Sorry..some of these links are out of date as I haven't had time to update this page....

E. Medicine - Intestinal Protozoal Diseases
This site lists symptoms, testing, treatment info. for many parasites, including Blastocystis hominis & Dientamoeba fragilis. Unfortunately it takes a conservative view of the symptoms, describing Blasto. hominis as causing mild diarrhoea and some other parasites as self-limiting.

Genetic diversity of Dientamoeba fragilis may explain why some people infected with
this parasite become sick whilst others experience no symptoms:
Cryptic genetic diversity in Dientamoeba fragilis.
Johnson JA, Clark CG
Department of Microbiology, East Surrey Hospital, Redhill, Surrey RH1 5RH, England.
J Clin Microbiol 2000 Dec;38(12):4653-4

PubMed:
Laboratories should test for Dientamoeba fragilis infection
J J Windsor, Senior biomedical scientist.
Department of Microbiology and Immunology, College of Medicine, Sultan Qaboos University
E H Johnson, Associate professor. Department of Animal and Veterinary Sciences, College of Agriculture, Sultan Qaboos University

Medline abstract:
Dientamoeba fragilis: the unflagellated human flagellate.
Windsor JJ, Johnson EH

Abstract from British Journal of Biomedical Science:
Incidence of Dientamoeba fragilis in faecal samples submitted for routine microbiological analysis
Author: Windsor JJ

More information can be found by searching PubMed

Medical Web Sites:

Merck Manual

DF as a cause of diarrhoea in children

Information on Intestinal protozoa - including D.fragilis:
http://gsbs.utmb.edu/microbook/ch080.htm

Pinworms - believed to be the vector (carrier) for D.fragilis
http://www.biosci.ohio-state.edu/~parasite/enterobius.html

About pinworms
Includes picture of adult pinworm on the perianal skin for identification.

Comprehensive info. regarding stool stool testing, treatment, and ways of
limiting spread of the infection.
Author: David R Mack, MD, Associate Professor, Department of Pediatrics,
Children's Hospital of Eastern Ontario

Dientamoeba fragilis masquerading as allergic colitis.

Colitis due to Dientamoeba fragilis.
Shein R, Gelb A
Am J Gastroenterol 1983 Oct;78(10):634-6

A link between colitis and d.fragilis?

Ulcerative colitis or amebic colitis--a case report. (German)
"As a conclusion is emphasized that in every symptomatology of colitis primarily bacterial and parasitologic examinations of the faeces should be brought about and it must be also thought of spontaneous amoebic infections in our country. "
Koppatz K, Wemmer R, Schillat I, Kuhn HG
Z Gesamte Inn Med 1990 Jan 1;45(1):25-7
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query_old?uid=2330735&form=6&db=m&Dopt=b

Colonic perforation in unsuspected amebic colitis:
"We recommend obtaining at least three stool specimens for microscopic examination, as well as testing for serum amoebic antibody. Patients should submit fresh stool specimens directly to the laboratory to allow for prompt diagnostic evaluation. Such an approach might lead to the improved diagnosis of amebiasis. "
Abbas MA, Mulligan DC, Ramzan NN, Blair JE, Smilack JD, Shapiro MS, Lidner TK, Olden KW Dig Dis Sci 2000 Sep;45(9):1836-41

Purged stool tests
"The first method typically recommended for amoeba, worms, giardia, and such is the purged stool test. A strong purgative, like Fleet Phospho-Soda, is taken. The next day samples of the stool are preserved in formaldehyde after each evacuation and examined microscopically...."

Advice on collection of stool samples ie.
"Do not use toilet paper to collect stool. Toilet paper may be impregnated
with barium salts, which are inhibitory for some faecal pathogens"

PRESENTATION OF DIAGNOSTIC QUIZ #3 (February, 2001)
A patient is diagnosed as having diarrhea and 2 stool specimens are submitted to the laboratory. After examination of the concentration sediment from both specimens, nothing was seen and the results were reported as NO PARASITES SEEN.

