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Taylor-Orozco, V. ., López-Fajardo, A. ., Muñoz-Marroquín, I. ., Hurtado-Benítez, M. ., & Ríos-Ramírez, K. (2016). Blastocystis sp: evidencias de su rol patógeno. Biosalud, 15(2), 69–86. https://doi.org/10.17151/biosa.2016.15.2.8
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Blastocystis sp. es un parásito de distribución mundial, que se transmite por vía fecal-oral, colonizando el tracto gastrointestinal, tanto de animales como de humanos. Existen múltiples factores que favorecen su transmisión tales como el pobre saneamiento, el consumo de alimentos contaminados y la propagación de vectores. Este parásito ha despertado gran interés científico y clínico en los últimos años, por su potencial asociación con enfermedad; sin embargo, no ha sido posible establecer con exactitud su rol patógeno. También ha sido considerado agente oportunista, por su alta prevalencia en pacientes inmunosuprimidos, específicamente en aquellos con VIH/SIDA y cáncer. Actualmente, en el GenBank se han descrito secuencias de 33 subtipos (STs) diferentes, si bien en la literatura solo se encuentran reportados 17 subtipos hasta el momento, de los cuales 9 han sido aislados en el ser humano. Aunque buena parte de los estudios reportan a ST3 como el de mayor prevalencia, unos cuantos autores sugieren predominio de ST1 y ST4 en ciertas zonas, indicando que algunos subtipos varían dependiendo de la distribución geográfica. Varios de estos STs se han relacionado directamente con sintomatología gastrointestinal aguda y crónica e incluso con manifestaciones clínicas extraintestinales, encontrándose con mayor frecuencia el ST3 en pacientes sintomáticos, generalmente seguido de ST1 y en algunos casos de ST2. Además, se han reportado infecciones mixtas, de las cuales la más común se ha presentado entre los ST1 – ST3. En Latinoamérica, y particularmente en Colombia, se han desarrollado pocas investigaciones orientadas a identificar y definir la prevalencia, coinfección y potencial patógeno de las diferentes formas y subtipos conocidos de Blastocystis sp., por lo cual el conocimiento que se tiene hasta el momento es escaso e inespecífico, requiriéndose más estudios que permitan obtener mayor información al respecto.
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Citas
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2. Barahona R, Maguiña V, Náquira V, Terashima I, Tello R. Blastocystosis humana: estudio prospectivo, sintomatología y factores epidemiológicos asociados. Rev gastroenterol Peru. 2003; 23:
29-35.
3. Cárdenas M, Martínez R. Protozoarios parásitos de importancia en salud pública transportados por Musca domestica Linnaeusen Lima, Perú. Rev peru biol. 2004; 11:149-153.
4. Quiceno J, Bastidas X, Rojas D, Barayona M. La mosca doméstica como portador de patógenos microbianos, en cinco cafeterías del norte de Bogotá. Rev UDCA Act & Div Cient. 2010; 13: 23-29.
5. Dagci H, Kurt Ö, Demirel M, Mandiracioglu A, Aydemir S, Saz U, et al. Epidemiological and diagnostic features of Blastocystis Infection in symptomatic patients in Izmir province, Turkey. Iranian J Parasitol. 2014; 9:519-529.
6. Muñoz V, Frade C. Blastocystis Hominis: parásito enigmático. Cuad - Hosp Clín. 2005; 50:1-5.
7. Tan K. New insights on classification, identification and clinical relevance of Blastocystis spp. Clin Microbiol Rev. 2008; 21: 639-665.
8. Abu-Madi M, Aly M, Behnke JM, Clark CG, Balkhy H. The distribution of Blastocystis subtypes in isolates from Qatar. Parasit Vectors. 2015; 8: 465.
9. Tan S, Singh M, Yap E. Recent advances in Blastocystis hominis research: hot spots in terra incognita. Int J Parasitol. 2002; 32: 789-804.
10. Domínguez M. Heterogenicidad genética de Blastocystis hominis: implicaciones patogénicas [tesis doctoral]. Valencia: Universidad de Valencia. Departamento de Microbiología y Ecología; 2003.
11. Tan K, Mirza H, Teo J, Wu B, Macary P. Current views on the clinical relevance of Blastocystis spp. Curr Infect Dis Rep. 2010; 12:28-35.
12. Nagel R, Cuttell L, Stensvold C, Mills P, Bielefeldt H, Traub R. Blastocystis subtypes in symptomatic and asymptomatic family members and pets and response to therapy. Intern Med J. 2012; 42:1187-1195.
