clinical symptoms rather than merely the presence of these organisms in stool samples. The diagnosis and management of infectious diarrhea should follow the guidelines outlined by the Infectious Diseases Society of America, which emphasizes the importance of laboratory diagnostics and clinical assessment in guiding treatment decisions 1.

Key considerations in the management of patients with Entamoeba coli and Blastocystis hominis include:

• Clinical assessment to determine the presence of symptoms
• Laboratory diagnostics to rule out other pathogens
• Hygiene practices to prevent transmission
• Treatment based on clinical symptoms and laboratory findings, with metronidazole being a common choice for symptomatic cases.

From the Research

Treatment for Entamoeba coli and Blastocystis hominis

• The treatment for a positive stool test showing Entamoeba coli (E. coli) cysts and trophozoites with a few Blastocystis hominis is not directly addressed in the provided studies, as they primarily focus on Blastocystis hominis or other parasites.
• However, for Blastocystis hominis, the studies suggest the following treatments:
  • Metronidazole: 2, 3, 4, 5
  • Saccharomyces boulardii: 2
  • Paromomycin: 3
  • Trimethoprim/Sulfamethoxazole (TMP/SMX): 4
• For Entamoeba coli, one study mentions the treatment of intestinal amoebiasis with tinidazole and metronidazole: 6

Efficacy of Treatments

• The efficacy of metronidazole in eradicating Blastocystis hominis varies across studies, with some showing low efficacy: 5
• Paromomycin appears to have a higher eradication rate compared to metronidazole and clioquinol: 3
• Saccharomyces boulardii has potential beneficial effects in B. hominis infection: 2

Considerations

• The choice of treatment may depend on the severity of symptoms, the presence of other parasites, and the patient's overall health: 2, 3, 4
• Further research is needed to determine the most effective treatment for Entamoeba coli and Blastocystis hominis infections: 2, 3, 4, 5