We cannot offer a complete list of parasites because of their vast number.But the laboratory uses a special concentration method and will find any worm eggs, lavae and protozoen cysts and consequently identify the species. If the staff is in any doubt, they consult associated specialists.


Protozoa (in Greek proto = first and zoa = animals) are one-celled eukaryotes (that is,
unicellular microbes whose cells have membrane-bound nuclei).
Some protozoa have the ability to form cysts to protect them from harsh conditions, allowing
them to survive exposure to extreme temperatures or harmful chemicals or without food,
water, or oxygen for a period of time. For parasitic species the cysts will also enable them to
survive outside of the host, allowing them to be transferred from one host to another. This
ability to form cysts also ensures their suvival in a stool sample.

Intestinal entamoeba: Entamoeba is a genus of Amoebozoa found as internal parasites or
commensals of animals. Several species are found in humans. Entamoeba histolytica is the
pathogen responsible for amoebiasis (which includes amoebic dysentery and amoebic liver
abscesses), while others such as Entamoeba coli and E. dispar are harmless. With the
exception of Entamoeba gingivalis, which lives in the mouth, and E. moshkovskii, which is
frequently isolated from river and lake sediments, all Entamoeba species are found in the
intestines of the animals they infect.

Dientamöba fragilis: Ever since its first description in 1918, Dientamoeba fragilis has
struggled to gain recognition as a significant pathogen. There is little justification for this
neglect, however, since there exists a growing body of case reports from numerous countries
around the world that have linked this protozoal parasite to clinical manifestations such as
diarrhea, abdominal pain, flatulence, and anorexia.

Blastocystis hominis: Blastocystis is a highly prevalent single-celled parasite that infects the
gastrointestinal tract of humans and animals. Many different types of Blastocystis exist, and
they can infect humans, farm animals, birds, rodents, amphibians, reptiles, fish, and even
cockroaches. Infection with Blastocystis can produce the disease Blastocystosis. The most
frequently described symptoms of Blastocystosis are abdominal pain, constipation and

Cryptosporidium: Cryptosporidium is a protozoan pathogen of the Phylum Apicomplexa and
causes a diarrheal illness called cryptosporidiosis.
Cyclospora cayetanensis: Cyclospora cayetanensis is a protozoan that causes disease in
humans, and perhaps other primates. It is sometimes referred to as the “yuppie disease” due to
outbreaks in the United States from fecally-contaminated imported raspberries and was
virtually unknown before about 1990, but has been on the rise since. The health risk
associated with the disease is usually confined to adult foreigners visiting endemic regions
and acquiring the infection. This is why C. cayetanensis has been labeled as causing
“traveler’s diarrhea.” Due to its small size, intracellular habitat, and inability to properly
uptake many histological stains, diagnosis of Cyclospora cayetanensis can be very difficult.

Giardia lamblia: Giardia lamblia (synonymous with Lamblia intestinalis and Giardia
duodenalis) is a flagellated protozoan parasite that colonises and reproduces in the small
intestine, causing giardiasis. The giardia parasite attaches to the epithelium. Giardiasis does
not disseminate haematogenously, nor does it spread to other parts of the gastro-intestinal
tract, but remains confined to the lumen of the small intestine. Giardia trophozoites absorb
their nutrients from the lumen of the small intestine, and are anaerobes. Colonisation of the
gut results in inflammation and villous atrophy, reducing the gut’s absorptive capability. In
humans, infection is symptomatic about 50% of the time

Isospora belli: Isosporiasis is a human intestinal disease caused by a parasite called Isospora
belli. Symptoms include diarrhea and weight loss. It is sometimes associated with AIDS.
Sarcocystis: This parasite’s life cycle is heteroxenous, meaning that it has more than one
obligatory host in its life cycle. Sarcocystis relies on the predator-prey relationship of animals.
Oocysts are passed through the feces of an infected individual where it undergoes sporogony
and becomes infected itself. Intermediate hosts can be cows or pigs. Human infection is rare
but can happen when undercooked meat is ingested. Symptoms include diarrhea, which may
be mild and transient or severe and life threatening. Human outbreaks have occurred in

Trematodes: Liver and gut flukes

Fasciolopsis buski: often referred to as the giant intestinal fluke, is a parasite of
Southern Asia.
Fasciola hepatica: Known as the common liver fluke or sheep liver fluke, is a parasitic
flatworm of the class Trematoda that infects the liver of a various
mammals, including man.
Dicrocoelium dendriticum: The Lancet liver fluke (Dicrocoelium dendriticum) is a parasite
fluke that tends to live in cattle or other grazing mammals.

