The GI Map test from Diagnostic Solutions laboratory, covers a lot of different gut health markers, but in this article we are going to focus on the GI Map pathogens and parasites section of the test.
The GI Map stool test uses a single stool sample to measure the gastrointestinal microbiota with qPCR DNA technology - this is a lot more accurate than using stool cultures or having a lab technician identify pathogens and parasites with a microscope.
Previously with testing parasites we can only identify if they were present or not, but now with the GI Map test we can get an exact number, this is important because sometimes low levels of parasites may not need to be treated.
When assessing your GI Map results this table helps to understand the level of pathogens per each gram of stool.
The GI Map Pathogens (bacteria, parasites and viral)
The GI Map stool test includes pathogens commonly known to cause gastroenteritis, and these symptoms include vomiting, diarrhea, malaise, fever and abdominal pain.
It’s important to remember that not everyone with positive test results will present with symptoms. Many factors including immune function, overall health, the transient nature of some pathogens and the levels of the beneficial bacteria will all influence how you feel.
Bacterial Pathogens
Campylobacter
Epidemiology
One of the most common causes of foodborne illness in the U.S.
fever, malaise; lasting several days to several weeks
Vast majority of those with symptoms of gastroenteritis recover without treatment
Fecal contamination of poultry and water
Clinical Implications
May be infectious at very low exposures
Symptoms range from mild to severe abdominal pain, diarrhea,
Consider high dose probiotics, broad-spectrum antimicrobial herbs, and addressing inflammation if necessary
Heavy infections can be treated with azithromycin and fluoroquinolones (antibiotics would be a last resort as they can disrupt other aspects of the microbiome
Clostridium difficile, Toxin A and Toxin B
The GI-MAP tests only for the genes for toxin A and toxin B, which are carried by C. difficile. The GI-MAP does not measure toxins directly for any microbe, this is why it is possible to be asymptomatic and have high levels of C. Difficile on your results.
Epidemiology
2–10% of population are carriers, most are asymptomatic
Prolonged use of antibiotics is a causative factor
Clinical Implications
Symptoms include inflammation, abdominal pain, cramping, fever, and diarrhea
Symptoms often present during antibiotic use and often subside once antibiotics are discontinued
Gastrointestinal (GI) infection can cause reactive arthritis
Therapeutic Approaches & Considerations
See patient’s calprotectin and secretory IgA (SIgA) levels to determine GI inflammation and immune response.
Consider Saccharomyces boulardii, high dose probiotics, broad-spectrum antimicrobial herbs, and 5R Protocol
Mild infections can be treated with metronidazole
Heavy infections can be treated with vancomycin and fidaxomicin or fecal microbial transplant (FMT)
Asymptomatic patients may not need treatment
In asymptomatic patients with positive toxins A and/or B, the genes are likely not “turned on,” and thus not causing disease. It is still prudent to avoid antibiotics in these patients, consider antimicrobial herbal formulas, which can suppress C. diff without activating toxin production.
Enterohemorrhagic E. coli (EHEC)
Epidemiology
Fecal contamination of food (undercooked beef, raw milk, and unpasteurized juice) and water
Implicated in hemorrhagic colitis, may progress to hemolytic uremic syndrome (HUS)
Clinical Implications
Symptoms include fever, abdominal cramping, fatigue, nausea, and diarrhea
Symptoms may last up to a week
Therapeutic Approaches & Considerations
See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response.
Antibiotics may be contraindicated; they can initiate hemolytic uremic syndrome (HUS)
Consider bacteriophages, broad-spectrum antimicrobial herbs, and assess other markers on the test to determine what treatment should be the priority
A GI Map Test sample report
Shiga-like Toxin E. coli stx1
Epidemiology
Most common cause of traveler’s diarrhea
Clinical Implications
Diarrhea is the most common symptom
Therapeutic Approaches & Considerations
See patient’s calprotectin and SIgAlevels to determine GI inflammation and immune response, note that this is the same for all of the pathogens as we need to determine if they are causing GI damage or if they are present and possibly not causing symptoms
Antibiotics may be contraindicated; they can initiate HUS
Consider bacteriophages, broad-spectrum antimicrobial herbs but most important is to treat the person and not just the test results as some people may not be able to tolerate the herbs or even probiotics
Shiga-like Toxin E. coli stx2
Epidemiology
Fecal contamination of ingested foods (undercooked meat, unpasteurized milk, juice, and water)
Clinical Implications
Symptoms may include severe abdominal cramps and diarrhea
Toxins may elicit strong inflammatory response
Therapeutic Approaches & Considerations
See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response
Antibiotics may be contraindicated; they can initiate HUS
Consider high-dose probiotics
Consider bacteriophages, broad-spectrum antimicrobial herbs, and other GI Markers on the test
Antibiotics and antidiarrheal medicines are contraindicated; they may increase the risk of developing HUS
Salmonella
Epidemiology
Fecal contamination of ingested foods (eggs, poultry, meat, unpasteurized milk, raw fruits, and vegetables)
Exposure to pets (reptiles, amphibians, baby chicks)
Clinical Implications
May be asymptomatic
Symptoms include fever, vomiting, and severe diarrhea
Typically self limiting within seven days
GI infection can cause reactive arthritis and may be involved in ankylosing spondylitis
Systemic infections may require treatment with antibiotics in some situations
Therapeutic Approaches & Considerations
See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response
Remove sources of infection
Consider high-dose probiotics
Consider broad-spectrum antimicrobial herbs and 5R Protocol
Vibrio cholerae
Epidemiology
Fecal contamination of ingested foods (raw shellfish) and often picked up during international travel
Clinical Implications
May be asymptomatic or cause mild symptoms
Severe infections present with profuse watery diarrhea (“rice-water stools”), vomiting, rapid heart rate, loss of skin elasticity, thirst, dry mucous membranes, low blood pressure, restlessness, or irritability
Therapeutic Approaches & Considerations
See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response.
