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A case of enterobiasis presenting as post-traumatic-stress-disorder / PTSD (i.e. a common and parasitic pinworm infection)

February 3, 2023 By Trudy Scott 11 Comments

Enterobiasis (oxyuriasis) is a common infection in humans caused by Enterobius vermicularis (E. vermicularis), a human intestinal helminth. Because of the easy way of its transmission among people, it has an extremely high prevalence in overcrowded conditions, such as nurseries and primary schools. Oxyuriasis’s symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis.

Here we report a curious case of oxyuriasis in the settings of a refugee camp in Greece. The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis.

This infection is the first documented case of enterobiasis in the settings of a refugee camp and can highlight the unsanitary living conditions that refugees have to endure in those camps.

The above is the abstract from a 2017 paper: A case of enterobiasis presenting as post-traumatic-stress-disorder (PTSD): a curious case of the infection with predominant mental health symptoms, presenting for the first time in the settings of a refugee camp

In addition to her symptoms of insomnia and irritability, she had a decreased appetite and mild abdominal (tummy) pain. She was also experiencing nausea and vomiting and had a slightly raised body temperature (subfebrile). She was severely malnourished and had lost 3kg/6.6lbs in 5 days.

Because of the violent nature of her situation she was initially seen by a psychologist but her symptoms worsened in a few days. When this young girl complained about itching in the perianal area (around her anus), the clinic reassessed her and scars around the anal area from the scratches.

They then confirmed enterobiasis/pinworm after using a piece of clear adhesive tape “to collect a specimen from the perianal surface of the girl, for three consecutive mornings … A microscopic examination showed the presence of oval shaped eggs, which is typical for the specific helminth [parasitic worm].”

She was treated with “two doses of albendazole, with each dose two weeks apart, in order to avoid reinfection …. And after a 3 month follow-up period, the patient remains asymptomatic without any signs of recurrence.”

An overview of pinworm infections, symptoms, tape test and treatment approaches

This WebMD article offers an overview of pinworm infections, the symptoms, the tape test and treatment approaches.

As you’ll read it’s not only a problem in refugee camps – it’s “very common in elementary school-aged children” and it’s the most common kind of worm infection in the United States. “Most of the time, pinworm infections don’t cause serious problems.” However, when one child (or adult) gets a pinworm infection it can easily be spread to the entire family. The Syrian refugee paper mentions the whole family was tested.

Systemic infection: female health issues and gut health

The WebMD authors also state, “in rare cases, and especially if you have a lot of them, the pinworms can travel from the anal area up the vagina to the uterus, fallopian tubes, and around the pelvic organs. This can cause inflammation of the vagina (vulvovaginitis).”

I first learned about these serious systemic issues in women from naturopathic doctor Rachel Arthur at a conference in Australia. Contrary to the WedMD article, she believes this is not rare and more common than you’d expect, contributing to hormonal imbalances and even infertility.

The research confirms the impacts of pinworm on the gut, with reports of pinworm associated with appendicitis, pinworm in the liver, pinworms contributing to dysbiosis and pinworm being a factor in inflammatory bowel disease.

The WebMD article doesn’t mention the mental health symptoms and mechanisms but you can read more about that (and my interview with Dr. Jay Davidson) below.

Annual deworming and concerns about drug resistance?

I’m not going to get into anti-parasitic medications and herbal alternatives in this blog post – Dr. Jay talks about mimosa pudica seeds and Dr. Rachel recommends chondroitin sulfate – but do I want to mention that there are many public policy papers calling for annual deworming procedures for everyone. It’s also mentioned in the above Syrian refugee paper, as is hand-washing for prevention.

And many folks recall annual deworming concoctions as a child and did/do the same with their children.

There is, however, the concern about antiparasitic drug resistance similar to what is being seen with antibiotics and antiviral drugs.