Comprehensive info. regarding stool testing for D.fragilis, treatment,
and ways of limiting spread of the infection.
David R Mack, MD, Associate Professor, Department of Pediatrics,
Children's Hospital of Eastern Ontario

Flagyl (metronidazole)
McGill University (Quebec, Canada) Faculty of Medicine site on Flagyl

Paromomycin sulfate (Humatin)
www.nursespdr.com/members/database/ndrhtml/paromomycinsulfate.html

Copy & paste the following:
In vitro response
into the search facility on the National Library of Medicine's PubMed site to view an abstract of the following research: In vitro response of Blastocystis hominis to antiprotozoal drugs.

Diiodohydroxyquin: (Iodoquinol/Yodoxin)
Info. on the manufacturer's site: http://www.glenwood-llc.com/pre-yodoxin.html

Copy & paste the following:
Susceptibility testing of Dientamoeba fragilis
into the National Library of Medicine's PubMed site to view an abstract of the following research: Susceptibility testing of Dientamoeba fragilis ATCC 30948 with iodoquinol, paromomycin, tetracycline, and metronidazole.

Cipro (Ciprofloxacin Hydrochloride)
US Food & Drug Administration Centre for Research includes comprehensive info. on Cipro:
http://www.fda.gov/cder/drug/infopage/cipro/cipro_faq.htm

Wall Street Journal article on Cipro.contains important info. about the dangers of this drug.
http://www.drugawareness.org/Archives/4thQtr_2001/record0041.html

"Flora Power"—Fecal Bacteria Cure Chronic C. difficile Diarrhea
Thomas J. Borody, M.D., F.R.A.C.P., F.A.C.G.a

Symptoms, Negative Tests, and Periodicity in Parasitic Infections
Dr. Omar M. Amin, Ph. D. is a professor of Parasitology at Arizona State University, Tempe, Arizona and the Director of the Institute of Parasitic Diseases (IPD) and it's Diagnostic and Educational Laboratory (DEL), Phoenix, Arizona. He is a recognized authority in the field of Parasitology with over 100 major scientific articles and books to his credit.

The Causation of Crohn's Disease and Treatment with Antimicrobial Drugs.
John Hermon-Taylor. University Department of Surgery, St. Georges Hospital Medical School, Cranmer Terrace, London SW17 0RE, U. K.

http://www.mc.vanderbilt.edu/peds/pidl/gi/pseudmem.htm
PSEUDOMEMBRANOUS ENTEROCOLITIS

Parasitic Infection
http://www.aegis.com/pubs/bala/1992/ba921213.html

Comprehensive set of links on parasitic diseases published by
Sweden's Medical University - Karolinska Institutet
"Karolinska Institutet answers for 40 percent of all medical research at universities
throughout Sweden. Our research spans a broad field: from fundamental research
in molecular biology to public health science and care research."

Cyclospora cayetanensis
Symptoms: "Cyclospora cayetanensis is a protozoan parasite that can cause diarrhea,
nausea and fatigue, as well as cramping, weight loss, aching muscles and fever."

BLASTOCYSTIS HOMINIS

Severe Blastocystis hominis in an elderly man.
This case presentation demonstrates the ability of
B. hominis to induce severe gastrointestinal manifestations and general deterioration
Levy Y, George J, Shoenfeld Y
J Infect 1996 Jul;33(1):57-9

BLASTOCYSTIS HOMINIS: A NEW PATHOGEN IN DAY-CARE CENTRES?
Canada Communicable Disease Report
Volume 27-09, 1 May 2001

Blastocystis hominis infection, a cause of human diarrhea.
Sinniah B, Rajeswari B
Southeast Asian J Trop Med Public Health 1994 Sep;25(3):490-3

Blastocystis hominis: evidence for human pathogenicity and effectiveness of metronidazole therapy. Clin Exp Pharmacol Physiol 1987 Apr;14(4):333-5
Guirges SY, et al

Blastocystis hominis: pathogen or fellow traveler?
Am J Trop Med Hyg 1986 Sep;35(5):1023-6
Markell EK, Udkow MP

