Paramecium caudatum is a genus of unicellular ciliated protozoan and Bacterium_under the m

PrOtozoa infectIon

Protozoa, a class of Parasite, but unlike Parasitic worms which are visible to the naked eye when mature, Protozoa Parasites are microscopic in size and single-celled by nature.

Protozoa parasitic infections are highly prevalent globally, affecting an estimated 3.5 billion people, and not uncommon within Australia. Clinical analysis within metropolitan regions such as Sydney, NSW reflect Blastocystis spp. is the most common infection, at 57%, Giardia at 27% and Dientamoeba fragilis at 12% [1]

Humans are exposed to protozoa parasites in contaminated food and water amongst other places. Once ingested Protozoa propagate within the intestine, even without any contact with another parasite, simply by cloning themselves [2].

This colonization of protozoa within the gastrointestinal system can be asymptomatic for some, but for others can cause a variety of symptoms. This is because protozoal infection can result in significant tissue damage, be it due to mechanical contact or immune mediated responses to the parasite and its toxins.

Parasitic protozoa have also been reported to synthesize low-molecular-weight toxins, such as indole catabolites which can produce pathologic effects, such as lethargy and immunosuppression [3].

Protozoa infection can also become chronic as they are clever organisms, utilising several strategies to avoid being killed by your immune system. They can change their surface proteins during infection, so when the immune system catches on, it’s already outdated, similar to a shape-shifter. They can coat themselves with antibodies that block the real immune cells from attacking them properly. They also often weaken the host's immune system, making it slower or less effective at fighting back. This gives the parasite more time to grow and reproduce [4].

In the United States, infections by protozoa are the most frequent causes of inflammation to the stomach and intestines (gastroenteritis), with the most frequent symptom being diarrhea affecting between 71 - 96% of Protozoa cases. Second to this, is digestive discomfort, affecting between 31 - 71% of cases, depending on the specific parasite [5][6].

The 5 most common pathogenic Protozoa Parasites are:

Blastocystis spp.
Dientamoeba fragilis
Giardia lamblia
Cryptosporidium

Entamoeba Histolytica [7]

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types & symptoms

Symptoms can alter slightly depending on the exact Protozoa Parasite, although both soft bowel motions to diarrhoea and abdominal discomfort are common occurrences with Parasitic Protozoa infection.

Blastocystis spp.

Blastocystis is one of the most common parasites, affecting up to 30% of those in industrialized countries and 30 - 76% in developing countries. Although there are 17 different Blastocystis subtypes, Subtypes 1 - 4 make up 90%, with subtype 3 as the most common.

Blastocystis transmission is via the fecal-oral route by ingesting contaminated food or water, with a significantly increased risk around exposure to others infected.

Blastocystis resides in the last part of the small intestine and the first part of the colon. Blastocystis adheres to mucus’ outer layer, and uses certain bacteria from its host as a nutritional source [8].

Symptoms;

Blastocystis can be asymptomatic, but when present, symptoms can include:

Soft Stool - Diarrhoea - 71% of cases
Abdominal pain - 71% of cases
Bloating
Nausea
Anal itching
Fatigue
Joint pain
Allergies [8].

Dientamoeba fragilis (D.fragilis)

D. Fragilis has a worldwide distribution, and is transmitted via the fecal-oral route, with a significantly increased risk around exposure to others infected, including domestic and wild animals [8].

Symptoms;

D.Fragilis can be asymptomatic, but when present, symptoms can include:

Soft Stool - Diarrhoea - 60% of cases
Abdominal pain
Bloating
Nausea
Weight loss
Can mimic inflammatory bowel disease [8]

Giardia Lamblia

Giardia has a worldwide distribution and is transmitted through the fecaloral route by the ingestion of contaminated water and food

When someone drinks or eats something contaminated with Giardia cysts, the cysts enter the stomach and small intestine. There, the stomach acid and digestive enzymes cause the cysts to release active forms called trophozoites. These trophozoites show up quickly in the small intestine and start multiplying. When they reach the large intestine, they turn back into cysts, which are then passed out into the environment for reinfection to others [8],[9].