If you are new to parasites and their impacts on mood issues, anxiety and insomnia and more

If you are new to parasites, here are some insights from an interview I did with Dr. Jay Davidson on The Anxiety Summit 5: Gut Brain Axis. The topic of our interview is – Parasites, Anxiety and TUDCA for Your Liver. He shares this:

The Greek meaning of parasite is one that sits at another’s table. So essentially think of a parasite as it’s taking things from you. It’s taking nutrients, it’s taking key things that your body needs and literally off of you, not to the point that it’s killing you because then you’re not a good host to give a good environment. So it’s basically just kind of sucking you dry.

We discussed symptoms individuals may experience: mood issues, anxiety and insomnia (especially around full moon). He shared that with insomnia “the big issue that I see is restless sleep where you toss, you turn, you wake often. You can’t just be relaxed when you sleep. Parasites get active when you go to bed. The more active they are within your body and the more you’re trying to calm down, the more your body is getting stressed out. This is where teeth grinding happens when you sleep.

This is very typical and likely the kinds of insomnia symptoms this young refugee girl experienced too. Pinworm is more active at night so the itching around her anus and the need to scratch would have affected her sleep too. This is a classic sign of pinworm.

With regards to anxiety and mood issues and possible mechanisms, Dr. Jay shares how parasites contribute to neurotransmitter imbalances:

Parasites will eat the protein you eat and not allow your body to break down that protein into amino acids. That’s why amino acid therapy can be so beneficial symptomatically and change people’s lives, because they’re getting these amino acids that they’re not getting when they have parasites.

When we digest protein, the amino acids are needed to help us make neurotransmitters. With his amino acid comments, he is making reference to my work with the amino acid tryptophan to support your low serotonin worry-type of anxiety symptoms and the amino acid GABA to support your low GABA physical-anxiety type symptoms. They are wonderful for quick relief of anxiety and mood symptoms, and even help sleep problems too. But as he says “you always want to make sure to go to the underlying cause to remove the parasitic infection.”

Other symptoms of parasitic infection that we discuss at length: restless legs and calf cramping, diarrhea, bowel urgency, SIBO (small intestinal bacterial overgrowth), vertical wrinkles above your mouth, nail-biting, food sensitivities, bed-wetting and night sweats. These are all symptoms that we need to look for and then consider stool testing and/or the sticky tape test/clear adhesive tape test for pinworm (as mentioned in the Syrian refugee paper and WebMD article above).

If you missed this interview and/or summit, you can find the purchase link on the above blog and here.

Tryptophan is not working (possibly because of parasites) and toxoplasma gondii (and GABA/anxiety)

Here is some additional reading on parasites on my site and in the literature:

Tryptophan doesn’t work, then it does and then it doesn’t: could it be hormonal shifts, dietary factors and/or parasites? As I share here, if you have a very pronounced shift in symptoms for 4-5 days around a full moon each month – more severe insomnia, more anxious, more depressed – I would want to check for parasites (as well as hormonal impacts and everything else covered on this blog).
Toxoplasma gondii: schizophrenia, bipolar disorder, OCD and unresolved anxiety? As I share in this blog, toxoplasma gondii is a microscopic parasite that infects cats and can be found in the soil – research shows it may be a factor in schizophrenia, bipolar disorder and OCD in susceptible individuals. Could toxoplasma gondii could be one of the root causes of unresolved anxiety? I believe so and feel it’s under-rated.
In this study, Toxoplasma gondii Infections Alter GABAergic Synapses and Signaling in the Central Nervous System, the authors share that “toxoplasma interferes with GABA signaling in the brain …playing a role in seizures and other neurological complications seen in Toxoplasma-infected individuals.” This particular parasite disrupts the workings of the glutamic acid decarboxylase 67 enzyme (GAD67), used to make GABA from glutamate, and very likely contributes to increased anxiety symptoms too.

Resources if you are new to using tryptophan, GABA and other amino acids as supplements

If you are new to using tryptophan, GABA or any of the other amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA and low serotonin).

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

If you or a family member have had a pinworm infection, what symptoms did you experience and was the entire family affected?

Have you had hormonal and/or pelvic issues and/or gut issues as a result of systemic infection with pinworm?

