Self-treating with NA

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Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. (NAthe human hookworm, Necator americanus) is a member of the phylum Nematoda. Commonly known as the New World hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., it is one of two hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. that are adapted to living in humans, and the only one used in helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy..

Dosing with hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.

See the following page.

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. storage and survival

Ideally, L3 NAthe human hookworm, Necator americanus larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. should be used as soon as possible after receipt, although they can be stored for a further week or two if kept at room temperature but out of direct sunlight and in their original packaging. They have been known to survive for as long as 3-5 months if kept in ideal conditions, i.e., out of light, at a favourable temperature (70ºF/21ºC), in distilled, demineralised or dechlorinated water. [1] [2] However, since L3 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. do not feed, they are reliant on their fat stores, which diminish over time, rendering them progressively weaker. Their survival time is also partly determined by the temperature at which they were incubated, with those grown at a lower temperature having greater longevity.

If L3 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. encounter extreme temperatures during transit, they may be dead on arrival. Worm growers have reported a 50% loss of larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. at 50ºF (10ºC) and a 90% loss if the temperature drops to 43ºF (6ºC) for several hours. Freezing will kill them, and the cargo hold in an aeroplane can fall well below zero during flight, so worms in packages placed at the edges of pallets will likely succumb, but the further the package is from the edge of a pallet, the better insulated it will be and the greater the chances of the larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. surviving. Sitting in an outdoor mailbox in sub-zero temperatures will also be fatal for the larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state., so delivery should be arranged to an address where the package can be received indoors.

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. are also susceptible to drying and heat, for example from direct sunlight. [3] (PDF) Temperatures above 113ºF (45ºC) will kill them, and they may only last for a week or two at 90ºF (32ºC).

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation]

See the following page section.

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. lifecycle

Hookworm LifeCycle.gif

Source: US Centers for Disease Control [4]

The developmental stages, migration and diet of Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.

Egg - HookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. start their life as unembryonated eggs in faeces deposited in soil, and initially gain nutrients from the faeces. When there is adequate warmth, shade and moisture, the eggs are embryonated and, within 1-2 days, hatch into first stage L1 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state..

L1 - In this first, non-infective, juvenile rhabditiform (free-living) stage, the larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. grow and feed on organic debris and bacteria in the soil until they molt, after approximately 3 days, into second stage larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state., L2s.

L2 - During this second rhabditoform (free-living) stage, the L2 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. will feed for 6 or 7 days and then molt again into third stage larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state., or L3s.

L3 - In this infective, filariform stage, characterized by a closed mouth, the L3 larvaThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. does not feed in its natural environment and will only survive for a few weeks until it exhausts its lipid metabolic reserves, or it finds a host, at which point it will commence feeding on protein in the bloodstream. [5] [6]. The lifespan of L3 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. supplied by commercial helminth providers may be further shortened by their exposure to the antibacterial rinse used by these companies to clean them.

Once the L3s enter the skin, they travel via the circulatory system and the heart to the lungs which they reach at around 4-7 days. After penetrating the lungs, the L3s ascend via the bronchioles to the trachea, during which journey they molt into the L4 stage.

Serum and gluthatione provide the signals for L3 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. to continue their development to the L4 adult stage.

In experimental conditions, exposure to serum has been shown to stimulate about 50% of hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. L3s to feed and undergo development, and this response can be increased to 90-100% by adding glutathione to the serum. [7] Starting this process in a petri dish in larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. that are to be used in therapy would make infection impossible, but the serum experiment might indicate that L3 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. are in fact able to feed once they enter the bloodstream, which might explain successful inoculations with old batches. [8]

L4 - The L4 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. transfer to the oesophagus and down to the intestines, which they reach between days 8-14. They then molt into the pre-adult stage around days 17–21 and commence feeding on blood drawn from the intestinal mucosa. Contrary to the impression created in many scientific texts, the amount of blood drawn by Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. is minuscule. When discussing the amount of blood lost to hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., researchers will often have in mind the Old World hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., Ancylostoma duodenaleA species of roundworm, aka the Old World hookworm, that is "not" used in helminthic therapy. [https://en.wikipedia.org/wiki/Ancylostoma_duodenale Wikipedia:Ancylostoma duodenale], which draws 9 times more blood than Necator.