Symptoms;

Giardia can be asymptomatic, but when present, symptoms can include:

Soft Stool - Diarrhoea - 90% of cases + the leading cause in the US of diarrhoea
Abdominal Pain - 70% cases
Bloating - 70% of cases
Nausea
Joint Pain
Chronic fatigue [8][10]

Cryptosporidium

Cryptosporidium is endemic to North, Central, and South America, Africa, and Australia.

Infection is spread via the fecal-oral route and indirectly through contaminated water. Cryptosporidium is a common cause of food and water-borne outbreaks

The parasite adheres to intestinal epithelial cells. The intestinal epithelium releases cytokines to incite an immune response and causes Cryptosporidium death. Cryptosporidium has developed ways to slow this protective mechanism; therefore, host immune competency determines the ability of Cryptosporidium to cause disease [8].

Symptoms;

In immunocompetent patients, infection is self-limiting with 2 weeks of watery diarrhea.

In immunosuppressed patients symptoms can be cyclical, and can include:

Soft Stool - Diarrhoea
Abdominal pain
Nausea
Fever [8]

Entamoeba histolytica (E. histolytica)

E. histolytica is the leading parasitic cause of death globally, and the third most common parasitic infection in the US.

E. histolytica has a worldwide distribution, but is most common in developing countries with poor sanitation and therefore infections typically occur during travel. Transmission is fecal-oral via ingestion of mature cysts from contaminated water or food, or contaminated individuals.

Cysts are ingested and excystation occurs. Colonization usually happens in the large bowel, but the cecum is most common. It penetrates the endothelium causing ulceration. Host factors appear to promote a more invasive, systemic disease with many other systemic complications [8].

Symptoms;

E. histolytica can be asymptomatic, symptoms of E. histolytica infection include:

Soft Stool - Diarrhoea
Nausea
Fatigue
Fever
Weight loss
Mimic Diverticulitis, Colitis and colon carcinoma [8][11]

Causes

Low Socioeconomic status

Low Socioeconomic status includes overcrowded places, increasing person-to-person transmission.

Areas lacking safe drinking water and sewage systems. Areas of malnutrition, weakening the immune system, or areas of poor hygiene.

Increasing the risk of infection as follows [12]:

Blastocystis x 57%
D. Fragilis x 57%
Giardia x 36 %

Contact with animals

Certain animals have a higher prevalency of protozoa infection, as an example Dogs can carry Giardia, Cattle and Sheep can carry Cryptosporidium, Most animals can carry Blastocystis

Increasing the risk of infection as follows [12]:

Blastocystis x 36%
D. Fragilis x 58%

Raw fruit and vegetable consumption

Fruits or vegetables can be irrigated or washed with water that contains protozoan cysts. Using animal manure as fertilizer can introduce protozoan cysts directly onto crops. Even during harvesting, transport, or food prep, produce is introduced to unwashed hands or cutting boards, as well as contaminated containers or market stalls

Increasing the risk of infection as follows [12],[13]:

Blastocystis x 64%
D. Fragilis x 60%
Giardia x 10%

Infected Members of the household

Protozoa parasites are often spread by the fecal-oral route, meaning microscopic cysts from the faeces of someone infected can cross spread to the hands of another when in situations sharing bathrooms, towels or hygiene spaces. Once on the hands this can be easily ingested once consuming food.

Increasing the risk of infection as follows [12]:

Blastocystis x 72%
D. Fragilis x 72%
Giardia x 51%

Contaminated drinking water - including filtered water

Drinking water can become contaminated with protozoa in a number of ways, especially if the water supply is not adequately treated or sanitized. Even filtered water, as protozoan cysts are often resistant to chlorine and other disinfectants, making them hard to eliminate unless the water is filtered with specific methods like UV light or ozone treatment

Increasing the risk of infection as follows [12],[14]:

Giardia x 71%
Cryptosporidium x 53%

Hypochlorydria - Low Stomach Acid

The acidic environment created by stomach acid is a crucial defense mechanism against various microorganisms, including parasites. This acidity helps to kill or weaken many pathogens that are ingested with food or drink.