How have other parasitic infections impacted your health?

How familiar are you with the fact that pinworm and other parasites can affect your mood, anxiety and sleep, as well as cause gut issues?

If you’re interested in learning more about testing and herbal protocols please let me know. If you’d like to share what has worked for you please do share too.

If you have other questions and feedback please share them here too.

Irukandji syndrome: severe pain, nausea, breathing difficulties and a feeling of impending doom (impact on serotonin and other neurotransmitters?)

December 30, 2022 By Trudy Scott 14 Comments

Irukandji syndrome is in the news again. In addition to the jellyfish sting causing severe pain, nausea and breathing difficulties, the research states there is a feeling of impending doom after you’re stung. I’m sharing this current news from Australia and a recent study because I’m curious about the mechanisms and short- and long-term impacts on serotonin and other neurotransmitters, likely affecting anxiety, depression, pain and insomnia. And I’d like to help create awareness since there is not 100% consensus on what to do right away after a sting and less awareness in the medical community than I feel comfortable with.

From the ABC article published this week in Australia: “Another child has been flown to Hervey Bay Hospital with a suspected Irukandji sting after swimming in a creek off Wathumba Road on K’gari (Fraser Island) in Queensland, Australia on Wednesday afternoon.

The key points of the article:

“Three young girls and a boy have been flown to hospital with suspected Irukandji stings in the past two days
The jellyfish stings can cause severe pain, nausea and breathing difficulties
A Toxicologist is calling for more research into their movements and physiology”

The yahoo news article expanded on the symptoms: “They have this severe body pain, often low back pain, nausea, vomiting, and this feeling of impending doom that sort of lays over the top of this whole thing.”

I found the latter interesting as impending doom is a classic sign of low serotonin. So I went digging into the research. I was enlightened and surprised by what I found.

Raising awareness on this worldwide increasing threat

This 2022 paper, Raising Awareness on the Clinical and Forensic Aspects of Jellyfish Stings: A Worldwide Increasing Threat is eye-opening and concerning and also mentions the impending doom symptom.

Irukandji syndrome is a severe illness produced by the envenomation i.e. injection of venom, of some species of small jellyfish from the Cubozoa class, known as box jellyfish.

It consists of a clinical picture dominated by systemic symptoms similar to a catecholamine surge, including hypertension, tachycardia, intense pain, and muscle cramping, eventually leading to pulmonary edema, shock and cerebral hemorrhage.

Also listed are symptoms of anxiety, restlessness, headache, localized sweating and impending doom. A feeling of impending doom is a classic symptom of low serotonin.

With regards to Irukandji syndrome it’s becoming a worldwide problem: “The first cases described happened in the northern Australian territories. However, similar disorders have been observed all over the tropical waters, including Thailand, the Caribbean, Florida, and Hawaii.”

The good news is that the authors state “Irukandji syndrome is typically not deadly, especially if supportive care is given early” and “not all encounters with species capable of producing Irukandji syndrome result in this clinical state.” They also share that typically the severe pain only lasts a few hours but do mention one case where “pain recurred up to a year later.” I discuss possible longer term effects below.

As you read the paper, be aware there are many types of jellyfish with many different mechanisms. Cubozoa includes the deadliest jellyfish species and includes Carukia barnesi and Chironex fleckeri. (commonly known as the Australian box jelly). It’s the Carukia barnesi that causes Irukandji syndrome.

The images in the above paper are graphic so be warned.

There is not 100% consensus on what to do right away

What is also really concerning is that there is not 100% consensus on what to do right away. This 2017 paper, Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations, published by Hawaiian researchers, found the “best outcomes occurred with the use of venom-inhibiting technologies (Sting No More® products)” and they state not to use a sea water rinse. They also found vinegar and heat treatment were less effective with certain types of jellyfish.

And yet the tentative recommendation from the above 2022 paper is to use vinegar, heat, sea water, and careful removal of remaining tentacles with tweezers quickly because only “about 1% of nematocysts (stinging cells) discharge upon initial contact.” They do suggest using Sting No More® before removing tentacles in order to deactivate the nematocysts.

