1887

Chapter 3 : Macroscopic and Microscopic Examination of Fecal Specimens

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $30.00

Preview this chapter:
Zoom in
Zoomout

Macroscopic and Microscopic Examination of Fecal Specimens, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555819002/9781555819002_ch3-1.gif /docserver/preview/fulltext/10.1128/9781555819002/9781555819002_ch3-2.gif

Abstract:

  • Macroscopic Examination
  • Microscopic Examination (Ova and Parasite Examination)
    • Direct wet smear
    • Concentration (sedimentation and flotation)
    • Permanent stained smear
  • Specialized Stains for Coccidia (, [], and Species) and the Microsporidia
    • Modified Kinyoun's acid-fast stain (cold method)
    • Modified Ziehl-Neelsen acid-fast stain (hot method)
    • Carbol fuchsin negative stain for (from W. L. Current)
    • Rapid safranin method for
    • Rapid safranin method for , using a microwave oven
    • Auramine O stain for coccidia (from Thomas Hänscheid)
    • Modified trichrome stain for the microsporidia (Weber—green)
    • Modified trichrome stain for the microsporidia (Ryan—blue)
    • Modified trichrome stain for the microsporidia (Kokoskin—hot method)
    • Acid-fast trichrome stain for and the microsporidia

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Image of Figure 3.1
Figure 3.1

Method of scanning direct wet film preparation with a 10× objective. Note that the entire coverslip preparation should be examined before indicating the examination is negative. (Illustration by Nobuko Kitamura.) Note: All methods contained in the figures can be found in . doi:10.1128/9781555819002.ch3.f1

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.2
Figure 3.2

Direct wet smear with saline. (Top row) () trophozoite (left), cyst (right); (second row) sp. (probably ) (left), spp. central body form (right); (third row) trophozoite (left), cyst (right); (fourth row) immature oocyst (left), cyst (right); (bottom row) cyst (left), cyst (right). doi:10.1128/9781555819002.ch3.f2

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.3
Figure 3.3

Direct wet smear with saline and iodine. (Top) cyst with saline (left), cyst with iodine (note chromatoidal bars with sharp ends) (right); (next row) egg in saline (left), egg with iodine added (right); (next row) cyst with saline (left), cyst with iodine (right); (bottom row) spp. in saline (left), spp. in iodine (right). Note that more detail can be seen once the iodine is added to the wet mount. Also, when iodine is used, the glycogen vacuole stains dark (brownish gold to brown) in the cysts and is clearly visible. doi:10.1128/9781555819002.ch3.f3

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.4
Figure 3.4

Commercially prepared D'Antoni's iodine; most commercial suppliers can provide this iodine solution. Do NOT USE Gram's iodine for the parasitology procedures. doi:10.1128/9781555819002.ch3.f4

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.5
Figure 3.5

Fecal concentration procedures: various layers seen in tubes after centrifugation. (A) Formalin-ether (or ethyl acetate). The sediment should be well mixed, and a drop of sediment should be examined using the 10× low-power objective and the 40× high dry power objective. (B) Zinc sulfate (the surface film should be within 2 to 3 mm of the tube rim). Material from both the surface film and the sediment must be examined before the specimen is indicated as negative. The amount of sediment should not be excessive in either the sedimentation or flotation procedure. Heavy or operculated helminth eggs do not float. (Illustration by Sharon Belkin.) doi:10.1128/9781555819002.ch3.f5

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.6
Figure 3.6

Sedimentation concentration. (Left) Unfertilized egg. (Right) egg. doi:10.1128/9781555819002.ch3.f6

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.7
Figure 3.7

Flotation concentration. (Upper) egg (left), egg (right). Note that both of these eggs in the top row are operculated and WILL NOT float in the zinc sulfate flotation concentration method; the opercula pop open, and the eggs fill with fluid and sink to the bottom of the tube. (Lower) Hookworm egg (left), egg (right). These eggs concentrate using the flotation method and can be seen in the surface film. However, remember that both the surface film and the sediment must be examined by this method before reporting the final ova and parasite examination results. doi:10.1128/9781555819002.ch3.f7

