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Resistance towards metronidazole in Blastocystis sp.: A pathogenic consequence

Arutchelvan Rajamanikam1, Ho Shiaw Hooi2, Madhav Kudva3

  • 1Depatment of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Plos One
|February 23, 2019
PubMed

Insights

Metronidazole treatment may unexpectedly increase the pathogenicity of Blastocystis sp. parasites, including enhanced growth and cancer cell proliferation. This finding necessitates a reevaluation of current treatment strategies for gastrointestinal infections caused by this protozoan.

Area of Science:

  • Microbiology
  • Parasitology
  • Gastroenterology

Background:

  • Blastocystis sp. is a common protozoan parasite causing gastrointestinal issues.
  • Metronidazole, a primary treatment, often shows inefficacy and variable resistance.
  • The impact of metronidazole on Blastocystis sp. pathogenicity across different host gut environments remains unclear.

Purpose of the Study:

  • To investigate the in vitro effect of metronidazole on the pathogenic potentials of Blastocystis sp. from urban and indigenous populations.
  • To analyze changes in parasite growth, apoptosis, protease activity, and cancer cell proliferation after metronidazole treatment.

Main Methods:

  • Blastocystis sp. ST 3 isolates from symptomatic and asymptomatic individuals were exposed to varying metronidazole concentrations.
  • Parasite growth, apoptotic rates, cysteine protease activity, and cancer cell proliferation were assessed post-treatment.
  • Comparative analysis was performed between urban and indigenous isolates.

Main Results:

  • Metronidazole treatment (0.001 mg/ml) increased Blastocystis sp. numbers, particularly amoebic forms in urban isolates.
  • Post-treatment isolates exhibited higher apoptosis rates and significantly increased cysteine protease activity.
  • Metronidazole-resistant Blastocystis sp. demonstrated enhanced cancer cell proliferation.
  • Pathogenicity differences between urban and indigenous isolates were not significant post-treatment.

Conclusions:

  • Metronidazole treatment can paradoxically enhance the pathogenic potential of Blastocystis sp., including increased proliferation and cancer cell invasiveness.
  • The study highlights the need to reassess metronidazole treatment protocols for Blastocystis sp. infections.
  • Findings suggest metronidazole may alter parasite virulence factors, necessitating further investigation into treatment efficacy and host-parasite interactions.

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