Other flukes:

Echinostoma ilocanum: Intestinal fluke which is a common infection in South-East Asia
where they have a high prevalence (from 1 to 30%).The infections are
acquired by eating raw or undercooked freshwater snails, clams, and
fish containing the metacercariae.
Echinostoma lindoense: The Echinostomes are a large group of flukes. The lifecycle has a
snail first intermediate host (as with all the Digenean flukes), usually
followed by a fish second intermediate host, although in some species
this may be an amphibian of another mollusc. A number of these
parasites have been reported in man, either as a natural parasite, or more
commonly as accidental infections.
Gastrodiscoides hominis: Member of the Digenean fluke family, found in Vietnam,
Philippines, Bangladesh and the Assam region of India
Watsonius watsoni: A trematode found in the intestinal wall of some primates. Causes
mucohemorrhagic diarrhea, hepatomegaly, ascites and urinary tract disease.

Nanophyetus salmincola: Human nanophyetiasis is a zoonotic disease recently recognized in
the coastal US Pacific Northwest and is caused by the trematode Nanophyetus

Metorchis conjunctus: Metorchis conjunctus is North American in distribution and the
metacercariae are unusual because they can withstand periods of freezing. In northern
communities where dogs are frequently fed rough fish, such as suckers, Metorchis can
pose a serious health problem to the dogs. Humans also can become infected. It’s life
cycle and pathology are similar to the Chinese liver fluke, Clonorchis sinensis.

Opisthorchis viverrini und felineus: These are trematode parasites that attack the area of the
bile duct. Opisthorchis viverrini infection predisposes for cholangiocarcinoma, a
cancer of the gall bladder and/or its ducts.

Clonorchis (Opisthorchis) sinensins: This is a human liver fluke in the class Trematoda. This
parasite lives in the liver of humans, and is found mainly in the common bile duct and
gall bladder, feeding on bile. These flukes which are believed to be the third most
prevalent worm parasite in the world, are endemic to Japan, China, Taiwan, and
Southeast Asia, currently infecting an estimated 30,000,000 humans.

Metagonimus yokogawai: A minute intestinal fluke, the smallest human fluke.The main
symptoms are diarrhea and colicky abdominal pain. Migration of the eggs to
extraintestinal sites (heart, brain) can occur, with resulting symptoms.
Heterophyes heterophyes: A fluke found in the Nile delta region of Egypt,
parts of Turkey, and some foci in the Far East (Japan, Central and Southern
China and Philippines)

Intestinal bilharziosis: The bilharziosis parasites (schistosoma) are sanguinary, minute flat
worms to be found in great quantities in blood vessels of the abdomen. Five of the species are
pathogenic for humans. The initial clinical manifestations of the disease, which they give rise
to, Schistosomiasis, are either cystic or intestinal. Other organs are invaded by the eggs of
these worms, the liver and the spleen being privileged targets.Known since very ancient times
and widespread in the tropics, where it affects some 300 million individuals, Schistosomiasis
figures among the most virulent epidemics in sub-Saharan Africa, the West Indies and South
East Asia.