13. Hameed D, Hassanin O, Zuel-Fakkar N. Association of Blastocystis hominis genetic subtypes with urticaria. Parasitol Res. 2011; 108:553-560.
14. Eroglu F, Genc A, Elgun G, Koltas I. Identification of Blastocystis hominis isolates from asymptomatic and symptomatic patients by PCR. Parasitol Res. 2009; 105:1589-1592.
15. Boorom K, Smith H, Nimri L, Viscogliosi E, Spanakos G, Parkar U, Li L-H, Zhou X-N, Ok U, Leelayoova S, Jones M. Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection. Parasit Vectors. 2008; 1:40.
16. Zapata J, Rojas C. Una actualización sobre Blastocystis sp. Revista Grastrohnup. 2012; 14: 94-100.
17. Tan S. New Insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev. 2008; 21: 639-665.
18. Londoño A, Mejía M, Gómez J. Prevalencia y factores de riesgo asociados a parasitismo intestinal en preescolares de zona urbana en Calarcá, Colombia. Rev salud pública. 2009; 11: 72-81.
19. Londoño A, Loaiza J, Lora F, Gómez J. Frecuencia y fuentes de Blastocystis sp. en niños de 0 a 5 años de edad atendidos en hogares infantiles públicos de la zona urbana de Calarcá, Quindío. Rev Biomédica. 2014; 34:218-227.
20. Stenzel D, Boreham P. Blastocystis hominis Revisited. Clin Microbiol Rev. 1996; 9: 563-584.
21. Basak S, Rajurkar M, Mallick S. Detection of Blastocystis hominis: a controversial human pathogen. Parasitol Res. 2014; 113: 261-265.
22. Tan T, Suresh K. Predominance of amoeboid forms of Blastocystis hominis in isolates from symptomatic patients. Parasitol Res. 2006; 98: 189-193.
23. Rajamanikam A, Govind S. Amoebic forms of Blastocystis spp. – evidence for a pathogenic role. Parasit Vectors. 2013; 6: 295.
24. Elwakil H, Hewedi I. Pathogenic potential of Blastocystis hominis in laboratory mice. Parasitol Res. 2010; 107: 685-689.
25. Mehlhorn H, Tan S, Yoshiwaka H, editors. Blastocystis: Pathogen or Passenger? 1a ed. Berlin: Springer; 2012.
26. Bálint A, Dóczi I, Bereczki L, Gyulai R, Szucs M, Farkas K. Do not forget the stool examination cutaneous and gastrointestinal manifestations of Blastocystis sp. infection. Parasitol Res. 2014; 113: 1585-1590.
27. Roberts T, Stark D, Harkness, Ellis J.Subtype distribution of Blastocystis isolates identified in a Sydney population and pathogenic potential of Blastocystis. Eur J Clin Microbiol Infect Dis. 2013; 32: 335-343.
28. Graczyk T, Shiff C, Tamang L, Munsaka F, Beitin A, Moss W. The association of Blastocystis hominis and Endolimax nana with diarrheal stools in Zambian school-age children. Parasitol Res. 2005; 98: 38-43.
29. David EB, Guimarães S, De Oliveira A, Goulart T, Nogueira G, Moraes A. Molecular characterization of intestinal protozoa in two poor communities in the State of São Paulo, Brazil. Parasit Vectors. 2015;8: 103.
30. Kulik R, Falavigna D, Nishi L, Marques S. Blastocystis sp. and other intestinal parasites in hemodialysis patients. Braz J Infect Dis. 2008; 12: 338-341.
31. Santalla J, Montaño W. Frecuencia de Blastocystis sp. y otros parásitos intestinales en niños entre 3 meses a 13 años provenientes del Hospital Municipal Corea de la Ciudad de El Alto[tesis]. Bolivia: Universidad Mayor de San Andrés; 2013.
32. Muñoz V, Borda M, Churqui C, Frade C. Intestinal parasites in children of incarcerated mothers of Center at the Feminine Orientation of Obrajes, La Paz Bolivia: High prevalence of Blastocystis hominis. Biofarbo. 2009; 17: 39-46.
33. Lozano S. Presencia de Blastocystis hominis como agente causal de enfermedades gastrointestinales en la comuna 7 (Gaira) del Distrito de Santa Marta. DUAZARY. 2005; 2: 37-40.
