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Chapter 9.2 : Collection and Preservation of Fecal Specimens

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Abstract:

One of the most important steps in the diagnosis of intestinal parasites is the proper collection of specimens ( ). Improperly collected specimens can result in inaccurate results. Fresh specimens are mandatory for the recovery of motile trophozoites. However, unless strict collection and delivery times are adhered to, the specimen may have little value for diagnostic testing.

Citation: Garcia L. 2010. Collection and Preservation of Fecal Specimens, p 544-558. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.2
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References

/content/book/10.1128/9781555817435.chap9.2
1. Garcia, L. S. 2007. Diagnostic Medical Parasitology, 5th ed. ASM Press, Washington, DC.
2. Garcia, L. S. 2009. Practical Guide to Diagnostic Parasitology, 2nd ed. ASM Press, Washington, DC.
3. Melvin, D. M.,, and M. M. Brooke. 1985. Laboratory Procedures for the Diagnosis of Intestinal Parasites, p. 163189. U.S. Department of Health, Education, and Welfare publication no. (CDC) 85-8282. U.S. Government Printing Office, Washington, DC.
4.NCCLS. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved guideline M28-A2. NCCLS, Wayne, PA.
1. Garcia, L. S. 2007. Diagnostic Medical Parasitology, 5th ed. ASM Press, Washington, DC.
2. Garcia, L. S. 2009. Practical Guide to Dignostic Parasitology, 2nd ed. ASM Press, Washington, DC.
3. Melvin, D. M.,, and M. M. Brooke. 1985. Laboratory Procedures for the Diagnosis of Intestinal Parasites, p. 163189. U.S. Department of Health, Education, and Welfare publication no. (CDC) 85-8282. U.S. Government Printing Office, Washington, DC.
4.NCCLS. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved guideline M28-A2. NCCLS, Wayne, PA.
1. Garcia, L. S. 2007. Diagnostic Medical Parasitology, 5th ed. ASM Press, Washington, DC.
2. Garcia, L. S. 2009. Practical Guide to Diagnostic Parasitology, 2nd ed. ASM Press, Washington, DC.
3. Garcia, L. S.,, R. Y. Shimizu,, T. C. Brewer,, and D. A. Bruckner. 1983. Evaluation of intestinal parasite morphology in polyvinyl alcohol preservative: comparison of copper sulfate and mercuric chloride base for use in Schaudinn's fixative. J. Clin. Microbiol. 17:10921095.
4. Garcia, L. S.,, R. Y. Shimizu,, A. Shum,, and D. A. Bruckner. 1993. Evaluation of intestinal protozoan morphology in polyvinyl alcohol preservative: comparison of zinc sulfate-and mercuric chloride-based compounds for use in Schaudinn's fixative. J. Clin. Microbiol. 31:307310.
5. Horen, W. P. 1981. Modification of Schaudinn's fixative. J. Clin. Microbiol. 13:204205.
6. Isenberg, H. D.(ed.). 1998. Essential Procedures for Clinical Microbiology. ASM Press, Washington, DC.
7. Melvin, D. M.,, and M. M. Brooke. 1985. Laboratory Procedures for the Diagnosis of Intestinal Parasites, p. 163189. U.S. Department of Health, Education, and Welfare publication no. (CDC) 85-8282. U.S. Government Printing Office, Washington, DC.
8.NCCLS. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved guideline M28-A2. NCCLS, Wayne, PA.
9. Scholten, T. H.,, and J. Yang. 1974. Evaluation of unpreserved and preserved stools for the detection and identification of intestinal parasites. Am. J. Clin. Pathol. 62:563567.
1. Garcia, L. S. 2007. Diagnostic Medical Parasitology, 5th ed. ASM Press, Washington, DC.
2. McVicar, J. W.,, and J. Suen,. 1995. Packaging and shipping biological materials, p. 239. In D. O. Fleming,, J. H. Richardson,, J. J. Tulis,, and D. Vesley (ed.), Laboratory Safety: Principles and Practices, 2nd ed. ASM Press, Washington, DC.
3.World Health Organization. 1997. Guidelines for the safe transport of infectious specimens and diagnostic specimens. World Health Organization, Geneva, Switzerland.