Intestinal nematodes: Roundworms

The nematodes or roundworms (Phylum Nematoda) are one of the most common phyla of
animals, with over 80,000 different described species (over 15,000 are parasitic).
Parasitic forms often have quite complicated life cycles, moving between several different
hosts or locations in the host’s body. Infection occurs variously by eating uncooked meat with
larvae in it, by entrance into unprotected cuts or directly through the skin, by transfer via
blood-sucking insects, and so forth.
However, it can be difficult to find some of these species in a stool sample.
Instead these roundworms can be collected seperately with sticky tape from the anus area.
They tend to migrate out of the anus over night and can be collected from there in the
These are highly infectious and strict hygiene has to be observed.
Ascaris lumbricoides: (Roundworm) Infections with these parasites are more common
where sanitation is poor and human feces are used as fertilizer.
Enterobius vermicularis: Human pinworm, also known as threadworm.
The pinworm lives in the lower part of the small intestine, and the upper part of the
colon. It is found worldwide and causes the common infection enterobiasis in humans.
It is frequent in children. Unlike many other intestinal parasites, the pinworm does not
usually enter the bloodstream or any other organs besides the intestines. Only in rare
cases disoriented pinworms can be found in the vagina, and even more rarely in the
uterus, fallopian tubes, liver and peritoneum; but the worms cannot survive long in
these places.
Except for itching, pinworm infestation does not usually cause any damage to the
body. Sleep disturbance may arise from the itching or crawling sensations.
(For this worm a sticky tape sample from the anus is required.)
Strongyloides stercoralis: human parasitic roundworm causing the disease of strongyloidiasis.
Ternidens deminutus: The nematode Ternidens deminutus belongs to the Chabertiidae. The
parasite is related to Oesophagostomum sp. Infection is not infrequent, but only occurs
in specific areas. Its distribution includes Asia and Africa, chiefly in Zimbabwe. The
normal hosts are various monkeys.
Trichiuris trichiura: (Whipworm) Light infestations are frequently asymptomatic, heavy
infestations may have bloody diarrhea and long-standing blood loss may lead to irondeficiency
anemia. Whipworm commonly infects patients also infected with Giardia,
Entamoeba histolytica, Ascaris lumbricoides, and hookworms.
Trichinella spiralis: The small adult worms mature in the intestine of an intermediate host
such as a pig. Each adult female produces batches of live larvae, which bore through the
intestinal wall, enter the blood and lymphatic system, and are carried to striated muscle tissue.
Once in the muscle, they encyst, or become enclosed in a capsule.
Larvae encysted in the muscles remain viable for some time. When the muscle tissue is eaten
by a human, the cysts are digested in the stomach; the released larvae migrate to the intestine
to begin a new life cycle. Female trichina worms live about six weeks and in that time may
release larvae. The migration and encystment of larvae can cause fever, pain, and even death.
One of the classic signs of Trichinella spiralis infection is a combination of splinter
hemorrhages (not to be confused with those of bacterial endocarditis) and periorbital edema
(eye swelling). Trichina are classified in the phylum Nematoda.
Trichostrongylus species:
Black scour worms occur in all sheep production districts of Australia.
It can also be found as a gut nematode in the United Kingdom. On its own it would be
unusual to get high enough numbers to cause problems but the worm is sometimes found in
mixed infections with other worms.

Parasites which might be missed in a stool sample

Tape worms (cestodes)

When humans are the primary host, the adult cestode is limited to the intestinal tract. When
humans are the intermediate hosts, the larvae are within the tissues, migrating through the
different organ systems.
Many cestode infestations are asymptomatic at first. However, once symptoms occur, they are
usually vague GI complaints such as abdominal pain, anorexia, weight loss, or general
Unfortunately with intestinal tapeworms, the release of egg containing parts (proglottida) is
only intermittent. There might be samples without any traces. But the tapeworm parts can be
seen with the naked eye as little moving white worm like bits in the stool.
The stool has to be observed in case of a suspicion.
Diphyllobothrium latum : Fish tape worm
Taenia solium: Pig tape worm
Taenia saginata: Cattle tape worm
Dipylidium caninum: Cucumber tapeworm or the double-pore tapeworm,
Vampirolepsis nana: Vampirolepis nana, the mouse tapeworm, is the most common cestode
in humans especially children. Domestic mice and rats can serve as definitive hosts for
V. nana.
Hymenolepsis diminuta: Hymenolepsis diminuta is primarily a tapeworm of rodents. Humans
are infected following the accidental ingestion of arthropods containing the
cysticercoid stage of the parasite.

Rare tape worms:

Mesocestoides: Humans can experience severe diarrhoea with intestinal infections
Raillietina celebensis: (no common name)
Inermicapsifer madagascariensis: Cestode often seen as human infection in Cuba in children
1 –3 years old; causes vague intestinal symptoms; suspected arthropod vector; proglottids,
eggs, and egg capsules resemble those of Raillietina spp.

Lactose Intolerance

A widespread cause for digestive problems.

Extract from an article by Christiane Pies, MSc (Translated from German by Ute Marie Allison)
A case: Jane M. has been suffering from recurring digestion problems for years. Repeatedly she gets diarrhoea, sometimes accompanied by vertigo or nausea. Then she has periods when she feels fine again, but all of a sudden her problems can reoccur. Her diarrhoea attacks restrict her in her daily activities and she feels worse each year. After many years she hears about the phenomenon of milk intolerance and simply leaves out all dairy products. This improves her symptoms to a certain degree. Now she develops a profound interest in the subject and realises that lactose, the carbohydrate in milk, is not only contained in dairy but also in a lot of convenience food and even some medication. After that she also eliminates these products from her diet and her symptoms disappear completely.

