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LAB #: F
CLIENT #: 
!Microbiology Profile, stool Commensal (Imbalanced) flora
NG Bacteroides fragilis group 2+ Enterobacter cloacae 4+ Klebsiella oxytoca 4+ Bifidobacterium spp.
3+ Gamma hemolytic strep 4+ Escherichia coli 1+ Staphylococcus aureus 3+ Lactobacillus spp.
1+ Enterococcus spp.
1+ Clostridium spp.
Expected /Beneficial bacteria make up a significant portion of the total microflora in a healthy & balanced GI tract. These beneficial bacteria have many
health-protecting effects in the GI tract including manufacturing vitamins, fermenting fibers, digesting proteins and carbohydrates, and propagating anti-
tumor and anti-inflammatory factors.
Clostridia are prevalent flora in a healthy intestine. Clostridium spp. should be considered in the context of balance with other expected/beneficial flora.
Absence of clostridia or over abundance relative to other expected/beneficial flora indicates bacterial imbalance. If C. difficile associated disease is
suspected, a Comprehensive Clostridium culture or toxigenic C. difficile DNA test is recommended.
Commensal (Imbalanced) bacteria are usually neither pathogenic nor beneficial to the host GI tract. Imbalances can occur when there are insufficient
levels of beneficial bacteria and increased levels of commensal bacteria. Certain commensal bacteria are reported as dysbiotic at higher levels.
Dysbiotic bacteria consist of known pathogenic bacteria and those that have the potential to cause disease in the GI tract. They can be present due to a
number of factors including: consumption of contaminated water or food, exposure to chemicals that are toxic to beneficial bacteria; the use of antibiotics,
oral contraceptives or other medications; poor fiber intake and high stress levels.
Normal flora
Candida parapsilosis Yeast normally can be found in small quantities in the skin, mouth, intestine and mucocutaneous
junctions. Overgrowth of yeast can infect virtually every organ system, leading to an extensive array
of clinical manifestations. Fungal diarrhea is associated with broad-spectrum antibiotics oralterations of the patient's immune status. Symptoms may include abdominal pain, cramping and The microscopic finding of yeast in the stool is irritation. When investigating the presence of yeast, disparity may exist between culturing and microscopic examination. Yeast are not uniformly dispersed throughout the stool, this may lead to proliferation of yeast. Rare yeast may be undetectable or low levels of yeast identified by microscopy, despite a cultured amount of yeast.
normal; however, yeast observed in higher Conversely, microscopic examination may reveal a significant amount of yeast present, but no yeast amounts (few, moderate, or many) is abnormal.
cultured. Yeast does not always survive transit through the intestines rendering it unvialble.
Comments:
Date Collected: 11/29/2011
* Aeromonas, Campylobacter, Plesiomonas, Salmonella, Shigella, Vibrio, Yersinia, &
Date Received: 12/1/2011
Edwardsiella tarda have been specifically tested for and found absent unless reported.
Date Completed: 12/12/2011
DOCTOR'S DATA, INC. ! ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 ! CLIA ID NO: 14D0646470 ! MEDICARE PROVIDER NO: 148453

LAB #: F
CLIENT #: 
Natural antibacterial agents may be
useful for treatment of patients when
organisms display in-vitro sensitivity tothese agents. The test is performed by using standardized techniques and filter paper disks impregnated with the listedagent. Relative sensitivity is reported for each natural agent based upon thediameter surrounding the disk. Data based on over Grapefruit Seed Extract 5000 individual observations were used torelate the zone size to the activity level of the agent. A scale of relative sensitivity isdefined for the natural agents tested.
Susceptible results imply that an infectiondue to the bacteria may be appropriately treated when the recommended dosage ofthe tested antimicrobial agent is used.
Intermediate results imply that response
rates may be lower than for susceptiblebacteria when the tested antimicrobial agent is used.
Resistant results imply that the bacteria will
not be inhibited by normal dosage levels of the tested antimicrobial agent.
Comments:
Date Collected: 11/29/2011
Natural antibacterial agent susceptibility testing is intended for research use only.
Date Received: 12/1/2011
Not for use in diagnostic procedures.
