GI360 stool profile

rarely a cause of disease in humans

one of the largest bacterial phyla

considered low abundance colonizers of the GI tract with primary residence on the skin.

Adenovirus gastroenteritis generally causes watery diarrhea lasting one to two weeks.

Aeromonas: A Pathogenic Gram-Negative Bacterium Aeromonas is a gram-negative bacterium from the Vibrionaceae family, known to be pathogenic regardless of the amount detected. It is most commonly observed in two age groups: children aged 6 months to 2 years and adults over 60 years. Aeromonas thrives in freshwater and brackish water environments and is frequently found in a variety of food products, including fresh produce, meats (beef, poultry, pork), and dairy products like raw milk and ice cream. It is also commonly isolated from raw fish and shellfish, particularly oysters. Clinical Presentation Two distinct forms of gastroenteritis are associated with Aeromonas species: Cholera-like Illness: Symptoms include acute watery diarrhea, mild or absent fever, abdominal pain, and occasional vomiting, particularly in children. Dysenteric Illness: Characterized by loose stools containing blood and mucus. While symptoms are typically mild and self-limiting, more severe cases may occur. Individuals with weakened immune systems or underlying malignancies are at risk for severe infections, which can sometimes be fatal. Potential Complications Hemolytic Uremic Syndrome (HUS): May result in kidney disease requiring transplantation. Chronic Diarrhea: Non-resolvable, intermittent diarrhea can persist for months or even years after the initial infection. Extraintestinal Infections: In immunocompromised individuals, Aeromonas can lead to septicemia, meningitis, pneumonia, endocarditis, skin infections, eye or urinary tract infections, and hypotension. Epidemiology While most cases of Aeromonas gastroenteritis are sporadic, increased incidence has been reported in some clinical settings. Severe dysentery-like illness is rare but may last for several weeks in some cases. Management and Treatment Antibiotics may be necessary for prolonged symptoms or systemic infections. Treatment should be guided by antimicrobial susceptibility testing to identify the most effective agent. Consult a healthcare provider for appropriate treatment and management if Aeromonas infection is suspected, especially in high-risk individuals.

Akkermansia muciniphila may represent 3–5% of the microbial composition in the healthy human intestinal tract, and have a crucial role in the regulation of the gut barrier and other homeostatic and metabolic functions.

genus in the phylum Bacteroidota (Bacteria)

genus in the phylum Bacteroidota (Bacteria)

Ascaris is a worm that infects the small intestine, but its life cycle includes migration through the circulation to the heart and lungs, and into the oropharynx. Infection is acquired through the ingestion of embryonated eggs in contaminated soil or water. Ascariasis is the most prevalent intestinal helminth infection in the world; current estimates suggest that more than 1 billion persons are infected. In the US, infection is more common in rural parts of the southeast. Most individuals have no noticeable symptoms. Migrating larvae may produce “verminous pneumonia”. However, heavy infection, especially in children, may produce abdominal cramps, and a mass of tangled worms may cause intestinal obstruction. Aberrant migration of individual adult worms occasionally leads to obstructions resulting in cholangitis, cholecystitis, liver abscess, pancreatitis, appendicitis, or peritonitis. Passage of an adult worm by mouth or rectum is possible. All Ascaris infections should be treated. If other intestinal helminths are present, Ascaris must be treated first to prevent aberrant migration of worms. Treat adults with mebendazole (200 mg bid x 20 days) or albendazole (400 mg x 1 dose). Repeat stool exam 1-2 weeks after therapy. Garlic, onion, wormwood, black walnut, quassia, and pumpkin seeds may be effective natural agents. Minimize meat, dairy, and refined carbohydrates while increasing fiber in the diet.

part of the phylum Firmicutes

usually neither pathogenic nor beneficial to the host GI tract

Gram-negative species of the Bacteroidetes phylum.

contributes to breakdown of dietary pectins

Species in the genus Bacteroides carry out broad metabolic functions, including degradation of complex plant polysaccharides, proteolytic activities, de-conjugation of bile acids, mucosal barrier integrity, short chain fatty acid production, fatty acid storage and glucose metabolism. Bacteroides spp. are maintained at a higher abundance in breastfed individuals into adulthood. Bacteroides fragilis plays an important role in the prevention of intestinal inflammation. An energy-restricted diet has been shown to increase B. fragilis in overweight adolescents. An increase in B. stercoris has been associated with higher risk of colon cancer. Decreased levels of Bacteroides spp. have been reported in association with multiple sclerosis, rheumatoid arthritis and Parkinson’s disease.

