Clinical Impact of the HCPL Gastrointestinal (GI) Panel

Interpretation of the GI Panel Report

Doctors receive an easy to read “Detected” or “Not Detected” result for each pathogen.

Nationally Notifiable Pathogens:

  • Vibrio cholerae
  • Cryptosporidium
  • Cyclospora
  • Giardia
  • Salmonella
  • Shiga-like toxin-producing E. coli (STEC)
  • Shigella
  • Vibrio

Challenges in Diagnosing Gastrointestinal Infections

Overlapping signs and symptoms:

  • Watery diarrhea (bloody and non-bloody)
  • Stomach pain, cramping
  • Fever
  • Nausea
  • Headache
  • Vomiting

Differential Diagnosis:

  • Food Poisoning
  • Traveler’s Diarrhea
  • IBD (Crohn’s, Colitis)
  • Medical Reactions
  • Colon Cancer
  • Diverticulosis
  • Cystic Fibrosis
  • Intussusception
  • Thyroid Disorder
  • Tumors
  • Autoimmune Disease

Guidelines & References:

Practice Guidelines for the Management of Infectious Diarrhea.
    IDSA Guidelines. Clinical Infectious Diseases, 2001:32

Clinical Practice Guidelines for Clostridium difficile Infection in
   Adults: 2010 Update by SHEA and the IDSA. Infection Control
   and Hospital Epidemiology, Vol 31 No 5, May 2010.

Guideline for the Prevention and Control of Norovirus
  Gastroenteritis Outbreaks in Healthcare Settings. CDC.

Centers for Disease Control and Prevention: Cholera-Vibrio
  cholerae Infection Rehydration and Antibiotic Treatment

Emergent Treatment of Gastroenteritis. Medscape Reference:
Drus, Diseases and Procedures.
  http://emedicine.medscape.com/article/775277-overview

Pediatrics Vol. 131 No. 1 January 1, 2013 pp. 196-200
(doi: 10.1542/peds.2012-2992)

Clin. Microbiol. Rev. January 1998 vol. 11 no. 1 142-201

Bad Bug Book 2012. FDA
http://www.fda.gov/food/foodborneillnesscontaminants/causesofillnessbadbugbook/ucm070530.htm

Film Array GI Instruction Booklet. Salt Lake City, UT: BioFire
Diagnostics, LLC.

Diarrheagenic E. coli/Shigella

EAEC

  • Fecal-oral transmission via contaminated food and water
  • Watery and sometimes bloody stool with low grade fever, vomiting and abdominal pain
  • Suggested to be the most common cause of diarrhea illness in the US

EPEC

  • EPEC has been associated with several deadly outbreaks at hospital nurseries in developed countries.
  • Outbreaks appear in warmer months.
  • Asymptomatic carriage has been documented.

ETEC

  • Important cause of diarrhea in developing countries especially among children
  • Most common bacterial cause of watery Diarrhea in US and EU travelers returning from abroad
  • Transmitted via fecal-oral route and becoming more common as a foodborne pathogen

STEC

  • STEC are the primary cause of bloody diarrhea and can progress from mild (non-bloody) diarrhea to a potentially fatal condition known as hemolytic uremic syndrome (HUS).
  • STEC are important foodborne Most illness is caused by ingestion of contaminated ground beef, as dairy and beef cattle are often colonized with this bacterium.

Shigella/EIEC

  • Strains contain a plasmid encoding virulence factors that allow the bacteria to invade the colon and produce a watery diarrhea syndrome that his identical to that caused by Shigella.
  • Shigella and EIEC infections are generally treated in the same manner.

Comprehensive, Accurate, and Fast Results

  • Identify polymicrobial infections which may be missed if using standard testing methods.
  • Can inform appropriate patient management.
  • Can ensure appropriate treatment.
  • May improve treatment outcomes.
  • Can improve patient isolation and cohorting decisions to prevent secondary transmission.
  • May inform improved quality of care.
  • Can guide appropriate patient follow-up.
  • Can reduce morbidity.
  • May lead to shorter hospital visits.

Sample Requirements:

Stool collected in Cary Blair transport medium.

  •  Specimens are best collected in a Another option is to place plastic wrap over the toilet seat opening.
  • A suitable area (i.e. bloody, slimy, watery) from the sides, ends and middle of the stool should be selected using the collection spoon Fill with sufficient stool to bring the liquid level up to the “Fill” line.
  • Stir each specimen with the spoon provided, tighten the cap and shake firmly until the specimen is adequately When mixing is complete the specimen should appear uniform.
  • Complete the label on each vial and replace the vials in the plastic Transport the specimen to the laboratory. Specimen may be refrigerated or kept at room temperature.

HCPL GI Panel Pathogens

Bacteria

  • Campylobacter (jejuni, coli and upsaliensis)
  • Clostridium difficile (Toxin A/B)
  • Plesiomonas  shigelloides
  • Salmonella
  • Yersinia  enterocolitica
  • Vibrio (parahaemolyticus, vulnificus and cholerae)
  • Vibrio cholerae
  • Diarrheagenic E. coli/Shigella
  • Enteroaggregative E. coli (EAEC)
  • Enteropathogenic E. coli (EPEC)
  • Enterotoxigenic E. coli (ETEC) lt/st
  • Shiga-like toxin-producing E. coli (STEC) stx1/stx2
  • E. coli 0157
  • Shigella/Enteroinvasive E. coli (EIEC)

Parasites

  • Cryptosporidium
  • Entamoeba  histolytica
  • Cyclospora cayetanensis  
  • Giardia lamblia

Viruses

  • Adenovirus F40/41
  • Astrovirus
  • Norovirus GI/GII
  • Rotavirus A
  • Sapovirus (I, II, IV and V)

Fecal Swab Sample Stool Collection

 

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