I’m not sharing any of the above as conclusive in all situations but more to illustrate what both papers state: further research is needed in different places of the world, as different jellyfish species seem to react differently to the treatments.

There is also less awareness in the medical community than I feel comfortable with hence my desire to share this so you are more aware if you or a family member is stung by a jellyfish.

Are there possible long-term impacts on anxiety, depression, pain and insomnia? (and the potential role of amino acids)

Just like we have long-term impacts on anxiety, depression, pain and insomnia with Lyme disease and other infections like Bartonella – due to effects on serotonin, GABA and other neurotransmitters – do we need to consider these long term impacts after a jellyfish sting too?

I have to wonder if there are also longer term impacts given the trauma of the situation and the many medications that are needed to save your life: nitroglycerin, opioids, benzodiazepines and others.

If mood, anxiety, pain and sleep issues persist after the acute recovery phase (which can take up to 3 months and more) and there are other signs of low serotonin, GABA, dopamine and endorphins, it’s important to consider the use of targeted amino acids. I recommend tryptophan or 5-HTP for low serotonin symptoms (worry type of anxiety, insomnia and low mood), GABA for low GABA symptoms (physical anxiety and tension), tyrosine for low dopamine symptoms (depressed with low energy and poor focus) and DPA for low endorphin symptoms (pain and weepiness).

It would be wonderful to see research in this area.

Is there a possible role for GABA right after the sting too?

Given there is “hypertension, tachycardia, intense pain, and muscle cramping”, would the amino acid GABA help?

With Irukandji syndrome, “there have been reports of blood pressures as high as 300/180 mmHg” (normal is 120/80 mmHg). In one study, 80mg GABA was found to reduce mild hypertension and it’s possible that a higher dose of GABA may help right after the sting. It may also help to alleviate pain and muscle tension/muscle cramping too.

It would be wonderful to see research on GABA use right after the sting too.

Resources if you are new to using amino acids as supplements

If you are new to using GABA or any of the other amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA and low serotonin).

I do hope these 4 young Australian children are doing well after having been stung.

Have you or a family member been stung by a jellyfish? Where did it happen and what type of jellyfish? What symptoms did you experience? What was the treatment and what was recovery like?

Have you or your family member had any long-term lingering symptoms of anxiety, depression, pain and insomnia? Have the amino acids or other solutions helped?

If you’re a practitioner have you seen long-term lingering symptoms of anxiety, depression, pain and insomnia in your clients/patients who have had a jellyfish sting?

Feel free to post your questions and feedback in the comments below.

Anxiety case study: a very very slow SSRI taper with tryptophan and other nutritional support

August 28, 2020 By Trudy Scott 14 Comments

Today I’m sharing an update from someone in my community who is tapering from an SSRI (Cipralex/lexapro) in the best way possible – very methodically and doing a very very slow taper, using compounded medication and nutritional support. It is a team approach with a supportive doctor monitoring for serotonin syndrome, her pharmacist compounding her medication and input from me.

She has an excellent diet that contains enough healthy protein and fats, plenty of vegetables, and no sugar or caffeine. She has the basic nutrients covered and is on the pyroluria protocol (these nutrients help make serotonin). She is using the amino acid tryptophan for serotonin support as she tapers. And she is out walking in nature and practicing mindfulness.

All of this sets her up for success and being able to avoid antidepressant discontinuation syndrome.

Here is her story:

I began tapering off 10 mg of Cipralex in November 2017. I have my little “Support Team” that includes a compounding pharmacist and my GP. Feeling very fortunate that I have these people as my taper has not exactly gone as planned (although far better than my last two attempts)

Originally, the plan was to go down by 10% of the dose and stay at that dose for 4 weeks. That didn’t work for me. I was fine when I dropped from 10mg to 9, but after my next 10% drop I experienced that familiar withdrawal hell. I got a little scared, but stuck with it, and decided to stay at that dose for a bit longer. While I leveled out, I did a lot of reading about how SSRIs work. I learned about the 1/2 life of Cipralex (all SSRIs have a different 1/2 life) and what was actually happening physiologically as my body adjusts to the lower dose. It’s a recovery process.