The predominant genera in the human colonic microbiota are Bacteroides and Prevotella, which belong to the major phyla Bacteroidetes.

An increase has been associated with higher risk of colon cancer

part of the Bacteroides genus

Considered amongst the most beneficial commensal bacteria in the human gut, Bifidobacterium spp. are able to degrade monosaccharides, galacto-, manno-, and fructo-oligosaccharides, as well as some complex carbohydrates. Many of the non-digestible oligosaccharides, found as natural components in mother’s milk, select for colonization of these species which dominate the infant gut shortly after birth. Bifidobacteria may provide health benefits directly through interactions with the host, and indirectly through interactions with other microorganisms. Bifidobacterium spp. take part in production and adsorption of vitamins, such as vitamins K and B12, biotin, folate, thiamine, riboflavin, and pyridoxine. They are also involved in lipid absorption and metabolism, glucose and energy homeostasis, and regulating intestinal barrier function. Although Bifidobacterium produce acetate over butyrate, healthy levels of Bifidobacterium spp. facilitate colonization of Faecalibacterium. prausnitzii. Polyphenols derived from chocolate, green tea, blackcurrant, red wine and grape seed extracts have been shown to increase Bifidobacterium species. The increased abundance of Bifidobacterium species has been associated with amelioration of inflammation. Multiple published studies have suggested that there is an association between obesity and a lower abundance of bifidobacteria. They may also be less abundant in elderly populations, patients with rheumatoid arthritis, and in individuals diagnosed with Alzheimer’s disease. Patients with active inflammatory bowel disease (IBD) have a lower abundance of Bifidobacterium spp. than patients whose IBD is in remission. Taking a probiotic containing bifidobacteria, lactobacilli, and streptococci might help in controlling ulcerative colitis symptoms and preventing their recurrence. Some Bifidobacterium strains have been shown to have beneficial effects in irritable bowel syndrome (IBS). Bifidobacterium spp. abundance has been shown to be diminished with IBD and with long term use of macrolide antibiotics. Luminal bifidobacteria is reduced with restriction of fermentable carbohydrates, i.e. a low FODMAP diet. High fat dietary feeding is also associated with reduced abundance of bifidobacteria. Consumption of maize and barley-based whole grain products and red berries, which are comprised of anthocyans, are known to increase levels of bifidobacteria.

Most Campylobacter infections in industrialized countries are caused by C. jejuni, C. coli, and C. lari with an estimated 1.5 million cases of foodborne illness due to Campylobacter per year in the US. Campylobacter spp. are responsible for approximately 15% of hospitalizations resulting from foodborne infections. Generally, campylobacteriosis presents as one to three days of fever, vomiting, and headaches followed by three to seven days of watery or bloody diarrhea and may include abdominal pain, cramping, nausea, headache, and/ or muscle pain within 2-5 days of infection. Contaminated water, pets, food, unpasteurized milk and undercooked poultry, are sources of infection. Use of antibiotics is controversial but may benefit children whom have had symptoms for less than 7 days, and immunocompromised individuals. Recommendations potentially include Azithromycin 500 mg daily for 3 days or Fluoroquinolone for 3 days, but infection may resist fluoroquinolones. Extracts of Acacia nilotiac show in vitro antibacterial activities against Campylobacter spp. isolated from sheep. Oral rehydration therapy is recommended to prevent dehydration, along with symptomatic treatment of fever and muscle aches.

should not be appreciably present in the colon

positively associated with obesity-related insulin resistance

Charcot-Leyden crystals are formed from the breakdown of immune cells, especially eosinophils, and may be seen in the stool of patients with parasitic diseases. The crystals are indicative of immune response and can sometimes be seen in association with non-parasitic infection or inflammation.

