Extended parasite screening with additional SIBO & intestinal permeability assessment

Clinical overview

THE PARASITE BOX – XL includes all analyses performed in THE PARASITE BOX – LARGE, and extends the diagnostic scope with functional gut testing for SIBO and intestinal permeability (Leaky Gut) as well as with a test for 7 UTIs, of which a few are very rarely tested for by the NHS.

In addition to identifying parasitic, viral and bacterial pathogens, the XL box provides insight into small intestinal bacterial overgrowth and gut barrier integrity, which may contribute to chronic or recurrent gastrointestinal symptoms.

Analytical methods

• Microscopy for helminths and unicellular parasites
• Real-time PCR for protozoa, viruses and pathogenic bacteria
• Urine test PCR – for 7 different UTIs
• Urine-based biomarkers for SIBO and intestinal permeability (XL exclusive)

Sample material & turnaround time

• Sample material: Stool sample + urine sample
• PCR results: Typically available within 24–48 hours
• Microscopy results: 5–14 business days

All testing is performed at an EU-based accredited laboratory.

Parasitological analysis – Microscopy

(Identical to THE PARASITE BOX – LARGE) + H Pylori

Parasitological analysis – Microscopy

Roundworms (Nematodes)

• Ancylostoma duodenale (Hookworm) *
• Ascaris lumbricoides (Human roundworm) *
• Enterobius vermicularis (Pinworm) *
• Strongyloides stercoralis (Strongyloides)
• Trichuris trichiura (Whipworm) *
• Necator Americanus
• Ancylostoma ceylanicum *
• Ancylostoma braziliense *
• Ancylostoma caninum *
• Ancylostoma tubaeforme  *
• Uncinaria stenocephala  *
• Others

Tapeworms (Cestodes)

• Dipylidium caninum (Dog tapeworm)
• Diphyllobothrium latum (Broad fish tapeworm) *
• Hymenolepis nana (Dwarf tapeworm)
• Taenia saginata (Beef tapeworm / Unarmed tapeworm)
• Taenia solium (Pork tapeworm / Armed tapeworm) *
• Hymenolepis Diminuta
• Rodentolepis nana
• Echinococcus granulossus  *
• Others

Flukes (Trematodes)

• Fasciolopsis buski (Intestinal fluke)
• Fasciola hepatica (Large liver fluke) *
• Opisthorchis viverrini (Liver fluke) *
• Schistosoma haematobium (Blood fluke) *
• Schistosoma Mansoni *
• Opistorchis Felineus
• Dicrocoelium dendriticum
• Clonorchis sinensis
• Paragonimus westermani
• Paragonimus africanus
• Paragonimus mexicanus
• Others

(* we have optional PCR analysis available for extra cost)

Unicellular parasites (Protozoa)

Microscopy and/or PCR detection of:

• Blastocystis (microscopy and PCR included)
• Dientamoeba fragilis (microscopy and PCR included)
• Giardia lamblia (microscopy and PCR included)
• Cryptosporidium (microscopy and PCR included)
• Entamoeba histolytica / dispar (microscopy and PCR included for Histolytica)
• Cyclospora cayetanensis (microscopy and PCR included)
• Entamoeba Hartmanni
• Entamöba Polecki
• Entamoeba coli
• Chilomastix Mesnili
• Endolimax Nana (non pathogenic)
• Iodamöba Butschii
• Cystoisospora Belli
• Sarcocystis Hominis
• Others

Broad-spectrum PCR – Viruses & bacteria

Viruses

• Sapovirus
  • GI
  • GII
  • GIV
  • GV
• Adenovirus
• Astrovirus
• Norovirus
  • GI
  • GII
• Rotavirus A

Pathogenic bacteria

Gram-positive:

• Clostridium difficile
  • Toxin A
  • Toxin B
  • Binary toxin

Gram-negative:

• Plesiomonas shigelloides
• Salmonella spp.
• Campylobacter spp.
• Vibrio parahaemolyticus
• Vibrio cholerae
• Vibrio vulnificus
• Shigella / Enteroinvasive E. coli (EIEC)
• Enteroaggregative E. coli (EAEC)
• Shiga toxin-producing E. coli (STEC)
• Enteropathogenic E. coli (EPEC)
• Enterotoxigenic E. coli (ETEC)
• Yersinia enterocolitica

H Pylori test – Antigen

UTIs:

A test for 7 Sexually Transmittable Diseases and Infections – all in a single urine sample.

This analysis is for the following infections:

• Ureaplasma Parvum
• Ureaplasma Urealyticum
• Mycoplasma Hominis
• Mycoplasma Genitalium
• Trichomonas Vaginalis
• Chlamydhia
• Gonorrhea

Gut health & functional testing – XL exclusive

In addition to standard stool-based gut health markers, THE PARASITE BOX – XL includes:

SIBO assessment

• A highly specific urinary biomarker associated with bacterial overgrowth in the small intestine
  • Hexahydrocurcumin (HHC)

Intestinal permeability (Leaky Gut)

• A validated urinary marker reflecting gut barrier integrity
  • lactulose (LAC) – not to be confused with lactose (milk sugar) – to assess intestinal permeability is a well-established method in both medical research and clinical practice. Under normal conditions, only a very small amount of ingested lactulose passes through the lining of the small intestine. However, if a larger amount of lactulose is detected in the urine, this indicates that the intestinal barrier function is compromised – a condition commonly referred to as “leaky gut” (increased intestinal permeability)

Systemic Stress

• TMAO
  • TMAO (trimethylamine-N-oxide) is a bacterial metabolite formed when gut bacteria metabolize choline, carnitine; nutrients primarily obtained from meat, fish, eggs, and legumes. In research, TMAO levels are used to study the composition of the microbiome, and several studies have associated elevated TMAO with the presence of bacteria in the small intestine (SIBO). Scientific publications also describe statistical associations between increased TMAO levels and intestinal permeability (“leaky gut”)

This functional testing adds clinically relevant information in patients with symptoms such as bloating, chronic diarrhoea, malabsorption or treatment-resistant gastrointestinal complaints.

Medical support & add-ons

As with the Large box, a free digital consultation is included in the event of a confirmed tapeworm infection. Additional PCR and antibody-based tests can be added where clinically appropriate.

Clinical indication

THE PARASITE BOX – XL is recommended for patients requiring both extensive pathogen screening and functional gut assessment, particularly in complex or long-standing cases.