Hypochlorhydria (low stomach acid) weakens this protective barrier, making it easier for parasites to survive and potentially multiply in the digestive system, with evidence directly towards susceptibility to Giardia infection, amongst others [15].

Impaired GI immunity

T cells, particularly CD4+ and CD8+ T cells are immune cells that play a key role in fighting Protozoa parasitic infection [16],[17]. Clinical studies have demonstrated that invasion by intestinal parasites can be facilitated by impaired T-cell immune response in the GI tract [18].

Studies have also demonstrated Parasites have the ability to down-regulate, make inactive or even destroy T lymphocytes. This renders the GI immune system unresponsive to fighting infection[19].

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References

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC4207027/

[2].https://www.ncbi.nlm.nih.gov/books/NBK8325/#:~:text=The%20most%20common%20type%20of,no%20apparent%20anterior%2Dposterior%20axis.

[3] https://www.ncbi.nlm.nih.gov/books/NBK8043/

[4].https://www.ncbi.nlm.nih.gov/books/NBK8043/#:~:text=Pathology,and%2For%20to%20mechanical%20damage.

[5].https://pmc.ncbi.nlm.nih.gov/articles/PMC11095845/#:~:text=INTRODUCTION,parasitic%20infections%20due%20to%20immunosuppression.

[14].https://pmc.ncbi.nlm.nih.gov/articles/PMC5877040/#:~:text=Parasitic%20protozoa%20that%20are%20transmitted,and%20Naegleria%20spp.

[15] https://pubmed.ncbi.nlm.nih.gov/3925541/

[16].https://pmc.ncbi.nlm.nih.gov/articles/PMC4195384/#:~:text=CD4+%20T%20cells%20are%20critical,persistence%20and%20development%20of%20disease.

Flagging Potential Infections

The symptoms that present when infected with parasites, appear the same as many other GI dysfunctions and disorders. Therefore identifying if parasites are a necessary element to the treatment protocol, we identify if you are experiencing the most common symptoms of Parasitic infections, and if you are, we suggest stool testing for clarification and accuracy.

The core symptoms associated with worm infections amongst the different kinds include;

Soft Stool > Diarrhoea
Abdominal Pain
Nausea
Bloating
Fatigue
Joint Pain

At-home stool testing is available for an additional fee. To request this, please email us at:

info@remedylane-co.com.au

With the subject line: Faecal Multiplex : 2002

If you choose to proceed with treatment without completing stool testing, there are no anticipated adverse consequences. In many cases, empiric treatment can still provide meaningful therapeutic benefit.

PrOtozoa infectIon

Protozoa, a class of Parasite, but unlike Parasitic worms which are visible to the naked eye when mature, Protozoa Parasites are microscopic in size and single-celled by nature.

Humans are exposed to protozoa parasites in contaminated food and water amongst other places. Once ingested Protozoa propagate within the intestine, even without any contact with another parasite, simply by cloning themselves [2].

Parasitic protozoa have also been reported to synthesize low-molecular-weight toxins, such as indole catabolites which can produce pathologic effects, such as lethargy and immunosuppression [3].

The 5 most common pathogenic Protozoa Parasites are:

Blastocystis spp.

Dientamoeba fragilis

Giardia lamblia

Cryptosporidium

Entamoeba Histolytica [7]

testING

types & symptoms

Symptoms can alter slightly depending on the exact Protozoa Parasite, although both soft bowel motions to diarrhoea and abdominal discomfort are common occurrences with Parasitic Protozoa infection.

Blastocystis spp.

