GI Map Test – Bacterial Pathogens and Parasites

GI Map Test: Bacterial Pathogens and Parasites

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.

Table to assess levels of pathogens per gram of stool in GI Map Stool.

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,
Therapeutic Approaches & Considerations
  • See patient’s calprotectin level to determine GI inflammation
  • 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 high-dose probiotics (300+ billion CFU/g) such as: Lactobacillus acidophilus‚ Bifidobacterium bifidum‚ Bifidobacterium longum‚ Lactobacillus rhamnosus‚ Bifidobacterium breve‚ Lactobacillus casei‚ Streptococcus thermophilus
  • Consider bacteriophages, broad-spectrum antimicrobial herbs

E. coli O157

Epidemiology
  • Fecal contamination of food and liquids (dairy, undercooked beef, vegetables, juices)
  • Implicated in many outbreaks and cases of bloody diarrhea and HUS » High prevalence worldwide
Clinical Implications
  • Symptoms may include severe abdominal cramps and diarrhea  
  • Shiga toxins inhibit protein synthesis & elicit strong inflammatory response
Therapeutic Approaches & Considerations
  • See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response - these markers are included on the GI Map test
  • Antibiotics may be contraindicated; they can initiate HUS
  • Consider high-dose probiotics (300+ billion CFU/d)
  • Consider bacteriophages, broad-spectrum antimicrobial herbs, and assess other results on the GI Map test

Enteroinvasive E. coli / Shigella

Epidemiology
  • Fecal contamination of ingested foods
Clinical Implications
  • Symptoms include diarrhea (with blood and/or mucus), vomiting, fever, chills, fatigue, and abdominal cramping
  • Symptoms are generally self-limiting but can lead to long lasting symptoms by altering the gut microbiome
  • Gastrointestinal (GI) infection can cause reactive arthritis
Therapeutic Approaches & Considerations
  • See patient’s calprotectin and SIgA levels to determine GI inflammation and immune response as this help to understand if treatment is a priority
  • Antibiotics may be contraindicated; they can initiate HUS
  • Consider high-dose probiotics (300+ billion CFU/d)
  • Consider bacteriophages, broad-spectrum antimicrobial herbs, and assess other markers on the test to determine what treatment should be the priority
GI Map Test – Bacterial Pathogens and Parasites 1

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 high-dose probiotics (300+ billion CFU/d)
  • 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
GI Map Test – Bacterial Pathogens and Parasites 2

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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