With that new knowledge, I decided to try another approach. I knew I couldn’t handle a drop of 10%. So, I started to taper at a rate of 0.1mg once a week (far less than 10%!). By day three at the new dose, I could feel the withdrawal, but it was far less severe. Small drops=small “withdrawal wave”. I discovered that I am able to manage a 2% drop of the current dose and I have been able to drop that % each week. So, I’m still reducing by 8% a month, which means I am close to the original plan of dropping by 10% a month. At this time I am at 6.24mg.

Yes, it is a very slow process and I have a long way to go, but it’s working. I have read that some people have to reduce by 1% of their current dose and remain at that dose for 4 weeks to allow their body the time to heal and adjust to life on the lower dose. Having the liquid compound has made such a difference! You sure would have difficulty accurately shaving off a pill by 2%!! If anyone is trying to come off of this drug, do your best to find a compounding pharmacist!

I find that I must stick to a very healthy diet. I eat a lot of fresh, raw and cooked vegetables. I mean a LOT of vegetables. I eat good sources of protein and walk for at least 45 min almost every day. I steer clear of sugar and caffeine. Both make my withdrawal much worse.

Every day I take omega 3, vitamin C, vitamin D, vitamin B complex. I take the supplements for pyroluria, vitamin B6, evening primrose oil and zinc. I take magnesium at night. I took Trudy’s amino acids course online and did all of the amino acid trials. I discovered all I really need is tryptophan. It has made a huge difference for me. Yes, I take Lidke tryptophan. For us Canadians, it can be ordered online.

I practice mindfulness. I’ve read a lot about the anxious brain (the reason I took Cipralex in the first place) so I understand what is happening now, what is real and what is just noise in my head.

Antidepressant discontinuation syndrome

This is the best way to taper SSRI medications in order to avoid withdrawal effects, also known as discontinuation syndrome which can be very severe for some folks.

Accordingly to this paper, Antidepressant discontinuation syndrome occurs in about 20% of patients who reduce the dose or abruptly stop an antidepressant that they have been taking for one month. This paper states that “symptoms are usually mild….occur within two to four days after drug cessation and usually last one to two weeks.”

It also states that occasionally symptoms “may persist up to one year…and if the same or a similar drug is started, the symptoms will resolve within one to three days.”

I typically hear from individuals who fall into the category of severe symptoms that are persisting past 2 weeks. It’s not uncommon to see symptoms continue for a year and often longer in some cases.

Also from the above paper, is the mnemonic FINISH which summarizes these symptoms:

Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
Insomnia (with vivid dreams or nightmares)
Nausea (sometimes vomiting)
Imbalance (dizziness, vertigo, light-headedness)
Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations) and
Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).”

How you will feel if your serotonin is low and how to learn more

With low serotonin you will have the worry-in-your-head and ruminating type of anxiety, panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues, insomnia and afternoon/evening cravings.

If you suspect low serotonin symptoms and are new to using the amino acids and do not have my book I highly recommend getting it and reading it before jumping in to taking supplements and navigating this with your prescribing physician: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings. You may need to lend him/her a copy of my book too.

There is a complete chapter on the amino acids and one for pyroluria, plus information on real whole food, sugar and blood sugar, gluten, digestion and much more. If you’re not a reader there is now also an audible version.

Here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary

Please also read and follow these Amino Acid Precautions.

This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs – you will find the Lidtke Tryptophan here. You can also read more about why I prefer the Lidtke tryptophan on this blog.

I would like to end off by saying how much I appreciate this woman and others sharing their stories like this so we can all learn!

Please also share your taper story and what you did to make it easier. If you had challenges share those too. Let us know if you can relate to any of the above FINISH symptoms and how long they lasted.

Feel free to post your questions here too.