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.8
Figure 3.8

Method used to remove the surface film in the zinc sulfate flotation concentration procedure. (A) A wire loop is gently placed on (not under) the surface film. (B) The loop is then placed on a glass slide. (Illustration by Nobuko Kitamura.) doi:10.1128/9781555819002.ch3.f8

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.9
Figure 3.9

(Upper) FPC JUMBO large concentration tubes and connector system (Evergreen Scientific). (Lower) Small concentration tubes and FPC HYBRID connector system (Evergreen Scientific). doi:10.1128/9781555819002.ch3.f9

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.10
Figure 3.10

Stool collection vial and funnel used in fecal concentration (Hardy Diagnostics). doi:10.1128/9781555819002.ch3.f10

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.11
Figure 3.11

(Top) PARA-SED concentration system with both small and large tubes (Medical Chemical Corp.). (Middle) SED-CONNECT system with collection vials and various reagents (Medical Chemical Corp.). (Bottom) Filter attachment system (Medical Chemical Corp.). Note the screen, which is a substitute for the gauze in the traditional gauze/filter concentration method. See also MICRO-SED. doi:10.1128/9781555819002.ch3.f11

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.12
Figure 3.12

(Upper left) MACRO-CON concentration system (Meridian Bioscience). (Upper right) SPINCON concentration system (Meridian Bioscience). (Lower) Funnel used in fecal concentration (Meridian Bioscience). doi:10.1128/9781555819002.ch3.f12

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.13
Figure 3.13

Countertop workstation that automates the microscopic analysis of fecal concentrates (Apacor Ltd. USA, Brooklyn, NY). doi:10.1128/9781555819002.ch3.f13

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.14
Figure 3.14

Dual-flow-cell Optical Slide Assembly (Apacor Ltd USA, Brooklyn, NY) that fits into the stage clips of any standard upright microscope. doi:10.1128/9781555819002.ch3.f14

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.15
Figure 3.15

Work flow diagram for fecal specimens. The total examination includes the direct mount, concentrate, and permanent stained smear (fresh specimen) or the concentrate and permanent stained smear (preserved specimens). doi:10.1128/9781555819002.ch3.f15

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Algorithm 3.1
Algorithm 3.1

Method for the preparation of TOTAL-FIX-preserved fecal specimens (Universal Fixative) for the concentration, permanent stained smear, fecal immunoassays, and special stains for the coccidia and microsporidia. (a) This fixative contains NO mercury, NO formalin, and NO polyvinyl alcohol (PVA); use one-third stool and two-thirds fixative and MIX WELL. Allow 30 min prior to processing. (b) The EIA and rapid cartridge detect antigen; sample the clear fluid at the top of the vial containing the stool/fixative mixture. If the vial is shaken, make sure it stands on the counter for 5 to 10 min to allow the particulate material to settle out; work with the clear fluid only. (c) TOTAL-FIX has been tested with a number of molecular methods; however, there is no confirmation that the specimen will work with every possible available method. (d) Rinse fluids (water, saline, formalin) will PREVENT permanent stained smears from staining correctly; rinse fluids can ONLY be used for the final concentration step (after original sediment has been removed for permanent stained slide preparations—STEP 2). (e) Since the direct fluorescent antibody immunoassay (DFA) detects the actual cysts (rare trophozoites—much less intense fluorescence) and oocysts, this test sensitivity is enhanced if centrifuged sediment is used for testing; the same advantage is seen using modified acid-fast stains for (use sediment). Remember, do not use RINSED sediment, but sediment from the original centrifugation. (f) Examine entire 22-by-22-mm coverslip at low power (10× objective); examine one-third to one-half coverslip at high dry power (40× objective).