34. Rivero Z, Hernández A, Bracho A, Salazar S, Villalobos R. Prevalencia de microsporidios intestinales y otros enteroparásitos en pacientes con VIH positivo de Maracaibo, Venezuela. Rev. Biomédica. 2013;33: 538-545.
35. Tian L, Chen J, Wang T, Cheng G, Steinmann P, Cai Y, et al. Co-infection of HIV and intestinal parasites in rural area of China. Parasites and vectors. 2012; 5:1-7.
36. Tan T, Suresh K, Ong S. Genetic variability of Blastocystis sp. Isolates obtained from cancer and HIV/AIDS patients. Parasitol Res. 2009; 105: 1283-1286.
37. Chandramathi S, Suresha K, Bustam A, Kuppusamyc U. Infections of Blastocystis hominis and microsporidia in cancer patients: are they opportunistic? Trans R Soc Trop Med Hyg. 2012; 106: 267-269.
38. Pipatsatitpong D, Leelayoova S, Mungthin M, Aunpad R, Naaglor T, Rangsin R. Prevalence and Risk Factors for Blastocystis Infection Among Children and Caregivers in a Child Care Center, Bangkok, Thailand. Am J Trop Med Hyg. 2015; 93:310-315.
39. Badparva E, Sadraee J, Kheirandish F, Frouzandeh M. Genetic diversity of human Blastocystis isolates in Khorramabad, Central Iran. Iran J Parasitol. 2014; 9:44-49.
40. Clark C, van der Giezen M, Alfellani M, Stensvold C. Recent developments in Blastocystis research. Adv Parasitol. 2013;82:1-32
41. Alfellani M, Stensvold C, Vidal A, Onuoha E, Fagbenro A, Clark C. Variable geographic distribution of Blastocystis subtypes and its potential implications. Acta Trop. 2013; 126: 11-18.
42. Domínguez M, Guna R, Muñoz C, Gómez M, Borrás R. High prevalence of subtype 4 among isolates of Blastocystis hominis from symptomatic patients of a health district of Valencia (Spain). Parasitol Res. 2009; 105:949-955.
43. Stensvold C, Christiansen D, Olsen K, Nielsen H. Blastocystis sp. subtype 4 is common in Danish Blastocystis-positive patients presenting with acute diarrhea. Am J Trop Med Hyg. 2011; 84:883- 885.
44. Lee I, Tan T, Tan P, Nanthiney D, Biraj M, Surendra K, Suresh K. Predominance of Blastocystis sp. subtype 4 in rural communities, Nepal. Parasitol Res. 2012; 110:1553-1562.
45. Abdulsalam A, Ithoi I, Al-Mekhlafi H, Al-Mekhlafi A, Ahmed A, Surin J. Subtype Distribution of Blastocystis Isolates in Sebha, Libya. PLoS ONE. 2013; 8: e84372.
46. Malheiros A, Stensvold C, Clark C, Braga G, Shaw J. Short Report: Molecular Characterization of Blastocystis Obtained from Members of the Indigenous Tapirapé Ethnic Group from the Brazilian Amazon Region, Brazil. Am.J.Trop.Med.Hyg. 2011; 85: 1050-1053.
47. Souppart L, Sanciu G, Cian A, Wawrzyniak I, Delbac F, Capron M, Dei-Cas E, Boorom K, Delhaes L, Viscoqliosi E. Molecular epidemiology of human Blastocystis isolates in France. Parasitol Res. 2009; 105:413-421.
48. Forsell J, Granlund M, Stensvold C, Clark C, Evengård B. Subtype analysis of Blastocystis isolates in Swedish patients. Eur J Clin Microbiol Infect Dis. 2012; 31:1689-1696.
49. Bart A, Wentink E, Gilis H, Verhaar N, Wassenaar C, Van Vugt M et al. Diagnosis and subtype analysis of Blastocystis sp. in 442 patients in a hospital setting in the Netherlands. BMC Infect Dis. 2013; 23: 389.
50. Meloni D, Sanciu G, Poirier P, El Alaoui H, Chabé M, Delhaes L et al. Molecular subtyping of Blastocystis sp. isolates from symptomatic patients in Italy. Parasitol Res. 2011; 109:613-619.
51. Dogruman-Al F, Yoshikawa H, Kustimur S, Balaban N. PCR-based subtyping of Blastocystis isolates from symptomatic and asymptomatic individuals in a major hospital in Ankara, Turkey. Parasitol Res. 2009; 106: 263-268.
