Management of acute diarrhea is directed at maintaining adequate hydration, and laboratory diagnosis is generally unnecessary in the otherwise well child without a travel history and non-bloody diarrhea. In the school age child or adolescent with chronic diarrhea organic disease, particularly inflammatory bowel disease, must be considered. In the Maritime provinces, parasites are the most common infectious agents identified when stools are submitted from patients with chronic diarrhea. The parasites likely to be acquired here are Blastocystis hominis, Dientamoeba fragilis, Giardia lamblia, and much less commonly Cryptosporidia . Entamoeba histolytica , a common enteric parasite in warmer climates, was identified in 20 specimens.
Infection is thought to be acquired by the fecal-oral route.
Infections have been associated with intra-familial spread, contaminated water and travel to the tropics. There is considerable debate in the medical literature as to whether BH is a normal commensal of the lower intestinal tract or an enteric pathogen. It is clear that there is an asymptomatic carrier state, and in many individuals the organism is eradicated over time. In a subset of patients, particularly those with human immunodeficiency virus infection, a clinical syndrome of abdominal pain, diarrhea, flatulence and constipation has been reported to occur, and to be remediated by antimicrobial therapy. No correlation has been found between BH and fecal leucocytes or significant intestinal inflammation on endoscopy, and most studies with a comparison group have found no difference in symptomatology between infected and uninfected patients.