Blastocystis hominis in feces. An assessment of 56 cases
Schweiz Med Wochenschr 1990 May 19;120(20):742-4
Krech T, Nguyen XM, Spicher H

Blastocystis hominis may be a potential cause of intestinal disease.
Scand J Infect Dis 1991
;23(3):389-90 Telalbasic S, Pikula ZP, Kapidzic M

Frequency of recovery of Blastocystis hominis in clinical practice.
J Clin Gastroenterol 1990
Oct;12(5):525-32 Zuckerman MJ, Ho H, Hooper L, Anderson B, Polly SM

Association of Blastocystis hominis with signs and symptoms of human disease
J Clin Microbiol 1986 Oct;24(4):548-50 . Sheehan DJ, Raucher BG, McKitrick JC

Blastocystis hominis in hospital employees.
Grossman I, Weiss LM, Simon D, Tanowitz HB, Wittner M
Department of Medicine, Long Island College Hospital, Brooklyn, New York.
Am J Gastroenterol 1992 Jun;87(6):729-32

STRONGYLOIDIASIS

"Strongyloidiasis is caused by the round worm Strongyloides stercoralis.
This worm is fairly common in warm moist areas, but in North America it can be found as far north as Canada. This tiny worm is barely visible to the naked eye.
Symptoms of infection may range from no symptoms to abdominal pain, vomiting and diarrhea.
Cough may be present as the migrating larvae pass through the lungs.
Heavy infestation of adult worms may damage the intestinal mucosa
and cause malabsorption. Weight loss can occur in heavily infected people."

A case of systemic strongyloidiasis
in an ex-coal miner with idiopathic colitis.
de Goede E, Martens M, Van Rooy S, VanMoerkerke I
Eur J Gastroenterol Hepatol 1995 Aug;7(8):807-9
"An ex-coal miner was diagnosed with an idiopathic sigmoiditis compatible with
colitis ulcerosa. He was treated with corticosteroids because of his deteriorating
clinical condition, but his condition continued to worsen. He revealed to have a
systemic Strongyloides stercoralis hyperinfection and Strongyloides colitis.
A short time after diagnosis he died from septic shock despite therapy with
thiabendazole and antibiotics."

Mistaken diagnosis of eosinophilic colitis.
Corsetti M, Basilisco G, Pometta R, Allocca M, Conte D
Ital J Gastroenterol Hepatol 1999 Oct;31(7):607-9
"Diagnosis was based on the presence of marked peripheral eosinophilia and
massive eosinophilic infiltration at colonic biopsy, and the exclusion of parasitic
infection by means of two different microscopic stool examinations of five samples.
However, repeated stool examinations of ten samples collected on separate days
and evidence of impaired cell-mediated immunity allowed a definite diagnosis of
Strongyloides stercoralis autoinfection or hyperinfection."

Chronic relapsing colitis due to Strongyloides stercoralis.
Berry AJ, Long EG, Smith JH, Gourley WK, Fine DP
Am J Trop Med Hyg 1983 Nov;32(6):1289-93

Improved diagnosis of strongyloides stercoralis by seven consecutive stool specimens.
Nielsen PB, Mojon M
"Seven consecutive stool cultures have been used in order to diagnose strongyloidiasis.
The study took place in the follow up period after treatment and seventy patients participated.
The diagnostic sensitivity of the seven consecutive cultures compared to a single examination
was increased from two to five times."

