What is Blastocystis?

 What is Blastocystis?

Blastocystis is one of many microscopic parasites that can live in your digestive tract. Some people experiencing diarrhea, abdominal pain or other gastrointestinal problems have blastocystis organisms in their stool. Researchers don't fully understand the role blastocystis plays, if any, in causing disease. Most commonly, blastocystis organisms simply live in a person's digestive tract without causing harm.

 

Blastocystis may be transmitted through food or water or by contact with human or animal feces. Generally speaking, Blastocystis infection is more common among people who live in or travel to developing countries and among people who work with animals and clean up after animals.

 

Blastocystis in humans was once identified as a single species called Blastocystis hominis, but to date, 17 subtypes have been found. The scientific name used now is Blastocystis spp, an abbreviation that means "multiple species." A blastocystis infection is called blastocystosis.

(LEFT) Blastocystis in simple smear. Researchers have cited the non-descript appearance of Blastocystis as one reason for the low sensitivity of clinical diagnostic methods, along with the possibility that not all stages have been documented [52]. (RIGHT) The classic diagnostic form of Blastocystis found in the stool of patients varies in size from 6 to 40 μm. The parasite is characterized by a central body (blue) that morphologically resembles a vacuole. The central body pushes the nuclei to the periphery of the cell. The central body is a reservoir for proteases [83] and may serve other functions as well. Photos courtesy of Dr. Hanaa Moussa, Cairo University.

What symptoms have been associated with Blastocystis?

Signs and symptoms possibly associated with blastocystis may include:

Constipation                                                       Excessive gas

Watery diarrhea                                                  Loss of appetite

Mucous diarrhea                                                Weight loss

Nausea and dizziness                                        Vomiting

Abdominal pain (intense)                                   Fatigue

Bloating                                                              Extreme anal itching

Fever                                                                  Bloody stool

Chills                                                                  Dehydration

Cramping                                                           Hives, welts, raised very itchy skin rash

Sleeplessness                                                   Continual inclination to evacuate the bowels

Is Blastocystis a pathogen?

Blastocystis is a microscopic single-celled organism. Many parasitic protozoans normally live in your digestive tract and are harmless or even helpful; others cause disease. It's not clear whether blastocystis causes disease. Most people who carry the organism have no signs or symptoms, but it's also found in people who have diarrhea and other digestive problems. Of the 17 different subtypes, some types of blastocystis may be more likely to cause disease than others. Disease or infection may be caused by other organisms that coexist with Blastocystis.

Is Blastocystis transmissible?

Blastocystis can be passed between people and from animals to people. Transmission may be from contaminated food or water where there is poor water sanitation; exposure to human or animal feces such as in a children’s daycare or veterinary clinic; mechanical transmission from flies or cockroaches; or unhygienic sexual practices. The forms commonly found in stool samples are the thick walled cysts, which are believed to be responsible for external transmission.

Can we prevent blastocystis infection?

Yes we can. 

Practice good hygiene:

1.     Wash fruits and vegetables before eating.

2.     Keep cooking surfaces clean.

3.     Wash your hands frequently with soap and water for at least 20 seconds, especially,

before, during and after meal preparation

after using the toilet

after changing a diaper or helping a child use the toilet

after helping a person who is sick with vomiting or diarrhea

after touching animals or handling animal food or feces

after handling garbage

before and after cleaning a cut or wound.

When you can't use soap and water, use a hand sanitizer that contains at least 60% alcohol.

Be a careful traveller:

1.     Avoid eating what you can't boil, cook or peel: 

Food from street vendors

Unpasteurized milk and dairy products, including ice cream

Raw or undercooked meat, fish, shellfish or eggs

Food at room temperature, such as sauces and buffet offerings

Fresh greens; foods that can't be peeled, such as berries

Fruits or vegetables that you did not peel yourself

Frozen pops and flavored ice

Dishes or condiments made with uncooked fruits or vegetables

2.     Avoid unsterilized water from tap, well or stream.

Avoid ice cubes or beverages made with tap water.

Keep your mouth closed while showering.

Use bottled water to brush your teeth.

Make sure hot beverages, such as coffee or tea, are steaming hot.

Drink bottled beverages from original, unopened containers after cleaning them.

If you need to use unsterilized water for drinking or washing food items, boil the water for at least three minutes and let it cool or use a portable ultraviolet light water purifier.

Eat nutrient-rich foods: 

·       Avoid simple carbohydrates, such as those found in refined foods, fruits, juices, dairy products, and all sugars, except honey.

·       Eat more raw garlic, pumpkin seeds, pomegranates, beets, and carrots. There was one study in which researchers found that a mixture of honey and papaya seeds cleared stools of parasites in 23 out of 30 subjects!  

·       Drink a lot of water to help flush out your system.

·       Eat more fibre.

Take supplements (check with your health professional):

·       Probiotics (Lactobacillus acidophilus, Lactobacilus plantarum, Saccharomyces boulardii, and bifidobacteria) help keep your digestive tract healthy.

·       Digestive enzymes will help restore your intestinal tract to its normal “inhospitable to parasites” state. 

·       Vitamin C supports the immune system.

·       Zinc supports the immune system. 

