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blastocystis treatment

What is the best treatment for blastocystis homini for a 13 year old.  I am concerned to treat with Flagyl because I hear so moany time that this is effective for a short period of time and then the blastocystis comes back.


This discussion is related to Diarrhea, gallbladder sludge, diverticulitus, parasites....I'm confused.
15 Responses
Avatar universal
For the most part, the majority of reports on the effect of antimicrobial therapy for B. hominis infection are either case reports or small, noncontrolled studies. There are a few small studies that suggest that metronidazole 800 mg three times daily for 5–10 days is effective in some, but the reports seems to indicate that it's difficult to have an accurate prediction as to whether or not it will work - percentages vary. Some studies suggest co-trimoxazole (sulfamethoxazole 800 mg and trimethoprim 160 mg, twice daily for 7 days) may eradicate the organism in about 90% of infected, symptomatic individuals - but no treatment seems to be foolproof. Even a newer drug, nitazoxanide, shows variable results: nitazoxanide (500 mg twice daily for 3 days) showed a 'cure-rate' of about 85 percent (small study, I believe).
Avatar universal
Thanks so much for your response. A recent test on her gallbladder showed it functioning at 23%. I am told that it should be at about 35%.  
I have two questions.  
Can you treat blastocystis without taking out the gallbladder?  
Do you know of a good gastroenterologist? We are seeing a pediatric gastroenterologist and are in the midst of a bunch of tests on much of her entilre body but I want to make sure she gets the best treatment initially once a treatment process is started. I would be happy to travel to the best one or have my present doctor consult with one on the cutting edge of knowledge about this blastocystis and how it affects the digestive system and the body.
Avatar universal
It can be treated w/o removing the GB. That ejection fraction is just a bit low. Most docs these days would not suggest removing the GB unless there was a presence of stones or sludge. There are unfortunately too many who suffer from some rather severe side-effects when the GB is removed with 'only' a low EF and no other sign of disease or dysfunction.

I'm sorry, I can't recommend a doc. I would suggest you ask those that you know and trust for a recommendation.
Avatar universal
Ok, CalGal.  It sounds like you know a little bit about this and I am a concerned Mom trying to find the best medical care for my daughter. So, if you treat this with the drugs you mentioned above, then there is some hope it will be eliminated from the gallbladder, is that right?  My daughter had an ultrasound done on the gallbladder and nothing showed up on the ultrasound.  After she had the hidascan done of the gallbladder showing a 23%, she has also had a test done to see how fast the food goes through her stomach.  I think the score shoud run at about a 60. Her score, I am told is in the range of what is acceptable, but in the high end of acceptability. She scored a 90 on this test. I find it interesting that both have a ratio of two thirds.  How do I find out if this parasite is in her gallbladder?  We are doing a stool test. One done previously, about 2 to 3 weeks ago found a few blastocystis homini in her stool. It did note or find any other bacteria or parasites in the report. She gets a feeling of nausea after every meal, the bigger the meal the more nauseous she says she feels.
Avatar universal
I reread your last posting. I guess I got so excited that I did not comprehend what you so clearly stated. You are suggesting to treat the blastocystis and not remove the gallbladder. You state too many people suffer severe side effects when removing the gaalbadder when not having another disease or dysfunction. I am trusting what you say. You are giving me hope. How do you know all of this. Are you a doctor? Help me to understand this further and to convince my doctors that the above mentioned drugs are the best treatment.How can I find a doctor I trust completely and one that will use a course of treatment or a combination of drugs that are not widely known to be used for blastocystis. I am not sure, but I think most doctors prescribe Flagyl which seems to have a poor success rate and you seem to think others have a better success rate.. Are these drugs you mentioned previously safe for someone who will be 13 in April, 2009. Her body weight is between 125 and 128. What are the side effects of these drugs?  What is it does not leave her body with these suggested drugs, what then?
Avatar universal
I am not saying that the GB should not be removed. If it is diseased, or nearly non-functional then it will have to come out. But there should be clear indications that the problem is truly due to the GB. Both a GB ultrasound and HIDA scan with CCK injection should indicate the presence of stones, or sludge, or an enlarged/thickened wall, and a lowered ejection fraction. Many people with only a slightly low ejection fraction - and no other indication of other problems - have undergone GB removal and continue to have problems after the surgery. When the problems continue, those individuals are then told - after other tests come back negative - that the surgery 'uncovered' an underlying problem that was probably present and was causing the symptoms in the first place - spasms of the common bile duct or sphincter of Oddi. The condition is called sphincter of Oddi dysfunction (SOD) and it is extremely difficult to resolve - there's no easy way to do it. Many people unfortunately have the problem, and it's starting to force the surgeons to rethink what should be done with people present with GB symptoms, but the tests don't show 'true' GB issues.

