Parasites and Biologics

Hi everyone!

I'm back, and doing some research based on some client work I've been doing. I'm not sure if anyone here can answer this question. So far I haven't had a lot of luck with peer reviewed research, maybe because it's a new topic, or it just hasn't been considered too deeply.

So I have two questions, both are related to parasitic infection while on a biologic.

1) If a person has UC and parasites, what could be the consequences of taking a biologic like entyvio or remicade? A lot of parasites are hard to track down without special (and expensive) lab testing. Modern medical stool tests are usually insufficient. Has anyone here had experience treating a known parasite while dealing with their UC? Any experience dealing with a parasitic infection while on a biologic? (Common ones are CMV and c diff., which they try hard to test for extensively before giving immune suppressants but they don't always succeed.)

2) My second question is, does anyone have any data or personal experience treating a parasite WHILE on a biologic? This can be a natural treatment (like grapefruit seed extract, caprylic acid) or a pharmaceutical treatment, doesn't matter. Did you find that the treatment conflicted with the biologic at all? Was there any indication that the biologic reduced treatment effectiveness of the parasite?

Please note, the purpose of this thread is NOT to discuss whether parasites CAUSE ulcerative colitis or not. I'm specifically asking about having UC and parasites while on a biologic, and treating parasites while on a biologic.

Thanks a million for taking the time!

I'm not entirely sure what you're asking.

Immunomodulators and biologics make patients more prone to fungal, bacterial, and viral infections because the immune system's capabilities are slightly reduced and therefore not as effective at fighting them in on it's own. Infections hit harder, require treatment earlier, and might quickly land that person in the hospital if infections aren't treated (infections can spread and become sepsis).

The basic mechanism of action for most biologic medications is to block/reduce part of the immune system's inflammation signaling abilities within the bloodstream. Most biologics are bioengineered proteins that are designed to dock with and make the immune system's tnf-alpha protein inert, and as a result it passes harmlessly out of the body. Otherwise, tnf-alpha essentially says "send inflammation over here" and the immune system attacks and causes inflammation in the requested area. Good for fighting off an infection bad for chronic uc inflammation.

Biologics aren't going to make things harder to identify. I cannot imagine many natural things interfere with or make biologics less effective.

I generally wouldn't recommend many alternatives though as these patients need antibiotics pronto. FMT shows some promise for cdiff but that's the only one I'm aware of.

Please define parasite. Are you using it interchangeably with pathogen.
C. Diff and CMV are not parasites so you need to give specific examples of what parasite you are talking about.
Unless you mean pathogen
And many of us have had c diff or cmv while on biologics

Chiron, I don't believe there's any studies of using parasites in addition to biologic medications. Generally parasites and biologics haven't been combined to my knowledge here on healing well. And I think that's why you're not getting any answers about it.

(As I'm sure you'll say you already know, but I'll clarify for the benefit of other readers) There are studies of people intentionally getting infected with a parasite such as whipworms (which lower immune systems response) to treat uc, even a few posts here on healingwell but those folks were not taking biologics or immunomodulators at that time. If memory serves me well, those studies produced poor results. Nobody's tried parasites on healing well to treat uc in quite a while due to that fact.

Many people get c diff while on biologics or immunomodulators. Lot's of posts about that. Anyone on immunomodulators or biologics is at increased risk. Most go the antibiotic route or the FMT route. C diff is a real nasty, tricky thing that keeps reappearing time and time again. Hard to truly beat on the first attempt.

There's been a few who've used grape seed extract to change the bacterial makeup of their gut. Some did before and after stool bacteria tests and saw results. I forget the specific details, a search on hw will likely pull it up. Nobody's used grape seed extract to beat c diff or anything else that I'm aware of.

I distinguish parasites form other pathogens like bacteria or virus in that parasites require a living host to survive. some are single-cell, but many are larger.

both bacteria and parasites are usually treated with antibiotics. larger parasites are generally poisoned.

The immune suppression in TNF-alpha is pretty focused on inflammatory response. It should not reduce the body's ability to form antigens or attack invaders. Only when the attach requires an inflammatroy response should there be a real disadvantage. Technically, "immune suppressed" to broad a term to use with TNF-alpha drugs.

However, taking a more general immune suppressant like Imuran to prevent antibodies to Remicade - well that could make it harder for the body to form antigens against parasites.

What you say reflects a lot of what I've heard, regarding not screening for parasites (generally) before giving a biologic. Last year when I was in flare and they tried remicade, I got the c. diff and TB screen as you mentioned. They also looked for CMV via the biopsies. Unfortunately biologics didn't work on me, but my UC cleared up anyway through other means. But I know that's not standard for most.

The whole parasite topic is controversial. In the alternative health world, people claim that "most people" have them, which I question. On the other hand, modern medicine only looks for parasites under microscope with the naked eye, and if they don't see parasites or ova in that one sample, then you "don't have them". Some of the private labs in the U.S. (like Great Plains Lab, Smoky Mountain Lab, etc.) culture stool over several weeks and are more extensive. In my research of individual species, it's true that a lot of people have them, but in an asymptomatic state. B. hominis is a good example. So many people have it in North America that there's great debate over whether or not it even does anything.

