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Chapter 26 : Collection, Preservation, and Shipment of Fecal Specimens

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Abstract:

This chapter discusses various collection methods that are available for specimens suspected of containing parasites or parasitic elements. When a laboratory selects its collection methods, the decision should be based on a thorough understanding of the value and limitations of each. One of the most important aspects of specimen collection is that the final laboratory results based on parasite recovery and identification will depend on the initial fixation of the organisms. Procedures for the recovery of intestinal parasites should always be performed before barium is used for radiological examination. There are several fixatives available; the more common ones, including formalin, merthiolate (thimerosal)-iodine-formalin (MIF), sodium acetate-acetic acid-formalin (SAF), Schaudinn's fluid, polyvinyl alcohol (PVA), and the single-vial systems are discussed in the chapter. Regardless of the fixative selected, adequate mixing of the specimen and preservative is mandatory. Fixatives for fecal specimens are checked for quality control by the manufacturer before sale, generally with the use of living protozoa. Double mailing containers should be used in shipping any parasitologic specimens other than microscope slides. The inner container is an aluminum screw-cap mailing tube that fits into an outer cardboard screw-cap mailing container. For all packages containing infectious substances, an itemized list of contents must be enclosed between the secondary packaging and the outer packaging.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26

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Giardia lamblia
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Hepatitis C virus
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Figures

Image of Figure 26.1
Figure 26.1

Stool collection vial; “clean vial” contains no fixatives.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.2
Figure 26.2

Increased detection of by using various diagnostic techniques and serial stool specimens. (Adapted by E. K. Markell, M. Voge, and D. T. John, , 7th ed., The W. B. Saunders Co., Philadelphia, Pa., 1992, from references , and .)

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.3
Figure 26.3

Flow diagram for preservation and processing of stool specimens. As mentioned in the text, the examination of fecal specimens using the ova and parasite examination is not considered complete unless a concentration and a permanent stained smear are examined for every specimen submitted to the laboratory. For a fresh specimen, a direct wet mount should be performed if the specimen is very soft to liquid; the complete ova and parasite examination would include the direct wet mount, the concentration, and the permanent stained smear. If the specimen is submitted in preservative, the direct wet mount should be eliminated (no motility is possible); the complete ova and parasite examination would include the concentration and the permanent stained smear ( ).

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.4
Figure 26.4

Stool collection vial containing 10% formalin; note the “FILL LINE” and the poison signs at each side of the label. When the stool specimen is added to the vial, the final ratio of stool to preservative is about 1:3.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.5
Figure 26.5

Stool collection vials, one containing SAF fixative and the other containing Z-PVA, one of the non-mercury-based fixatives. This combination of collection vials is an excellent option; concentrations and fecal immunoassays can be performed from the SAF vial, while the permanent stained smear can be performed from the Z-PVA vial. If the laboratory is going to use the iron-hematoxylin permanent stain, the permanent smear for staining could also be prepared from the SAF vial.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.6
Figure 26.6

Albumin used to precoat the slide prior to the application of SAF-fixed stool concentration sediment. Once the smear is dry, it is ready for permanent staining.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.7
Figure 26.7

ECOFIX is an example of a fixative that represents the single-vial collection system. This fixative has been coupled with its own stain, the ECOSTAIN ( ). Remember to inquire about the compatibility of all single-vial systems with the immunoassay procedures; not all single-vial preservatives are compatible with all fecal immunoassays.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.8
Figure 26.8

ProtoFix is a single-vial collection option. It is always important to review peer-reviewed literature regarding the results of new products compared with those previously in use.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Image of Figure 26.9
Figure 26.9

UNIFIX is a single-vial collection system; information on this product can be found at the company website (www.med-chem.com). This fixative works well with trichrome stain.

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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References

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50. Yang, J.,, and T. Scholten. 1977. A fixative for intestinal parasites permitting the use of concentration and permanent staining procedures. Am. J. Clin. Pathol. 67:300304.
51. Zimmerman, S. K.,, and C. A. Needham. 1995. Comparison of conventional stool concentration and preserved-smear methods with Merifluor Cryptosporidium/Giardia direct immunofluorescence assay and ProSpecT Giardia EZ microplate assay for detection of Giardia lamblia. J. Clin. Microbiol. 33:19421943.

Tables

Generic image for table
Table 26.1

Fecal specimens for parasites: options for collection and processing

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Table 26.2

Approaches to stool parasitology: test ordering

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
Generic image for table
Table 26.3

Stool collection: pros and cons of fresh and preserved specimens

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Table 26.4

Preservatives used in diagnostic parasitology (stool specimens)

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Formalin: summary

Formalin: summary

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
Generic image for table
MIF: summary

MIF: summary

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
Generic image for table
SAF: summary

SAF: summary

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
Generic image for table
Schaudinn’s fluid: summary

Schaudinn’s fluid: summary

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
Generic image for table
PVA: summary

PVA: summary

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
Generic image for table
Modified PVA: summary

Modified PVA: summary

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Single-vial systems: summary

Single-vial systems: summary

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Table 26.5

Agencies governing transportation of dangerous goods

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Table 26.6

Definitions of relevant terms for packing and shipping

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
Generic image for table
Table 26.7

Comparison of packing directions for exempt human specimens and IATA packing instructions 650 and 602

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26
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Table 26.8

Changes in IATA requirements effective 2 June 2006 (relevant for parasitology)

Citation: Garcia L. 2007. Collection, Preservation, and Shipment of Fecal Specimens, p 761-781. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch26

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