As far as the drugs go, if you reread my post you'll note that I said that no drugs are foolproof. Some drugs may be slightly better than others for one individual, but there's no way of knowing which drugs are going to work unless they're tried. It's like using meds to suppress acid production - nexium works for one person and not for another.

I believe you're assuming that B. hominis may be causing the lowered ejection fraction, and that may not be the case. The two issues may be entirely unconnected. You also need to keep in mind that B. hominis is, in many cases, considered a commensal organism in the GI tract and unless a person is immunocompromised or is otherwise having medical issues, the organism is not considered to be a cause of problems.

I can't tell you which drugs are safe or not, it's something you're going to have to discuss with your doc. Only he/she knows your daughter and knows the in's and out's of what's going on with her system. All I can do is provide you with info on the subject. Most docs probably will start with something like flagyl and if that fails they'll move on to other drugs. Flagyl is a 'known' entity for most docs and that would be considered 'safer' and a way to start.

Avatar universal
Thank you.  You provide so much information. Are you a doctor?  How do you know so much? If not, do you work for doctors? If not, how do you know so much about this?

I am seeing a GI doctor. He is having a battery of tests done since seeing him for the first time two weeks ago. At the first visit he put aside her hidascan result and the stool test result immediately and said this was probably not the problem. He then had an EKG done which showed she came back normal. Then, on the same day, his nurse called our house and had requested that we send them the hidascan CD and the stool result. It was also decided that they would check a multitude of other options out --  so as to rule out what could not be the source of the problem. She is seeing an endocrinologist next week.  She had an MRI done of her brain yesterday. When I gave them the CD of the hidascan and the stool test, I also dropped off a bunch of articles on blastocystis, and so he is now setting me up to see an infectious disease doctor.  (perhaps to satisfy my thoughts, I don't know).  My appointment with the infectious disease doctor in their group is not until March 5th. However, I made an appointment with a different infectious disease doctor for this Monday so I can consult with him. I do not know if he is good or not. I will share with the GI doctor what you stated about SOD.  Her symptoms first developed in late August of last year. The symptoms started getting worse in December which is when we started checking things out.

By the way, when I first made an appointment with this group of pediatricians, a nurse called me back when I left a message to ask if I needed to bring my daughter for a consultation. ( I did not want to needlessly take her out of school and also did not want to scare her about blastosystis since I am very concerned because of the postings and articles I read  on the internet) They said yes since they wanted to ask her questions about her symtpoms, etc. ( I think this was a nurse for the pediatric group generally and not her direct GI nurse.  Anyway, I asked if they always get rid of blastocystis and the nurse honestly replied--not always, it depends on it if has colonized.  What exactly does colonized mean? This is another reason I am concerned.  All of your answers are greatly appreciated.
Avatar universal
I just posted a response to your last message.  I am not sure if you will receive notification of it since I sent it to Cal Gal instead of CalGal.  So I am sending you another message informing you of this so you can read the posting once signing on through the links and hopefully respond. Thanks so very much.
Avatar universal
I am not a medical doctor. My background includes clinical research and teaching some of the 'hard-core' subjects to medical students, so I'm familiar with these subjects. I do work with docs, however.

What specific symptoms are being experienced? You've been focusing on B. hominis as 'the cause' and it sounds like your docs are not that sure.

There are a number of bacteria we harbor that, despite their being potenitally harmful if they're kept at low levels and 'in check' by the more friendly bacteria around them, pose no problem whatsoever. C. diff is an example (and many believe that B. hominis may fall into the same category). It's only when large quantities of antibiotics wipe out large numbers of the beneficial bacteria we have in our GI systems, or someone is immunosuppressed, and C. difficle is allowed access to the suddenly 'more abundant' nutrient stream that C. diff begins to overgow and cause problems. At that point it starts to put out toxins that can cause a large amount of destruction in the GI system. At that point the C. diff has colonized.

Avatar universal
Ok. so how do you know if there are toxins that have developed and so created destruction in the GI system. I do not want her symptoms to get worse.

How do you test for or find out if there is spasms of the bile duct, sphincter of ODDI dysfunction (SOD)?

If I continue to focus on this blastocystis homini, I was thinking that perhaps it would be chosen for her to have another HIDA scan, then treat for the blastocystis, then do another HIDA scan.

Her symptoms are as follows: Nausea immediately after eating, followed by the start of a headache, followed by a feeling of wanting to vomit. The heavier the meal, the greater the feeling of these symptoms.  She has lost about 6 lbs. over the course of about 6 or 7 weeks. Two lbs in the last 3 weeks or so. But, I am giving her less rice or pasta at dinnertime. Sometimes, we are skipping the rice or pasta. I have changed from white to brown rice and for her school lunch from white bread to some sort of wheat bread. She is 5'4 and a quarter" tall, was at her heaviest in December or so at 132, and now weighs 126.2   Like I said, her HIDA scan EF was 23% and her stomach emptying test score was a 90. Her first stool sample given 2 to 3 weeks ago showed a few blastocystis homini and nothing more. We are doing another stool sample now, one where I supply 3 consecutive stools to be tested. I will not know the results of this stool sample until probably mid to maybe late next week.