52. Jantermtor S, Pinlaor P, Sawadpanich K, Pinlaor S, Sangka A, Wilailuckana C et al. Subtype identification of Blastocystis spp. Isolated from patients in a major hospital in northeastern Thailand. Parasitol Res. 2013; 112:1781-1786.
53. Souppart L, Moussa H, Cian A, Sanciu G, Poirier P, El Alaoui H. et al. Subtype analysis of Blastocystis isolates from symptomatic patients in Egypt. Parasitol Res. 2010; 106:505-511.
54. Poirier P, Wawrzyniak I, Vivares C, Delbac F, El Alaoui H. New insights into Blastocystis spp: A potential link with irritable bowel syndrome. PLoS Pathog. 2012; 8: e1002545–e1002545.
55. Scanlan P. Blastocystis: past pitfalls and future perspectives. Trends Parasitol. 2012; 28: 327-334.
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66. Casero R, Mongi F, Sánchez A, Ramírez J. Blastocystis and urticarial: Examination of subtypes and morphotypes in an unusual clinical manifestation. Acta Trop. 2015; 148: 156-161.
67. Kumarasamy V, Kuppusamy U, Samudi C, Kumar S. Blastocystis sp. Subtype 3 triggers higher proliferation of human colorectal cancer cells, HCT116. Parasitol Res. 2013; 112: 3551-3555.
2. Barahona R, Maguiña V, Náquira V, Terashima I, Tello R. Blastocystosis humana: estudio prospectivo, sintomatología y factores epidemiológicos asociados. Rev gastroenterol Peru. 2003; 23:
29-35.
3. Cárdenas M, Martínez R. Protozoarios parásitos de importancia en salud pública transportados por Musca domestica Linnaeusen Lima, Perú. Rev peru biol. 2004; 11:149-153.
4. Quiceno J, Bastidas X, Rojas D, Barayona M. La mosca doméstica como portador de patógenos microbianos, en cinco cafeterías del norte de Bogotá. Rev UDCA Act & Div Cient. 2010; 13: 23-29.
5. Dagci H, Kurt Ö, Demirel M, Mandiracioglu A, Aydemir S, Saz U, et al. Epidemiological and diagnostic features of Blastocystis Infection in symptomatic patients in Izmir province, Turkey. Iranian J Parasitol. 2014; 9:519-529.
6. Muñoz V, Frade C. Blastocystis Hominis: parásito enigmático. Cuad - Hosp Clín. 2005; 50:1-5.
7. Tan K. New insights on classification, identification and clinical relevance of Blastocystis spp. Clin Microbiol Rev. 2008; 21: 639-665.
8. Abu-Madi M, Aly M, Behnke JM, Clark CG, Balkhy H. The distribution of Blastocystis subtypes in isolates from Qatar. Parasit Vectors. 2015; 8: 465.
9. Tan S, Singh M, Yap E. Recent advances in Blastocystis hominis research: hot spots in terra incognita. Int J Parasitol. 2002; 32: 789-804.
10. Domínguez M. Heterogenicidad genética de Blastocystis hominis: implicaciones patogénicas [tesis doctoral]. Valencia: Universidad de Valencia. Departamento de Microbiología y Ecología; 2003.
11. Tan K, Mirza H, Teo J, Wu B, Macary P. Current views on the clinical relevance of Blastocystis spp. Curr Infect Dis Rep. 2010; 12:28-35.
12. Nagel R, Cuttell L, Stensvold C, Mills P, Bielefeldt H, Traub R. Blastocystis subtypes in symptomatic and asymptomatic family members and pets and response to therapy. Intern Med J. 2012; 42:1187-1195.
13. Hameed D, Hassanin O, Zuel-Fakkar N. Association of Blastocystis hominis genetic subtypes with urticaria. Parasitol Res. 2011; 108:553-560.
14. Eroglu F, Genc A, Elgun G, Koltas I. Identification of Blastocystis hominis isolates from asymptomatic and symptomatic patients by PCR. Parasitol Res. 2009; 105:1589-1592.
15. Boorom K, Smith H, Nimri L, Viscogliosi E, Spanakos G, Parkar U, Li L-H, Zhou X-N, Ok U, Leelayoova S, Jones M. Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection. Parasit Vectors. 2008; 1:40.
