Pentatrichomonas hominis is a flagellated protozoa considered to be a commensal that inhabits caecum and large intestine in man. It is regarded to be non-pathogenic, however, it has been postulated that these trichomonads undergo multiplication under favorable conditions for growth and exhibit a form of opportunism eventually causing diarrhea. We report, for the first time in India, a case of diarrhea due to P. hominis in an elderly male with myeloid malignancy that resolved on treatment with metronidazole

Das, Shukla

Kaushik, Stuti

Saha, Rumpa

Singal, Archana

English

Atharva Scientific Publications (E-Jounals)

Vol 2 | Issue 2 | Apr - Jun 2017 Eastern J Medical Sciences 37
Case Report
Pentatrichomonas hominis in an immunosuppressed patient with enteric 
manifestations
Rumpa Saha1, Archana Singal2, Stuti Kaushik1, Shukla Das1
From Departments of 1Microbiology, 2Dermatology & STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, 
New Delhi, India
Correspondence to: Rumpa Saha, Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur 
Hospital, Dilshad Garden, New Delhi - 110095, India. Phone: +91-9953007273. E-mail: rumpachatterjee@yahoo.co.in
Received – 15 April 2017 Initial Review – 05 May 2017 Published Online – 25 May 2017
Trichomonads are flagellated protozoa. Four species, namely, Dientamoeba fragilis, Pentatrichomonas hominis, Trichomonas vaginalis, and Trichomonas tenax are 
specifically found in human hosts. T. vaginalis is the only member 
that holds an established pathogenic potential for humans and 
contributes to a majority of cases of non-viral sexually transmitted 
infections [1]. T. tenax has been recovered from the human oral 
cavity in periodontal infections and some chronic pulmonary 
illnesses [2]. Dientamoeba fragilis has been reported from stool 
samples of patients presenting with gastrointestinal disturbances 
and a possible link with irritable bowel syndrome has been put 
forward in recent times [3]. In the past three decades, P. hominis 
has been reported to be a prospective cause of diarrheal illness, 
particularly in children [4].
CASE REPORT
We present a case of diarrhea due to P. hominis in our tertiary 
care hospital in Delhi. A 60-year-old cachectic male from the 
neighboring state of Uttar Pradesh was admitted in dermatology 
inpatient, with generalized fluid filled lesions of 3 days duration. 
He developed these lesions 3-4 days after taking antimalarial 
treatment along with norfloxacin and cefixime from emergency for 
fever, vomiting, and pain abdomen. He was running intermittent 
high-grade fever and anorexia with unintended weight loss 
(7-8 kg) in past 2 months.
Hematological examination revealed moderate anemia, 
thrombocytopenia, neutropenia, and significant eosinophilia. Large 
numbers of trophozoites of trichomonas were detected on stool 
examination. Hepatosplenomegaly along with retroperitoneal and 
mesenteric lymphadenopathy was detected on ultrasonography 
abdomen. Fine needle aspiration cytology axillary lymph nodes 
showed atypical cells in a reactive background with numerous 
neutrophils and eosinophils. Due to moderate anemia, bone 
marrow examination was done that depicted presence of dysplastic 
cells with increased number of monocytes and immature blood 
cells. A final diagnosis of drug-induced toxic epidermal necrolysis 
with myeloid malignancy was made.
During the hospital stay, he developed acute onset diarrhea 
(6-8 episodes/day) associated with colicky abdominal pain. 
A stool sample was sent to the enterobacteriaceae and parasitology 
laboratory of the microbiology department for routine examination 
and culture sensitivity. The sample was pale brown to yellowish in 
color, watery in consistency, not associated with blood or mucus 
and had a foul odor. No adult worm segments were seen.
Routine microscopy was done after preparation of wet mount 
in normal saline and Lugol’s iodine. More than 100 pear shaped 
motile trophozoites of P. hominis per high power field were seen 
(Figure 1a). The motility was jerky. There were numerous pus 
cells and Charcot-Leyden crystals (Figure 1b). Smears (stained 
with Giemsa and modified trichrome stain after methanol fixation) 
revealed numerous trophozoites, each trophozoite measuring 
around 10-12 μ. The trophozoites were pear shaped with a single 
nucleus and the undulating membrane extended beyond the length 
of the body (Figure 1c). The number of flagella could not be 
ascertained. Trophozoites were pink and blue colored (modified 
trichrome and Giemsa stains, respectively). Similar findings were 
noted on all three occasions when stool sample was received. No 
bacterial cause of diarrhea was isolated on stool culture.
The patient was promptly started on tablet metronidazole 
400 mg thrice daily along with water and electrolyte replacement. 
Repeat sample on the 3rd day of treatment showed a significant 
ABSTRACT
Pentatrichomonas hominis is a flagellated protozoa considered to be a commensal that inhabits caecum and large intestine in man. 
It is regarded to be non-pathogenic, however, it has been postulated that these trichomonads undergo multiplication under favorable 
conditions for growth and exhibit a form of opportunism eventually causing diarrhea. We report, for the first time in India, a case of 