Chilomastix mesnili in the Doctor's Data CSAP Panel Chilomastix mesnili is a flagellated protozoan sometimes found in human stool. It is part of the parasite panel tested in the CSAP using microscopy and other validated methods to detect cysts or trophozoites across multi-day stool samples. Is Chilomastix mesnili Harmful? Generally Non-Pathogenic: C. mesnili is typically considered a commensal organism—meaning it lives in the intestine without causing harm. Indicator of Exposure: Its presence may reflect exposure to contaminated water or food, suggesting a possible fecal-oral transmission route. Context Matters: While usually harmless, its detection should be evaluated in the context of symptoms and alongside other test results. In symptomatic individuals or if other parasites are also found, further evaluation may be needed. Quick Summary Table Marker Method Used Significance Result Options Chilomastix mesnili Microscopy Typically non-pathogenic; marker of exposure Detected / Not Detected

a gram-negative bacterium and member of the Enterobacteriaceae family

a gram-negative bacterium and member of the Enterobacteriaceae family

This trematode infects the bile ducts. Infection occurs through consumption of encysted metacercariae in raw, dried, or pickled fish imported from endemic areas, which include Japan, Korea, China, Taiwan, and Vietnam. Light infection is usually asymptomatic. Most pathologic manifestations result from inflammation and intermittent obstruction of the biliary ducts. In the acute phase, abdominal pain, nausea, diarrhea, and eosinophilia can occur. In long-standing infections cholangitis, cholelithiasis, pancreatitis, biliary obstruction, portal fibrosis, and cholangiocarcinoma can develop. Praziquantel (25 mg/kg tid x 1 day, adult dose) is considered the most effective drug. Natural agents include elecampane, costus, and quassia.

Prominent and diverse group of bacteria in the microbiome of the large intestine.

may cause diarrhea following the production of two toxins, enterotoxin A and cytotoxin B

ferments the naturally occurring sugar L-rhamnose

Stool is normally brown because of pigments formed by bacteria acting on bile introduced into the digestive system from the liver. While certain conditions can cause changes in stool color, many changes are harmless and are caused by pigments in foods or dietary supplements.

Stool normally contains about 75% water and ideally should be formed and soft. Stool consistency can vary based upon transit time and water absorption.

ferments glucose and other common sugars

causes disease in humans through ingestion of infectious oocysts

generally considered an endodontic pathogen

generally considered an endodontic pathogen

D. fragilis infects the large intestine. This parasite does not have a cyst stage, and cannot survive long outside the body alone. It may be spread in pinworm (Enterobius vermicularis) eggs. Infection is common worldwide, including in the United States. D. fragilis is known to cause non-invasive diarrheal illness in humans. 90% of children are symptomatic, whereas only 15-20% of adults are. The most common symptoms include diarrhea, stomach pain, and stomach cramping. Loss of appetite and weight, nausea, and fatigue are also common. Recommended treatment is iodoquinol (650 mg tid x 20 days, adult dose). Alternatives include tetracycline (500 mg qid x 10 days, adult dose) and metronidazole (500-750 mg tid x 10 days, adult dose). Natural agents include berberine, wormwood, black walnut, grapefruit seed extract, and oil of oregano.

may be associated with bloating

a pancreatic enzyme that digests and degrades a number of proteins

E. hartmanni is generally considered nonpathogenic or commensal. It lives in the large intestine of humans, mainly at the level of the cecum and feeds on bacteria. Infection occurs via fecal-oral route, and indicates increased risk of exposure to potential pathogens. Natural treatment agents include garlic, berberine, and quassia.

a protozoan parasite

part of the Enterobacteriaceae family

a large family of bacteria within the Proteobacteria phyla

This nematode inhabits the large intestine and migrates to the anus at night, where it deposits eggs on the perianal surface. Pinworm is the most common worm infection in the United States. School-age children, followed by preschoolers, have the highest rates of infection. Perianal pruritus, especially at night, is a characteristic symptom. Disturbed sleep, loss of appetite, restlessness and irritability may be experienced with heavy infection. Very rarely, E. vermicularis will migrate to the urinary bladder, vagina, or peritoneal cavity. All infected individuals in a communal group should be treated simultaneously. Eggs can survive up to 2 weeks on clothing or bedding, so laundering these items is imperative during treatment. Mebendazole (100 mg x 1 dose, repeat in 2 weeks) or pyrantel pamoate (11 mg/kg <1.0 gm qd x 1 dose, repeat in 2 weeks, adult dose) are effective drug treatments. Natural agents include quassia, black walnut, and garlic.