One thing that has come up is that most people with UC are dysbiotic, which seems to come part and parcel with GI immune system dysfunction. But it's the chicken and the egg. Treating dysbiosis helps some achieve remission while for others it does nothing.

Anyway, I was just looking into how biologics could play a role with parasitic infections, and so far it's incredibly difficult to find information on this subject. That's why I turned to asking people for their stories because the research side isn't turning up much... which kind of surprises me. It means that we are giving people biologics without any knowledge about how occult parasite infection could react.

Well there's lots of talk about Crohn's disease being a MAP infection (if you've read much of OldMike's and CanadaMark's recent debates). Certain people with an immune deficiency (us) are susceptible to an infection (similar to Jones disease in cattle) that causes an immune system to go wild. Our immune system can't stop the attack (MAP like bacteria can avoid immune attack), the cycle persists.

Qu Biologics has some interesting research and a treatment they're working on in that area.

Thanks :) That's useful!

I've read about MAP. Similar, e. histolytica (and anything from amoeba family) can encyst and hide in the bowel wall during periods of health, and then explode into active adults during periods of weakness.

IIRC there's a doctor in the UK trying to develop a MAP vaccine. Too bad there's no way to test for MAP in the average person, that info could be useful.

Chiron said...
Parasite... like a amoeba, a worm, a protozoan, certain fungi (like major candida overgrowth), and certain bacteria.

Anything classified as a "parasite".

You should use the term pathogen than. Bacteria and fungi are not usually categorized as parasites. Usually parasites are classifies seperatly.

But yes. I was found to have a C. Diff infection and was started on remicade because the colitis was quite severe.
They did test for cmv before starting remicade but they would have likely started the remicade even if it came back positive.
There is good information about patients on remicade Etc with infections. You might not be getting good results in your literature review because you are using the term parasite where you shouldn't.
Look up the classification of microorganisms in a micro book and you will see a good explanation in the difference in classifications.

In the US parasites like helminths are usually not common. Preschool children are an exception where pinworms or even tapeworms might be found. This is because they "itch" and do not practice proper hygiene

They tested me for ova and parasites before starting biologics.
I was on flagyl for a short time while on remicade as well as vankomaycin

Some fungi, bacteria, and virus can survive on surfaces. To repeat, parasites require a living host.

DBwithUC said...
Some fungi, bacteria, and virus can survive on surfaces. To repeat, parasites require a living host.

Yes!! That's it, thank you!

Dikid said...
I hope this helps.

in generall if patients test positive for mycobacterium tuberculosis they treat with a year of antibiotics. If they will get remicade they will probably have to see an infectious disease specialist. In the Midwest (and a few other places) there are experts that work for a company called metro infectious disease consultants. Two experts that come to mind are dr chundy and Heinz (not sure how to spell)
You might be able to Contact them and see if they have any good data or info

I thought that there are only tests available for the non-tuberculosis kind of mycobacterium, but not MAP? I might be wrong.

Thanks a million for that professional contact. I found their website and will be contacting them :)

Pluot said...
Chiron, I think you are still a little confused. Mycobacteria are not "part fungi" -- they are so named ("myco-" means fungus) because they LOOK like fungus when cultured. Fungi are eukaryotes (organisms that have cell nuclei) and mycobacteria, like all other bacteria, are prokaryotes (organisms that do not have nuclei).

Thanks, I just read that on Wiki last night, which is obviously where you just read it from too.

Pluot said...
There are absolutely tests available for MAP. How could we know that MAP might be implicated in Crohn's disease if we couldn't test humans for it?

From here: http://crohnsmapvaccine.com/faq/can-i-get-tested-for-map/

said...
MAP testing is not available through hospital clinics; it is currently only done in research laboratories. No tests for MAP are yet ‘clinically validated’ although with the modern methods used they are highly accurate and sensitive. This is the case worldwide, not just in the UK. The lack of a reliable MAP test that can be accessed via clinics is a major unmet medical need.

Pluot said...
There is certainly research concerning anti-TNF therapy as it relates to parasitic infection. Here's the first study I found, which studies the use of infliximab in patients with Chagas' disease: http://www.ncbi.nlm.nih.gov/pubmed/25140115.

Here's a case report of a child with ulcerative colitis who was found to have a parasitic infection during treatment with infliximab and corticosteroids, and subsequently successfully treated with antibiotics: http://www.ncbi.nlm.nih.gov/pubmed/23709557

I suggest searching for specific drug names (e.g. infliximab, adalimumab, etc) or mechanisms of action (e.. anti-TNF) when searching for academic literature. "Biologic" is a totally non-specific term that outside of the UC context really just refers to how the drug is produced.

Thanks for these tips.

I got a killer bacteria/fungus/parasite while on remicade + prednisone. It left me in the ICU on life support. I don't have any information for you... they never found out what I had - I guess it didn't come up in any of the tests or cultures. All that could be said of the lab work was that I had an infection. If you had something like what I had, I don't think an OTC med would treat it. Mine was wide spread and in my lungs. I wouldn't recommend anyone go at something like that without the help of a team of doctors.

I think I got the parasite because of the reduced immunity. I was on the biologic for a while. I guess it could have been in my body indefinitely and replicated to the point it did because of the reduced immunity. No one really knows.

The treatment, loads of antibiotics, was successful even though I was on the biologic. If it weren't I wouldn't be breathing.