Unsuspected, Uninvited Visitors.
Giant Intestinal Fluke, Fasciolopsis buski
The reader may remember my column of last year "Just A Fluke." It recalls a 36-year-old male with severe jaundice and a bilirubin of 11.6 (n=l.l). He had been worked up by his local gastroenterologist and was found negative to hepatitis A, B, C, and autoimmune hepatitis. His radiology of liver, gallbladder, and pancreatic ducts was normal. Having seen many other members of his family, they brought him to see me. They had many animals, and he shot and ate wild pigs. After one day's dose of praziquantel, his urine turned clear in two days; and bilirubin was 1.0 in two weeks. It was necessary to re-treat him in about one month.
This parasite is endemic in Asia and India, occurring in Taiwan, Thailand, Laos, Bangladesh, India, Vietnam, and Hawaii. It is especially prevalent in areas where pigs are raised. It has a prevalence of up to 60% in India and mainland China and adheres to the small intestine of its host, remaining until it dies or is removed. It also inhabits horses and cows and breeds continuously, producing about 16,000 eggs per day, with an average number of offspring from 13,000 to 26,000, and measures 20 to 75 mm. They inhabit most of the intestinal tract starting with the stomach. Other members of the genus invade the liver. (1-3) Remembering Hulda Clark's admonition that all cancer patients have Fasciolopsis, I'm beginning to think she was correct. I am finding it in cancer patients. Why it is here is a good question; but with the consumption of foods from international sources, it is not too much of a stretch to look for this fluke.
One of my diagnostic signatures of the fluke is that the patient complains they eat and blow up, eat and blow up. It can be any food even if avoiding tested and suspected food allergens. After praziquantel (Biltracide), the digestion usually improves in several days generally without a dramatic die off. The dose is 25 mg/kg in three divided doses for one day, four to six hours apart with food. Some patients have observed it works better if avoiding coffee and alcohol the day before, day of, and day after praziquantel as they may impair the medication's ability to paralyze the fluke's mouth parts, which adhere to the intestines and liver. It may need to be repeated in several weeks if the digestive symptoms return or if the flukes weaken the patient on EAV. Ordering the praziquantel from your compounding pharmacy made without lactose can cost $150.00 to $200.00 depending on patient weight. Commercially, it could be many times that. Adding bile salts with the meal and herbal support such as MarcoPharma Cholenest to improve portal stasis has been helpful.
Other drugs used against fasciolopsiasis are mebendazole, thiabendazole, pyrantel pamoate, oxyclozanide, nitroxinil, and hexachlorophene. Black walnut green hulls have been used against adult worms, and wormwood herb kills larvae.
Symptoms of infections can include allergic reaction, anemia, ascites, diarrhea, fever, obstruction of the bowel, abdominal pain, swelling of the skin, and generalized toxemia. I postulate that right upper quadrant pain or epigastric swelling with normal or abnormal liver function tests should raise suspicion of Fasciolopsis infestation. It may be that liver congestion from the fluke reduces bile flow, which would disrupt fat emulsification and bicarbonate production. Remembering that all the pancreatic enzymes work in an alkaline environment, it makes sense that impaired digestion of fats, proteins, and carbohydrates exerts a powerful toll on nutrient absorption. Undigested carbohydrates ferment, proteins putrefy, and fats become oxidized and rancid; and the patient is miserable.
After reading the editorial last year from our fearless leader Jonathan Collin, MD, publisher of TL, questioning the presence of schistosomiasis in our northern hemisphere, I became more curious about the possibility this blood parasite may be infecting our patients. As an avid student of live blood analysis, I was shocked to acknowledge many of the long worm-like structures I had observed for decades in the blood were Schistosoma and resembled structures of the parasite in online microscopy.
Afflicting many patients especially those with a history of foreign travel, it is endemic to Africa, Egypt, South America, parts of the Caribbean, Southeast Asia, and Yemen in the middle East. Schistosoma penetrate the skin directly from fresh water as well as from food and contaminated water ingestion. Schistosomiasis, also known as snail fever and Bilharzia, is a disease caused by parasitic flatworms. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody stool, or blood in the urine. It also may affect the lungs, liver fibrosis, spleen, spinal cord, nervous system, and the brain. More than 200 million people world-wide have schistosomiasis according to the CDC. It can also cause pulmonary hypertension and a higher risk of bladder cancer.
Treatment is praziquantel at 25 mg/kg in three divided doses for two days and needs to be repeated at two months. Patients with chronic schistosomiasis may need 40 mg/kg for two days. The chronically infected may need to have yearly treatments.