Severe colitis with eosinophilia
Perrot PA, Berthoud S, Widgren S
Schweiz Med Wochenschr 1979 Jun 16;109(24):920-7

Mistaken diagnosis of eosinophilic colitis.
Ital J Gastroenterol Hepatol 1999
Oct;31(7):607-609
Corsetti M, Basilisco G, Pometta R, Allocca M, Conte D.
"Due to the poor sensitivity of stool examination in the diagnosis of Strongyloides stercoralis infection, a careful search for this parasite should be made in all patients with comparable clinical findings before formulating a diagnosis of idiopathic eosinophilic colitis" h

Entamoeba histolytica:

Amebiasis or Disparosis?
Edward Markell, MD, PhD

Recent studies suggest that stool antigen assays are more sensitive and specific than microscopy for the diagnosis of Entamoeba histolytica infection. http://www.emory.edu/WHSCL/grady/amreport/litsrch99/p000308d.html

Crohn's colitis complicated by superimposed invasive amebic colitis.
Lysy J, Zimmerman J, Sherman Y, Feigin R, Ligumsky M
J Gastroenterol 1991 Aug;86(8):1063-5
"Stool specimens, mucosal biopsies, and serological studies were negative for E. histolytica,
and the diagnosis was established on pathological examination of a surgically
resected bowel. Anti-amebic therapy should be considered in endemic areas in cases
of persistent IBD."

Case Studies in International Travelers
LYNN W. KITCHEN, M.D., M.P.H., Regions Hospital St. Paul, Minnesota
Liver abscess due to E.histolytica. Treatment with Flagyl failed but treatment with Iodoquinol resulted in resolution of symptoms and gradual resolution of liver abscess.

Infection and immunity mediated by the
carbohydrate recognition domain of the Entamoeba histolytica Gal/GalNAc lectin.
Infect Dis 1999 Feb;179(2):460-6
"Entamoeba histolytica causes invasive amebiasis, a major parasitic disease of the
developing world, whose primary symptoms are liver abscess and colitis.
Dodson JM, Lenkowski PW, Eubanks AC, Jackson TF, Napodano J, Lyerly DM, Lockhart LA,
Mann BJ, Petri WA Department of Medicine, University of Virginia, Charlottesville, USA.

Rapid diagnosis of Entamoeba infection by using Entamoeba and Entamoeba histolytica stool antigen detection kits.
"Humans are infected by two morphologically identical species of Entamoeba:
Entamoeba histolytica causes amebic colitis and liver abscess, and
Entamoeba dispar is noninvasive"
Haque R, Neville LM, Hahn P, Petri WA
J Clin Microbiol 1995 Oct;33(10):2558-61

Detection of Entamoeba histolytica antigens in stool in amebiasis.
"Stool microscopy, the conventional method of diagnosing intestinal amebiasis,
fails to detect Entamoeba histolytica in more than 30-40% of clinically suspected cases"
Vinayak VK, Kumar P, Punj V, Vashist N, Kanwar JR, Bhasin DK, Singh K
ndian J Gastroenterol 1993 Jul;12(3):77-9

Klebsiella:
Klebsiella are pathogens that can lead to bacteremia, pneumonia, urinary tract and several
other types of human infections. Many Klebsiella strains are resistant to a variety of
antibiotics such as ampicillian. It is often acquired in hospital.

Value of rectosigmoidoscopy with bacteriological culture of colonic biopsies in the
diagnosis of post-antibiotic hemorrhagic colitis related to Klebsiella oxytoca
"We report 7 cases of antibiotic-associated and hemorrhagic colitis due to Klebsiella oxytoca."
Bellaiche G, Le Pennec MP, Choudat L, Ley G, Slama JL
Gastroenterol Clin Biol 1997;21(10):764-7
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query_old?uid=9587518&form=6&db=m&Dopt=b

Worms:
Enterobius vermicularis (human pinworm) - believed to be the carrier of D.fragilis

Diphyllobothriasis
fish tapeworm infection

Autism & undiagnosed gastrointestinal disorders::
"In an accompanying editorial, Drs. Pasquale Accardo and Howard Bostnick of
New York Medical College in Valhalla, New York, write, "In its complexity,
autism is beginning to look like the proverbial horse put together by a committee."
More seriously, they comment, "[This] study...demonstrates consistent physiologic
abnormalities...in autism that are not known to occur in any other specific
gastrointestinal disorder." They add, "The correlation of these findings with a
clinical symptom...and its response to secretin...provide further support for a true
physiologic abnormality."
J Pediatr 1999;133:559-563".

