Detection of Blastocystis sp Infection using different investigation techniques in children with or without acute diarrhea

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Background: Blastocystis is a common human intestinal parasite with high prevalence in developing countries and one of the causative agent for acute infectious diarrhea. Microscopic methods such as native-lugol and trichrome staining are most frequently used in routine diagnosis. Our study to evaluate the prevalence of Blastocystis in children in Eskisehir, Turkey with or without acute diarrhea, using direct microscopy, trichrome stain and real-time polymerase chain reaction (PCR) technique. Methods & Materials: Study was carried out between January 2011 and March 2013 in Eskisehir city center in children. They were admitted to the emergency unit with acute diarrhea and school children without diarrhea from seven different socioeconomic backgrounds have been enrolled. Stool specimens were investigated by routine fecal examinations in the Parasitology laboratory of Eskisehir Osmangazi University Education and Research Hospital. We investigated 961 stool samples taken from children. We have a limited number of molecular tests therefore 303 samples have been evaluated with these three methods. All of the symptomatic childrens stool samples (n = 84) were chosen for moleculer test and in asymptomatic children's stool samples (n = 219) we were chosen by randomly selection. Results: Blastocystis were seen in 38.6% of samples with direct microscopic examination, 35.6% of samples by the trichrome stain, 38.2% by PCR method. In symptomatic group respectively; 14.2%, 19.0% and 19.0% also asymptomatic group ratio respectively; 47.9%, 42.0% and 45.6%. In the symptomatic group, compared to PCR-based evaluation of Blastocystis infection, for direct microscopic evaluation the sensitivity was 12.5% and the specificity was 85.2%, while for trichrome staining 31.2% and 83.8% respectively while the negative predictive value was 80.5% and 83.8%, respectively. In the asymptomatic group, compared to PCR-based evaluation of Blastocystis infection, for direct microscopic evaluation the sensitivity was 74.0% and the specificity was 73.9%, while for trichrome staining 59.0% and 72.2%. Conclusion: PCR is a useful technique for the evaluation of fecal samples in acute diarrhea for Blastocystis sp. Direct microscopic evaluation can be used to rule out Blastocytis infection in children with acute infectious diarrhea but there are needed multicenter and large-scaled molecular and clinical studies.