Lactose and Lactase

People with lactose intolerance either cannot digest lactose (milk sugar) from food sources properly or not at all. This is caused by a lack of the enzyme lactase. Lactose is a disaccharide, which is composed of the monosaccharides galactose and glucose. Lactose represents the most important carbohydrate in the milk of mammals and the respective concentration depends on the species. Lactose is of crucial importance in nutrition and especially for babies. It is the most important energy source during the first years of a baby’s life. It makes sure that the physiological gut flora can develop and that the calcium in milk can be best utilised by the body. In the food industry lactose also plays an important role. Due to its chemical and technological properties lactose is frequently used in the production of industrial food products like baked products, sweets, meat preparations like pates, low fat foods, convenience foods, spice mixtures and artificial sweeteners. Lactose works as a binder and a carrier for aroma substances. It ensures a better firmness and a higher volume. A lot of medication also contains lactose as a filler or for taste correction. To enable absorption by the body the disaccharide has to be split into its two monosaccharides. Lactase is the necessary enzyme, which can split the ß-glycosidic bond between galactose and glucose. A lack of lactase is the world’s most frequent ‘enzyme deficiency’. About two thirds of the world’s human population loose the ability to split lactose after weaning – as do most mammals. Interestingly there is a characteristic North-South gradient. In Scandinavia only 3-8% of the population show a loss of lactase after weaning. In Germany about 13-14% and in Austria about 20% of the population is lactose intolerant. However, this number is on the increase through the rising number of immigrants from the Mediterranean. In the Mediterranean the percentage of the population with lactose intolerance is rising to about 70%, and in Africa close to the equator about 98% of the population show lactose mal-digestion.

Symptoms of Lactose Intolerance

Diarrhoea/Diarrhoea like problems (These problems can occur as early as 15-30 minutes after the lactose containing meal, a few hours later or even in the morning of the following day.)
mushy stool tummy rumbling
bloating vomiting
constipation wind
feeling sick after food tummy ache
belching colic like pain
Non-specific complaints
chronic tiredness joint pain
depressive moods restlessness
subjective feeling ill nausea
headache exhaustion
nervousness feeling low
feeling tense sleep problems
skin impurities lack of concentration
deficiency symptoms fatigue
(from Schleip, Laktoseintoleranz, Trias-Verlag)


In former times lactose intolerance was diagnosed by a lactose tolerance test. Before and after a provocation meal of 50g lactose (in children 2 g/kg, maximum of 50g) blood was taken to measure blood glucose. If there was an increase of blood glucose of over 20 mg/dl in two hours, it was assumed that sufficient lactose had been split and absorbed. Today this lactose intolerance test has been widely replaced by the H2 breath test in which the hydrogen concentration is measured before and after a provocation meal with 25g lactose (in children 1g/kg, maximum 25g). If there is an increase in H2 concentration by more than 20 ppm above the basal reading, it can be assumed that enough lactose has been metabolised. Both methods can lead to severe symptoms in lactose intolerant patients.
A gene test is a new detection method.
Only recently the genetic cause for the lactose intolerance was discovered. At the location 13910 before the lactase gene (LCT) there is a polymorphism, which determines the quantity of lactase produced. By testing the LCT genotype the genetic disposition can be determined. Our gene test is performed from a simple swab of the mouth mucosa inside the cheek. Epithelial cells stick to the cotton bud. The investigation is done on their cell nuclei.

Christiane Pies, MSc
Head of Science
Dr. Hauss Laboratory
Kieler Str. 71
24340 Eckernförde

What is Candida?

In our intestines we have about 500 different species of micro-organisms, mostly bacteria. Usually bacteria are thought to be the bad guys which make us ill, but in fact we need these tiny tenants to keep food bugs and upset stomachs at bay and to produce a number of useful substances for our health. These good guys are called “the intestinal flora”. There are also fungi among them. These can be yeasts, similar to the ones we know for baking bread or making wine or moulds similar to the tasty ones, which make cheeses. Or they can be the black stuff which causes food to ferment and decay. Usually their numbers are small.

