However, patients that received the more balanced ratio of 1:1:1 were less likely to die as a result of exsanguination in 24 hours and were more likely to achieve hemostasis. Additionally, reduction in time to first plasma transfusion has shown a significant reduction in mortality in damage control resuscitation.In addition to blood products, products that prevent the breakdown of fibrin in clots, or antifibrinolytics, have been studied for their utility in the treatment of hemorrhagic shock in the trauma patient. Several antifibrinolytics have been shown to be safe and effective in elective surgery. The CRASH-2 study was a randomized control trial of tranexamic acid versus placebo in trauma has been shown to decrease overall mortality when given in the first three hours of injury. Follow-up analysis shows additional benefit to tranexamic acid when given in the first three hours after surgery.Damage control resuscitation is to occur in conjunction with prompt intervention to control the source of bleeding. Strategies may differ depending on proximity to definitive treatment.For patients in hemorrhagic shock, early use of blood products over crystalloid resuscitation results in better outcomes. Balanced transfusion using 1:1:1 or 1:1:2 of plasma to platelets to packed red blood cells results in better hemostasis. Anti-fibrinolytic administration to patients with severe bleed within 3 hours of traumatic injury appears to decrease death from major bleed as shown in the CRASH-2 trial. Research on oxygen-carrying substitutes as an alternative to packed red blood cells is ongoing, although no blood substitutes have been approved for use in the United States.
The cyst form also differs from the trophozoite form because it is non-motile and does not undergo reproduction. Instead, the cyst is the form that the parasite takes when it causes infection. Diagnosis
The diagnosis of balantidiasis can be an intricate process, partly because the related symptoms may or may not be present. However, the diagnosis of balantidiasis can be considered when a patient has diarrhea combined with a probable history of current exposure to pigs (since pigs are the primary reservoir), contact with infected persons, or anal intercourse. In addition, the diagnosis of balantidiasis can be made by microscopic examination of stools in search of trophozoites or cysts, or colonoscopy or sigmoidoscopy to obtain a biopsy from the large intestines which may provide evidence for the presence of trophozoites. Prevention
Preventative measures require effective personal and community hygiene. Some specific safeguards include the following:
Purification of drinking water. Proper handling of food. Careful disposal of human feces. Monitoring the contacts of balantidiasis patients. Treatment
Balantidiasis can be treated with tetracycline, metronidazole or iodoquinol. History
The first study to generate balantidiasis in humans was undertaken by Cassagrandi and Barnagallo in 1896. However, this experiment was not successful in creating an infection and it was unclear whether Balantidium coli was the actual parasite used. The first case of balantidiasis in the Philippines, where it is the most common, was reported in 1904. Currently, Balantidium coli is distributed worldwide but less than 1% of the human population is infected.