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Bile Salts and Parasites

arney arney at vianet.net.au
Fri Apr 18 02:03:28 EST 1997

Dear Parasitologists,

In October 1992 I went to north India to do fieldwork for a Phd thesis in
the history of  religion.  Almost immediately I came down with symptoms
that a doctor in a fairly remote town recognized as being due to "malaria."
 Whatever the medicine was that he gave me, it worked fine, and over a
period of about two months I gradually began to regain my strength.  Before
I had fully recovered, however, the bouts of diarrhea that one tends to get
periodically in India became more or less chronic and, by the time I had
left the country in January 1993, I realized that the diarrhea and
debilitation I was experiencing were probably caused by something other
than just contaminated food, malnutrition and the harsh climate. 

In New York tests showed that I had blastocystis hominis.  At different
times I was given Flagyl, Doxycycline Hyclate, and Humatin by a general
practioner, gastroenterologist, and tropical disease specialist.  None of 
these drugs got rid of the parasites, my diarrhea, or--what was,
subjectively, most worrying to me--my fatigue.  The stool examinations,
x-rays of the entire GI tract with barium enema, and various other tests
failed to show any other abnormality apart from maldigestion, as revealed
most dramatically, to me as a lay person, by the presence of undigested
vitamin tablets in the colon.

Warm stool tests taken during Febuary 1995 in Perth, Australia revealed
that I had blastocystis hominis, endolimax nana, entamoeba hartmanni, and
also possibly dientamoebae fragilis.  Although I had a low total white cell
count and subnormal CD4 count, tests showed that it was unlikely that there
was any significant immunodeficiency.  A catscan, gastroscopy, endoscopy,
and small bowel and colonic biopsies indicated that  my oesophagus,
stomach, duodenum, and ileum were normal, although the lamina propria
showed patchy lymphoid aggregates and large collections of mucin laden
macrophages, without evidence of malignancy or tropical sprue.  I was
successfully treated for the parasites with Paromomycin, Humatin, and
Fasigyn, and susequent tests failed to show any evidence that the parasites
had returned.

However, loose bowel movements with intermittent diarrhea persisted, as
well as the chronic fatigue.  In July 1996, mal-absorbtion of bile salts
was discovered.  Questran brought the diarrhea under control, and I began
to have normal bowel movements once again for the first time in four years.
 The wasting fatigue was not reduced, however, and when at the beginning of
this year I stopped taking the Questran, the diarrhea immediately returned.
 Because my symptoms are said to overlap those of irritable bowel syndrome,
I took Endep for two months in an effort to soothe the nerves of the gut. 
This anti-depressant had no effect, however, and I am once again left
pondering my medical options.

I really would be most grateful if anyone could advise me whether in their
experience the mal-absobtion of bile salts and other symptoms described
above are likely to be due to, (a) the presence of some still undetected
parasite or virus; (b) residual damage to the gut caused by the parasites
erradicated in early 1995; (c) some other cause.  Any diagnostic or
treatment advice would be _most_ appreciated.  Although I do not find it
particularly difficult living with the diarrhea and loose bowel movements,
the debilitating fatigue that I suffer from makes it extremely difficult to
do mental or physical work for sustained periods, and my academic and
personal life is going down the toilet--in more ways than one :-)!

Please send any advice or suggestions to either myself or my
gastroenterologist, Dr Lindsay Mollison <mollison at cyleene.uwa.edu.au>, or
if you think the topic is of general interest post it to the newsgroup.

Paul Arney  <arney at vianet.net.au>
88 Burke Drive
Attadale (Perth)
WA  6156
fax & phone:  (international access code) 619 330 3198


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