Chronic Diarrhea and Therapeutic Trial with Metronidazole in Balantidium coli Infected Cattle and Buffaloes

Abstract

The study was conducted to investigate chronic diarrhea cases and therapeutic trial in dairy cattle and buffaloes infected with Balantidium coli. Hundred and one adult dairy cattle and buffaloes presented with the history of diarrhea (>2 weeks) were selected for the study. Balantidium coli was isolated and diagnosed in 38 infected cattle and buffalo. Therapeutic efficacy of oral and intravenous metronidazole in dairy animals due to balantidiasis was evaluated. Efficacy of drug in the study was determined on the basis of reversal of clinical signs and reduction in Balantidium coli cysts/ trophozoites count. Complete clinical recovery was observed in 42.1 per cent of animals treated with oral metronidazole and in 63.1 per cent animals treated with intravenous metronidazole given at the dose rate of 10 mg/kg b.wt. The findings of this study substantiate that B. coli caused chronic diarrhea and haematological alterations of varied intensity in dairy cattle and buffaloes even with low cyst count and metronidazole as therapeutically effective drug, should be taken into consideration.

Full text

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page74
Original Research
Chronic Diarrhea and Therapeutic Trial with Metronidazole in Balantidium
coli Infected Cattle and Buffaloes
Nuzhat Hassan1*, Charanjit S. Randhawa1, Swaran Singh1 and Deepti Narang2
College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University,
Ludhiana- 1410 04, Punjab, INDIA
1Department of Veterinary Medicine
2Department of Veterinary Microbiology
*Corresponding author: drnuzhatzargar@gmail.com
Rec. Date:
Mar 12, 2017 14:42
Accept Date:
Apr 23, 2017 03:17
Published Online:
June 27, 2017
DOI
10.5455/ijlr.20170423031718
Abstract
The study was conducted to investigate chronic diarrhea cases and therapeutic trial in dairy cattle and
buffaloes infected with Balantidium coli. Hundred and one adult dairy cattle and buffaloes presented
with the history of diarrhea (>2 weeks) were selected for the study. Balantidium coli was isolated and
diagnosed in 38 infected cattle and buffalo. Therapeutic efficacy of oral and intravenous metronidazole in
dairy animals due to balantidiasis was evaluated. Efficacy of drug in the study was determined on the
basis of reversal of clinical signs and reduction in Balantidium coli cysts/ trophozoites count. Complete
clinical recovery was observed in 42.1 per cent of animals treated with oral metronidazole and in 63.1
per cent animals treated with intravenous metronidazole given at the dose rate of 10 mg/kg b.wt. The
findings of this study substantiate that B. coli caused chronic diarrhea and haematological alterations of
varied intensity in dairy cattle and buffaloes even with low cyst count and metronidazole as
therapeutically effective drug, should be taken into consideration.
Key words: Balantidium coli, Chronic Diarrhea, Metronidazole, Cattle, Buffalo, Trophozoite
How to cite: Hassan, N., Randhawa, C., Randhawa, S., & Narang, D. (2017). Chronic Diarrhea and
Therapeutic Trial with Metronidazole in Balantidium coli Infected Cattle and Buffaloes. International
Journal of Livestock Research, 7(7), 74-81. http://dx.doi.org/10.5455/ijlr.20170423031718
Introduction
The causes and patho-physiologic features of chronic diarrhea in bovines still remains a mystery in most
cases. Not much previous studies have been done on chronic diarrhea in cattle and buffalo. The
identification of the specific cause is essential for rational treatment of clinical cases and in the prevention
and control of the disease. Parasitic infections are other major constraints for profitable dairy industry