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.16
Figure 3.16

Trichrome staining. Option 1, for use with smears prepared from fixatives containing mercuric chloride. The iodine is used to remove the mercuric chloride, and the subsequent two alcohol rinse steps remove the iodine. Thus, prior to staining, both the mercuric chloride and iodine have been removed from the smear. Options 2 and 3, for use with smears prepared from fixatives containing no mercuric chloride (the user can select option 2 or 3; there is minimal to no difference). doi:10.1128/9781555819002.ch3.f16

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.17
Figure 3.17

Guess the identity of these intestinal protozoa! See p. 76 for the answers. doi:10.1128/9781555819002.ch3.f17

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.18
Figure 3.18

Intestinal protozoa (stained with Wheatley trichrome stain). Rows, from top to bottom (left and right), show trophozoite and ; trophozoite (note the ingested RBCs) and cyst; () trophozoite and cyst; trophozoite and cyst; and trophozoite and cyst. doi:10.1128/9781555819002.ch3.f18

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.19
Figure 3.19

Intestinal protozoa (preserved with TOTAL-FIX, stained with Wheatley trichrome stain). From top to bottom and left to right. Top row: (), 2 trophozoites, 2 cysts. Second row: (), 3 trophozoites, 1 cyst. Third row: , 3 trophozoites, 1 cyst. Note the nuclear variation in the three trophozoites (very common). Fourth row: , 3 trophozoites and 1 cyst. Fifth row: (3 trophozoites) and (1 trophozoite). doi:10.1128/9781555819002.ch3.f19

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.20
Figure 3.20

Intestinal protozoa stained with iron hematoxylin stain. (Top row) trophozoite (left), () cysts (right); (middle row) cyst (note the large glycogen vacuole) (left), trophozoite (note ingested RBCs) (right); (bottom row) cyst (note more than five nuclei) (left), cyst (right). doi:10.1128/9781555819002.ch3.f20

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.21
Figure 3.21

Iron hematoxylin stain incorporating the carbol fuchsin step. Note the modified acid-fast oocysts (4–6 μm) and the cyst. doi:10.1128/9781555819002.ch3.f21

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.22
Figure 3.22

Work flow diagram for fecal specimens (coccidia). The most important part of the procedure would be the concentrate ( sp.) and the permanent stained smear, using one of the modified acid-fast techniques ( and ). doi:10.1128/9781555819002.ch3.f22

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.23
Figure 3.23

Quality control slides for performing modified acid-fast stains ( and ) (Medical Chemical Corp.). doi:10.1128/9781555819002.ch3.f23

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.24
Figure 3.24

oocysts (8–10 μm). (Top) Autofluorescent oocysts; (bottom) oocysts stained with modified acid-fast stain. Note the range of color intensity; some oocysts resemble “wrinkled cellophane.” doi:10.1128/9781555819002.ch3.f24

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.25
Figure 3.25

(Left) (8 to 10 μm), (4 to 6 μm), and artifact (∼2 μm) stained with modified acid-fast stain. Note that one of the oocysts did not stain (modified acid-fast variable) and has the “wrinkled-cellophane” appearance, while the other oocyst displays the typical purple/red color; the oocyst and the artifact did stain modified acid-fast positive. These artifacts are frequently seen; it is very important to measure objects seen in the modified acid-fast smears to confirm that they are actual parasites and not artifacts. (Right) stained with a hot safranin stain (higher magnification than the image on the left). (Courtesy of CDC.) doi:10.1128/9781555819002.ch3.f25

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.26
Figure 3.26

(Upper) Immature oocyst stained with modified acid-fast stain. (Lower) immature oocyst (left) (note that the entire oocyst retains the stain) and mature oocyst containing two sporocysts (right). doi:10.1128/9781555819002.ch3.f26

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.27
Figure 3.27

spp. oocysts stained with auramine O fluorescent stain (using different filters). doi:10.1128/9781555819002.ch3.f27