Date Completed: 12/12/2011
DOCTOR'S DATA, INC. ! ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 ! CLIA ID NO: 14D0646470 ! MEDICARE PROVIDER NO: 148453

LAB #: F
CLIENT #: 
Natural antifungal agents may be useful
for treatment of patients when organisms
display in-vitro sensitivity to these agents.
The test is performed by using standardizedtechniques impregnated with the listed agent. Relativesensitivity is reported for each natural agent based upon the diameter of the zone ofinhibition surrounding the disk. Data based on over 5000 individual observations were used to relate the zone size to the activitylevel of the agent. A scale of relative Grapefruit Seed Extract sensitivity is defined for the natural agentstested.
Non-absorbed antifungals may be usefulfor treatment of patients when organisms display in-vitro sensitivity to these agents.
The test is performed using standardizedcommercially prepared disks impregnatedwith Nystatin. Relative sensitivity is reportedbased upon the diameter of the zone ofinhibition surrounding the disk.
Comments:
Date Collected: 11/29/2011
Yeast antifungal susceptibility testing is intended for research use only.
Date Received: 12/1/2011
Not for use in diagnostic procedures.
Date Completed: 12/12/2011
DOCTOR'S DATA, INC. ! ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 ! CLIA ID NO: 14D0646470 ! MEDICARE PROVIDER NO: 148453

LAB #: F
CLIENT #: 
Natural antifungal agents may be useful
for treatment of patients when organisms
display in-vitro sensitivity to these agents.
The standardized techniques and filter paper disks impregnated with the listed agent.
Relative sensitivity is reported for each natural agent based upon the diameter ofthe zone of inhibition surrounding the disk.
Data based on over 5000 individual observations were used to relate the zonesize to the activity level of the agent. A Grapefruit Seed Extract scale of relative sensitivity is defined for thenatural agents tested.
Non-absorbed antifungals may be usefulfor treatment of patients when organisms display in-vitro sensitivity to these agents.
The test is performed using standardizedcommercially prepared disks impregnatedwith Nystatin. Relative sensitivity is reportedbased upon the diameter of the zone ofinhibition surrounding the disk.
Susceptible results imply that an infection
due to the fungus may be appropriately
treated when the recommended dosage ofthe tested antifungal agent is used.
Susceptible - Dose Dependent (S-DD)
results imply that an infection due to thefungus may be treated when the highestrecommended antifungal agent is used.
Resistant results imply that the fungus will
not be inhibited by normal dosage levels of
the tested antifungal agent.
Standardized test interpretive categories established for Candida spp. are used for all yeast isolates.
Comments:
Date Collected: 11/29/2011
Yeast antifungal susceptibility testing is intended for research use only.
Date Received: 12/1/2011
Not for use in diagnostic procedures.
Date Completed: 12/12/2011
DOCTOR'S DATA, INC. ! ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 ! CLIA ID NO: 14D0646470 ! MEDICARE PROVIDER NO: 148453

LAB #: F
CLIENT #: 
Natural antifungal agents may be useful
for treatment of patients when organisms
display in-vitro sensitivity to these agents.
The standardized techniques and filter paper disks impregnated with the listed agent.
Relative sensitivity is reported for each natural agent based upon the diameter ofthe zone of inhibition surrounding the disk.
Data based on over 5000 individual observations were used to relate the zonesize to the activity level of the agent. A Grapefruit Seed Extract scale of relative sensitivity is defined for thenatural agents tested.
Non-absorbed antifungals may be usefulfor treatment of patients when organisms display in-vitro sensitivity to these agents.
The test is performed using standardizedcommercially prepared disks impregnatedwith Nystatin. Relative sensitivity is reportedbased upon the diameter of the zone ofinhibition surrounding the disk.
Susceptible results imply that an infection
due to the fungus may be appropriately
treated when the recommended dosage ofthe tested antifungal agent is used.
Susceptible - Dose Dependent (S-DD)
results imply that an infection due to thefungus may be treated when the highestrecommended antifungal agent is used.
Resistant results imply that the fungus will
not be inhibited by normal dosage levels of
the tested antifungal agent.
Standardized test interpretive categories established for Candida spp. are used for all yeast isolates.
Comments:
Date Collected: 11/29/2011
Yeast antifungal susceptibility testing is intended for research use only.
Date Received: 12/1/2011
Not for use in diagnostic procedures.