Rehydration therapy, electrolytes
Zinc, especially in children
Consider probiotics, broad-spectrum antimicrobial herbs and 5R Protocol
Yersinia enterocolitica
Epidemiology
Fecal contamination of ingested foods and liquids (water, undercooked pork, meats, and dairy products)
Clinical Implications
Symptoms usually develop four to seven days after exposure and are self-limiting (that is they will go away with no treatment)
Symptoms include water or bloody diarrhea, fever, vomiting, and abdominal pain (may resemble appendicitis)
Symptoms may mimic Crohn’s disease
May trigger autoimmune thyroiditis or inflammatory arthritis in susceptible individuals
Therapeutic Approaches & Considerations
Consider probiotics, broad-spectrum antimicrobial herbs and 5R Protocol
Heavy infections can be treated with doxycycline in combination with an aminoglycoside
Consider symptoms before implementing a treatment plan, don’t treat just based on individual markers on this test
Parasitic Pathogens
The first 3 parasites here would ideally be negative on the GI Map test, they are more serious pathogens that can cause systemic symptoms.
Cryptosporidium
Epidemiology
Fecal contamination of ingested foods and liquids (contaminated water and swimming pools, undercooked meat, and raw milk)
Common cause of traveler’s diarrhea
Clinical Implications
Symptoms typically last 2–3 weeks and are self-limiting
If symptoms persist, look for sources of contamination, such as drinking water
Can cause reactive arthritis
Therapeutic Approaches & Considerations
May not require treatment
See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response
If necessary, consider anti-parasitic herbal treatments containing ingredients such as black walnut, garlic oil, oil of oregano, Artemisia (wormwood), berberine, goldenseal, gentian root extract
Consider probiotics and 5R Protocol
Search for and remove sources of fecal contamination
Heavy infections can be treated with nitazoxanide, as a last resort
Entamoeba histolytica
Epidemiology
Fecal contamination of ingested foods or water
Pets may be a source of exposure
Sexual contact may be a source of exposure
Clinical Implications
Symptoms include diarrhea, fulminating colitis (resembling ulcerative colitis), and dysentery
Extreme cases may invade liver and lung tissues
This can be a serious parasitic infection and must be treated, luckily it is not a common parasite that I see frequently
Therapeutic Approaches & Considerations
See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response
Treatment may be indicated, even in asymptomatic carriers
Mild infections can be treated with Iodoquinol, paromomycin, or diloxanide furoate*
Moderate to heavy infections can be treated with metronidazole or tinidazole, followed by iodoquinol or paromomycin*
If appropriate, consider anti-parasitic herbal treatments, make sure you are working with an experienced practitioner
Consider probiotics and 5R Protocol
Avoid reinfection by fecal contamination
Giardia
Epidemiology
Most commonly isolated protozoan worldwide
Found in outside water sources (lakes, streams, ponds) and can get past filtration systems
Carried by animals
Common in daycare workers
Clinical Implications
May be asymptomatic, especially in patients with healthy levels of normal bacteria and SIgA
Symptoms include acute diarrhea, bloating, cramps, weight loss, intestinal malabsorption, and steatorrhea (fat in stool)
Can cause urticaria or neurologic symptoms such as irritability, sleep disorder, or depression
May cause malnutrition and vitamin B12 deficiency
Can cause reactive arthritis
Therapeutic Approaches & Considerations
See patient’s calprotectin, eosinophils and SIgA levels to determine GI inflammation and immune response
Infections can be treated with tinidazole, nitazoxanide, metronidazole, paramomycin, furazolidone, or quinacrine
Possible to treat naturally with herbal anti-parasitic formulas, and focus on repair and rebuild of the gut mucosa
With the following parasites they are fairly common, especially Blastocystis and Dientamoeba, and low levels may not need to be treated. In the past when test results could only show if someone was positive or negative these parasites were often blamed as the cause of G.I symptoms, but after treatment symptoms did not always resolve.