L5 - At about 5-9 weeks, the larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. attain their adult form, L5.

Note. Many of the details above were recorded from observations in a hamster model [9]

For more detail about the developmental stages and migration of NAthe human hookworm, Necator americanus in humans, see Immune responses following experimental human hookworm infection.

Where hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. live

According to Wikipedia, mature Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. live at the distal (lower) end of the jejunum and the proximal (upper) end of the ileum, while the other species of human hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., Ancylostoma duodenaleA species of roundworm, aka the Old World hookworm, that is "not" used in helminthic therapy. [https://en.wikipedia.org/wiki/Ancylostoma_duodenale Wikipedia:Ancylostoma duodenale] - which is not used in therapy - resides in the duodenum/jejunum. [10]

Croese, et al, used capsule endoscopyExamination using an endoscope - an instrument used to view the interior of a hollow organ or cavity within the body. to determine that the distribution of NAthe human hookworm, Necator americanus was influenced by the parasite’s maturity, and that, early in infestation with NAthe human hookworm, Necator americanus, the worms were distributed along the length of the jejunum but that, by 20 weeks, the predominant location of surviving worms was the proximal jejunum - the upper end of the jejunum, just below the duodenum. [11] It could be argued that this latter observation is more likely to be correct than the opinion expressed in Wikipedia and, if it is, mature NAthe human hookworm, Necator americanus are most likely to be found where the red text appears in the following representation.


mouth ➤ oesophagus ➤ stomach ➤ duodenumjejunumileumcaecum ➤ colon ➤ rectum

Rarely, NAthe human hookworm, Necator americanus have been observed in the stomach. This exceptional localisation might be caused by one of three factors:

1. the removal of the jejunum and/or duodenum
2. jejuno-duodeno-gastric reflux [12]
3. an excessively large hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. colony that has forced some of its members to spread out from their usual localisation site. [13]

A short video clip of a hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. in situ.

While it is theoretically possible that NAthe human hookworm, Necator americanus might be seen during a colonoscopy, this would only happen if the colonoscope were advanced into the lower end of the ileum, and only if some hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. had taken up residence there, which is unlikely unless the jejunum has been removed or very large numbers of NAthe human hookworm, Necator americanus - i.e., hundreds - are being hosted, forcing some NAthe human hookworm, Necator americanus to occupy the ileum. It is very unlikely that any would take up residence in the colon, which they normally only pass through after they die.

HookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. are not adversely affected by the laxatives used in preparation for a colonoscopy. While it is possible to lose hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. to very severe diarrhoea/diarrhea, they can withstand the effects of normal, recommended quantities of laxative, including the standard colonoscopy prep.

An upper endoscopyExamination using an endoscope - an instrument used to view the interior of a hollow organ or cavity within the body. (i.e. via the mouth) will not reach past the second of the four parts of the duodenum, so will not usually reveal, or disturb, any hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. unless these have been forced to spread beyond their usual location as a result of one of the three factors mentioned above.

Confirming hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. infection

There are three practical options for determining the presence of hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. in the gut.

1. Stool test

From about six weeks post inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] with hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., eggs will be detectable in the host's stool. Checking a stool sample for these eggs is the best way to establish that hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. are present, and most pathology labs will have a faecal (stool) test called something like "Ova, Cysts, and Parasites" or "Ova and Parasite". Unfortunately, most commercial laboratories do not have sufficient experience to accurately identify hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. eggs, a problem that is exacerbated by the relatively low numbers of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] used in helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy.. Testing is therefore best carried out by a laboratory associated with a school of tropical medicine, or by a veterinarian (vets are very familiar with hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. eggs), or done at home using a microscope and a fecalyzer.

2. Incubation

Some hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. hosts find it easier to check for the presence of worms by incubating a stool sample rather than attempting to count the eggs via a fecal float.

3. Blood test for eosinophilsEosinophils are a specialised type of white blood cell with a variety of both harmful and beneficial functions. Their numbers rise temporarily following inoculation with helminths.

