Abstract
BACKGROUND: Blastocystis spp. is a common protozoan found in the gastrointestinal tract, typically existing as a non-pathogenic organism in humans and other animals. However, it can become pathogenic when the immune system is compromised due to bacterial, viral, fungal, or other parasitic infections, as well as systemic conditions, leading to symptomatic blastocystosis. METHODS: Fecal samples were collected from patients at the University Hospital of Campania "Luigi Vanvitelli" and Cotugno Hospital in Naples. Among these samples, those that tested positive for Blastocystis spp. and were associated with other microbial infections were further analyzed. Bacterial co-infections were identified using immunochromatographic tests (ICTs) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Viral infections were detected using chemiluminescent immunoassay (CLIA), while fungal infections were diagnosed through microscopic examination and molecular biology techniques. Additionally, co-infections with other parasites were identified through microscopic analysis after Ridley's concentration and Giemsa staining (O&P). RESULTS: Out of the 2050 stool samples collected, 121 were positive for Blastocystis spp., of which 75 were associated with other infections. We identified the vacuolar form in patients co-infected with bacteria (n = 22), viruses (n = 30), fungi (n = 3), and other parasites (n = 20). CONCLUSIONS: Our findings indicated a higher incidence of the vacuolar form of Blastocystis spp. in symptomatic and immunocompromised patients, suggesting that a weakened immune system may increase the risk of contracting Blastocystis and other microbial infections.