Tables

Generic image for table

Fecal specimens for parasites: options for collection

O&P, ovum and parasite; FA, fluorescent-antibody immunoassay. See the following references:

1999. Utility of multiple stool specimen ova and parasite examinations in a high-prevalence setting. . 2408–2411.

1995. How many stool examinations are necessary to detect pathogenic intestinal protozoa? 36–39.

1996. Screening stools for are antigen tests enough? 133–135.

1992. Application of rejection criteria for stool ovum and parasite examinations. 3213–3216.

1990. Inappropriate testing for diarrheal diseases in the hospital. 979–982.

See in particular the first two references listed above.

See table below. Regarding ordering recommendations for routine O&P examinations or fecal immunoassays, it is difficult to know when you may be in an early outbreak situation where testing of all specimens for spp., or both may be relevant. Extensive efforts are under way to encourage communication among laboratories, water companies, pharmacies, and public health officials regarding the identification of potential or actual outbreaks. If it appears that an outbreak is in the early stages, then performing the immunoassays on request can be changed to testing all stools.

Citation: Garcia L. 2010. Collection and Preservation of Fecal Specimens, p 544-558. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.2
Generic image for table

Fecal specimens for parasites: options for collection

O&P, ovum and parasite; FA, fluorescent-antibody immunoassay. See the following references:

1999. Utility of multiple stool specimen ova and parasite examinations in a high-prevalence setting. . 2408–2411.

1995. How many stool examinations are necessary to detect pathogenic intestinal protozoa? 36–39.

1996. Screening stools for are antigen tests enough? 133–135.

1992. Application of rejection criteria for stool ovum and parasite examinations. 3213–3216.

1990. Inappropriate testing for diarrheal diseases in the hospital. 979–982.

See in particular the first two references listed above.

See table below. Regarding ordering recommendations for routine O&P examinations or fecal immunoassays, it is difficult to know when you may be in an early outbreak situation where testing of all specimens for spp., or both may be relevant. Extensive efforts are under way to encourage communication among laboratories, water companies, pharmacies, and public health officials regarding the identification of potential or actual outbreaks. If it appears that an outbreak is in the early stages, then performing the immunoassays on request can be changed to testing all stools.

Citation: Garcia L. 2010. Collection and Preservation of Fecal Specimens, p 544-558. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.2
Generic image for table

Approaches to stool parasitology: test orderinga

For abbreviations, see footnote above.

Depending on the particular immunoassay kit used, various single or multiple organisms may be included. Selection of a particular kit depends on many variables: clinical relevance, cost, ease of performance, training, personnel availability, number of test orders, training of physician clients, sensitivity, specificity, equipment, time to result, etc. Very few laboratories handle this type of testing exactly the same. Many options are clinically relevant and acceptable for good patient care. It is critical that the laboratory report indicate specifically which organisms could be identified using the kit; a negative report should list the organisms relevant to that particular kit. .

Citation: Garcia L. 2010. Collection and Preservation of Fecal Specimens, p 544-558. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.2
Generic image for table

Preservatives used in diagnostic parasitology (stool specimens)

See references , and .

This fixative uses the mercuric chloride base in the Schaudinn's fluid; this formulation is still considered the “gold standard,” against which all other fixatives are evaluated (organism morphology after permanent staining). Additional fixatives prepared with non-mercuric chloride-based compounds are used; however, the overall organism morphology is not as good.

This modification uses a copper sulfate base rather than mercuric chloride.

This modification uses a zinc base rather than mercuric chloride and works well with both trichrome and iron hematoxylin stains.

These modifications use a combination of ingredients (including zinc) but are prepared from proprietary formulas and may or may not contain PVA. The aim is to provide a fixative that can be used for the fecal concentration, permanent stained smear, and available immunoassays for , spp., and (or the / group). Universal fixatives do not contain formalin, PVA, or mercury compounds (concentration, permanent stain, fecal immunoassays). However, fresh/frozen specimens are still required for testing or the / group.

ND, no data.

Citation: Garcia L. 2010. Collection and Preservation of Fecal Specimens, p 544-558. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.2

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