Child diagnosed with autism tests positive for D.fragilis and B.hominis
(click on "stool analysis")

Child diagnosed with ADD & ADHD -
symptoms greatly improved after treatment for D.fragilis infection

Stress & the immune response

Risk Factors for Diarrhoea Illnesses - information for travellers:

False-Positive Laboratory Tests for Cryptosporidium Involving an Enzyme-Linked Immunosorbent Assay -- United States, November 1997-March 1998
Food & infection
US Govt Centers for Disease Control and Prevention

Foodborne illness
Produce Handling and Processing Practices
Chronic Sequelae of Foodborne Disease

FIBROMYALGIA & IBS SYMPTOMS:
Bowel dysfunction and irritable bowel syndrome in fibromyalgia patients.
In conclusion, we found that patients with fibromyalgia have a high prevalence of gastrointestinal complaints confirming the results indicating that fibromyalgia and irritable bowel syndrome frequently coexist. This may suggest a common pathogenic mechanism for both conditions.
Clin Rheumatol 1996 May;15(3):283-6
Sivri A, Cindas A, Dincer F, Sivri B

CHRONIC FATIGUE SYNDROME & IBS:
Prevalence of irritable bowel syndrome in chronic fatigue.
In chronic fatigue, irritable bowel symptoms may be one aspect of a more generalised disorder
Gomborone JE, Gorard DA, Dewsnap PA, Libby GW, Farthing MJ
J R Coll Physicians Lond 1996 Nov-Dec;30(6):512-3

IRRITABLE BOWEL SYNDROME:
Carbohydrate malabsorption and the effect of dietary restriction on
symptoms of irritable bowel syndrome and functional bowel complaints.
Isr Med Assoc J. 2000 Aug;2(8):583-7
Goldstein R, Braverman D, Stankiewicz H Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel.

IBS - A Postinfectious and Inflammatory Disorder?
Nicholas J. Talley, MD, PhD
Digestive Disease Week 2000 Day 3 - May 23, 2000 ...
Article headings:
— Can Infection Change Gut Sensory Perception?
— Is There Evidence of Increased Inflammation in IBS?
— Post-Campylobacter Enteritis and IBS
Conclusion:
"The results of these new studies are exciting. There appears to be
increasing evidence that IBS and probably other functional gastrointestinal
disorders are, at least in a subset, due to structural disease. Host and bacterial factors may both be important. The development of new disease markers appears likely from the novel
work in progress. This in turn should lead to characterization of more homogenous
groups of patients and the development of better-targeted therapeutic approaches
(perhaps NK-1 antagonists). Clinicians should watch this space!"
(Join Medscape to view this article)

Leo Galland, M.D.
The role parasites play in gastro. problems

Gut Health

Protozoa: Structure, Classification, Growth, and Development
by Robert G. Yaeger

Mental health problems and infection:
Physicians and federal agencies addressing the problems of emerging
infectious diseases should examine the possibility of infection as a cause of
mental illness. Better communication among infectious disease and mental health experts,
as well as additional training, will be needed to shed light on the growing phenomenon of
infectious diseases manifesting themselves as neuropsychiatric disorders.
Edward McSweegan
National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA

Lettuce can transmit E. coli 0157:H7 to humans

Swimming pools and diarrhoeal illnesses

Crohns drug treatment

Google Groups

Healing Well.Com IBS message board

All Health.com - Irritable Bowel Syndrome (IBS)
also on All Health.com:-
General Digestive Disorders (IBD and undiagnosed disorders)

MSN Message Board:
Irritable Bowel Syndrome: Open Discussion with Scott Ketover

Health Boards.com Bulletin Board - Bowel Disorders

About.us: IBS Self Help Group Bulletin Board includes the following forums:

DiagnosisHealth.com:
Families of IBDers Support Group

WWW.IBSPage.com -
The IBS Page Irritable Bowel Syndrome Web Sites

Message board - parasites and parasitology resources:
hosted by Biological Sciences Dept. at Ohio State University,