diarrhea due to P. hominis in an elderly male with myeloid malignancy that resolved on treatment with metronidazole.
Key words: Diarrhea, Metronidazole, Pentatrichomonas hominis
Saha et al. Pentatrichomonas hominis
Vol 2 | Issue 2 | Apr - Jun 2017 Eastern J Medical Sciences 38
reduction in the number of trophozoites (10-15/hpf). After 5 days 
of treatment with metronidazole, trophozoites of P. hominis were 
not seen on stool routine microscopy. Charcot-Leyden crystals 
were found to persist probably due to significantly elevated 
eosinophil counts.
Urine sample of both the patient and his wife was examined 
for trophozoites of Trichomonas vaginalis. It was, however, found 
to be negative. At this stage, the patient was then transferred 
to AIIMS, New Delhi, for the treatment of his malignancy and 
hence his further clinical improvement was not known.
DISCUSSION
To the best of our knowledge, this is the first case report of 
diarrhea due to P. hominis in an immune suppressed individual 
being reported in India.
Severe diarrhea due to this organism has been reported in a 
patient with lymphoma in China [5]. It was also cited as the cause 
of watery diarrhea in a 28-year-old woman with systemic lupus 
erythematosus in Thailand [6]. Two cases, in an adult and child, 
respectively, have been reported from Italy in 2011 [7]. Diarrhea 
in a 68-year-old man with rheumatoid arthritis was attributed to 
this organism in France in 2013 [8]. Children of Morocco have 
shown a prevalence of 1.1% of this organism [9].
P. hominis is considered to be a commensal that inhabits 
caecum and large intestine in man. Although regarded to be 
non-pathogenic, it has been postulated that these trichomonads 
undergo multiplication under favorable conditions for growth and 
exhibit a form of opportunism eventually causing diarrhea. The 
distinct role as an etiopathological agent of diarrhea is yet to be 
elucidated. This organism is also found in non-human primate 
hosts, such as cats and dogs throwing light on the zoonotic 
potential of this trichomonad [10]. Reports of the few cases 
available shows that the parasite is susceptible to metronidazole 
and furazolidone with evidence of complete cure [4,7,8].
With only a handful of such reports across the world and none 
before this from India, it is highlighted that this organism is grossly 
under-reported. Being a commensal of the gastrointestinal tract, 
an insight into the possible role of P. hominis as an etiological 
agent of diarrhea needs to be further contemplated to estimate its 
true prevalence. A need to spread awareness among clinicians is 
also warranted.
REFERENCES
1. Kissinger P, Adamski A. Trichomoniasis and HIV interactions: A review. 
Sex Transm Infect. 2013;89(6):426-33.
2. Duboucher C, Mogenet M, Périé G. Salivary trichomoniasis. A case report 
of infestation of a submaxillary gland by Trichomonas tenax. Arch Pathol 
Lab Med. 1995;119(3):277-9.
3. Hussein EM, Al-Mohammed HI, Hussein AM. Genetic diversity of 
Dientamoeba fragilis isolates of irritable bowel syndrome patients 
by high-resolution melting-curve (HRM) analysis. Parasitol Res. 
2009;105(4):1053-60.
4. Mancilla-Ramírez J, González-Yunes R. Diarrhea associated with 
Trichomonas hominis in a newborn infant. Bol Med Hosp Infant Mex. 
1989;46(9):623-5.
5. Shaio MF, Lo HS, Huang SW. Trichomonas hominis: Isolation and axenic 
cultivation (author’s transl). Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi 
Xue Za Zhi. 1981;14(2):73-7.
6. Jongwutiwes S, Silachamroon U, Putaporntip C. Pentatrichomonas hominis 
in empyema thoracis. Trans R Soc Trop Med Hyg. 2000;94(2):185-6.
7. Meloni D, Mantini C, Goustille J, Desoubeaux G, Maakaroun-Vermesse Z, 
Chandenier J, et al. Molecular identification of Pentatrichomonas 
hominis in two patients with gastrointestinal symptoms. J Clin Pathol. 
2011;64(10):933-5.
8. Compaoré C, Kemta Lekpa F, Nebie L, Niamba P, Niakara A. 
Pentatrichomonas hominis infection in rheumatoid arthritis treated with 
adalimumab. Rheumatology (Oxford). 2013;52(8):1534-5.
9. El-Fadeli S, Bouhouch R, Lahrouni M, Chabaa L, Asmama S, Fdil N, et al. 
The prevalence of intestinal parasites in school children in a rural region of 
Marrakech-Morocco. Int J Innov Sci Res. 2015;19(2):229-34.
10. Maritz JM, Land KM, Carlton JM, Hirt RP. What is the importance of zoonotic 
trichomonads for human health? Trends Parasitol. 2014;30(7):333-41.
Funding: None; Conflict of Interest: None Stated.
How to cite this article: Saha R,  Singal A, Kaushik S, Das S. 
Pentatrichomonas hominis in an immunosuppressed patient with enteric 
manifestations. East J Med Sci. 2017;2(2):37-38.
Figure 1: (a) Trophozoites of Pentatrichomonas hominis on stool wet mount under ×400 magnification in light microscope, (b) trophozoites of 
Pentatrichomonas hominis on Giemsa stain under ×1000 magnification in light microscope, (c) Charcot-Leyden crystals on modified trichrome 
stain under ×1000 magnification in light microscope
a b c


Pentatrichomonas hominis in an immunosuppressed patient with enteric manifestations

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Pentatrichomonas hominis in an immunosuppressed patient with enteric manifestations

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