Paragonimus westermanli is a Mexican lung fluke. When treating refractory lung conditions that are not responsive to usual antibiotic or antifungal treatments, consider Paragonimus, especially if the patient has a history of living or traveling through central, southern Mexico or Central America. It is treated with a one-day prescription of praziquantel, 25 mg/kg in three divided doses. It occasionally needs to be repeated.
Coccidiomycosis imitis, valley fever, should always be considered in chronic lung afflictions especially if the patient has resided in the California central valley or Arizona. Treatment with fluconazole is usually effective.
Babesia microti, a co-infection of Lyme disease, Borrelia burgdorferi, is frequently worse than Lyme and may cause extreme fatigue, heart symptoms, cognitive decline, and joint symptoms. It is a red cell parasite like malaria and can be diagnosed only with difficulty using a Giemsa stain. Live cell analysis can show red cell lysis. EAV has been reliable in my hands.
After trying several treatment modalities including quinine, which has many unfavorable side effects, I have been able to achieve good results with azithromycin 250 mg twice per day for one week and atovaquone, Mepron, 750 mg/5 ml, #70 ml taking one tsp twice per day for one week. Atovaquone comes as a fluorescent yellow liquid with dubious sweetening and coloring agents, but it is generally well tolerated. This regimen frequently needs to be repeated.
Roundworms, Cestodes (Tapeworms). Ascaris, roundworm, tapeworms and Trichinella spiralis (pork worms) can be treated with albendazole, 200 mg for two weeks twice per day. It can play a dramatic role in some patients' lives. Asthma and chronic lung conditions are one of the manifestations of Ascaris with patients passing large worms in the stool, coughing them up, and coming out the nose. Our compounding pharmacy makes this two-week regimen without lactose for $66.00. Regular retail price can cost from $900.00 to $4,000.00. Tinidazole 250 mg twice per day for two weeks is also a good backup. Our patients from Brazil routinely take albendazole whenever leaving the country and are quite blase about its routine use.
Fasciola hepatica. Another common liver fluke, sheep liver fluke, is acquired from sheep, watercress, and other vegetables and can also cause maldigestion. Treatment is with Alinia, nitazoxanide, 500 mg twice per day for one week. Brand name Alinia is frequently shockingly expensive. Remember to check GoodRx.com for competitive pricing from various pharmacies and coupons for a discounted price. Patients from Mexico, Canada, and South America find their off shore cost at $12.00 or $18.00.
Lyme/Borrelia burgdorferi has been frequently reviewed in these pages. Many of our venerable teachers advocate years of treatment with herbal compounds. I find that symptoms usually resolve in about one month with daily azithromycin and Nutrimedic's Samento (Cat's claw), Coumanda, and Burbur for drainage of die-off symptoms. Individualizing the dosing schedule according to patient tolerance is important. Give the tinctures from one to fifteen drops per day, let the mixture of tinctures stand for one minute, and increase gradually 12 days on and two days off to allow for Lyme's pleomorphism. In children, I find using the tinctures by themselves is frequently successful.
Bartonella henselae, cat scratch or cat bite fever and a co-infection of Lyme, frequently manifests with severe lymphadenopathy, day sweats, anxiety, pain on the soles of the feet, a rash that looks like stretch marks, severe cognitive dysfunction, neurologic symptoms of numbness or sharp, stabbing or burning pain, or abdominal pain for which there is no identifiable cause. Treatment with doxycycline is frequently effective as a first-line treatment. Nine species have been discovered.
Parasites are with us. Deworming pet animals is routine in veterinary practice. We should have a high index of suspicion of blood-borne and intestinal parasites. Foreign travel is not a prerequisite for evaluation of parasites. They are here, and patients who are unresponsive to lifestyle and immune-supportive therapies need a stronger approach.
(1.) Graczyk T, et al. Development of Fasciolopsis buski. Parasitology Research. 2000;86/4: 324-326.
(2.) Liu, L, et al. Liver and intestinal flukes. Gastroenterology Clinics of North America. 1996;25(3); 627-636.
(3.) Mas-Coma S, et al. Fascioliasis and other plant-borne trematode zoonoses. International Journal for Parasitology. 2005; 35(11-12): 1255-1278
by Michael Gerber, MD, HMD
Practitioner of Homeopathic Medicine
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|Title Annotation:||Monthly Miracles|
|Date:||Jul 1, 2019|
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