I was thinking, not a doctor, scientist or anything remotely educated in the sciences and am only a concerned mom, that because her gallbladder is not ejecting bile at a quick or normal rate (2/3) and that her stomach does not get rid of the food as quick as what is a score of 60, that it could be because she is not getting the bile into her system quick enough to assist in the absorption of her food.  Also, I am thinking she gets this feeling of nausea because she is not emptying, digesting her food quickly, and so feels this way.  Any comments?

I am so very glad to be communicating with you. You are helping me immensely. I am glad to hear that you have a background of clinical research and are teaching "hard-core" subjects to medical students. It makes me feel that I am talking to someone who knows the latest information on gastroenterology. My daughter, at this point in her life, is interested in the medical field. Hopefully, she will be able to give back to society like you are doing right now.

Avatar universal
Hello again,

Also please note that her gallbaldder EF rate was 23% (2/3 of 35%) and her stomach emptying test result was 90, instead of 60. (again a 2/3 ratio) I do not know if this is significant or not, but I thought it coincidental.


Avatar universal
The toxins that are developed due to C. diff specifically, not B. hominis.

Why do you believe that B. hominis is tied in with the lowered ejection fraction? The symptoms of B. hominis typically don't include symptoms relating to gallbladder issues. In addition, I don't believe any doc will order that many HIDA scans when no association has been found, and you'd also be exposing her to more tracer material.

I believe the 2/3 ratio is only a coincidence in both instances.There is feedback between the hormones/neurotransmitters produced that relay information between the stomach, the gallbladder and the rest of the digestive system. So when one portion is having a problem it's not entirely unreasonable to expect orther portions of the digestive system to have problems, too.

No one - docs or scientists - actually know what causes the feeling of nausea. It can accompany any number of GI issues. If food is retained in the stomach for longer than normal periods of time, it can cause nausea. If the gallbladder isn't working well that, too, can cause nausea. But nausea is also found in those with acid reflux, in those with celiac disease and in many other problems so it's hard to 'pin it' to any one thing.

I don't know what her diet is, but you may want to consider a low fat diet for several reasons. Fat can make gallbladder issues/symptoms worse. Fat is also retained in the stomach for a longer period of time than either protein or carbohydrates. It's not know yet what's going on with her system, but a low fat diet can't hurt and just might help.

The test for SOD is an invasive test called the ERCP with manometry. It's not something that should be done without a true indication that there is actually a problem with the biliary system. And that would mean exhausting all other tests and all other meds (because she still has her gallbladder) before a doc would even consider something like an ERCP. The ERCP carries with it a real risk of pancreatitis and other 'wonderful' side-effects such as damage to the common bile duct and pancreas. So it's not something to take lightly.
Avatar universal
Ok, I may slow down for a day or two in contacting you as I take in all you have told me. Also, her stoll is being tested.  I am giving the sample tomorrow morning and have to wait for the results.

Regarding the EF rate and her gallbladder and her stomach emptying rate both having the 2/3 ratio, here are my thoughts. Please keep in mind that I have a zero science or medical background. I thought bile assists in the digestion of one's food. If the EF rate is low, thereby releasing bile slowly and so less amount of bile quickly, then the digestion of food would perhaps be corresponding slow  since there is not as much bile to assist immediately in the process. Once the normal amount of bile is released that would have been released with a 35% EF rate, then the absorption of food is more easily accomplished.  Just my thoughts, without anyone else telling me that this is so.

Regarding the gallbladder and B. hominis connection, prior to being in touch with you, I read a few places on the internet about a possible connection.  One place was on medhelp in the liver disorders community from Wrldadvntr (not sure about the spelling because when I switch websites, I seem to lose this posting and can't seem to switch back and forth) On Aug , about the 7th, 2008.  this person asked about the connection.  Also on the Oregon research center ofor blastocystis, website is www.bhomcenter.org, look at the contact page and it mentions gallbladder there as well.
Avatar universal
I want to tell you once again how much I appreciate the fact that you take the time to communicate things to me and to, I am sure, others.  I will be back in touch when I get more results from her various tests and Dr. meetings.

Please write back sooner if you have any further comments/input to share from what I have wriiten to you most recently or from our various other communications.

Avatar universal
I had Blasto, did the triple therapy protocol, tested clear and still felt awful.

Turns out the cause of all my issues is actually a genetic disease called Pyroluria. Do some searches on Pyroluria and see if it matches the symptoms.

I blog about Pyroluria now too.

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