Best hospital in Bangkok for parasite treatment?

[dblaisde]

Hi all,

I was diagnosed with Blastocystosis hominis at Bumrungrad, a common gut parasite often with no symptoms in the young, but I'm 68 and it's causing daily nausea, lack of energy, abdominal cramps. I've had it for about 3 months and would like to get it treated.

Is there a good hospital for treatment? Someone mentioned Siriraj as being world famous.

PS: I've tried Tinidazole, but it didn't work and I'm allergic to Flagyl.

thanks for any help

[bendejo]

http://www.tm.mahidol.ac.th/tmho/index_eng.php

This may be more of a research institution than a hospital, but I'm sure they can help you out to some degree. The place is just up the street from Victory Monument, on the south side of the street. There are a whole lot of educational/medical buildings, just be sure to find the right one.

The first time I went there was for malaria pills, as I was heading to Indonesia. There was a doctor who spoke enough English to talk to me. I asked about mozzie repellents and he laughed, said his lab researched every reputed repellent they could come across, and the only one that could be counted on was DEET.

Went back a year or two later for something else, but the person they found for me didn't speak English very well. But we communicated well enough for the matter at hand.

If you go consider bringing a translator.

Best of luck getting this done with.

[wpcoe]

What did the doctor at Bumrungrad recommend? If they don't treat it, do they not recommend someplace else for treatment?

[peterjackson]

Be careful. Most hospitals seem to have many parasites ready to leech off foreigners.

The multi level pricing parasite appears to be the most common.

[Sheryl]

It is not an issue of which hospital but of which doctor.

I suggest either of these if you are not satisfied with the doctor who originally diagnosed and treated you:

Samitivej Hospital: https://www.samitivejhospitals.com/en/doctors/rungsun-rerknimitr/ (he is also at Bkk Hospital but I think by special appointment only)

Bangkok Hospital: https://www.bangkokhospital.com/en/doctors/?DrID=812

As you already took a course of treatment which did not improve sympotims, the first step needs to be a repeat stool test to see if the Blastocystosis is still there - it does not infrequently happen that the presence of B. Hominis is just an incidental finding and not what was causing the symptoms.

If it is still present, given that you already took tinidazole and are allergic to flagyl, next option would usually be Co-trimoxazole (sulfamethoxazole & trimethoprim -- well known as Bactrim in the west) double strength twice a day for 7 days (assuming you are not allergic to sulfa drugs).

If it is no longer present then a search for other cause is indicated.

In either case, would be well to take some probiotics such as unsweetened plain yogurt. Lalida brand can be found in most supermarkets.

[AyG]

In either case, would be well to take some probiotics such as unsweetened plain yogurt. Lalida brand can be found in most supermarkets.

I think that should be "Yolida".

[Sheryl]

Yes, yalida. Thnx

[dblaisde]

It is not an issue of which hospital but of which doctor.

I suggest either of these if you are not satisfied with the doctor who originally diagnosed and treated you:

Samitivej Hospital: https://www.samitivejhospitals.com/en/doctors/rungsun-rerknimitr/ (he is also at Bkk Hospital but I think by special appointment only)

Bangkok Hospital: https://www.bangkokhospital.com/en/doctors/?DrID=812

As you already took a course of treatment which did not improve sympotims, the first step needs to be a repeat stool test to see if the Blastocystosis is still there - it does not infrequently happen that the presence of B. Hominis is just an incidental finding and not what was causing the symptoms.

If it is still present, given that you already took tinidazole and are allergic to flagyl, next option would usually be Co-trimoxazole (sulfamethoxazole & trimethoprim -- well known as Bactrim in the west) double strength twice a day for 7 days (assuming you are not allergic to sulfa drugs).

If it is no longer present then a search for other cause is indicated.

In either case, would be well to take some probiotics such as unsweetened plain yogurt. Lalida brand can be found in most supermarkets.

Thanks, Sheryl. I'm in the US for a month and did a followup stool test and culture in NYC. All that turned up was the Blastocystis hominis, plus a non pathogenic amoeba called Endolimax nana. The doctor ordered Bactrim as you recommended. I'll keep my fingers crossed and hope that it goes away. I'll also keep up the yogurt.

It's frankly *amazing* how much you know about the medical scene in Thailand. I'm truly impressed and thank you heartily for all the advice you've given me (and many others) over the years

PS: Here's a link I found to a 2013 "meta" article on drug treatment research studies for Blastocystosis.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745668/

Edited September 11, 2015 by dblaisde

[dblaisde]

Thanks to all who took the time to reply.

[dblaisde]

What did the doctor at Bumrungrad recommend? If they don't treat it, do they not recommend someplace else for treatment?