Use herbs (check with your health professional):

Herbs are a way to strengthen and tone the body's systems. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). A few of the herbs that your health care provider might consider are:

Garlic (Allium sativum)

Barberry (Berberis vulgaris)

Goldenseal (Hydrastis canadensis)

Oregon grape (Berberis aquifolium)

Anise (Pimpinella anisum)

Wormwood (Artemisia annua)

Curled mint (Mentha crispa)

Black walnuts (Juglans nigra)

Reduce stress!

Although there is no conclusive research, some studies show that chronic stress exacerbates the infectivity and pathogenicity of this parasite. Stress can underly our body’s response to everything!

Rash from 39-year old US male diagnosed with chronic blastocystosis acquired domestically[60]. Skin rash in Blastocystis infection has been described as recurrent [65] and intensely pruritic [67]. Diagnosis of blastocystosis was by exclusion: eleven ova and parasite exams (trichrome staining) performed at clinical laboratories from 2003–2006 were negative except for findings of Blastocystis. Colonoscopy, endoscopy, and gluten challenge test were negative. The infection was unresponsive to metronidazole, nitazoxanide, and TMP/SMX. The isolate was genotyped as Blastocystis sp. subtype 3 in a 2007 study [49].

The characteristics of common enteric protozoa reported in study of 5792 specimens from US patients collected in 2000[14]. Studies from the 1980's reported Blastocystis was usually found as a co-infection with Giardia or Entamoeba histolytica in symptomatic patients [139, 140], which was not the case in 2000 [14]. In 2000, the number of symptomatic patients who were found to be singly infected with Blastocystis (400) exceeded the number of samples found positive for Cryptosporidium, Giardia, and Entamoeba histolytica combined. Patients singly infected with Blastocystis were as likely to be symptomatic as patients singly infected with Cryptosporidium (69% vs. 70%) [14].

How can I get rid of it?

Traditional medical treatment:

Usually, the first line of medical treatment is the drug Metronidazole. Its effectiveness is from 0 and 74%, so it is followed by a course of TMP-SMX or Nitazoxanide. Results of these treatments are mixed but may achieve up to 90% eradication; however, they can lead to the creation of drug-resistant forms of the parasites. Many studies have been done on these treatments and reveal high failure rates of eradication.

 

Alternative medical treatment:

Dr. Thomas Borody, of the Centre for Digestive Diseases in Australia, has created a unique approach to treatment of digestive diseases called Fecal Microbiota Transplantation. This treatment involves an infusion of three anti-parasite agents delivered intra-colonically via colonoscopy. The infusion contains 3 grams Nitazoxanide, 3.6 grams Secnidazole and 900 milligrams Furazolidine. The following day a rectal enema is performed. In a study of 100 patients, the Blastocystis was eradicated in 92% of the cases. Read the data here. After this treatment there are short term side effects caused from the antibiotics which can include diarrhea, rash, nausea, flatulence, transient abdominal discomfort and bloating. It can cost from $3,000. to $5000. for this treatment.

Rectal ozone treatment:

Rectal Insufflation is a 15 minute process which introduces ozone into the body through the rectum. Oxygen (O2) has been infused rectally during surgery for years, due to the fact that oxygen is easily absorbed through the walls of the colon. The same is true for ozone. Rectal Insufflation is useful in the colon as well as being absorbed into the bloodstream and is up to 90% as effective as Ozonated saline in an IV treatment. During rectal insufflations, a mix of ozone/oxygen is introduced through a catheter into the colon. It is an oxygen gas enema. The ozone helps remove inflammation and kills pathogens like bacteria, viruses, parasites and yeast. It can help restore healthy gut flora. It costs about $75.

Homeopathic treatment:

Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors, as well as any current symptoms and based on the totality of symptoms will determine the most appropriate remedy for a particular individual. The following remedies may be used:

Cina                                                     Cuprum oxidatum nigrum

Indigo                                                  Podophyllum

Sabadilla                                             Spigelia

Stanum                                               Teucrium

Will I be able to see the parasite in the stool?

Unlike worms, which have a form that is easy to see in stool, Blastocystis is a polymorphic organism, with 4 major morphologic forms: vacuolar, cyst, granular, and amoeboid; it can be seen in stool and in a single species culture under a microscope. The cyst and vacuolar forms are the easiest to identify. Other forms can be misidentified or missed altogether.

The thick-walled cyst form (.003–.005 mm) is postulated to be an infectious stage, but not confirmed. The predominant form found in human stool specimens is referred to as the vacuolar (or central body) form and is of variable size (.005–.04 mm, occasionally much larger). Replication appears to occur via binary fission. 

The amoeboid forms are the most virulent and are found most commonly in symptomatic patients, although they are harder to recognise in routine stool sample examinations as they resemble neutrophils and macrophages. They secrete proteases and lysates that cause bowel permeability and produce interleukin-8, increasing bowel inflammation.

Light microscopy of nonaxenic Blastocystis…

Can a parasite infection come back?

Unfortunately, it is possible. The lack of a reliable diagnostic method to determine if the infection has truly been eradicated complicates the evaluation of treatments. The behavior of Blastocystis in humans is consistent with that of Giardia and Entamoeba histolytica in that the expression of symptoms depends on parasite genotype, host genotype, host immunity, and age. Parasite genotype may vary geographically along with other factors.