Date Completed: 12/12/2011
DOCTOR'S DATA, INC. ! ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 ! CLIA ID NO: 14D0646470 ! MEDICARE PROVIDER NO: 148453
Lab number: F
This analysis of the stool specimen provides fundamental information about the overall gastrointestinal health of the patient. When abnormal microflora or significant aberrationsin intestinal health markers are detected, specific interpretive paragraphs are presented. If no significant abnormalities are found, interpretive paragraphs are not presented. Beneficial Flora One or more of the expected (beneficial) bacteria are low in this specimen. Beneficial flora include lactobacilli, bifidobacteria, clostridia, Bacteroides fragilis group, enterococci, and some strains of Escherichia coli. The beneficial flora have many health-protecting effects in the gut, and as a consequence, are crucial to the health of the whole organism. Some of the roles of the beneficial flora include digestion of proteins and carbohydrates, manufacture of vitamins and essential fatty acids, increase in the number of immune system cells, break down of bacterial toxins and the conversion of flavinoids into anti-tumor and anti-inflammatory factors. Lactobacilli, bifidobacteria, clostridia, and enterococci secrete lactic acid as well as other acids including acetate, propionate, butyrate, and valerate. This secretion causes a subsequent decrease in intestinal pH, which is crucial in preventing an enteric proliferation of microbial pathogens, including bacteria and yeast. Many GI pathogens thrive in alkaline environments. Lactobacilli also secrete the antifungal and antimicrobial agents lactocidin, lactobacillin, acidolin, and hydrogen peroxide. The beneficial flora of the GI have thus been found useful in the inhibition of microbial pathogens, prevention and treatment of antibiotic associated diarrhea, prevention of traveler's diarrhea, enhancement of immune function, and inhibition of the proliferation of yeast.
In a healthy balanced state of intestinal flora, the beneficial flora make up a significant proportion of the total microflora. Healthy levels of each of the beneficial bacteria are indicated by either a 3+ or 4+ (0 to 4 scale). However, some individuals have low levels of beneficial bacteria and an overgrowth of nonbeneficial (imbalances) or even pathogenic microorganisms (dysbiosis). Often attributed to the use of antibiotics, individuals with low beneficial bacteria may present with chronic symptoms such as irregular transit time, irritable bowel syndrome, bloating, gas, chronic fatigue, headaches, autoimmune diseases (e.g., rheumatoid arthritis), and sensitivities to a variety of foods. Treatment may include the use of probiotic supplements containing various strains of lactobacilli, bifidobacteria and enterococci and consumption of cultured or fermented foods including yogurt, kefir, miso, tempeh and tamari sauce. Polyphenols in green and ginseng tea have been found to increase the numbers of beneficial bacteria. If dysbiosis is present, treatment may also include the removal of pathogenic bacteria, yeast, or parasites. Percival M. Intestinal Health. Clin Nutr In. 1997;5(5):1-6.
Fuller R. Probiotics in Human Medicine. Gut. 1991;32: 439-442.
Siitonen S, Vapaatalo H, Salminen S, et al. Effect of Lactobacilli GG Yoghurt in Prevention of Antibiotic Associated Diarrhea. Ann Med. 1990; 22:57-59.
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Lab number: F
Client: 
Oksanen P, Salminen S, Saxelin M, et al. Prevention of Travelers' Diarrhea by Lactobacillus GG. Ann Med. 1990; 22:53-56.
Perdigon G, Alvarez M, et al. The Oral Administration of Lactic Acid Bacteria Increases the Mucosal Intestinal Immunity in Response to Enteropathogens. J Food Prot. 1990;53:404-410.
Valeur, N, et al. Colonization and Immunomodulation by Lactobacillus reuteri ATCC 55730 in the Human Gastrointestinal Tract. Appl Environ. Microbiol. 2004 Feb; 70(2):1176-81.
Elmer G, Surawicz C, and McFarland L. Biotherapeutic agents - a Neglected Modality for the Treatment and Prevention of Intestinal and Vaginal Infections. JAMA. 1996; 275(11):870-876.
Fitzsimmons N and Berry D. Inhibition of Candida albicans by Lactobacillus acidophilus: Evidence for Involvement of a Peroxidase System. Microbio. 1994; 80:125-133 Weisburger JH. Proc Soc Exp Biol Med 1999;220(4):271-5.
