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Enterocytozoon bieneusi  ( E. bieneusi ) and  Blastocystis  are common pathogens responsible for diarrhea in humans, especially in immunocompromised individuals. The number of cancer patients has been increasing and diarrhea is a common clinical symptom in the treatment of cancers. To understand the prevalences and genotypes/subtypes of  E. bieneusi  and  Blastocystis  in cancer patients in China, to track the infection sources, and to explore the relationships between  E. bieneusi  and  Blastocystis  infections and diarrhea, 381 fecal specimens were collected from cancer patients. Each of them was analyzed for the presence of  E. bieneusi  and  Blastocystis  by PCR amplifying and sequencing the ITS region of the rRNA gene and the barcode region of the SSU rRNA gene, respectively. 1.3 and 7.1% of cancer patients were positive for  E. bieneusi  and  Blastocystis , respectively. No statistical differences were observed in the infection rates between the groups by age, gender, and residence.  E. bieneusi  and  Blastocystis  were both significantly more common in cancer patients with diarrhea, and significant relationship of  Blastocystis  to diarrhea was found in chemotherapy group. Two  E. bieneusi  genotypes (D and a novel one named as HLJ-CP1) and two  Blastocystis  subtypes (ST1 and ST3) were identified with three novel ST1 sequences. This is the first report of occurrence and molecular characterizations of  E. bieneusi  and  Blastocystis  in cancer patients in China.  E. bieneusi  genotype D and  Blastocystis  ST1 and ST3 have been identified in humans and animals while one novel  E. bieneusi  genotype falling into zoonotic group 1, implying a potential of zoonotic transmission.

frontiers in microbiology

Genotyping of Enterocytozoon bieneusi and Subtyping of Blastocystis in Cancer Patients: Relationship to Diarrhea and Assessment of Zoonotic Transmission