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page75
associated with chronic diarrhea and loss of body condition in tropical and subtropical countries including
India (Hassan and Juyal, 2006). Among the protozoan diseases, balantidiasis caused by Balantidium coli
(a largest ciliate protozoan), is associated with chronic diarrhea in cattle (Alam et al., 1979) and water
buffaloes (Islam et al., 2000; Randhawa et al., 2010). Balantidium coli has worldwide distribution in a
variety of hosts, including both domestic and wild animals. The disease is endemic and prevalent
worldwide, mostly prevalent in subtropical and tropical regions (Sampurna, 2007). Balantidium coli is a
natural inhabitant of the caecum, colon and rectum of apparently healthy animals, produces clinical
disease under certain circumstances (Samad, 1996a). The clinical features are manifested by loose faeces
to watery foetid diarrhea with dehydration, loss of appetite, retarded growth, loss of body condition and
reduced production performance of the animals (Palanivel et al., 2005). In the chronic form, there are
episodes of intermittent diarrhea, weight loss or muscular weakness (Ichhpujani and Bhatia, 1994). The
disease may be diagnosed by direct demonstration of the parasite (trophozoites and cysts) from faeces,
intestinal scrapings and in wet mounts of fresh faeces. Balantidium coli also produce hyaluronidase
(Templis and Lipenko, 1957) which potentially enhances its ability to invade the intestinal mucosa. Nitro
heterocyclic compounds can be used as therapeutic agents in the treatment of balantidiasis (Raether and
Hanel, 2003). The therapeutic efficacies of various drugs like Secnidazole, Metronidazole, Benznidazole
and Furazolidone have been documented against Balantidium coli. Metronidazole is also successful in
some cases against balantidiasis in livestock (Reddy and Reddy, 1993; Patil et al., 1998). The efficacy of
drugs is mainly determined on the basis of disappearance of clinical signs and reduction of
cysts/trophozoites in faeces. The purpose of this study is to describe the clinical and therapeutic findings
of cattle and buffaloes naturally infected only by Balantidium coli, in view of the paucity of such
information about this disease in dairy animals.
Materials and Methods
The study involved 101 chronic diarrhea cases of cattle and buffalo of different age and breeds
presented at large animal clinics of Guru Angad Dev Veterinary and Animal Sciences University,
Ludhiana. Tentative diagnosis of chronic diarrhea was made on the basis of history and clinical
examination. Detailed history was recorded with respect to age and species; duration of diarrhea;
number of animals affected; dietary history; body condition; course of diarrhea-recurrent/persistent
frequency of diarrhea; other clinical signs associated with diarrhea; and faecal abnormalities were
recorded and a clinical examination was carried out to determine the severity and nature of diarrhea.
For body condition scoring (BCS) numerical value between 1 and 5, was given in order to gauge
overall condition of body in terms of size of the affected animal. Each animal was subjected to general
physical examination and rectal examination for lymphadenopathies. Rectal examination included-

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page76
intestinal status and any abnormal masses. Each animal was thoroughly evaluated for its general
condition (alert or depressed), status of diarrhea (persistent or intermittent) and weight loss (gradual or
severe). The vital parameters recorded were rectal temperature (°F), heart rate, respiration rate and
colour of mucous membrane. Auscultation of heart was performed to detect any abnormality.
Blood samples were collected from juglar vein puncture. Faecal samples and rectal scrapings were
collected directly from the rectum of the animal. The sedimentation and direct wet smear methods were
used to find the parasitic eggs and B. coli cysts. All the faecal smears from diarrheic animals were also
screened for bacilli, squamous epithelial cells and cell debris, undigested plant fibre(s).
Statistical Analysis
Prevalence of B. coli was estimated by Pearson’s chi-square test for significance whereas data on
hematology was analyzed by Student’s t-test. P<0.05 was considered as significant.
Results and Discussion
From the total of 101 clinical cases of dairy cattle and buffaloes, suffering from chronic diarrhea,
Balantidium coli was isolated and diagnosed from 37.9 per cent (n=38) of adult dairy cattle and buffalo.
Balantidium coli infection was seen in 39.3 per cent (n=26) of cattle and 34.2 per cent (n=12) of
buffaloes. Feeding pattern in 62.7 per cent (n=64) of animals was normal where as 35.6 per cent (n=36) of
animals had reduced feeding pattern (Table 1).
Table 1: Level of Balantidium coli infection in diarrheic and non-diarrheic cattle and buffalo
Species
Diarrheic Animals
Normal
No. of Cases
Balantidium coli
Positive
No. of
Cases
Balantidium coli
Positive
Cattle
66
26
64
2
Buffalo
35
12
36
3
Total No. of animals
101
38
100
5
Mean Cyst Count
2.73±0.918
0.18±0.447
Per cent Affected
37.99 %
5 %
No change in body weight was observed in 68.4 per cent of animals whereas partial weight loss was
observed in 18.4 per cent of animals. On clinical examination twenty one animals (55.2%) had average
body condition score (3-3.5) whereas 17 animals (42.2%) animals had poor body condition score (2-2.5).
Watery faeces were recorded from 47.3 per cent animals, 34.2 per cent animals had moderately loose
faeces and 18.42 per cent of cattle and buffaloes had mildly loose (soft feces). Foul smelling faeces were
reported in 5 animals (13.1%) whereas 33 animals (86.8%) had normal faecal odor. The vital signs
(temperature and heart rate) of 38 animals were within normal range.