He said either Flagyl or Tinidazole, but since I break out in red spots with Flagyl, he said to take the Tinidazole--which *didn't* work (2 back to back doses over 8 days). So no luck there. I'm taking Bactrim now and will try Nitazoxanide if that doesn't work.

I was only in Bangkok for 1 day to get this thing diagnosed and treated before my US flight, so there wasn't much time.

[Sheryl]

Nitazoxanide is not available in Thailand so if the Bactrim doesn't work (as evidenced by repeat stool test that still shows B. Hominis - don't go just by symptoms as they could have other causes) then be sure to get it in the US.

[dblaisde]

Nitazoxanide is not available in Thailand so if the Bactrim doesn't work (as evidenced by repeat stool test that still shows B. Hominis - don't go just by symptoms as they could have other causes) then be sure to get it in the US.

Thanks. I wasn't aware of that. It's difficult to come by in the US too. I'll have to search around.

[dblaisde]

Nitazoxanide is not available in Thailand so if the Bactrim doesn't work (as evidenced by repeat stool test that still shows B. Hominis - don't go just by symptoms as they could have other causes) then be sure to get it in the US.

US price for 30 500mg tablets: $1400. My eyes popped out. This is at Walmart, which usually has the lowest prices on drugs. At another big chain it was even higher. I can order it from Canada, $50 for 60 500mg tablets. Time for a revolution. I suspect it's probably available in Cambodia too.

Edited September 13, 2015 by dblaisde

[maxme]

Bumrungrad is one of the best i think when it comes to all things medical.

[whatawonderfulday]

Try Government house Infirmary, they are used to dealing with parasites

[dblaisde]

The Faculty of Tropical Medicine, Mahidol University 420/6 Rajvithi Road is by far the best bet. This faculty teaches in English so the Staff can communicate very well. As far a parasitic infections they are the best in Thailand and ranked with the best world wide.

They have an outpatient clinic as well as a hospital on site.

Fred Gallaher, BSc, MSc Tropical Medicine, retire Director of Laboratories Kaiser Permanente Sacramento

Thanks Fred. I got a referral just yesterday from a person who went there.

[dblaisde]

It is not an issue of which hospital but of which doctor.

I suggest either of these if you are not satisfied with the doctor who originally diagnosed and treated you:

Samitivej Hospital: https://www.samitivejhospitals.com/en/doctors/rungsun-rerknimitr/ (he is also at Bkk Hospital but I think by special appointment only)

Bangkok Hospital: https://www.bangkokhospital.com/en/doctors/?DrID=812

As you already took a course of treatment which did not improve sympotims, the first step needs to be a repeat stool test to see if the Blastocystosis is still there - it does not infrequently happen that the presence of B. Hominis is just an incidental finding and not what was causing the symptoms.

If it is still present, given that you already took tinidazole and are allergic to flagyl, next option would usually be Co-trimoxazole (sulfamethoxazole & trimethoprim -- well known as Bactrim in the west) double strength twice a day for 7 days (assuming you are not allergic to sulfa drugs).

If it is no longer present then a search for other cause is indicated.

In either case, would be well to take some probiotics such as unsweetened plain yogurt. Lalida brand can be found in most supermarkets.

Still not sure but I think the Bactrim treatment might have worked; my fingers are crossed. I may be allergic to the drug though. In the last 2 days of treatment my temperature went up to 104F (approx 40C). Could be just a coincidence, and I know I was supposed to phone my doc but I was almost at the end of the meds and so took the last 2 and eventually moderated the fever with paracetamol. (figuring that running a high fever for a few days might help kill off the parasite as well, and the fever (at 104) was still out of the critical zone).

For possible future use of Bactrim against this common parasite, I've read that the Sulfa part of the drug isn't even active against this particular parasite, so I was thinking I could take Trimethoprim instead if it's the sulfa part I'm allergic too. (if I even *am* allergic)

Right after the Bactrim (actually about a week later) the parasite symptoms came back again, but even worse (and qualitatively different than previously). I had to hop a flight in 2 days back here, so took the last Tinidazole set I had (3 tablets, couldn't find the fourth) to get me through the 24 hour plane ride and deal with the parasite on return, but...it's over a week since the Tinidazole and no return. Perhaps I killed off the B Hominis and acquired something else in its place (opportunistic parasite??) which was in turned killed off by Tinidazole. Anyway, this is all anecdotal speculation and doesn't crave a reply.

[Sheryl]

A repeat stool test is in order if the diarrhea returns and lasts more than 1-2 days. For that matter, at your convenience would be wise toi get one anyway to see if the b. hoiminis has been eliminated.

If there was any rash with that fever, sulfa allergy is very likely and important to note/avoid in future. if it was only fever with no rash, could have been something else especially since you soon after developed diarrhea. May simply have had a GI bug, which are usually self-limiting, and the tinidazole may have had nothing to do with it.