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Interpreting the GI Pathogen Screen Tests (#401 & #401-H)
From BioHealth Laboratory
By Tracy Tranchitella, ND
Going from top to bottom, I will discuss possible findings in each section of the
test and what those findings mean.
Stool Culture
In this portion of the test, the stool is cultured for 24 hours to determine which
bacteria are present. The sample is then studied under a microscope and a
bacterial count is taken. The lab reports on normal or abnormal bacteria and
the amount present is quantified as mild, moderate or abundant. The lab reports
on all normal bacteria; only the one that is present in the greatest amount. If
abnormal bacteria are present, those are reported over any normal flora.
If the lab sees normal bacteria and it is quantified as abundant in growth that
may be an indication of bacterial dysbiosis. Normal bacteria can cause
problems such as bloating, gas and maldigestion if there is an imbalance in the
normal bacteria or if they are located in the wrong area of the GI tract as with
SIBO (small intestinal bacterial overgrowth). This particular finding can be fairly
common with or without other infections.
If normal flora is found in moderate or mild amounts, this may be an indication of
normal levels of flora. All test results must be interpreted within the context of the
patient’s history. A finding of pathogenic bacteria in any amount is not
considered normal and should be treated appropriately. Some bacteria that
are part of normal flora according to the Centers for Disease Control (CDC),
can be considered opportunistic infections and can cause problems if there are
too many of them. Again, consider your patient’s history and treat
appropriately. Please see the list below for further clarification.
Normal Flora – E. coli, lactobacilli, bifidobacterium, Bacteroides, Eubacterium.
Opportunistic Bacteria – Bacillus cereus, Citrobacter, Edwardsiella, Enterobacter,
Klebsiella. These bacteria are considered to be part of normal flora, however,
they can be considered opportunistic pathogens. If your patient is experiencing
several GI symptoms and there are no other pathogens present on the stool test,
consider treating these bacteria with herbal antimicrobials to reduce their
numbers.
Bacterial Pathogens – Campylobacter, Proteus, Pseudomonas, Salmonella,
Shigella, Toxic E. Coli, Vibrio, Yersinia. These organisms are pathogenic in any
amount and should be treated appropriately.
Ova & Parasites
This section of the test is a microscopic study of the stool looking for parasites in
their various forms in all four samples. The trichrome stain fluoresces the sample
making the parasite, eggs and cysts more apparent under a microscopic study.
There are some parasites considered to be non-pathogenic by the CDC. Please
see the list below. Non-pathogenic parasites are still parasites and may cause
issues in the digestive tract. If a non-pathogenic parasite is isolated on the stool
test and there are no additional infections but your patient is symptomatic,
consider treating with an herbal anti-parasitic formula for 4-6 weeks (or longer if
necessary). Pathogenic parasites should be treated appropriately either with an
herbal anti-parasitic or an antibiotic protocol.
Non-Pathogenic Protozoa - Chilomantix mesnili, Endolimax nana, Entamoeba
coli, Entamoeba dispar, Entamoeba hartmanni, Entamoeba polecki,
Iodamoeba butschlii.
http://www.cdc.gov/parasites/nonpathprotozoa/faqs.html.
Pathogenic Parasites –
1. Protozoa (single cell parasite) – Amoeba, Giardia, Trichomonis hominis,
Balantidium coli, Cryptosporidium, Blastocystis hominis, Dientamoeba
fragilis, Entamoeba histolytica.
2. Platyhelminthes (flat worms) – Flukes and Tapeworms
3. Nemathelminthes (round worms) – Strongyloides, Trichuris, Trichinella, Pin
worms, Ascaris.
For a more extensive list of pathogenic parasites, go to the following link.
http://en.wikipedia.org/wiki/List_of_parasites_of_humans.
Stool Antigens
This portion of the test is done using a kit that detects the presence of specific
antigens in the stool. Antigens are protein fragments of the organism. This is a
physical representation of the presence of the parasite. Specifically, the lab is
looking for Cryptosporidium, Giardia, Entamoeba histolytica and Helicobacter.
pylori (H. pylori). A positive result means the organism is present in the stool.
Additional Tests
1. Fungi & Yeasts – These are cultured and microscopically analyzed to
determine their presence. A positive finding shows that the yeast or fungus
is present and shedding in the stool. A negative finding indicates that the
yeast or fungus are not shedding into the stool but may still be present in
the GI tract. Consider your patient’s symptoms and other positive findings.
Yeast is an opportunistic infection. It is part of normal flora but can
overgrow if the environment allows for it. Treat appropriately if you suspect
yeast.
2. C. Difficile Toxins A&B – the presence of these toxins is determined through
direct immunochromatographic assay specific for each toxin. A positive
result indicates the presence of C. Difficile. Clostridium difficile is a grampositive bacteria that is commonly picked up in hospitals and other health
care facilities. C. Difficile can develop after antibiotic use, extended use
of proton pump inhibitors, gastrointestinal surgery and
immunocompromised states. The treatment for C. Difficile is an antibiotic,
some botanicals, potentially with Saccharomyces boulardii at 1 gram per
day for 4 weeks.
3. Occult Blood – the presence of blood in the stool can be due to
something simple and non-threatening such as hemorrhoids or it can be
due to something more serious such as colon cancer. If there is blood in
the stool, further investigation is warranted. We cannot tell if the blood is
coming from as far up as the stomach or as far down as the rectum. A
thorough exam and an appropriate work up by a physician should be
completed.