Acute Blastocystis-Associated Appendicular Peritonitis in a Child, Casablanca, Morocco

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Emilie Fréalle1

, Dima El Safadi1, Amandine Cian, Estelle Aubry, Gabriela Certad, Marwan Osman, Agnès Wacrenier, Emmanuel Dutoit, Colette Creusy, François Dubos, and Eric Viscogliosi

Author affiliations: University of Lille, University Hospital Center, Lille, France (E. Fréalle, E. Aubry, A. Wacrenier, E. Dutoit, F. Dubos); Pasteur Institute of Lille, Center for Infection and Immunity of Lille, Lille (E. Fréalle D. El Safadi, A. Cian, G. Certad, M. Osman, E. Viscogliosi); Doctoral School of Sciences and Technology, Lebanese University, Tripoli, Lebanon (D. El Safadi, M. Osman); Hospital Group of the Catholic Institute of Lille, France (C. Creusy)

Abstract

Despite increasing reports that Blastocystis infection is associated with digestive symptoms, its pathogenicity remains controversial. We report appendicular peritonitis in a 9-year-old girl returning to France from Morocco. Only Blastocystis parasites were detected in stools, appendix, peritoneal liquid, and recto-uterine pouch. Simultaneous gastroenteritis in 26 members of the child’s family suggested an outbreak.

Blastocystis is a genus of anaerobic protozoan parasites that infect humans and a vast range of animal species. Prevalence in humans varies from 0.5%–24% in industrialized countries to 30%–76% in developing countries (1,2). Classic clinical features of infection include gastrointestinal symptoms such as nausea, anorexia, flatulence, and acute or chronic diarrhea. Fever is usually absent. An association with irritable bowel syndrome and extraintestinal manifestations such as urticaria has been suggested (2). Reports about invasive infection or disseminated diseases are rare (3). Here, we report the case of a pediatric patient infected with Blastocystis that was manifested by gastroenteritis associated with suppurative appendicitis and peritonitis.

Thumbnail of Micrographs showing histopathologic examination of appendix samples from a child who had peritonitis, Casablanca, Morocco, 2013. A) Ulceration (U) covered with suppurative and fibrinous exudates (SE) (hematoxylin-eosin stain). Scale bar indicates 200μm. B) Blastocystis parasites (arrows) in the lumen (L), and at the surface of the epithelium (E) (hematoxylin-eosin stain). Scale bar indicates 20μm. C) Blastocystis parasites (arrows) in the lumen, at the surface of the epithelium and

Figure. Micrographs showing histopathologic examination of appendix samples from a child who had peritonitis, Casablanca, Morocco, 2013. A) Ulceration (U) covered with suppurative and fibrinous exudates (SE) (hematoxylin-eosin stain). Scale bar indicates...

Dr Fréalle is a hospital practitioner and researcher in Lille University Hospital Center and Pasteur Institute of Lille. Her primary research interests are respiratory fungal and intestinal parasitic infections, with special emphasis on biodiversity and pathogenesis.

Acknowledgments

We thank the members of the Biology and Diversity of Emerging Eukaryotic Pathogens team of the Pasteur Institute of Lille, especially Sadia Benamrouz and Karine Guyot, for their support.

This work was supported by grants from the Programme Orientations Stratégiques from the University of Lille, the Centre National de la Recherche Scientifique, and the Pasteur Institute of Lille. D.E.S. and M.O. were both supported by PhD fellowships from the Conseil National de la Recherche Scientifique and the Azm & Saade Association from Lebanon. A.C. was supported by a PhD fellowship from the Pasteur Institute of Lille and the University of Lille.

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Figure

Figure. Micrographs showing histopathologic examination of appendix samples from a child who had peritonitis, Casablanca, Morocco, 2013. A) Ulceration (U) covered with suppurative and fibrinous exudates (SE) (hematoxylin-eosin stain). Scale bar...

Table

Table. Microbiological examination of samples of feces, appendix, recto-uterine pouch, and peritoneal fluid from child who had peritonitis, Casablanca, Morocco

Suggested citation for this article: Fréalle E, El Safadi D, Cian A, Aubry E, Certad G, Osman M, et al. Acute Blastocystis-associated appendicular peritonitis in child, Casablanca, Morocco. Emerg Infect Dis. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.140544

DOI: 10.3201/eid2101.140544

1These authors contributed equally to this article.