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page77
In the present study, 32.3 per cent positive cases revealed cysts while 5 per cent (n=4) positive cases
revealed both cysts and trophozoites (Fig.1).
Fig 1: Level of Balantidium coli infection in diarrheic and non-diarrheic cattle and buffalo
The mean of cyst count 2.73±0.918 hpf was recorded in balantidiasis affected animals. Severity of
diarrhea was less in animals with faecal cyst count 2-3 high power field, whereas it was moderate with
cyst count 3-5 high power field and severe with cyst count above 5 high power field. Non-diarrheic
animals revealed only cysts and the mean cyst count was 0.11±0.447 hpf and only five per cent were
positive for rare Balantidium coli. In both, cattle and buffaloes having normal faecal consistency (control
group), only cysts were revealed in all positive cases whereas trophozoite was not observed in faeces of
any of the animal. Chronic balantidiasis is characterized by the signs of alternating watery diarrhea of
prolonged duration (Ichhpujani and Bhatia, 1994). Diarrheic loose faeces and moderate loss of body
weight in cattle with B. coli infection was reported by Sudan et al. (2012). Diarrhea due to Balantidium
coli infection was also reported by Patnaik (1965), Christopher and Rao (1972), Singh (1979), and Sahoo
et al. (1984).
Level of infection with respect to severity of diarrhea was determined on the basis of cyst count. The
incidence of Balantidiasis was higher in cattle and buffalo with chronic diarrhea as compared to bovines
having normal faecal consistency. This finding was similar in cattle and buffaloes. Sengar and Singh
(2005) reported that 51.9 per cent of positive cases revealed only cysts, while 48.03 per cent positive
cases revealed both cysts and trophozoites in cattle. The diarrhea associated with presence of both
trophozoites and cysts was observed by Sreemannarayana et al. (1976). The paucity on the reports on the
occurrence of trophozoites of Balantidium coli in bovines may be due to their quick disintegration in
faecal sample. Sengar and Singh (2005) reported similar results with higher incidence of B. coli infection
in bovines having diarrheic faecal consistency as compared to bovines having normal faecal consistency.
Udupa et al. (1998) reported Balantidium coli prevalence rate 17.07 per cent in buffaloes with the history
0
50
100
150
Diarrheic
non diarrheic
No. of cases
Total
B.coli …

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page78
of diarrhea. Motaleb (1996) reported prevalence rate of balantidiasis as 1.5 per cent and 2.2 per cent in
dairy cattle and buffalo’s respectively in Bangladesh whereas Sahoo et al. (1984) reported 1.2 per cent
prevalence rate in cattle and buffaloes in India. Palanivel et al. (2005) reported higher prevalence of
Balantidium coli as 45.4 per cent and 51.4 per cent in cattle and buffaloes, respectively, which is higher
than the findings of the present study. The variations between the present and previous findings might be
due to difference in the disease condition, geographical location, climatic condition, and managemental
factors of the animals. Islam et al. (1988) and Rajkovic et al. (1997) observed that the prevalence of the
balantidiasis in dairy animals valued from 12-48 per cent in Bangladesh and Croatia respectively. Islam et
al. (2000) reported the higher prevalence of Balantidium coli infection in adult buffaloes of 5 years age
(4.0%) than in animals below 2 years (3.4%). Since Balantidium coli infection was recorded more in
diarrheic cases, it could be suggested that Balantidium coli infection causes chronic diarrhea. Balantidium
coli has two developmental stages, a trophozoite stage and a cyst stage and usually affects the large
intestine, from the caecum to rectum. The trophozoite is motile and contains cilia around its ovoid shaped
body. Diagnosis of balantidiasis is established by demonstration of cysts or trophozoites of Balantidium
coli in faeces (Samad, 1996b). Balantidia produce no known toxins, but their ability to produce ulceration
of the colon wall is attributed to hyaluronidase, an enzyme that digests hyaluronic acid, which potentially
enhances its ability to invade the intestinal mucosa, and cause enteritis.
Therapeutic Study in Balantidium coli Treated Group
Efficacy of drugs used in the study was determined on the basis of clinical response. The effect of
metronidazole treatment is presented in Fig.2 and Table 2.
Table 2: Effect of metronidazole on cyst count of Balantidium coli infected dairy cattle and buffaloes
Pre-treatment
Post-treatment
Oral treatment group (n=19)
2.73±0.918
0.18±0.447
I/V treatment group (n=17)
2.41±1.162
0.11±.332
p=0.0001
Significant (P<0.01) difference between groups at pre treatment and post treatment
Mean cyst count reduced from 2.41±1.16 to 0.11±.33 hpf with oral metronidazole treatment. Similarly
mean cyst count decreased from 2.73±0.91 to 0.18±0.44 hpf with intravenous metronidazole treatment.
Complete clinical recovery was observed in 42.1 per cent of animals and 31.5 per cent animals showed no
clinical recovery treated with oral metronidazole (Table 3). Treatment with intravenous infusion of
metronidazole, resulted in recovery in 63.1 per cent of cases and 17.6 per cent did not recovered.