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.28
Figure 3.28

(Left) Microsporidian spores in a nasopharyngeal specimen stained with a Ryan modified trichrome stain; (right) microsporidian spores in stool stained with a Weber modified trichrome stain. The spores range from about 1.5 to 2.0 μm in diameter. Note the horizontal lines, indicating the presence of a polar tubule. doi:10.1128/9781555819002.ch3.f28

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.29
Figure 3.29

(Left) Microsporidian spores in a urine sediment, stained with calcofluor white stain; (right) spores stained with an organism-specific fluorescent antibody reagent. Note that some of the spores are intracellular. A urine specimen tends to be “cleaner” than stool; therefore the spores may be easier to see and identify in urine or any specimen that contains less artifact material than stool. doi:10.1128/9781555819002.ch3.f29

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3.30
Figure 3.30

() oocyst and microsporidian spores in an acid-fast trichrome stain. Note the size differential. doi:10.1128/9781555819002.ch3.f30

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint

References

/content/book/10.1128/9781555819002.garcia.ch03
1. California State Department of Public Health Microbial Disease Laboratory. 1979. PARA-1A Revised. California State Department of Public Health, Sacramento.
2. Clinical and Laboratory Standards Institute. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved guideline M28-A2. Clinical and Laboratory Standards Institute, Villanova, PA.
3. Faust EC,, D'Antoni JS,, Odom V,, Miller MF,, Peres C,, Sawitz W,, Thomen LF,, Tobie J,, Walker JH. 1938. A critical study of clinical laboratory technics for the diagnosis of protozoan cysts and helminth eggs in feces. Am J Trop Med 18:169183.
4. Garcia L,, Brewer T,, Bruckner D. 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.
5. Garcia LS,. 1990. Laboratory methods for diagnosis of parasitic infections, p 776861. In Baron EJ,, Finegold SM (ed), Bailey & Scott's Diagnostic Microbiology, 8th ed. The C. V. Mosby Co., St. Louis, MO.
6. Gleason NN,, Healy GR. 1965. Modification and evaluation of Kohn's one-step staining technic for intestinal protozoa in feces or tissue. Am J Clin Pathol 43:494496.
7. Gomori G. 1950. A rapid one-step trichrome stain. Am J Clin Pathol 20:661663.
8. Kellogg JA,, Elder CJ. 1999. Justification for use of a single trichrome stain as the sole means for routine detection of intestinal parasites in concentrated stool specimens. J Clin Microbiol 37:835837.
9. Kohn J. 1960. A one stage permanent staining method for fecal protozoa. Dapim Refuiim Med Q Isr 19:160161.
10. Lawson LL,, Bailey JW,, Beeching NJ,, Gurgel RG,, Cuevas LE. 2004. The stool examination reports amoeba cysts: should you treat in the face of over diagnosis and lack of specificity of light microscopy? Trop Doct 34:2830.
11. Levine JA,, Estevez EG. 1983. Method for concentration of parasites from small amounts of feces. J Clin Microbiol 18:786788.
12. Markell EK,, Voge M. 1981. Medical Parasitology, 5th ed. The W. B. Saunders Co., Philadelphia, PA.
13. 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.
14. Miller JM,. 1991. Quality control of media, reagents, and stains, p. 12031225. In Balows A,, Hausler WJJr,, Herrmann KL,, Isenberg HD,, Shadomy HJ (ed.), Manual of Clinical Microbiology, 5th ed. American Society for Microbiology, Washington, DC.
15. Nair C. 1953. Rapid staining of intestinal amoebae on wet mounts. Nature (London) 172:1051.
16. Ritchie L. 1948. An ether sedimentation technique for routine stool examinations. Bull US Army Med Dept 8:326.