Blastocystis is one of the most common parasites, affecting up to 30% of those in industrialized countries and 30 - 76% in developing countries. Although there are 17 different Blastocystis subtypes, Subtypes 1 - 4 make up 90%, with subtype 3 as the most common.

Blastocystis transmission is via the fecal-oral route by ingesting contaminated food or water, with a significantly increased risk around exposure to others infected.

Blastocystis resides in the last part of the small intestine and the first part of the colon. Blastocystis adheres to mucus’ outer layer, and uses certain bacteria from its host as a nutritional source [8].

Symptoms;

Blastocystis can be asymptomatic, but when present, symptoms can include:

Soft Stool - Diarrhoea - 71% of cases

Abdominal pain - 71% of cases

Bloating

Nausea

Anal itching

Fatigue

Joint pain

Allergies [8].

Dientamoeba fragilis (D.fragilis)

D. Fragilis has a worldwide distribution, and is transmitted via the fecal-oral route, with a significantly increased risk around exposure to others infected, including domestic and wild animals [8].

Symptoms;

D.Fragilis can be asymptomatic, but when present, symptoms can include:

Soft Stool - Diarrhoea - 60% of cases

Abdominal pain

Bloating

Nausea

Weight loss

Can mimic inflammatory bowel disease [8]

Giardia Lamblia

Giardia has a worldwide distribution and is transmitted through the fecaloral route by the ingestion of contaminated water and food

Symptoms;

Giardia can be asymptomatic, but when present, symptoms can include:

Soft Stool - Diarrhoea - 90% of cases + the leading cause in the US of diarrhoea

Abdominal Pain - 70% cases

Bloating - 70% of cases

Nausea

Joint Pain

Chronic fatigue [8][10]

Cryptosporidium

Cryptosporidium is endemic to North, Central, and South America, Africa, and Australia.

Infection is spread via the fecal-oral route and indirectly through contaminated water. Cryptosporidium is a common cause of food and water-borne outbreaks

Symptoms;

In immunocompetent patients, infection is self-limiting with 2 weeks of watery diarrhea.

In immunosuppressed patients symptoms can be cyclical, and can include:

Soft Stool - Diarrhoea

Abdominal pain

Nausea

Fever [8]

Entamoeba histolytica (E. histolytica)

E. histolytica is the leading parasitic cause of death globally, and the third most common parasitic infection in the US.

E. histolytica has a worldwide distribution, but is most common in developing countries with poor sanitation and therefore infections typically occur during travel. Transmission is fecal-oral via ingestion of mature cysts from contaminated water or food, or contaminated individuals.

Cysts are ingested and excystation occurs. Colonization usually happens in the large bowel, but the cecum is most common. It penetrates the endothelium causing ulceration. Host factors appear to promote a more invasive, systemic disease with many other systemic complications [8].

Symptoms;

E. histolytica can be asymptomatic, symptoms of E. histolytica infection include:

Soft Stool - Diarrhoea

Nausea

Fatigue

Fever

Weight loss

Mimic Diverticulitis, Colitis and colon carcinoma [8][11]

Causes

Low Socioeconomic status

Contact with animals

Raw fruit and vegetable consumption

Infected Members of the household

Contaminated drinking water - including filtered water

Hypochlorydria - Low Stomach Acid

The acidic environment created by stomach acid is a crucial defense mechanism against various microorganisms, including parasites. This acidity helps to kill or weaken many pathogens that are ingested with food or drink.

Hypochlorhydria (low stomach acid) weakens this protective barrier, making it easier for parasites to survive and potentially multiply in the digestive system, with evidence directly towards susceptibility to Giardia infection, amongst others [15].

Impaired GI immunity

T cells, particularly CD4+ and CD8+ T cells are immune cells that play a key role in fighting Protozoa parasitic infection [16],[17]. Clinical studies have demonstrated that invasion by intestinal parasites can be facilitated by impaired T-cell immune response in the GI tract [18].