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page79
Fig 2: B. coli cyst count in oral and I/V pre and post treatment groups
Table 3: Clinical response to metronidazole therapy in Balantidium coli induced diarrhea
Recovery
No Recovery
Recurrence
Oral Metronidazole (n=19)
8 (42.1)
6 (31.5)
5 (26.3)
Intravenous Metronidazole (n= 17)
12 (63.1)
3 (17.6)
2 (11.7)
The relapse of diarrhea occurred in 26.3 per cent of animals treated with oral metronidazole and 11.7 per
cent of animals had clinical relapse treated with intravenous therapy. The clinical response was achieved
over a period of 7-10 days of the initiation of treatment. Successful treatment of bovine balantidiosis with
metronidazole has been reported by some authors (Reddy and Reddy, 1993; Patil et al., 1998). Recovery
rate was 63.1 per cent against bovine balantidiasis, similar (68% recovery) to the findings of Christopher
and Sudharshana (1972) in cattle and buffaloes. Rehman and Samad (2010) reported that a single oral
dose of metranidazole resulted in reduction of Balantidium coli trophozoites by 42.8 per cent. When
given intravenously or orally at usual recommended doses, metronidazole attains concentrations well
above the minimum inhibitory concentrations for most susceptible micro-organisms. Present findings are
in line with Raether and Hanel (2003) who reported that nitro heterocyclic compounds (Secnidazole,
Metronidazole, Benznidazole and Furazolidone) can be used as treatment drugs against balantidiasis.
Animals with diarrhea had significantly (P<0.05) higher mean cyst count (38%; chi square=30.34,
p=0.0001) in comparison to non-diarrheic cattle and buffalo (5%).
Conclusion
Balantidiasis was higher in bovines with chronic diarrhea as compared to bovines having normal faecal
consistency. B. coli infected cattle and buffalo revealed cysts in 32.3 per cent cases while 5 per cent
0
0.5
1
1.5
2
2.5
3
Oral treatment group
I/V treatment group
Mean
Pre-treatment
Post-treatment

