I’m one of many doctors who believe that the intestinal parasite called Blastocystis Hominis can cause episodes of diarrhea or abdominal discomfort.

 Many of my colleagues have doubts. The Stanford University website points out that:  The status of Blastocystis “as a true pathogen is controversial” and the Mayo Clinic site states doctors don’t “fully understand the role, if any, the parasite plays in causing a disease.”

The parasite, Blastocystis, is common in countries where drinking water isn’t routinely treated, and NIH researcher Charles H. Zierdt estimated the “organism has a worldwide distribution and that it infects more than one billion individuals.”

A drug called Alinia—nitazoxanide-- “has (according to the CDC) been shown to be effective in clearing organisms and improving symptoms.”  The agency lists Alinia as treatment option number 3—third choice.  The CDC claims treatment with options one and two “have been reported.” Their website doesn’t state the drugs help or that they don’t help.  A lot of my former colleagues don’t know about Alinia and don’t use it.  

from Mayo Clinic

I became interested in the bug and drug a few decades back on the final afternoon of Digestive Disease Week in New Orleans. The big pharmaceutical and equipment manufacturers were dismantling their extravagant booths, and my plane didn’t take off till 8pm.  I stopped at the card table of a man who was sitting in the corner of the huge exhibition hall, and we talked.  He was an employee of Romark, a small pharmaceutical business in Florida.  He told me about corporation’s only product, the drug Alinia-Nitazoxanide.

I later learned his company was started in 1993 by a scientist named Dr. Jean-Francois Rossignol and an investor, Marc Ayers. 

Rossignol had co-discovered nitazoxanide in 1974 when he was a young researcher in Paris.  Then he and a colleague named Cavier gave it to animals that were infected by a few protozoa and helminthes-- and it was effective.  Rossignol later worked for SmithKline and French and was part of the team that developed albendazole, a drug that remains the main therapy for intestinal worms.  In 1993, working with the NIH, Rossignol “re-invented” (probably restudied) nitazoxanide. 

The medication, Alinia, is FDA approved as a treatment for Giardia and it’s the only medication that’s FDA certified to treat cryptosporidia, the parasite that was responsible for a serious outbreak of prolonged diarrhea in Milwaukee Wisconsin in 1993.  (The parasite got into the city’s water supply.) In a 2005 peer reviewed study from the Nile delta of Egypt, 84 people with Blastocystis in their stool who had diarrhea and enteritis were treated with nitazoxanide or placebo.  36 (86%) of the 42 patients who received nitazoxanide got well.  16 (38%) of 42 patients who received placebo got well.  .

I’ve used Alinia to successfully treated 2 hospitalized patients with prolonged, infectious diarrhea of unknown cause. When a friend (wife of an MD) stopped visiting Cuba because she had recurrent diarrhea and showed me her lab results, I noticed her stool was full of Blastocystis.  On my recommendation she took Alinia and her diarrhea episodes stopped.  When another friend had an unexplained year long illness with weight loss and abdominal pain I visited.  He’d had an extensive workup –a normal colonoscopy, CAT scan, etc, and he had Blastocystis in his stool.  He’d been told the parasite wasn’t the problem.  I suggested a three day trial of Alinia and his M.D. reluctantly prescribed it.  My friend took the pills for three days – that’s how it is given—and it didn’t work.  He was still sick a week after he was treated.  Then, within a few weeks his symptoms magically disappeared.  He doesn’t think the Alinia helped him.

My Hint:  if you have recurrent or chronic well studied diarrhea that is unexplained, or if you have irritable colon and have had a thorough medical workup—especially if there are Blastocystis parasites in your stool--- ask your doctor what he or she thinks about Alinia.  Good luck. 

 

https://www.nejm.org/doi/full/10.1056/nejm199407213310304

https://www.cdc.gov/parasites/blastocystis/health_professionals/index.html

https://www.cdc.gov/parasites/blastocystis/health_professionals/index.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627840/

Effect of Nitazoxanide in Persistent Diarrhea and Enteritis Associated With Blastocystis hominis Clinical Gastroenterology and Hepatology Oct, 1, 2005.  https://www.cghjournal.org/article/S1542-3565(05)00427-1/fulltext




 

 

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