Blastocystis hominis
Epidemiology
Fecal contamination of food or water is common
Found worldwide
Clinical Implications
Symptoms include diarrhea, abdominal pain, nausea and vomiting, fever, fatigue, irritable bowel syndrome, infective arthritis
Therapeutic Approaches & Considerations
Difficult to eradicate, first check eosinophils in a blood test and calprotectin levels to see if treatment is necessary
Consider Paromomycin, nitazoxanide or tinidazole if you want to use pharmaceutical treatments
Consider Artemisia, Coptis, or other broad-spectrum antiparasitic herbal formulas
Assess all of the results and symptoms before considering a treatment plan
Dientamoeba fragilis
Epidemiology
Not well understood; probably fecal contamination of food or water
Clinical Implications
May be asymptomatic
May cause diarrhea, abdominal pain, nausea, fever, fatigue, weight loss, appetite loss, and/or fatigue
Therapeutic Approaches & Considerations
“Moderate” amounts of DNA, that are not above the laboratory reference range, may cause symptoms and warrant treatment
Infection can be treated with iodoquinol, paromomycin, or metronidazole*
Consider probiotics, broad-spectrum anti-parasitic herbal formula, and the 5R Protocol
Look for and address sources of reinfection
Address other imbalances on the GI-MAP, as these maybe the main cause of symptoms
Chilomastix mesnili
Epidemiology
Fecal contamination of food or water
Clinical Implications
Considered non-pathogenic and may not cause symptoms
May indicate dysbiosis or suppressed immunity
Therapeutic Approaches & Considerations
Look for and address sources of fecal-oral contamination
Consider probiotics and 5R Protocol
Address other imbalances on the GI Map test
Cyclospora spp. (Cyclospora cayetanensis)
Epidemiology
Fecal contamination of food and water
Associated with water- and food-borne outbreaks
Common cause of traveller’s diarrhea
May be found on imported fresh produce from tropical regions
Clinical Implications
Symptoms include prolonged watery diarrhea, abdominal cramping, loss of appetite, weight loss, nausea, and vomiting
May cause alternating diarrhea and constipation
Flu-like symptoms such as fatigue, headaches, and low fever may be present in some individuals
Infection is usually self-limiting, with symptoms usually lasting about seven days, but can last weeks or months in immunosuppressed patients
Therapeutic Approaches & Considerations
In cases lasting more than seven days, treatment with probiotics, broad-spectrum anti-parasitic herbal formula
Look for and address sources of reinfection
Anti-parasitic pharmaceuticals can be considered in serious cases
Endolimax nana
Epidemiology
Fecal contamination of food or water
Clinical Implications
Considered non-pathogenic; individuals may be asymptomatic
May be indicative of dysbiosis, conservative treatment may be indicated if clinical presentation is consistent with enteroparasitosis
Therapeutic Approaches & Considerations
Consider probiotics and the 5R Protocol
Assess other markers on the GI Map test
Pentatrichomonas hominis
Epidemiology
Fecal contamination of food or water
Clinical Implications
Considered harmless, a non-pathogen » Infected individuals are usually asymptomatic
May contribute to dysbiosis
Also colonizes dogs, cats, and other animals
Therapeutic Approaches & Considerations
If treatment is needed, consider a broad-spectrum antiparasitic herbal formula
Consider probiotics
Look for and address sources of fecal contamination
Address other imbalances on the GI-MAP
Worms
Everyone is used to the idea that we have bacteria living and thriving inside of us, but the thought of parasites, and in particular worms living inside our gastrointestinal system is enough to freak most people out.
The GI Map test measures the presence of the eggs that worms produce, and does not assess the number of individual worms.