16. Zapata J, Rojas C. Una actualización sobre Blastocystis sp. Revista Grastrohnup. 2012; 14: 94-100.
17. Tan S. New Insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev. 2008; 21: 639-665.
18. Londoño A, Mejía M, Gómez J. Prevalencia y factores de riesgo asociados a parasitismo intestinal en preescolares de zona urbana en Calarcá, Colombia. Rev salud pública. 2009; 11: 72-81.
19. Londoño A, Loaiza J, Lora F, Gómez J. Frecuencia y fuentes de Blastocystis sp. en niños de 0 a 5 años de edad atendidos en hogares infantiles públicos de la zona urbana de Calarcá, Quindío. Rev Biomédica. 2014; 34:218-227.
20. Stenzel D, Boreham P. Blastocystis hominis Revisited. Clin Microbiol Rev. 1996; 9: 563-584.
21. Basak S, Rajurkar M, Mallick S. Detection of Blastocystis hominis: a controversial human pathogen. Parasitol Res. 2014; 113: 261-265.
22. Tan T, Suresh K. Predominance of amoeboid forms of Blastocystis hominis in isolates from symptomatic patients. Parasitol Res. 2006; 98: 189-193.
23. Rajamanikam A, Govind S. Amoebic forms of Blastocystis spp. – evidence for a pathogenic role. Parasit Vectors. 2013; 6: 295.
24. Elwakil H, Hewedi I. Pathogenic potential of Blastocystis hominis in laboratory mice. Parasitol Res. 2010; 107: 685-689.
25. Mehlhorn H, Tan S, Yoshiwaka H, editors. Blastocystis: Pathogen or Passenger? 1a ed. Berlin: Springer; 2012.
26. Bálint A, Dóczi I, Bereczki L, Gyulai R, Szucs M, Farkas K. Do not forget the stool examination cutaneous and gastrointestinal manifestations of Blastocystis sp. infection. Parasitol Res. 2014; 113: 1585-1590.
27. Roberts T, Stark D, Harkness, Ellis J.Subtype distribution of Blastocystis isolates identified in a Sydney population and pathogenic potential of Blastocystis. Eur J Clin Microbiol Infect Dis. 2013; 32: 335-343.
28. Graczyk T, Shiff C, Tamang L, Munsaka F, Beitin A, Moss W. The association of Blastocystis hominis and Endolimax nana with diarrheal stools in Zambian school-age children. Parasitol Res. 2005; 98: 38-43.
29. David EB, Guimarães S, De Oliveira A, Goulart T, Nogueira G, Moraes A. Molecular characterization of intestinal protozoa in two poor communities in the State of São Paulo, Brazil. Parasit Vectors. 2015;8: 103.
30. Kulik R, Falavigna D, Nishi L, Marques S. Blastocystis sp. and other intestinal parasites in hemodialysis patients. Braz J Infect Dis. 2008; 12: 338-341.
31. Santalla J, Montaño W. Frecuencia de Blastocystis sp. y otros parásitos intestinales en niños entre 3 meses a 13 años provenientes del Hospital Municipal Corea de la Ciudad de El Alto[tesis]. Bolivia: Universidad Mayor de San Andrés; 2013.
32. Muñoz V, Borda M, Churqui C, Frade C. Intestinal parasites in children of incarcerated mothers of Center at the Feminine Orientation of Obrajes, La Paz Bolivia: High prevalence of Blastocystis hominis. Biofarbo. 2009; 17: 39-46.
33. Lozano S. Presencia de Blastocystis hominis como agente causal de enfermedades gastrointestinales en la comuna 7 (Gaira) del Distrito de Santa Marta. DUAZARY. 2005; 2: 37-40.
34. Rivero Z, Hernández A, Bracho A, Salazar S, Villalobos R. Prevalencia de microsporidios intestinales y otros enteroparásitos en pacientes con VIH positivo de Maracaibo, Venezuela. Rev. Biomédica. 2013;33: 538-545.
35. Tian L, Chen J, Wang T, Cheng G, Steinmann P, Cai Y, et al. Co-infection of HIV and intestinal parasites in rural area of China. Parasites and vectors. 2012; 5:1-7.
36. Tan T, Suresh K, Ong S. Genetic variability of Blastocystis sp. Isolates obtained from cancer and HIV/AIDS patients. Parasitol Res. 2009; 105: 1283-1286.
37. Chandramathi S, Suresha K, Bustam A, Kuppusamyc U. Infections of Blastocystis hominis and microsporidia in cancer patients: are they opportunistic? Trans R Soc Trop Med Hyg. 2012; 106: 267-269.
