Difference between revisions of "Helminth inoculation"

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(→‎Inoculation with NA: Added a link.)
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* [https://youtu.be/hm32xL2e6CA Hookworm inoculation using a pre-loaded patch]
 
* [https://youtu.be/hm32xL2e6CA Hookworm inoculation using a pre-loaded patch]
  
After the bandage/dressing has been applied, the larvae will detect the presence of skin [https://www.ncbi.nlm.nih.gov/pubmed/27211240] [https://www.ncbi.nlm.nih.gov/pubmed/30017486] and, responding in particular to warmth, [https://www.ncbi.nlm.nih.gov/pubmed/15614586] will swing into action, often producing an itch within just a few minutes. Occasionally, the itch may be delayed for up to several hours. [https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12061538&ref=NZH_fb]
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After the bandage/dressing has been applied, the larvae will detect the presence of skin [https://www.ncbi.nlm.nih.gov/pubmed/27211240] [https://www.ncbi.nlm.nih.gov/pubmed/30017486] and, responding in particular to warmth, [https://www.ncbi.nlm.nih.gov/pubmed/15614586] will swing into action, often producing an itch within just a few minutes. Occasionally, the itch may be delayed for up to several hours, [https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12061538&ref=NZH_fb] or even until the next day. [https://www.facebook.com/groups/htsupport/permalink/3758883734167554?comment_id=3759189137470347]
  
 
The bandage/dressing should be left in place for a minimum of four hours and, ideally, for twelve hours. If you need to take a shower before the bandage/dressing is due to come off, cut a piece from a plastic bag and tape this over the area to keep it dry. [https://www.facebook.com/groups/htsupport/permalink/2157753440947266/?comment_id=2157764654279478&reply_comment_id=2157772957611981&comment_tracking=%7B%22tn%22%3A%22R%22%7D] Duct tape or electrical insulation tape are ideal for this purpose because they are waterproof.
 
The bandage/dressing should be left in place for a minimum of four hours and, ideally, for twelve hours. If you need to take a shower before the bandage/dressing is due to come off, cut a piece from a plastic bag and tape this over the area to keep it dry. [https://www.facebook.com/groups/htsupport/permalink/2157753440947266/?comment_id=2157764654279478&reply_comment_id=2157772957611981&comment_tracking=%7B%22tn%22%3A%22R%22%7D] Duct tape or electrical insulation tape are ideal for this purpose because they are waterproof.

Revision as of 11:30, 1 April 2021

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The first inoculation should be with a single species[edit]

When two species of worm are introduced together by someone who has not previously hosted helminths, or not hosted for some time, the initial immune response may be excessive and the risk of side effects greatly increased.

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I got crazy side effects when I started the HDC and NA close together. The worm flu phase can be brutal if you start them about the same time. [1]
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Irritability, anxiety and agitation were typical symptoms for me when I started HDC and NA… the combination was too much for me… I really tried for 6-8 weeks and then cancelled the HDC. [2]
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I’m one month post inoculation with 5 HW and one week post inoculation with 2500 TSO. I totally underestimated how bad worm flu would feel. It’s hard not to give up. I feel like I’ve been hit by a truck! [3] [4]

If helminthic therapy is commenced with a single species of worm, and if initial dosing is conservative, any side effects that appear should be mild and transient.

There may be an advantage in adding a second species eventually, but only once the first is well established.

Inoculation is safe, even when the recipient has a cold[edit]

Research suggests that helminths may boost humoral immunity, so inoculation with appropriately sized doses of therapeutic helminths might actually be helpful if taken while suffering from a cold or the flu. However, chronic infections may be exacerbated temporarily by inoculation, especially the first time that a helminth is introduced.

Inoculation with NA[edit]

NA larvae are applied to the skin on a bandage/dressing and should be used as soon as they are available.

They can survive for as long as 3-5 months if kept at a favourable temperature (70ºF/21ºC), although their longevity is also dependent on the temperature at which they were incubated, with larvae grown at a lower temperature surviving for longer. Since they do not feed at this stage in their development, the larvae are reliant on their fat stores, which obviously diminish over time, rendering them progressively weaker. For more detail, see the following page.

After being pipetted onto a bandage/dressing, the hookworm larvae should be applied to a hairless, convex area of skin to ensure good skin contact, as demonstrated in the following instructional video.