Candida is a kind of yeast, a tiny single celled organism, which in normal circumstances is a harmless part of our intestinal flora. However, sometimes when we are not so fit these Candida yeasts can develop the ability to get nasty, grow into large numbers and cause symptoms.

There is more than just Candida

Candida is a much used general term. Usually it refers to Candida albicans. Yet there are many more species like Candida parapsilosis, or glabrata. Sometimes symptoms can also be caused by moulds like Aspergillus niger or Geotrichum (milkmould). It is essential therefore to know which of these many possibilities is the cause of the problem, and that is why an accurate analysis is needed before treatment should begin.

Why do we get Candida?

Usually our own friendly bacteria keep fungi in our intestines at bay. Just sometimes our little helpers are weakened, for example by treatments with antibiotics, cortisone, hormones, other drugs or too much sugar in our diet, or our immune system is weak for some reason. In this case the fungi can cause symptoms rapidly.

Isn’t Candida Harmless?

I’ve heard that “Candida is harmless.”
All practitioners will have heard the argument that candida needs no treatment as it is harmless and everybody has it. This is only partially correct. Candida is indeed a harmless symbiont in everybody’s intestinal flora – providing the number is low and the fungus metabolises only carbohydrates.
If, however, the conditions for the fungus become too advantageous, these microbes can perform what is called a metabolic switching. This means they can produce a protein digesting enzyme which enables them to cling to the intestinal walls whereupon their number will increase greatly and no diet will get rid of them.
This is why BTS provides you with a full cell count and an enzyme analysis to identify the scale of problem your patient has.

Candida Symptoms

Typical symptoms of a Candida infection
When an uncontrolled overgrowth of Candida or other fungi occurs in the intestinal tract, we can get many and sometimes seemingly unrelated symptoms. The most common is heavy bloating, especially after eating. Diarrhoea or constipation may also be part of the picture; frequently these alternate. Nausea and acid regurgitation can be present as well as extreme tiredness, lethargy, sweet craving, depression, allergies, recurrent colds, eczema, palpitations, recurrent vaginal thrush, recurrent cystitis and many more.

Why does Candida cause all these symptoms?
Once Candida or other fungi have managed to overgrow our healthy intestinal flora, they usually develop the ability to cling to our intestinal walls, which makes them very persistent. An important part of our immune system is located in our intestines. Here the white blood cells get trained to distinguish bad from good and then they migrate to distant parts of the body to do their work. The fungal overgrowth can irritate this system heavily and may cause the immune system to react allergically to different substances, especially foods. The local irritation can also cause the ”tight junctions” between the gut wall cells to become leaky (Leaky Gut Syndrome), so that incompletely digested food molecules can slip into the blood stream and also cause allergic reactions. In addition to this the fungi give off gas and toxins, especially when they are well fed. The gas results in heavy bloating, especially after a meal rich in carbohydrates, and the toxins stress the liver and nervous system, thus causing the chronic tiredness.


Candida is not always the culprit
Even if you think you clearly recognise your own problems in this description, fungi may not be the cause at all. These symptoms can also be caused by something completely different. A safe diagnosis is essential; otherwise you could waste money and possibly loose valuable time by “barking up the wrong tree”.

The safe diagnosis
Micro-organisms are far too small to be seen by the naked eye and even if they are grown in a dense layer, completely different kinds can look alike. That is why the only safe way to diagnose intestinal Candida is a stool analysis in a specialised micro-biological laboratory. Our diagnoses are done by a German laboratory, which has many years of experience and performs regular research on the subject. This laboratory will not only identify the exact species of fungus but also investigate if it is a harmless or an invasive kind.

Can a diet kill Candida?

Often the advice is given to treat Candida overgrowth with a strict sugar and carbohydrate free diet. As these fungi live on sugar and carbohydrates the diet will certainly reduce the number of cells but in most cases it can’t reverse the fungi’s ability to cling to the intestinal walls. So Candida will use its fungal ability to rest when it is starved and start replicating again when its food supply gets better. In extreme cases of carbohydrate deficiency the fungi can even switch to protein digestion, leaving us with an impossible dietary challenge.

Candida Treatment

After a safe diagnosis the detected fungus should be treated with an appropriate naturopathic anti-fungal remedy, an appropriate diet, and proper hygiene measures and anti-relapse precautions have to be taken.