38. Pipatsatitpong D, Leelayoova S, Mungthin M, Aunpad R, Naaglor T, Rangsin R. Prevalence and Risk Factors for Blastocystis Infection Among Children and Caregivers in a Child Care Center, Bangkok, Thailand. Am J Trop Med Hyg. 2015; 93:310-315.
39. Badparva E, Sadraee J, Kheirandish F, Frouzandeh M. Genetic diversity of human Blastocystis isolates in Khorramabad, Central Iran. Iran J Parasitol. 2014; 9:44-49.
40. Clark C, van der Giezen M, Alfellani M, Stensvold C. Recent developments in Blastocystis research. Adv Parasitol. 2013;82:1-32
41. Alfellani M, Stensvold C, Vidal A, Onuoha E, Fagbenro A, Clark C. Variable geographic distribution of Blastocystis subtypes and its potential implications. Acta Trop. 2013; 126: 11-18.
42. Domínguez M, Guna R, Muñoz C, Gómez M, Borrás R. High prevalence of subtype 4 among isolates of Blastocystis hominis from symptomatic patients of a health district of Valencia (Spain). Parasitol Res. 2009; 105:949-955.
43. Stensvold C, Christiansen D, Olsen K, Nielsen H. Blastocystis sp. subtype 4 is common in Danish Blastocystis-positive patients presenting with acute diarrhea. Am J Trop Med Hyg. 2011; 84:883- 885.
44. Lee I, Tan T, Tan P, Nanthiney D, Biraj M, Surendra K, Suresh K. Predominance of Blastocystis sp. subtype 4 in rural communities, Nepal. Parasitol Res. 2012; 110:1553-1562.
45. Abdulsalam A, Ithoi I, Al-Mekhlafi H, Al-Mekhlafi A, Ahmed A, Surin J. Subtype Distribution of Blastocystis Isolates in Sebha, Libya. PLoS ONE. 2013; 8: e84372.
46. Malheiros A, Stensvold C, Clark C, Braga G, Shaw J. Short Report: Molecular Characterization of Blastocystis Obtained from Members of the Indigenous Tapirapé Ethnic Group from the Brazilian Amazon Region, Brazil. Am.J.Trop.Med.Hyg. 2011; 85: 1050-1053.
47. Souppart L, Sanciu G, Cian A, Wawrzyniak I, Delbac F, Capron M, Dei-Cas E, Boorom K, Delhaes L, Viscoqliosi E. Molecular epidemiology of human Blastocystis isolates in France. Parasitol Res. 2009; 105:413-421.
48. Forsell J, Granlund M, Stensvold C, Clark C, Evengård B. Subtype analysis of Blastocystis isolates in Swedish patients. Eur J Clin Microbiol Infect Dis. 2012; 31:1689-1696.
49. Bart A, Wentink E, Gilis H, Verhaar N, Wassenaar C, Van Vugt M et al. Diagnosis and subtype analysis of Blastocystis sp. in 442 patients in a hospital setting in the Netherlands. BMC Infect Dis. 2013; 23: 389.
50. Meloni D, Sanciu G, Poirier P, El Alaoui H, Chabé M, Delhaes L et al. Molecular subtyping of Blastocystis sp. isolates from symptomatic patients in Italy. Parasitol Res. 2011; 109:613-619.
51. Dogruman-Al F, Yoshikawa H, Kustimur S, Balaban N. PCR-based subtyping of Blastocystis isolates from symptomatic and asymptomatic individuals in a major hospital in Ankara, Turkey. Parasitol Res. 2009; 106: 263-268.
52. Jantermtor S, Pinlaor P, Sawadpanich K, Pinlaor S, Sangka A, Wilailuckana C et al. Subtype identification of Blastocystis spp. Isolated from patients in a major hospital in northeastern Thailand. Parasitol Res. 2013; 112:1781-1786.
53. Souppart L, Moussa H, Cian A, Sanciu G, Poirier P, El Alaoui H. et al. Subtype analysis of Blastocystis isolates from symptomatic patients in Egypt. Parasitol Res. 2010; 106:505-511.
54. Poirier P, Wawrzyniak I, Vivares C, Delbac F, El Alaoui H. New insights into Blastocystis spp: A potential link with irritable bowel syndrome. PLoS Pathog. 2012; 8: e1002545–e1002545.
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