Anti-inflammatory effect of probiotics in patients with Blastocystis spp. infection

Blastocystis hominis BH infection has been linked to a variety of intestinal immunopathologies. Probiotic therapy is suggested to improve gastrointestinal inflammation during blastocystosis by inducing a pro-inflammatory cytokine response and modulating immune signaling pathways. A hundred patients infected with BH were divided into 4 groups. Group 1: 20 patients did not receive any treatment; Group 2: 40 patients received probiotic therapy; Group 3: 20 patients received metronidazole; and Group 4: 20 patients received both metronidazole and probiotics. Metronidazole was administered at a dose of 250 mg three times daily for 10 days, whereas probiotic therapy consisted of Lacteol forte (Lactobacillus acidophilus LB) capsules twice daily for seven days. Patients were clinically evaluated for the outcome of gastrointestinal symptoms. In addition, fecal calprotectin (FCP) and tumor necrosis factor alpha (TNF-α) levels were measured by ELISA to assess intestinal inflammation and immune response. Between-groups comparison for the presence of gastrointestinal symptoms after treatment did not show any significant difference except for the enhanced effect of probiotic therapy over metronidazole in relieving flatulence. Within-groups comparisons showed a significant reduction in the number of patients complaining of diarrhea in non-treated patients and in patients receiving combined treatment. A significant resolution of abdominal pain was observed among patients receiving probiotics. The number of patients suffering from flatulence significantly decreased in metronidazole and combined therapy-treated groups. Assessment of FCP showed that the highest values were among non-treated patients, followed by patients receiving metronidazole, whereas the lowest values were detected in patients receiving probiotic therapy. As for the TNF-α levels, a significant reduction was observed in all patient groups. Probiotic therapy alleviates intestinal inflammation in blastocystosis as indicated by the reduction of FCP and TNF-α after treatment and can also add a synergistic effect to that of metronidazole.