a major cause of traveler’s diarrhea in adults

member of the pathogenic enterohemorrhagic E. coli strains

Gram-negative genus in the Proteobacteria phylum.

part of the Lachnospiraceae family

part of the Lachnospiraceae family that is in the Firmicutes phylum

part of the Lachnospiraceae family and produces butyrate

Eubacterium siraeum on the GI 360 Stool Panel Eubacterium siraeum is a bacterial species commonly detected on the GI 360 Stool Panel from Doctors Data. It is part of the Firmicutes phylum, a group of bacteria known to play essential roles in gut health. This species is recognized for its involvement in breaking down dietary fiber and producing short-chain fatty acids (SCFAs), including butyrate, which contribute to gut barrier integrity, energy metabolism, and anti-inflammatory effects. Clinical Significance Normal Levels: A balanced population of Eubacterium siraeum is often associated with healthy digestive function and microbial diversity. Low Levels: Reduced Eubacterium siraeum may indicate a disrupted gut microbiome, often linked to conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or poor dietary fiber intake. High Levels: Overgrowth may suggest dysbiosis, potentially linked to changes in gut motility or an imbalance favoring certain microbial groups. What Influences Eubacterium siraeum Levels? Diet: A high-fiber diet encourages growth, while a low-fiber or high-fat diet may suppress it. Probiotics and Prebiotics: Supplementation with specific fibers or resistant starches can enhance butyrate production and support balanced levels. Gut Health: Factors like antibiotic use, chronic inflammation, or stress can disrupt Eubacterium siraeum and other beneficial bacteria. Improving Gut Microbiota Balance Increase dietary fiber from sources like vegetables, fruits, legumes, and whole grains. Incorporate fermented foods or prebiotic-rich supplements to nurture beneficial bacteria. Avoid unnecessary antibiotic use and prioritize gut-healing strategies if dysbiosis is suspected. Understanding the role of Eubacterium siraeum can offer insight into gut health and guide personalized interventions for restoring balance in the microbiome. Always consult with a healthcare professional to interpret lab results and create an appropriate plan.

one of the most abundant butyrate producing bacteria in a healthy gastrointestinal tract

Individuals who have pancreatic insufficiency secondary to pancreatic or biliary tract disease may be unable to efficiently digest and absorb fat normally. The microscopic fecal fat test is a reliable marker for fat malabsorption, and evaluation enzyme therapy in patients with pancreatic exocrine insufficiency. When assessing the root cause of fat malabsorption the following should be considered: dietary fat intake, gastric surgery, pancreatic disease, biliary obstruction, liver disease, mucosal integrity, and problems with chylomicron formation. Supplementation with pancreatic enzymes, HCL, and/or bile salts may be indicated. Steatorrhea is associated with a particularly foul odor of the stool.

bacterial phyla that dominate the entire human digestive tract

the most frequent cause of non-bacterial diarrhea in the United States

The adult nematodes attach to the wall of the small intestine and suck blood. The hookworm life cycle also includes migration through the circulation to the heart and lungs, and into the oropharynx. Infection occurs when larvae from fecally-contaminated soil penetrate human skin. A. duodenale is widely distributed in the Mediterranean basin, India, China, Japan, and the Pacific coastal areas of South America but is rare in the USA and equatorial Africa. N. americanus is the predominant hookworm of Central and South Africa, southern Asia, Melanesia, and Polynesia. It is widely distributed in the southern USA, on islands of the Caribbean, and on the Atlantic side of Central and South America. About 25% of the world’s population is infected with hookworms. Hookworm infection is asymptomatic in most cases. Nutritional status, anemia, and iron stores should be evaluated in infected persons. During the acute phase, adult worms in the intestine may cause colicky epigastric pain, anorexia, flatulence, diarrhea, and weight loss. A pruritic papulovesicular rash (ground itch) may develop at the site of larval penetration. Migration of large numbers of larvae though the lungs occasionally causes Löffler’s syndrome. Chronic infection may lead to iron-deficiency anemia and hypoproteinemia, causing pallor, dyspnea, weakness, tachycardia, lassitude, impotence, and edema. A low grade eosinophilia often persists. Severe chronic blood loss may lead to growth retardation, cardiac failure, and anasarca. Mebendazole is the drug of choice in the USA. A cure rate of > 99% has been reported after a course of 100 mg bid x 3 days. Natural agents include quassia, black walnut, garlic, and thyme.

