Human Transmission of Blastocystis by Fecal Microbiota Transplantation Without Development of Gastrointestinal Symptoms in Recipients

Elisabeth M Terveer, Tom van Gool, Netherlands Donor Feces Bank (NDFB) Study Group, Rogier E Ooijevaar, Ingrid M J G Sanders, Eline Boeije-Koppenol, Josbert J Keller, Aldert Bart, Ed J Kuijper

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BACKGROUND: Patients with multiple recurrent Clostridioides difficile infections (rCDI) are treated with fecal microbiota transplantation (FMT), using feces provided by healthy donors. Blastocystis colonization of donors is considered an exclusion criterion, whereas its pathogenicity is still under debate.

METHODS: The introduction of molecular screening for Blastocystis sp. at our stool bank identified 2 donors with prior negative microscopies but positive polymerase chain reactions (PCRs). Potential transmission of Blastocystis sp. to patients was assessed on 16 fecal patient samples, pre- and post-FMT, by PCR and subtype (ST) analyses. In addition, clinical outcomes for the treatment of rCDI (n = 31), as well as the development of gastrointestinal symptoms, were assessed.

RESULTS: There was 1 donor who carried Blastocystis ST1, and the other contained ST3. All patients tested negative for Blastocystis prior to FMT. With a median diagnosis at 20.5 days after FMT, 8 of 16 (50%) patients developed intestinal colonization with Blastocystis, with identical ST sequences as their respective donors. Blastocystis-containing fecal suspensions were used to treat 31 rCDI patients, with an FMT success rate of 84%. This success rate was not statistically different from patients transferred with Blastocystis sp.-negative donor feces (93%, 76/82). Patients transferred with Blastocystis sp.-positive donor feces did not report any significant differences in bowel complaints in the first week, after 3 weeks, or in the months following FMT.

CONCLUSIONS: We demonstrated the first transmission of Blastocystis ST1 and ST3 from donors to patients by FMT. This did not result in gastrointestinal symptomatology or have any significant effect on rCDI treatment outcomes.

Original languageEnglish
Pages (from-to)2630-2636
Number of pages7
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Issue number10
Publication statusPublished - 17 Dec 2020

Bibliographical note

Financial support.This work was supported by the Netherlands Organization for Health Research and Development, Netherlands Organization for Health Research and Development (ZonMW) Verspreidings-en implementatie impuls number 1708810011).

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.


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