Cysts are the stage responsible for transmission of balantidiasis (1). The host most often acquires the cyst through ingestion of contaminated food or water (2). Following ingestion, excystation occurs in the small intestine, and the trophozoites colonize the large intestine (3). The trophozoites reside in the lumen of the large intestine and appendix of humans and animals, where they replicate by binary fission, during which conjugation may occur (4). Trophozoites undergo encystation to produce infective cysts (5). Some trophozoites invade the wall of the colon and multiply, causing ulcerative pathology in the colon wall. Some return to the lumen and disintegrate. Mature cysts are passed with feces.
