ORIGINAL PAPER Do not forget the stool examination!—cutaneous and gastrointestinal manifestations of Blastocystis sp. infection Anita Bálint & Ilona Dóczi & László Bereczki & Rolland Gyulai & Mónika Szűcs & Klaudia Farkas & Edit Urbán & Ferenc Nagy & Zoltán Szepes & Tibor Wittmann & Tamás Molnár Received: 11 December 2013 /Accepted: 28 January 2014 /Published online: 20 February 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Blastocystis sp. is one of the most common para- sites in the human intestinal tract. This infection commonly is accompanied by diarrhoea and abdominal pain, but extrain- testinal symptoms, such as skin lesions, may also accompany the disease. In this study, our aim was to assess the frequency, clinical symptoms and skin manifestations of confirmed pos- itive Blastocystis sp. infections. Data of 80 patients with confirmed positive Blastocystis sp. infections were assessed retrospectively. The average age of the patients was 46.3 years of age (with a range between 13 and 85 years of age). The number of female patients was higher than the number of males (48 vs. 32; 60 vs. 40 %). Gastrointestinal and dermato- logical symptoms and the results of routine biochemical and haematological blood tests of enrolled patients were collected and analyzed. The skin manifestations were analyzed using the data available (including descriptions, photos and histolo- gies). We discovered that 11.25 % of our enrolled patients exhibited skin manifestations associated to Blastocystis sp., mainly on the females. The occurrence of Blastocystis sp. was 6 % in symptomatic patients who required medical attendance in the time period between 2005 and 2013. Of the 80 patients, 73.75 % indicated that they had gastrointestinal symptoms: 40 patients complained of abdominal pain and 17 with blood in their stool, while other symptoms, such as meteorism (15 subjects), weigh loss (8 subjects), perianal pain or itching (6 subjects), passing stool with mucus (5 subjects), vomiting (2 subjects) and fever (2 subjects) were less frequent. The prevalence of abdominal pain in the cohort without skin lesions was higher compared to those patients with skin prob- lems (p =0.007). The mean value of C-reactive protein showed elevated levels, but eosinophils were within a normal range. In addition, we did not find significant difference in eosinophilia between patients with vs. without skin manifestations. Thus, we suggest that eosinophilia is not an obligatory laboratory finding in protozoon infections, such as Blastocystis sp. In the light of our results, we suggest a stool parasite examination for patients with skin lesions of unknown origin. Introduction Many gastrointestinal diseases are accompanied by cutaneous manifestations, and some skin disorders also may result in lesions in the intestine. Inflammatory bowel diseases of un- known origin, gluten-sensitive enteropathy, polyposis syn- dromes and gastrointestinal malignancies are bowel diseases which are often accompanied by special extraintestinal cuta- neous manifestations (Ghevariya et al. 2013). However, a much more typical clinical scenario is a patient who has non-specific gastrointestinal symptoms and recurrent non-specific skin abnormalities. In this case, food aller- gy and small intestinal bacterial overgrowth are the most common causes, but testing first for a Helicobacter pylori infection is also a common practice, although a microbiolog- ical stool examination should be one of the first diagnostic procedures in these cases. A. Bálint : K. Farkas : F. Nagy : Z. Szepes : T. Wittmann : T. Molnár (*) 1st Department I of Medicine, University of Szeged, 8-10 Korányi fasor, 6720 Szeged, Hungary e-mail: molnar.tamas@med.u-szeged.hu I. Dóczi : L. Bereczki : E. Urbán Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary R. Gyulai Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Pécs, Hungary M. Szűcs Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary Parasitol Res (2014) 113:1585–1590 DOI 10.1007/s00436-014-3805-0