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Chapter 2 : Collection, Preservation, and Shipment of Fecal Specimens

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Collection, Preservation, and Shipment of Fecal Specimens, Page 1 of 2

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Abstract:

  • Safety
  • Fresh-specimen collection
    • Collection of the specimen
    • Number of specimens to be collected (standard recommendation)
    • Number of specimens to be collected (pros and cons of various options)
    • Collection times
    • Specimen type, specimen stability, and need for preservation
  • Preservation of specimens
    • Preservatives
      • Formalin
      • MIF
      • SAF
      • Schaudinn's fluid
      • Schaudinn's fluid containing PVA (mercury base)
      • Schaudinn's fluid containing PVA (copper base, zinc base)
      • Single-vial collection systems (other than SAF)
      • Universal Fixative (TOTAL-FIX)
    • Use of fixatives
      • Quality control for stool fixatives
      • Procedure notes for use of preservatives
      • Procedure limitations for use of preservatives
  • Shipment of diagnostic specimens, biological products, etiologic agents, or infectious substances
    • Documentation

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Figures

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Figure 2.1

Stool collection vial; “clean vial” contains no fixatives. doi:10.1128/9781555819002.ch2.f2.1

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.2
Figure 2.2

Increased detection of by using various diagnostic techniques and serial stool specimens. (Adapted by Markell EK, Voge M, John DT, 1992, , 7th ed., The W. B. Saunders Co., Philadelphia, PA, from and , with permission.) doi:10.1128/9781555819002.ch2.f2.2

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.3
Figure 2.3

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 ( ). doi:10.1128/9781555819002.ch2.f2.3

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.4
Figure 2.4

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. doi:10.1128/9781555819002.ch2.f2.4

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.5
Figure 2.5

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. doi:10.1128/9781555819002.ch2.f2.5

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.6
Figure 2.6

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. doi:10.1128/9781555819002.ch2.f2.6

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.7
Figure 2.7

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. doi:10.1128/9781555819002.ch2.f2.7

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.8
Figure 2.8

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. doi:10.1128/9781555819002.ch2.f2.8

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.9
Figure 2.9

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. doi:10.1128/9781555819002.ch2.f2.9

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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Image of Figure 2.10
Figure 2.10

TOTAL-FIX is a single-vial collection system; the fixative contains no mercury, no formalin, and no PVA. It is considered a Universal Fixative and can be used for concentrations, permanent stained smears, fecal immunoassays, special stains, and some molecular methods. doi:10.1128/9781555819002.ch2.f2.10

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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References