There can be stragglers trapped in water droplets in the vial after the contents have been pipetted onto a bandage/dressing, so at least one rinse should be carried out. Some providers supply a second vial of distilled water for this purpose. Even a second rinse can capture the odd straggler. [5]

If inoculating with home-grown larvae, use a bandage/dressing with a flat central pad in preference to the quilted type. A Band-Aid dressing with a ⚠️"Quilt-Aid Comfort Pad" has been reported to have prevented successful inoculation in one case. [6]

If a ready-made bandage/dressing is not available, an effective substitute can be made by using a makeup pad, or by cutting the required size from a large lint pad and securing this to the skin with medical tape. [7]. Alternatively, a piece of toilet paper, or flat paper towel, stuck to a piece of masking/painter's tape will work. [8] [9]

Some hookworm suppliers have experimented with pre-loading the larvae onto a small damp cotton patch, which needs to be placed onto a larger bandage/dressing after receipt, before being applied to the skin. So far, this method has proved to be less successful than the traditional method requiring the self-treater to pipette the larvae from an eppendorf tube onto a bandage/dressing, but, for those who do receive a pre-loaded patch, this can be applied as demonstrated in the following video.

After the bandage/dressing has been applied, the larvae will detect the presence of skin [10] [11] and, responding in particular to warmth, [12] will swing into action, often producing an itch within just a few minutes. Occasionally, the itch may be delayed for up to several hours, [13] or even until the next day. [14]

The bandage/dressing should be left in place for a minimum of four hours and, ideally, for twelve hours. If you need to take a shower before the bandage/dressing is due to come off, cut a piece from a plastic bag and tape this over the area to keep it dry. [15] Duct tape or electrical insulation tape are ideal for this purpose because they are waterproof.

When the bandage is removed, this may reveal the beginnings of a rash. For more about this and how to treat the itch, see the following page.

Best time of day to inoculate with NA[edit]

Different self-treaters prefer to inoculate at different times during the day.

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I get a very aggressive itch, so I always inoculate in the morning. This way, I can distract myself during the day. I take the bandage/dressing off before I retire for the night, and take my hair dryer to bed with me. [16]
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I like to inoculate at night because I sleep through the itch! I hair dryer in the morning. [17]

Body sites used for hookworm inoculation[edit]

The inside of the forearm or bicep is a good choice because it is convenient to access in order to treat the rash with creams or apply hot air from a hair dryer, but inoculation too close to the armpit can cause lymph nodes there to swell. Inoculation high on the inner thigh - and even occasionally on the outer thigh [18] - can cause painfully raised lymph nodes in the groin, which can be uncomfortable when walking. [19]

Many hookworm hosts have found that repeatedly using the same site results in a more robust skin reaction, and that varying the site effectively reduces both the rash and the itching.

Sites that have been used include the following, starting with the feet and moving up to the shoulder.

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I put mine on the instep/arch of my foot. I did not have any histamine reaction. No bumps, no itching. [20]
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Treated on the bottom of my foot 2 days ago. So far there’s barely any response, it’s definitely an improvement compared to other areas of my skin. [21]
However, someone else who tried the underside of their foot has said, "Never again"! [22]
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I liked it on the top of my foot. [23]
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I have inocculated with NA 5 weeks ago and my foot was so swollen that I couldn't walk. [24]
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I like to do ankles. [25]
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I’ve used my ankle for the first time which seems a LOT better than my arm or hip/upper thigh. [26]
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I did inside my ankle so I could scratch with the other foot. [27]
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3 days after inoculation i can barely walk...guess i shouldn’t have done it on my ankle. [28]
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Worst rash I've had was on my arm, smallest on my ankle. [29]
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I have tried ankle/lower calf and it seems less sensitive than arm. Getting less of a reaction at innoculation site. [30]
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Calf. [31]
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I put them somewhere that isn't hard to scratch. Down on my calf I'd be bent over all day long. [32]
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I've been inoculating into different areas on my knees. I have OA in my knees. No rash at all. [33]
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It always itches badly, but say the most sensitive places such as inner lower arm and inner calf (not to mention the hollow of the knee :-o ) are "10" on the itching scale, then the middle of the thigh, or slightly above the knee, is "7" or "8"... [34]
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Inner thigh a few inches above my knee. [35]
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I did my second dose on my thigh and that worked fine. [36]
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I use somewhere on my legs because it's easier to hide under clothes. I always get an awfully itchy itch -- but slightly less when using the upper parts of the leg. [37]
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Top of the upper leg is best for me. Less visible. [38]
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Since it's summer, I think I'm going for left thigh or hip this time. [39]
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Fatty part of hip. [40]
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Hip was by far the worst. I had a terribly inflamed hard patch about the size of my hand for weeks. [41]
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I always do my stomach. [42]
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I've done my thigh but much prefer my arm as the itch seems more managable. [43]
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I always use the place on my inner arm halfway between my elbow and wrist, because it's flat and smooth... The forearm can easily be covered with a light sleeve but also quickly accessed for airing out or changing dressing. [44]
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I prefer the inner left forearm because I’m right handed and this makes applying anti-itch cream easier. [45]
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I did 2 on my thigh then switched to my arm. I've found that the closer to my armpit, the faster it heals, and generally my arms heal faster than my legs. [46]
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I find the best place for me is the shoulder tip. [47]
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I started inoculating high on my shoulder because I sleep on my side, and that part is always squished against and rubbing around on the bed, and plus not very sensitive, so the itch is quite bearable. [48]