Not all worms are bad, in fact Helminth Therapy is when someone is deliberately infected with worms to help treat specific health conditions, in particular autoimmune and inflammatory conditions. (though not something that I am recommending as part of my treatment protocols)
Ancylostoma duodenale and Necatur americanus (Hookworms)
Epidemiology
Infection occurs via skin contact with soil contaminated with larvae or ingestion of larvae
Infected cats and dogs are a source of exposure
Prevalent in southern Europe, Northern Africa, India, Asia, Caribbean islands, South America, and small areas of the United States
Associated with poor sanitation, inadequate housing construction, and lack of access to medications
Clinical Implications
Early symptoms are itching and rash where the larvae penetrated the skin
Symptoms of heavy infestations include: abdominal pain, diarrhea, fatigue, weight loss, iron deficiency anemia (IDA), coughing, and loss of appetite
Infected individuals may also be asymptomatic
Therapeutic Approaches & Considerations
Heavy infections can be treated with albendazole or mebendazole
Individuals presenting with IDA may need iron supplementation (careful as iron can feed bacterial infections so work with your practitoner)
Consider anti-parasitic herbal treatments, gut immunity support, and the 5R Protocol
Look for and remove sources of reinfection
Ascaris lumbricoides (Roundworm)
Epidemiology
Fecal contamination of food or water
Common in international travellers and recent immigrants from Latin America and Asia
Clinical Implications
Early symptoms include fever, coughing, wheezing, and dyspnea
Late symptoms include abdominal pain, nausea, vomiting, frequent throat clearing, dry cough, “tingling throat,” appendicitis, pancreatitis, and obstruction
Can cause reactive arthritis
Therapeutic Approaches & Considerations
Infections may be treated with albendazole, mebendazole, or ivermectin
Consider anti-parasitic herbal treatments, gut immunity support, and the 5R Protocol
Look for and remove sources of reinfection
Trichuris trichiura (Whipworm)
Epidemiology
Fecal contamination of produce or person-to-person contact
Prevalent in Asia, Africa, South America, and rural southeastern United States
Clinical Implications
Most individuals are asymptomatic, however diarrhea with mucus and blood may occur in some infected individuals
Therapeutic Approaches & Considerations
Infections may be treated with albendazole, mebendazole, or ivermectin
Individuals presenting with IDA may need iron supplementation
Consider herbal worm treatments, gut immunity support and probiotics
Look for and remove the source of reinfections
Taenia spp. (Tapeworm)
Epidemiology
Fecal contamination of undercooked pork (T. solium) or beef (T. saginata)
T. solium is found worldwide, but prevalent in communities who raise and eat pigs
T. saginata is prevalent in Africa, parts of Eastern Europe, the Philippines, and Latin America where people raise cattle and eat raw beef
Clinical Implications
May be asymptomatic or present with mild symptoms
Symptoms include abdominal pain, nausea, weakness, increased appetite, loss of appetite, headache, constipation, dizziness, diarrhea, pruritus ani, hyperexcitability, and anemia
Therapeutic Approaches & Considerations
Infections may be treated with albendazole or praziquantel
Consider anti-parasitic herbal treatments, gut immunity support, and the 5R Protocol
Look for and remove sources of reinfection
Viral Pathogens
These types of infections can be easily spread, often the whole house-hold is affected by the virus. Speaking from experience this is the worst infection that our family has ever experienced.
Adenovirus 40/41
Epidemiology
Common cause of diarrhea in infants and children but can also affect adults
Mainly transmitted by fecal contamination (fecal-oral route)
Clinical Implications
Causative agents of gastrointestinal disease and gastroenteritis
Symptoms include fever and watery diarrhea, usually limited to 1–2 weeks
May also be present in the stool of asymptomatic carriers and may not require treatment
Therapeutic Approaches & Considerations
Handwashing
Hydration - this is very important with the amount of fluid loss through diarrhea
Antiviral herbs such as cat’s claw, osha root, reishi mushrooms, vitamins A, C, and D, zinc, Echinacea
Address other imbalances on the GI-MAP and use 5R Protocol to rebuild gut health and gut immunity
Norovirus GI/GII
Epidemiology
Fecal contamination of ingested foods and water
Common cause of stomach flu on cruise ships
Common cause of nonbacterial gastroenteritis and outbreaks in the world
Clinical Implications
Symptoms include nausea and vomiting, diarrhea, abdominal cramps, low-grade fever, muscle aches, fatigue, and headache
Generally short-lived, lasting about 24–72 hours
Therapeutic Approaches & Considerations
Antivirals are not recommended
Supportive care for the gastric mucosa, and hydration is the most important thing to focus on
Handwashing to prevent spread
Address other imbalances on the GI-MAP to rebuild gut health
Sources of Exposure and Re-Infection
Whenever someone comes back with a positive test results to a bacterial pathogen or parasite the first question is “how did I get this?”
Often it is impossible to know how you contracted an infection, but to prevent future infections it can be a good idea to try and identify the source.
Most exposure to pathogens occurs via fecal-oral transmission, most often due to use of contaminated water sources or improper hand hygiene. This may include drinking contaminated water, eating raw foods washed in contaminated water or harvested (e.g. shellfish) in contaminated water, or improper handwashing.
To remove microorganisms from food, the FDA recommends first washing your hands, running cool water over fruits and vegetables, while rubbing or scrubbing, and then letting them dry out before eating. During treatment, consider all possible sources of fecal transmission: romantic partners, children (especially if in diapers or not toilet-trained), sheets, towels, water source to the home, etc.
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