17. Shoaib S,, Hafiz A,, Tauheed S. 2002. Role of trichrome staining techniques in the diagnosis of intestinal parasitic infections. J Pak Med Assoc 52:152154.
18. Smith JW,, Bartlett MS,. 1985. Diagnostic parasitology: introduction and methods, p. 595611. In Lennette EH,, Balows A,, Hausler WJJr,, Shadomy HJ (ed.), Manual of Clinical Microbiology, 4th ed. American Society for Microbiology, Washington, DC.
19. Spencer FM,, Monroe LS. 1976. The Color Atlas of Intestinal Parasites, 2nd ed. Charles C Thomas, Publisher, Springfield, IL.
20. Tompkins VN,, Miller JK. 1947. Staining intestinal protozoa with iron-hematoxylin-phosphotungstic acid. Am J Clin Pathol 17:755758.
21. Truant AL,, Elliott SH,, Kelley MY,, Smith JH. 1981. Comparison of formalin-ethyl ether sedimentation, formalin-ethyl acetate sedimentation, and zinc sulfate flotation techniques for detection of intestinal parasites. J Clin Microbiol 13:882884.
22. Wheatley W. 1951. A rapid staining procedure for intestinal amoebae and flagellates. Am J Clin Pathol 21:990991.
23. Neimeister R,, Logan A,, Gerber B,, Egleton J,, Kleger B. 1987. Hemo-De as substitute for ethyl acetate in formalin-ethyl acetate concentration technique. J Clin Microbiol 25:425426.
24. Higgins GV. 1988. Iodine-trichrome staining technique: a replacement of iodine solution in fecal examination. Lab Med 19:824825.
25. Hanson KL,, Cartwright CP. 2001. Use of an enzyme immunoassay does not eliminate the need to analyze stool specimens for sensitive detection of Giardia lamblia. J Clin Microbiol 39:474477.
26. Morimoto N,, Komatsu C,, Nishida M,, Sugiura T. 2001. Detection of Giardia lamblia cysts in non-fixed long-term stored human feces by direct immunofluorescence assay. Jpn J Infect Dis 54:7274.
27. Fedorko DP,, Williams EC,, Nelson NA,, Mazyck TD,, Hanson KL,, Cartwright CP. 2000. Performance of Para-Pak Ultra ECOFIX compared with Para-Pak Ultra formalin/mercuric chloride-based polyvinyl alcohol for concentration and permanent stained smears of stool parasites. Diagn Microbiol Infect Dis 37:3739.
28. 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.
29. Garcia LS,, Shimizu RY,, Shum AC,, 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.
30. Ignatius R,, Lehmann M,, Miksits K,, Regnath T,, Arvand M,, Engelmann E,, Futh U,, Hahn H,, Wagner J. 1997. A new acid-fast trichrome stain for simultaneous detection of Cryptosporidium parvum and microsporidial species in stool specimens. J Clin Microbiol 35:446449.
31. Jensen B,, Kepley W,, Guarner J,, Anderson K,, Anderson D,, Clairmont J,, De L'aune W,, Austin EH,, Austin GE. 2000. Comparison of polyvinyl alcohol fixative with three less hazardous fixatives for detection and identification of intestinal parasites. J Clin Microbiol 38:15921598.
32. Pietrzak-Johnston SM,, Bishop H,, Wahlquist S,, Moura H,, De Oliveira N,, Da Silva,, Pereira Da Silva S,, Nguyen-Dinh P. 2000. Evaluation of commercially available preservatives for laboratory detection of helminths and protozoa in human fecal specimens. J Clin Microbiol 38:19591964.
33. Fayer R,, Ungar BLP. 1986. Cryptosporidium spp. and cryptosporidiosis. Microbiol Rev 50:458483.
34. Ma P,, Soave R. 1983. Three-step stool examination for cryptosporidiosis in 10 homosexual men with protracted watery diarrhea. J Infect Dis 147:824828.
35. Henriksen SA,, Pohlenz JFL. 1981. Staining cryptosporidia by a modified Ziehl-Neelsen technique. Acta Vet Scand 22:594596.
36. Baxby D,, Blundell N,, Hart C. 1984. The development and performance of a simple, sensitive method for the detection of Cryptosporidium oocysts in feces. J Hyg 93:317323.