/content/book/10.1128/9781555819002.garcia.ch02
1. Clinical and Laboratory Standards Institute. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved guideline M28–2A. Clinical and Laboratory Standards Institute, Villanova, PA.
2. Garcia LS. 2009. Practical Guide to Diagnostic Medical Parasitology, 2nd ed. ASM Press, Washington, DC.
3. McVicar JW,, Suen J,. 1994. Packaging and shipping biological materials, p. 239246. In Fleming DO,, Richardson JH,, Tulis JJ,, Vesley D (ed), Laboratory Safety: Principles and Practices, 2nd ed. ASM Press, Washington, DC.
4. Code of Federal Regulations. 1991. Occupational exposure to bloodborne pathogens. Fed Regist, 29CFR1910.1030.
5. Sapero JJ,, Lawless DK. 1942. The MIF stain-preservation technique for the identification of intestinal protozoa. Am J Trop Med Hyg 2:613619.
6. Garcia LS,, Voge M. 1980. Diagnostic clinical parasitology. I. Proper specimen collection and processing. Am J Med Technol 46:459467.
7. Cartwright CP. 1999. Utility of multiple-stool-specimen ova and parasite examinations in a high-prevalence setting. J Clin Microbiol 37:24082411.
8. Chan RJ,, Chen J,, York MK,, Setijono N,, Kaplan RL,, Graham F,, Tanowitz HB. 2000. Evaluation of a combination rapid immunoassay for detection of Giardia and Cryptosporidium antigens. J Clin Microbiol 38:393394.
9. Church D,, Miller K,, Lichtenfeld A,, Semeniuk H,, Kirkham B,, Laupland K,, Elsayed S. 2005. Screening for Giardia/Cryptosporidium infections using an enzyme immunoassay in a centralized regional microbiology laboratory. Arch Pathol Lab Med 129:754759.
10. Garcia LS,, Shimizu RY. 1997. Evaluation of nine immunoassay kits (enzyme immunoassay and direct fluorescence) for detection of Giardia lamblia and Cryptosporidium parvum in human fecal specimens. J Clin Microbiol 35:15261529.
11. Garcia LS,, Shimizu RY. 1998. Evaluation of intestinal protozoan morphology in human fecal specimens preserved in EcoFix: comparison of Wheatley's Trichrome stain and EcoStain. J Clin Microbiol 36:19741976.
12. Garcia LS,, Shimizu RY. 1999. Detection of Giardia lamblia and Cryptosporidium parvum antigens in human fecal specimens using the ColorPAC combination rapid solid-phase qualitative immunochromatographic assay. J Clin Microbiol 38:12671268.
13. Garcia LS,, Shimizu RY,, Bernard CN. 2000. Detection of Giardia lamblia, Entamoeba histolytica/E dispar, and Cryptosporidium parvum antigens in human fecal specimens using the EIA triage parasite panel enzyme immunoassay. J Clin Microbiol 38:33373340.
14. Haque R,, Ali IKM,, Akther S,, Petri WA. 1998. Comparison of PCR, isoenzyme analysis, and antigen detection for diagnosis of Entamoeba histolytica infection. J Clin Microbiol 36:449452.
15. Isenberg HD (ed). 2004. Clinical Microbiology Procedures Handbook, 2nd ed. ASM Press, Washington, DC.
16. Isenberg HD (ed). 1995. Essential Procedures for Clinical Microbiology. American Society for Microbiology, Washington, DC.
17. Lincicome DR. 1942. Fluctuation in numbers of cysts of Entamoeba histolytica and Entamoeba coli in the stools of rhesus monkeys. Am J Hyg 36:321337.
18. Melvin DM, Brooke MM. 1982. Laboratory Procedures for the Diagnosis of Intestinal Parasites, 3rd ed. U.S. Department of Health, Education, and Welfare publication (CDC) 82–8282. Government Printing Office, Washington, DC.
19. Sawitz WG,, Faust EC. 1942. The probability of detecting intestinal protozoa by successive stool examinations. Am J Trop Med 22:131136.
20. Scholten TH,, Yang J. 1974. Evaluation of unpreserved and preserved stools for the detection and identification of intestinal parasites. Am J Clin Pathol 62:563567.
21. Yang J,, Scholten T. 1977. A fixative for intestinal parasites permitting the use of concentration and permanent staining procedures. Am J Clin Pathol 67:300304.
22. Zimmerman SK,, Needham CA. 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.
23. Hiatt RA,, Markell EK,, Ng E. 1995. How many stool examinations are necessary to detect pathogenic intestinal protozoa? Am J Trop Med Hyg 53:3639.
24. Jones JL,, Lopez A,, Washquist SP,, Nadle J,, Wilson M, the Emerging Infections Program FoodNet Working Group. 2004. Survey of clinical laboratory practices for parasitic diseases. Clin Infect Dis 38:S198S202.
25. Garcia LS,, Smith JW,, Fritsche TR,. 2003. Cumitech 30A, Selection and use of laboratory procedures for diagnosis of parasitic infections of the gastrointestinal tract. Coordinating ed, Garcia LS. ASM Press, Washington, DC.
26. Garcia LS,, Brewer TC,, Bruckner DA. 1979. A comparison of the formalin-ether concentration and trichrome-stained smear methods for the recovery and identification of intestinal protozoa. Am J Med Technol 45:932935.
27. Dunn FL. 1968. The TIF direct smear as an epidemiological tool, with special reference to counting helminth eggs. Bull WHO 39:439449.
28. Brooke MM,, Goldman M. 1949. Polyvinyl alcohol-fixative as a preservative and adhesive for protozoa in dysenteric stools and other liquid material. J Lab Clin Med 34:15541560.
29. Garcia LS,, Shimizu RY,, Brewer TC,, Bruckner DA. 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.
30. Horen WP. 1981. Modification of Schaudinn fixative. J Clin Microbiol 13:204205.
31. Garcia LS,, Shimizu RY,, Shum A,, Bruckner DA. 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.
32. Garcia LS (ed). 2010. Clinical Microbiology Procedures Handbook, 3rd ed. ASM Press, Washington, DC.
33. International Air Transport Association (IATA). 2013. Dangerous Goods Regulations, 54th Ed., Montreal, Canada. http://www.iata.org/publications/dgr/Pages/manuals.aspx (accessed 4/17/13)
34. Gray LD,, Snyder JW. ASM Laboratory Protocol Working Group. 2011. Sentinel Laboratory Guidelines for Suspected Agents of Bioterrorism and Emerging Infectious Diseases: Packing and Shipping Infectious Substances. American Society for Microbiology, Washington, DC. http://www.asm.org/images/pdf/Clinical/pack-ship-7-15-2011.pdf (accessed 3/12/15).
35. Kehl KSC. 1996. Screening Stools for Giardia and Cryptosporidium: are antigen tests enough? Clin Microbiol Newsl 18:133135.
36. Morris AJ,, Wilson ML,, Reller LB. 1992. Application of rejection criteria for stool ovum and parasite examinations. J Clin Microbiol 30:32133216.
37. Siegel DL,, Edelstein PH,, Nachamkin I. 1990. Inappropriate testing for diarrheal diseases in the hospital. JAMA 263:979982.

Tables

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TABLE 2.1

Fecal specimens for parasites: options for collection and processing

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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TABLE 2.2

Approaches to stool parasitology: test ordering

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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TABLE 2.3

Stool collection: pros and cons of fresh and preserved specimens

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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TABLE 2.4

Preservatives used in diagnostic parasitology (stool specimens)

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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SUMMARY: Formalin

SUMMARY: Formalin

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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SUMMARY: MIF

SUMMARY: MIF

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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SUMMARY: SAF

SUMMARY: SAF

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
Generic image for table
SUMMARY: Schaudinn's fluid

SUMMARY: Schaudinn's fluid

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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SUMMARY: Schaudinn's fluid containing PVA (mercury base)

SUMMARY: Schaudinn's fluid containing PVA (mercury base)

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
Generic image for table
SUMMARY: Schaudinn's fluid containing PVA (copper base, zinc base)

SUMMARY: Schaudinn's fluid containing PVA (copper base, zinc base)

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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SUMMARY: Single-vial collection systems (other than SAF)

SUMMARY: Single-vial collection systems (other than SAF)

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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SUMMARY: Universal Fixative (TOTAL-FIX)

SUMMARY: Universal Fixative (TOTAL-FIX)

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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TABLE 2.5

Agencies governing transportation of dangerous goods

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2
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TABLE 2.6

Definitions of relevant terms for packing and shipping

Citation: Garcia L. 2016. Collection, Preservation, and Shipment of Fecal Specimens, p 6-25. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch2

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