Iodamoeba buetschlii is considered nonpathogenic or commensal. Infection occurs via fecal-oral route, and indicates increased risk of exposure to potential pathogens.

gram-negative bacilli belonging to the Enterobacteriaceae family

gram-negative bacilli belonging to the Enterobacteriaceae family

a diverse group of butyric acid producers

Decreased and normal levels of Lactobacillus spp. have been reported in patients with irritable bowel syndrome. Lactobacillus spp. abundance was shown to be lower in the active phase of ulcerative colitis. Lactobacillus levels were shown to be increased after inulin consumption, but decreased after consumption of maltodextrin. Polyphenols derived from chocolate, green tea, blackcurrant, red wine and grape seed extracts have been shown to increase Lactobacillus species. The increased abundance of Lactobacillus species has been associated with amelioration (=improvement) of inflammation.

A type of bacteria.

The presence of mucus in the stool may be due to prolonged irritation to the intestinal mucosa and may be secondary to a proliferation of gastrointestinal enteropathogens such as bacteria, yeast, or parasites. It can also be associated with an inflammatory bowel condition. Mucus is also secreted by the intestinal mucosa in response to parasympathetic excitability such as spastic constipation, mucus colitis, neoplasm of the rectum, or villous adenoma of the colon. A positive mucus result requires treatment of the cause of inflammation and possibly anti-inflammatory therapy. Microbial analysis, including PCR and culture along with microscopic studies of the stool are useful in the detection of dysbiotic bacteria, viruses, yeast, or parasites. Localized abscesses and inflammatory disorders should also be ruled out.

an indicator of incomplete digestion

from the Tenericutes phylum

leading contributor to acute gastroenteritis

In many cases, a positive occult blood results from gastrointestinal bleeding from the upper small intestine or higher. Gastric ulceration could, for example, result in a finding of occult blood rather than blood in the feces. However, a positive finding of occult blood may also be associated with colon cancer, ulcerative colitis (check fecal calprotectin and lactoferrin levels), ulceration of the esophagus, stomach or duodenum, diverticulitis, and gastric carcinoma.

major anaerobic producers of acetate and succinate

major anaerobic producers of acetate and succinate

P. hominis is considered nonpathogenic or commensal. It lives in the large intestine. Exposure occurs via fecal-oral route, and indicates increased risk of exposure to potential pathogens.

can produce short-chain fatty acids

make up approximately 2% of the gut microbiota in healthy adults

Red blood cells seen in a stool microscopy sample.

causes gastroenteritis

usually neither pathogenic nor beneficial to the host GI tract

Members of Ruminococcus sensu produce acetate

Members of Ruminococcus sensu produce acetate, but not butyrate.

anaerobic bacteria in the family of Enterobacteriaceae

A marker of gut secretory immunity and barrier function.