37. Garcia L,, Bruckner D,, Brewer T,, Shimizu R. 1983. Techniques for the recovery and identification of Cryptosporidium oocysts from stool specimens. J Clin Microbiol 18:185190.
38. Kokoskin E,, Gyorkos TW,, Camus A,, Cedilotte L,, Purtill T,, Ward B. 1994. Modified technique for efficient detection of microsporidia. J Clin Microbiol 32:10741075.
39. Ryan NJ,, Sutherland G,, Coughlan K,, Globan M,, Doultree J,, Marshall J,, Baird RW,, Pedersen J,, Dwyer B. 1993. A new trichrome-blue stain for detection of microsporidial species in urine, stool, and nasopharyngeal specimens. J Clin Microbiol 31:32643269.
40. Visvesvara GS,, Moura H,, Kovacs-Nace E,, Wallace S,, Eberhard ML. 1997. Uniform staining of Cyclospora oocysts in fecal smears by a modified safranin technique with microwave heating. J Clin Microbiol 35:730733.
41. Weber R,, Bryan RT,, Owen RL,, Wilcox CM,, Gorelkin L,, Visvesvara GS, and The Enteric Opportunistic Infections Working Group. 1992. Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. N Engl J Med 326:161166.
42. Long EG,, Ebrahimzadeh A,, White EH,, Swisher B,, Callaway CS. 1990. Alga associated with diarrhea in patients with acquired immunodeficiency syndrome and in travelers. J Clin Microbiol 28:11011104.
43. Long EG,, White EH,, Carmichael WW,, Quinlish PM,, Raja R,, Swisher BL,, Daugharty H,, Cohen MT. 1991. Morphologic and staining characteristics of a cyanobacterium-like organism associated with diarrhea. J Infect Dis 164:199202.
44. Didier ES,, Orenstein JM,, Aldras A,, Bertucci D,, Rogers LB,, Janney FA. 1995. Comparison of three staining methods for detecting microsporidia in fluids. J Clin Microbiol 33:31383145.
45. Garcia LS,, Shimizu RY,, Bruckner DA. 1994. Detection of microsporidial spores in fecal specimens from patients diagnosed with cryptosporidiosis. J Clin Microbiol 32:17391741.
46. Ignatius R,, Henschel S,, Liesenfeld O,, Mansmann U,, Schmidt W,, Koppe S,, Schneider T,, Heise W,, Futh U,, Riecken EO,, Hahn H,, Ulrich R. 1997. Comparative evaluation of modified trichrome and Uvitex 2B stains for detection of low numbers of microsporidial spores in stool specimens. J Clin Microbiol 35:22662269.
47. Yang J,, Scholten TH. 1977. A fixative for intestinal parasites permitting the use of concentration and permanent staining procedures. Am J Clin Pathol 67:300304.
48. Garcia LS (ed). 2010. Clinical Microbiology Procedures Handbook, 3rd ed. ASM Press, Washington, DC.
49. Palmer J. 1991. Letter. Clin Microbiol Newsl 13:3940.

Tables

Generic image for table
Untitled

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Generic image for table
REVIEW Direct Smear

REVIEW Direct Smear

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Generic image for table
Untitled

REVIEW Concentration

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Generic image for table
Untitled

Permanent Stained Smears

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Generic image for table
Untitled

Quantitation of parasites, cells, yeasts, and artifacts

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Generic image for table
Modified Trichrome-Stained Smears

Modified Trichrome-Stained Smears

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Generic image for table
Untitled

Quantitation of parasites, cells, yeasts, and artifacts

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3
Generic image for table
Untitled

Modified Acid-Fast Smears

Citation: Garcia L. 2016. Macroscopic and Microscopic Examination of Fecal Specimens, p 26-76. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch3

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error