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page80
positive cases revealed both cysts and trophozoites. Mean of cyst count was 2.73±0.91 in diarrheic
animals and 0.11±0.44 in non-diarrheic animals. Efficacy of drugs used in the study was determined on
the basis of reversal of clinical signs and reduction in Balantidium coli cysts/ trophozoites count.
Complete clinical recovery was observed in 42.1 per cent of animals and 31.57 per cent animals showed
no clinical recovery treated with oral metronidazole.
Acknowledgements
The author acknowledges Department of Science and Technology (DST), Government of India for
providing necessary support under AORC INSPIRE programme.
References
1. Alam M G S, Rahman A and Sen M M. 1979. Blantidiasis in cattle. Bangladesh Veterinary Journal 13:
39-42.
2. Behera K P. 1967. Treatment of balantidiosis in cattle and buffaloes with liquor arsenicalis. Indian
Veterinary Journal 44: 1080-81.
3. Christopher J and Sudharshana Rao T. 1972. Treatment of balantidiosis in cattle. Orissa Veterinary
Journal 7: 121-22.
4. Fabiyi J P. 2001. Parasitic zoonosis in Nigeria. African Journal of Natural Science 4: 9-15.
5. Hassan S S and Juyal P D. 2006. Epidemiological Observations of Paramphistomosis in Ruminants in
Endemic Regions of Punjab and Adjoining State (INDIA). Proceedings of the 11th International
Symposium on Veterinary Epidemiology and Economics.
6. Ichhpujani R L and Bhatia R. 1994. Medical Parasitology. Jaypee Brothers Medical Publishers, India.
Pp., 113-16.
7. Islam M A, Mukammeluddin A and Hussain S M A. 1988. Occurrence of certain parasitic infections
in apparently healthy rural cattle of Bangladesh. Bangladesh Veterinarian 5(2): 81.
8. Islam M R, Haque A K M F, Khan M A H N A and Talukder M R I. 2000. Balantidiasis in water
buffaloes: Incidences and Therapeutics Trial. Bangladesh Journal of Agricultural Sciences 27(1):143-
46.
9. Motaleb M A. 1996. The status of parasitic diseases in animals (cattle, buffaloes and goats) and their
possible remedies in Anwara, Chittagong. MS Thesis, submitted to the Department of Parasitology,
Bangladesh Agricultural University, Mymensingh.
10. Palanivel K M, Thangathurai R and Nedunchellian S. 2005. Epizootiology of Balantidium coli
infection in ruminants. Indian Veterinary Journal 82(6): 682-83.
11. Patil N A, Udupa K G and Kumar S P. 1998. Prevalence, clinical symptoms and treatment of
balantidiosis in buffaloes. Buffalo Bulletin 17: 61-64.
12. Patnaik K B. 1965.Clinical symptoms and treatment of balantidial infection in cattle and buffaloes.
Indian Veterinary Journal 42: 624-32.
13. Raether W and Hanel H. 2003. Nitro heterocyclic drugs with broad spectrum activity. Aventis Pharma
AG, Germany. 90: 19-39.
14. Rahman M M and Samad M A. 2010. Prevalence of subclinical gastrointestinal parasitosis and their
effects on milk production with therapeutic management in red Chittagong cattle. Bangladesh Journal
of Veterinary Medicine 8(1): 11-16.
15. Rajkovic J R, Bosnic S and Husnjak M. 1997. Endoparasite infections of cattle on family owned
farms. Praxis Veterinaria Zagreb 45(1-2): 87-90.
16. Randhawa S N S, Singla L D and Randhawa C S. 2010. Chronic cattle diarrhea due to Balantidium
coli infection-a clinical report. Journal of Veterinary Parasitology 24: 197-98.

International Journal of Livestock Research eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (7) July’17
Hosted@www.ijlr.org DOI 10.5455/ijlr.20170423031718
Page81
17. Reddy K P and Reddy L R. 1993. Flagyl in treatment of balantidiosis. Livestock Advisor 18: 32.
18. Roy B C, Mondal M M H, Talukder M H and Majumder S. 2011. Prevalence of Balantidium coli in
Buffaloes at different areas of Mymensingh. Journal of Bangladesh Agricultural University 9(1): 67-
72.
19. Sahoo S K, Rao A T, Behera A C and Mohapatra P K. 1984. Clinical trial of methylene blue in
treatment of bovine balantidiosis. Livestock Advisor 9(2): 49-50.
20. Samad M A. 1996a. Balantidiasis. Pashu Palon O Chikitsavidya (Animal Husbandry and Medicine).
Lyric- Epic Prokasoni, Mymensingh, pp. 765-767.
21. Samad M A. 1996b. Examination procedure of animals. Pashu Palon O Chikitsavidya (Animal
Husbandry and Medicine). Lyric-Epic Prokasoni, Mymensingh, pp. 127-33.
22. Sampurna Roy. 2007. Balantidiosis (Balantidium coli). Department of Histopathology, Lady Hardinge
Medical College, New Delhi, India. I.J.P. 22 (1).
23. Sengar Y S and Singh V. 2003. Balantidium coli infection in relation to consistency of faeces in cattle.
Journal of Parasitic Diseases 29(1): 74-76.
24. Sengar Y S and Singh V. 2006. Comparative therapeutic efficacy of tetracycline hydrochloride and
metronidazole plus furazolidone against Balantidium coli infection in buffalo calves. Journal of
Veterinary Parasitology 20(1): 89-91.
25. Singh K B. 1979. Treatment of balantidiosis in bovines. Livestock Advisor 4(5): 13-16.
26. Sreemannarayana O, Azeez S A and Zikriah S. 1976. Neftin in the treatment of balantidiosis. Indian
Veterinary Journal 53: 76-79.
27. Sudan V, Sharma R L, Patya A and Singh P K. 2012. An occurrence of clinical balantidiasis in a cross
bred cow and its therapeutic management. Journal of Veterinary Parasitology 26(2): 164-66.
28. Templis C H and Lysenko M G. 1957. The production of hyaluronidase by Balantidium coli.
Experimental Parasitology 6: 31-36.
29. Udupa K G, Patil N A and Kumar S P. 1998. Prevalence, clinical symptoms and treatment of
balantidiasis in buffaloes. Buffalo Bulletin 17(3): 61-64.