Parasite and Fungal Treatment Protocols

by | Feb 1, 2024 | Articles, Autoimmune, Chronic Infections, Chronic pain, Conditions

Chronic infection with parasites and/or fungi may be involved in all sorts of health issues, such as chronic fatigue, fibromyalgia, and autoimmune disease.  Eradicating the pathogens is not easy due to their persistent nature.  We have established parasite and fungal treatment protocols that aim to aggressively eliminate these pathogens.

What are Parasites?

Parasites are organisms that live in, or on, a host from which they get their nutrients.  Many live in the intestine or vagina of the host while other live in the blood or tissues.  Intestinal infections are often caused by ingestion of water or food that has been contaminated by fecal matter.  Others may be spread by skin contact with dirt or freshwater.  Some are spread by insect vectors such as mosquitos or ticks.

The bulk of parasite infections occur in areas with poor sanitation, such as Asia, Africa, Central and South America.  They are much less common in more developed countries.  We have quite a few that are endemic in the US, such as Giardia duodenalis, Cryptosporidium and pinworms, all which infect the intestines.  Trichomonas vaginalis is a fairly common vaginal infection.  Cryptosporidium is a leading cause of waterborne disease among humans in the US, while Giardia is found in nearly every single waterway in the US.

Types of Parasites

The three main types of parasites include single-cell organisms (protozoa and microsporidia), multicellular worms (helminths), and ectoparasites such as fleas, lice, mites, scabies and ticks.

Protozoa are simple single cell organisms that are able to reproduce within their host and as such can cause overwhelming infections. There are tens of thousands of different types of protozoans, which are classified by how they move.  Amoeba form temporary pseudopods that resemble feet, ciliates use short hair-like cilia, flagellates use one or more whip-like structures (flagella) while sporozoans such as Plasmodium (malaria) or Babesia aren’t capable of moving on their own.

Common intestinal protozoa include the amoeba Entamoeba hystolytica, the ciliate Balantidium coli, the flagellate Giardia duodenalis, or the sporozoan Cryptosporidium and Cyclosporiasis species.  Giardia is really common and we often treat people that have been out enjoying nature hiking, camping or hunting and had contaminated water to drink.  Recall in 2018 there was an outbreak of Cyclosporiasis in the US that originated from a packaged vegetable product.  Systemic protozoa infections include diseases such as malaria, babesiosis, toxoplasmosis, or sleeping sickness.

Microsporidia are really more closely related to fungi and they live inside the host cells where they reproduce by making spores which then travel through the body causing an inflammatory response.  There are about a dozen that infect humans and the route of transmission is mostly ingestion or inhalation.  Typically microsporidia is a concern only in immune compromised hosts, although asymptomatic infections likely occur.

Helminths, or worms, are more sophisticated than protozoa as they have multiple cells and complex organ systems.  The two main categories of helminths are roundworms and flatworms.  Helminths don’t reproduce within the host but they can hang out in the host for a long, long time.  Some worms can infect their host for decades and grow to as much as 50 feet long!

Roundworms, or “nematodes”, are cylindrical with an internal body cavity.  They inhabit the intestines and are spread by ova or larvae in the feces.  Common round worms include Ascaris, Trichuris, Strongyloides and Necator americanus (hookworm).  We routinely treat kids with itchy bottoms for Enterobius vermicularis, known as the common pinworm or threadworm.

Flatworms include tapeworms and flukes.  Tapeworms, or “cestodes”, are fairly common and mostly obtained by eating infected meat, typically fish, pork or beef.  The tapeworm attaches to the gut lining and absorbs nutrients directly from the host.  It’s important when treating tapeworms to kill not just the long worm but also the attached head section which may regenerate.  Flukes, or “trematodes”, infect the gut, but also the blood, liver or lungs.  Common flukes are Schistosoma (blood fluke), Fasciola and Clonorchis (liver/bile flukes), and Paragonimus (lung fluke).  Infections with flukes are mostly caused by eating various contaminated foods or water, but some such as Shistosoma can invade through the skin while wading or swimming in contaminated water.

Symptoms of Parasite Infection

Given the many parasites that infect the intestine it’s not surprising that gastrointestinal symptoms are very common, including watery diarrhea or bloody dysentery, abdominal pain, increased appetite or unexplained weight loss.  Also, since parasites commonly disrupt the lining of the intestine and consume nutrients, deficiencies of iron, B12 or folate may occur.  Beyond this however, it gets complicated as parasites may infect nearly everywhere else in the body, causing a myriad of symptoms including fever, chills, fatigue, weakness, muscle aches, or skin rashes.

Diagnosing Parasite Infections

Specialized stool studies or blood tests are the usual way to diagnose parasite infections.  Often multiple samples are taken as parasites may only intermittently “shed” into the stool.  Sometimes we just treat empirically for possible occult infections that are not evident from standard testing.

Most Common Parasite Protocols

  • Ivermectin (Stromectol) 12 mg 3-4x/day with pyrantel pamoate 250 mg 3-4x/day
  • Praziquantel (Biltricide) 600 mg 4x/day (or Levamisole 50 mg 4x/day)
  • Tinidazole 500 mg 3 – 4x/day (or Metronidazole 500mg tid)
  • Nitazoxanide (Alinia) 500 mg 3x/day
  • Albendazole (Albenza) 400 mg 2x/day

Most Common Fungal Protocols

  • Diflucan (fluconazole) 200 mg 1x/day
  • Diflucan (fluconazole) 200 mg 1x/day + Nystatin capsules 500,000IU 4x/day
  • Diflucan (fluconazole) 100 mg 1x/day + Sporanox (itraconazole) 100 mg 1x/day
  • Sporanox (itraconazole) 200 mg 1x/day
  • Ketaconazole 200 mg 2x/day

Treatment Cycles

Due to parasite resistance to drugs we often use 2-3 anti-parasitic drugs at once.  This is followed by anti-fungal treatment.  Ideally one starts only one medication at a time for the first round in order to identify any side effects.  Depending on which medications are used a metabolic panel and cbc are usually done between cycles.  It’s always a good idea to run a drug interaction check as well.

  1. Treat parasites for 10 – 21 days
  2. Treat fungus for at least 10 days
  3. Take a break for a week.  On the break week do a gallbladder/liver flush.

This cycle is performed at least 4 to 6 times, or even longer as indicated.


Antiparasitic Therapy

Parasitic worms and inflammatory diseases


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