Another way to determine whether or not you are hosting helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] is to have a blood draw to see if your eosinophilEosinophils are a specialised type of white blood cell with a variety of both harmful and beneficial functions. Their numbers rise temporarily following inoculation with helminths. level is elevated. Although this is not a foolproof test for the presence of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], it is fairly reliable. It is also quick, and is a method that a medical insurer might pay for.

Caring for hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.

See the following page.

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. lifespan

Once inside a host, NAthe human hookworm, Necator americanus are reported to survive for 3-10 years [14] [15] but to be capable of living for up to 15 years, [16] and possibly even 18 years. [17] However, the experience of hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. self-treaters suggests that they typically only survive for approximately 1-3 years, and sometimes for only a few months, depending on the strength of the individual host’s immune response. For more detail about this, see the following page section.

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. respiration

HookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., like other nematodesA category of worms with slender, unsegmented, cylindrical bodies that include roundworms and threadworms., have digestive, nervous and reproductive systems but no circulatory or respiratory system. They pick up oxygen and give off carbon dioxide via the surface of their bodies using diffusion, which occurs whether they are in water or air. They are also able to extract oxygen from their host's blood. [18]

Is there genetic degradation in laboratory-reared hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.?

Concern is sometimes expressed about the possibility that the hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. being sold by the commercial helminth providers may have become weakened as a result of a genetic bottleneck in the domesticated hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. stock.

It is probable that all the NAthe human hookworm, Necator americanus on sale today would have originated in the same cohort gathered from the wild by the helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy. pioneers who founded the first two companies to sell NAthe human hookworm, Necator americanus (Worm Therapy and Autoimmune Therapies). In view of this, there is unlikely to be much, if any, advantage to be gained by sharing NAthe human hookworm, Necator americanus larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. with other members of the helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy. community in an attempt to increase diversity.

So far as is known, there is only one other stock of safe NAthe human hookworm, Necator americanus that might be available to helminth self-treaters, and this is the Nottingham cohort, collected by David Pritchard and colleagues from Papua, New Guinea, and shared with other researcher departments working with this species in other countries. Although the genetic diversity of the research stock may theoretically also be limited, obtaining a sample form this stock might arguably somewhat increase the gene pool of someone who is hosting NAthe human hookworm, Necator americanus obtained from commercial helminth providers.

Any attempt to obtain new stock from the wild would introduce a significant level of risk for anyone who was to host hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. obtained in this way. Walking barefoot in open-air latrines is not a not a good idea, as is explained here by someone who did this. There is also the risk of inadvertently acquiring a different type of helminthAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], such as the less desirable species of hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., Ancylostoma duodenale, which causes nine times more blood loss than NAthe human hookworm, Necator americanus, and can be passed in a mother’s milk and even cross the placenta to infect a foetus. Even more risky is the roundworm, Strongyloides stercoralis, which is autoinfective and potentially hyperinfective, with a risk of fatality.

Since the eggs of both these species are virtually identical to those of NAthe human hookworm, Necator americanus, anyone attempting to obtain “wild” NAthe human hookworm, Necator americanus would need a considerable level of expertise in species identification and would need to undertake a series of colony terminations, followed by reinoculation with individually selected larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state., to be certain that they were not harbouring something much less desirable along with their NAthe human hookworm, Necator americanus.

While the genetic degradation of the commercial stock may be a theoretical concern, there is no evidence of any diminution of therapeutic effect in the NAthe human hookworm, Necator americanus obtained from the helminth providers, therefore the possibility of a genetic bottleneck is arguably nothing that today’s self-treaters need be concerned about in their lifetime.

Genetic degradation is not an automatic sequel to restricting a colony. Some insect species are able to withstand the genetic bottleneck of high levels of inbreeding and still produce healthy offspring, a feature also seen in cockroaches and bed bugs. [19]

A study comparing mitochondrial cytochrome oxidase 1 DNA sequences from N. americanus maintained for 100 generations in laboratory-reared golden hamsters with those from natural human infections, concluded that:

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The genetic differences between the laboratory, hamster maintained strain of N. americanus and field isolates from throughout China and Togo are very small (nucleotide diversity 0.0337). [20]

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. incubation

See the following page.

Further reading

  • NA (Details from the Introduction to helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy.)
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