One site that should be avoided is the thumb!

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When I was doing my inoculation, I accidentally dropped a drop of water onto my thumb and just wiped it off, but it was ridiculously painful the night I inoculated. Since then it's been like a big red boil - literally a throbbing cartoon thumb! Its been 6 days now and it's still kinda sore. I definitely don't recommend inoculation around the skin of the thumb nails! (Via private message.)

Oral inoculation with NA is not recommended[edit]

There are several reasons why it is not recommended to swallow NA larvae.

1. While oral inoculation has been shown to be effective with some hookworm species, such as the dog hookworm, Ancylostoma caninum, [49] and the human hookworm, Ancylostoma duodenale, [50] oral inoculation with Necator americanus has been found to be ineffective, possibly because passage through the lungs is omitted.

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N. americanus may require a period of growth in the lungs, which is not required by A. duodenale. This deduction is based on the observation that development of N. americanus following oral infection rarely succeeds and, even then, very few worms develop… the apparent inability of N. americanus to do this is thought to be attributable to an obligate pneumonic phase in its life history. [51]

2. L3 hookworm larvae are particularly susceptible to acid, so there must be some developmental change that occurs during the few days that they normally take to travel from the skin to the stomach which enables them to survive the harsh, acidic gastric environment. Hotez and colleagues have reported that, following entry into the host via the skin, L3 larvae receive a signal present in mammalian blood and tissue that causes them to resume development and secrete bioactive polypeptides. [52] [53] Larvae that are swallowed will obviously not experience this trigger.

3. Hookworms have probably taken the same route throughout most of their long co-evolution with mankind, so they are likely to try to follow the same pathway irrespective of where they actually enter the body. Therefore, unless they are encapsulated, larvae that are swallowed may still be looking for skin, and might mistake the lining of the mouth or throat for external skin and enter via these surfaces. Nagahana, et al., have reported that N. americanus L3 larvae will invade the buccal epithelium if they enter through the mouth. (Nagahana M, et al. Experimental studies on the oral infection of Necator americanus. III. Experimental infection of three cases of human beings with Necator americanus larvae through the mucous membrane of the mouth. Japanese Journal of Parasitology. 1963;12:162–167.) Since some people experience significant swelling at the inoculation site, there is a potential for blockage of the throat if larvae were swallowed.

4. Oral inoculation does not provide the visible confirmation of dose viability that is common with successful percutaneous inoculation. So, unless the worms have been cultured by the person inoculating, or they have a microscope with which to check the viability of doses received from other sources, they might unknowingly swallow a dose of dead worms, which could delay the progress of their treatment.

Possible side effects after inoculation with NA[edit]

See the following pages.

See also[edit]

Inoculation with TTO[edit]

TTO are taken orally in a drink.

Possible side effects after inoculation with TTO[edit]

See the following page section.

Inoculation with TSO[edit]

TSO are taken orally in a drink.

Possible side effects after inoculation with TSO[edit]

See the following page section.

Inoculation with HDC[edit]

HDC are taken orally in a drink, preferably something containing fat to help promote the growth of the cysticerci. Milk will work well, or a single fish oil capsule can be taken with any other liquid.

Possible side effects after inoculation with HDC[edit]

See the following page section.