Imbalanced flora Imbalanced flora are those bacteria that reside in the host gastrointestinal tract and neither injure nor benefit the host. Certain dysbiotic bacteria may appear under the imbalances category if found at low levels because they are not likely pathogenic at the levels detected. When imbalanced flora appear, it is not uncommon to find inadequate levels of one or more of the beneficial bacteria and/or a fecal pH which is more towards the alkaline end of the reference range (6.5 - 7.2). It is also not uncommon to find hemolytic or mucoid E. coli with a concomitant deficiency of beneficial E. coli and alkaline pH, secondary to a mutation of beneficial E. coli in alkaline conditions (DDI observations). Treatment with antimicrobial agents is unnecessary unless bacteria appear under the dysbiotic category. Mackowiak PA. The normal microbial flora. N Engl J Med. 1982;307(2):83-93.
In a healthy balanced state of intestinal flora, the beneficial bacteria make up a significant proportion of the total microflora. However, in many individuals there is an imbalance or deficiency of beneficial flora and an overgrowth of non-beneficial (imbalance) or even pathogenic microorganisms (dysbiosis). This can be due to a number of factors including: consumption of contaminated water or food; daily exposure of chemicals that are toxic to beneficial bacteria; the use of antibiotics, oral contraceptives or other medications; poor fiber intake and high stress levels.
A number of toxic substances can be produced by the dysbiotic bacteria including amines, ammonia, hydrogen sulfide, phenols, and secondary bile acids which may cause inflammation or damage to the brush border of the intestinal lining. If left unchecked, long-term damage to the intestinal lining may result in leaky gut syndrome, allergies, autoimmune disease (e.g. rheumatoid arthritis), irritable bowel syndrome, fatigue, chronic headaches, and sensitivities to a variety of foods. In addition, pathogenic bacteria can cause acute symptoms such as abdominal  1999-2011 Doctor's Data, Inc.
Lab number: F
pain, nausea, diarrhea, vomiting, and fever in cases of food poisoning. Bacterial sensitivities to a variety of prescriptive and natural agents have been provided for the pathogenic bacteria that were cultured from this patient's specimen. This provides the practitioner with useful information to help plan an appropriate treatment regimen. Supplementation with probiotics or consumption of foods (yogurt, kefir, miso, tempeh, tamari sauce) containing strains of lactobacilli, bifidobacteria, and enterococci can help restore healthy flora levels. Polyphenols in green and ginseng tea have been found to increase the numbers of beneficial bacteria. Hypochlorhydria may also predispose an individual to bacterial overgrowth, particularly in the small intestine. Nutritional anti-inflammatories can aid in reversing irritation to the GI lining. These include quercetin, vitamin C, curcumin, gamma-linoleic acid, omega-3 fatty acids (EPA, DHA), and aloe vera. Other nutrients such as zinc, beta-carotene, pantothenic acid, and L-glutamine provide support for regeneration of the GI mucosa. A comprehensive program may be helpful in individuals in whom a dysbiotic condition has caused extensive GI damage. Lispki E. Digestive Wellness. New Canaan,CT: Keats Publishing;1996.
Mitsuoka T. Intestinal Flora and Aging. Nutr Rev 1992;50(12):438-446.
Weisburger JH. Tea and Health: The Underlying Mechanisms. Proc Soc Exp Biol Med 1999;220(4):271-275.4. Pereira SP, Gainsborough N, Dowling RH. Drug-induced Hypochlorhydria Causes High Duodenal Bacterial Counts in the Elderly. Ailment Pharmacol Ther 1998;12(1)99-104.
Murray MT. Stomach Ailments and Digestive Disturbances. Rocklin, CA: Prima Publishing; 1997.
Klebsiella species Klebsiella belongs to the Enterobacteriaceae family and is closely related to the genera Enterobacter and Serratia. This gram-negative bacterium is considered dysbiotic in the amount of 3 - 4+.
Klebsiellae are widely distributed in nature and in the gastrointestinal tract of humans. In humans, they may colonize the skin, oral cavity, pharynx, or gastrointestinal tract. Klebsiellae may be regarded as normal flora in many parts of the colon, intestinal tract and biliary tract, but the gut is also the main reservoir of opportunistic strains.