can cause diarrhea

non-sporulating bacteria that belong to the family Enterobacteriaceae

Streptococcus agalactiae, also known as Lancefield’s group B streptococcus (GBS), is a gram-positive facultative anaerobe. Found in around 30% of healthy adult gastrointestinal tracts and vaginas, it can cause severe infections. The bacterium is the leading cause of septicaemia, pneumonia and meningitis in neonates. Additionally, a recent study showed that neonates of GBS+ women have a different microbiota composition compared to GBS-, possibly leading to disease development later in life. Eubacterium is a genus of gram-positive bacteria. They are one of the most abundant species in healthy colons and use lactate and acetate to produce butyrate, and 1,2 propanediol to produce propionate. Depletion of Eubacterium rectale has been associated with high fat diets, colorectal cancer and ulcerative colitis. Species belonging to this genus are also involved in the metabolism of polyphenols - health-promoting metabolites, which can reduce incidence of carcinogenesis. Eubacterium rely on sources of resistant starches for survival. References: - Facklam, R. What happened to the streptococci: overview of taxonomic and nomenclature changes. Clin. Microbiol. Rev. 15, 613–30 (2002). - Barcaite, E. et al. Prevalence of maternal group B streptococcal colonisation in European countries. Acta Obstet. Gynecol. Scand. 87, 260–271 (2008). - Glaser, P. et al. Genome sequence of Streptococcus agalactiae, a pathogen causing invasive neonatal disease. Mol. Microbiol. 45, 1499–1513 (2002). - Cassidy-Bushrow, A. E. et al. Maternal group B Streptococcus and the infant gut microbiota. J. Dev. Orig. Health Dis. 7, 45–53 (2016) - Engels, C., Ruscheweyh, H.-J., Beerenwinkel, N., Lacroix, C. & Schwab, C. The Common Gut Microbe Eubacterium hallii also Contributes to Intestinal Propionate Formation. Front. Microbiol. 7, 713 (2016). - Flint, H. J., Scott, K. P., Louis, P. & Duncan, S. H. The role of the gut microbiota in nutrition and health. Nat. Rev. Gastroenterol. Hepatol. 9, 577–589 (2012). - Wang, T. et al. Structural segregation of gut microbiota between colorectal cancer patients and healthy volunteers. ISME J. 6, 320–329 (2012). - Vermeiren, J. et al. Decreased colonization of fecal Clostridium coccoides/Eubacterium rectale species from ulcerative colitis patients in an in vitro dynamic gut model with mucin environment. FEMS Microbiol. Ecol. 79, 685– 696 (2012). - Cardona, F., Andrés-Lacueva, C., Tulipani, S., Tinahones, F. J. & Queipo-Ortuño, M. I. Benefits of polyphenols on gut microbiota and implications in human health. J. Nutr. Biochem. 24, 1415–1422 (2013).

usually neither pathogenic nor beneficial to the host GI tract

a common bacterium often carried in the intestines or lower genital tract.

Higher abundance of S. salivarius and S. thermophilus (Firmicutes phylum) have been associated with a moderate to severe disease course in newly diagnosed ulcerative colitis (UC) patients. These findings are in accordance with a study that showed that UC patients have significantly increased Streptococcus spp. and depletion of Bifidobacterium spp. Higher levels of Streptococcus spp. were also observed in patients with colorectal cancer compared to healthy controls. Administration of S. salivarius together with Bifidobacterium bifidum was shown to reduce the incidence of acute diarrhea and rotavirus shedding in infants. S. salivarius and S. thermophilus are also widely used in dairy products like yogurt and cheese.

Higher abundance of S. salivarius and S. thermophilus (Firmicutes phylum) have been associated with a moderate to severe disease course in newly diagnosed ulcerative colitis (UC) patients. These findings are in accordance with a study that showed that UC patients have significantly increased Streptococcus spp. and depletion of Bifidobacterium spp. Higher levels of Streptococcus spp. were also observed in patients with colorectal cancer compared to healthy controls. Administration of S. salivarius together with Bifidobacterium bifidum was shown to reduce the incidence of acute diarrhea and rotavirus shedding in infants. S. salivarius and S. thermophilus are also widely used in dairy products like yogurt and cheese.

a gram-positive bacterium

a gram-positive bacterium

Higher abundance of S. salivarius and S. thermophilus (Firmicutes phylum) have been associated with a moderate to severe disease course in newly diagnosed ulcerative colitis (UC) patients. These findings are in accordance with a study that showed that UC patients have significantly increased Streptococcus spp. and depletion of Bifidobacterium spp. Higher levels of Streptococcus spp. were also observed in patients with colorectal cancer compared to healthy controls. Administration of S. salivarius together with Bifidobacterium bifidum was shown to reduce the incidence of acute diarrhea and rotavirus shedding in infants. S. salivarius and S. thermophilus are also widely used in dairy products like yogurt and cheese.