This bacterium has the potential to cause intestinal, lung, urinary tract, and wound infections in susceptible individuals, but Klebsiella overgrowth is commonly asymptomatic. K. pneumoniae, in particular, may cause diarrhea and some strains are enterotoxigenic. Infection has been linked to ankylosing spondylitis as well as myasthenia gravis (antigenic cross-reactivity), and these patients usually carry larger numbers of the organism in their intestines than healthy individuals. Klebsiella oxytoca has been found to be the cause of antibiotic-associated hemorrhagic colitis. These strains have been shown to produce a cytotoxin that is capable of inducing cell death in various epithelial-cell cultures.
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Lab number: F
Klebsiella is also an infamously known nosocomial infectious agent, partially due to the ability of organisms to spread rapidly. Klebsiella accounts for approximately 3-7% of all hospital-acquired infections, placing it among the top eight pathogens in hospitals. Extraintestinal infection typically involves the respiratory or urinary tracts, but may infect other areas such as the biliary tract and surgical wound sites. K. pneumoniae and K. oxytoca are the two members of this genus responsible for most extraintestinal human infections.
Treatment of these species has become a major problem in most hospitals because of resistance to multiple antibiotics and potential transfer of plasmids to other organisms. Proper hand washing is crucial to prevent transmission from patient to patient via medical personnel. Contact isolation should be used for patients colonized or infected with highly antibiotic-resistant Klebsiella strains.
Klebsiella ozaenae and Klebsiella rhinoscleromatis are infrequent isolates that are subspecies of K. pneumoniae; however, each is associated with at unique spectrum of disease. K. ozaenae is associated with atrophic rhinitis, a condition called ozena, and purulent infections of the nasal mucous membranes. K. rhinoscleromatis causes the granulomatous disease rhinoscleroma, an infection of the respiratory mucosa, oropharynx, nose, and paranasal sinuses.
For the otherwise healthy individual, antimicrobial therapy is often unnecessary. Klebsiella thrives on a diet high in starch, so a low-starch diet may be helpful. A further caution is that Klebsiella thrives on Fructooligosaccharides (FOS) a class of oligosaccharides used as an artificial or alternative sweetener. Antibiotics may be indicated if symptoms are prolonged and in systemic infections. Refer to the bacterial sensitivities to identify the most appropriate pharmaceutical or natural agent. Hogenauer C, Langner C, Beubler E, et al. Klebsiella oxytoca as a Causative Organism of Antibiotic-Associated Hemorrhagic Colitis. New England Journal of Medicine. December 2006;355;23.
Levy I et al. Nosocomial Infections After Cardiac Surgery in Infants and Children: Incidence and Risk Factors. J Hosp Infect. 2003;53(2):111-6.
Washington W, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, Woods, G. Koneman's Color Atlas and Textbook of Diagnostic Microbiology, 6th edition. Lippincott Williams and Wilkins; 2006. pg 259-264.
Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH. Manual of Clinical Microbiology, 8th edition. Washington, DC: ASM Press; 2003. pg 688-689.
Yeast, such as Candida are normally present in the GI tract in very small amounts. Many species of yeast exist and are commensal; however, they are always poised to create opportunistic infections and have detrimental effects throughout the body. Factors that contribute to a proliferation of yeast include frequent use of wide-spread antibiotics/low levels of beneficial flora, oral contraceptives, pregnancy, cortisone and other immunosuppressant drugs, weak immune system/low  1999-2011 Doctor's Data, Inc.
Lab number: F
Microbiology Profile Page: 5
levels of sIgA, high-sugar diet, and high stress levels. When investigating the presence of yeast, disparity may exist between culturing and microscopic examination. Yeast grows in colonies and is typically not uniformly dispersed throughout the stool. This may lead to undetectable or low levels of yeast identified by microscopy, despite a cultured amount of yeast. Conversely, microscopic examination may reveal a significant amount of yeast present, but no yeast cultured. Yeast does not always survive transit through the intestines rendering it unviable for culturing. Therefore, both microscopic examination and culture are helpful in determining if abnormally high levels of yeast are present.
 1999-2011 Doctor's Data, Inc.

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