Strongyloides infects the duodenum and jejunum, but its life cycle also includes migration through the lungs. Infection occurs when larvae penetrate the skin of humans or are passed via the fecal-oral route. Strongyloidiasis is endemic throughout the tropics and subtropics, including rural areas of the southern USA. More than half of infected persons are asymptomatic. Acute symptoms of strongyloidiasis may include epigastric pain and tenderness, diarrhea, nausea, vomiting, constipation, and weight loss. Chronic infection may lead to glucose malabsorption and protein-losing enteropathy. Maculopapular or urticarial eruptions may occur. Occasionally, larvae mature in the bronchial submucosa and produce chronic bronchitis and asthma. Immunosuppression may lead to an overwhelming hyperinfection that can be potentially fatal. In uncomplicated infection, treatment with ivermectin (200 ug/kg/d x 2 days, adult dose) or thiabendazole (25 mg/kg bid, <3 g/day, for 2 days, adult dose) results in 80 to 90% cure. Side effects of thiabendazole are frequent and occasionally disabling. Patients with a history of Strongyloides stercoralis exposure should undergo several stool examinations and, if necessary, a string test or duodenal aspiration before receiving corticosteroids or other immunosuppressive therapy.

These cestodes usually infect the intestinal tract, but Taenia solium may also invade the CNS. Transmission is by ingesting cysts in raw or undercooked meat. Taenia solium transmission may also occur via the fecal-oral route, which increases chance of CNS involvement. T. saginata is prevalent in Ethiopia, Kenya, the Middle East, Yugoslavia, Mexico, and parts of South America and Eastern Europe. T. solium is found in Europe, Latin America, India, and China. Infection in the USA is rare. Taeniasis is usually asymptomatic. Mild abdominal symptoms may include epigastric discomfort, increased hunger, diarrhea, nausea, and weight loss. Death of cysts can elicit an intense inflammatory tissue response, with symptoms appearing 4 to 5 years after infection. Infection of the brain or CNS (neurocysticercosis) can cause severe symptoms including seizures, altered mental status, focal neurological signs, and aseptic meningitis. For treatment of intestinal infection praziquantel (5-10 mg/kg x 1 dose, adult dose) is recommended. An alternative is niclosamide (2 g x 1 dose, adult dose). Not all patients with neurocysticercosis should be treated, as the inflammatory response to treatment may be more damaging than the disease.

T. trichiura is a nematode that infects the large intestine. Infection is spread via the fecal-oral route. The parasite is found principally in the tropics and subtropics. Mild asymptomatic infections are common in rural parts of the southeastern USA. Light infections are often asymptomatic. Heavy infections cause abdominal pain, anorexia, and diarrhea and may retard growth. Very heavy infections may cause weight loss, anemia, and rectal prolapse in children and parturient women. No drug treatment is required for asymptomatic or light infections. Mebendazole (100 mg bid x 3 days, adult dose) or albendazole (400 mg qd x 3 days, adult dose) are used for more severe infections. These drugs should not be used during pregnancy. Natural agents include quassia and black walnut.

Vegetable fibers in the stool may be indicative of inadequate chewing, or eating “on the run”.

Commonly found in gut, mouth and vaginal tract

one of the most common causes of diarrhea worldwide

White Blood Cells (WBC) and Mucus in the stool can occur with bacterial and parasitic infections, with mucosal irritation, and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. Elevated levels of WBCs in the stool are an indication of an inflammatory process resulting in the infiltration of leukocytes within the intestinal lumen. This could be the result of an inflammatory bowel conditions including ulcerative colitis (UC) or Crohn’s disease (check fecal calprotectin and lactoferrin). Enteroinvasive bacteria such as Campylobacter, Shigella, Salmonella, and Enteropathogenic parasites such as Giardia, Blastocystis, Cryptosporidium, and Entamoeba can be a cause of inflammation to the mucosal lining. WBCs are often accompanied by mucus in the stool (macroscopic examination). Other conditions that may be associated with WBCs in the stool include localized abscesses and anal fistulas. A positive WBC result may warrant identification and eradication of the cause of inflammation and possible anti-inflammatory therapy.

may normally be present in small quantities on the skin, in the mouth and intestine.