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Chapter 3.8 : Fecal and Other Gastrointestinal Cultures and Toxin Assays

Author: Dylan R. Pillai
Content Type: Reference
Publication Year: 2016

Category: Clinical Microbiology

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Abstract:

Gastroenteritis can be caused by bacteria, parasites, or viruses. With such a wide array of pathogens and the need for cost containment, physician input and practice guidelines ( ) can help the laboratory determine which tests are appropriate for detecting the etiological agent of diarrhea. Microbiology laboratories should review the local epidemiology of bacterial enterocolitis and implement routine stool culture methods that will allow recovery and detection of all of the major pathogens causing most of the cases in their geographic area. All microbiology laboratories should routinely test for the presence of spp., spp., and spp. on all stool cultures. Other major pathogens, such as Shiga toxin-producing , particularly O157 or enterohemorrhagic (EHEC), should also be routinely tested for on bloody stool samples during the spring, summer, and early fall months in geographic areas where the prevalence of these strains has been shown to be increased. Microbiology laboratories situated in or near coastal communities may also test for and spp. since the prevalence of these types of infections is increased with exposure to water or contaminated food such as shellfish.

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
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Fecal and Other Gastrointestinal Cultures and Toxin Assays
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Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.fig3.8.1-1
Figure 3.8.1–1
Flowchart for the identification of oxidase-positive stool pathogens from BAP or from either TCBS or CIN. Most are also indole positive. Biochemical reactions for species identification are available for many commercial kits. Growth on TCBS implies that the organism is a sp., but not all spp. grow on TCBS. Abbreviations: MH, Mueller-Hinton agar; ID, identification; K, alkaline; A, acid; r/o, rule out.
10.1128/9781555818814/fig3.8.1-1_thmb.gif
10.1128/9781555818814/fig3.8.1-1.gif
Image of Figure 3.8.1–1
Figure 3.8.1–1

Flowchart for the identification of oxidase-positive stool pathogens from BAP or from either TCBS or CIN. Most are also indole positive. Biochemical reactions for species identification are available for many commercial kits. Growth on TCBS implies that the organism is a sp., but not all spp. grow on TCBS. Abbreviations: MH, Mueller-Hinton agar; ID, identification; K, alkaline; A, acid; r/o, rule out.

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
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/content/10.1128/9781555818814.chap3.8.fig3.8.1-2
Figure 3.8.1–2
Flowchart for identification of stool pathogens from routine stool cultures. Set up either TSI or KIA, BAP, and urea agar (or rapid urea tube) from all lactose-negative or HS-positive colonies on enteric selective agars. Reactions of the slant are listed with a slash before the butt reaction. Optionally for HS-negative colonies, Andrade’s glucose tube with Durham tube for gas will eliminate most questionable production of gas and provide a broth for VP testing. r/o, rule out.
10.1128/9781555818814/fig3.8.1-2_thmb.gif
10.1128/9781555818814/fig3.8.1-2.gif
Image of Figure 3.8.1–2
Figure 3.8.1–2

Flowchart for identification of stool pathogens from routine stool cultures. Set up either TSI or KIA, BAP, and urea agar (or rapid urea tube) from all lactose-negative or HS-positive colonies on enteric selective agars. Reactions of the slant are listed with a slash before the butt reaction. Optionally for HS-negative colonies, Andrade’s glucose tube with Durham tube for gas will eliminate most questionable production of gas and provide a broth for VP testing. r/o, rule out.

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
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/content/10.1128/9781555818814.chap3.8.fig3.8.2-1
Figure 3.8.2–1
identification flowchat or minimum identification of from stool specimens. Abbreviations: R, no zone; S, zone.
10.1128/9781555818814/fig3.8.2-1_thmb.gif
10.1128/9781555818814/fig3.8.2-1.gif
Image of Figure 3.8.2–1
Figure 3.8.2–1

identification flowchat or minimum identification of from stool specimens. Abbreviations: R, no zone; S, zone.

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
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Tables

Fecal and Other Gastrointestinal Cultures and Toxin Assays
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Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.1-1
Table 3.8.1–1
Commonly used primary plating and broth media for isolation of and
Generic image for table
Table 3.8.1–1

Commonly used primary plating and broth media for isolation of and

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.1-2
Table 3.8.1–2
Special highly selective media for specific pathogen requests
Generic image for table
Table 3.8.1–2

Special highly selective media for specific pathogen requests

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.1-3
Table 3.8.1–3
QC of specialized media for detection of fecal pathogens
Generic image for table
Table 3.8.1–3

QC of specialized media for detection of fecal pathogens

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.1-4
Table 3.8.1–4
Microscopic and gross observations of fecal specimens associated with various infections
Generic image for table
Table 3.8.1–4

Microscopic and gross observations of fecal specimens associated with various infections

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.1-5
Table 3.8.1–5
Biochemical differentiation of selected members of the group
Generic image for table
Table 3.8.1–5

Biochemical differentiation of selected members of the group

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.1-6
Table 3.8.1–6
Summary of detection media and identification methods for fecal pathogens
Generic image for table
Table 3.8.1–6

Summary of detection media and identification methods for fecal pathogens

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.2-1
Table 3.8.2–1
Taxonomic position, known sources, and common disease associations of and related species
Generic image for table
Table 3.8.2–1

Taxonomic position, known sources, and common disease associations of and related species

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.2-2
Table 3.8.2–2
Human disease associations of species by clinical syndrome
Generic image for table
Table 3.8.2–2

Human disease associations of species by clinical syndrome

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.2-3
Table 3.8.2–3
Commercial systems for generating microaerobic environments and the approximate atmospheric content
Generic image for table
Table 3.8.2–3

Commercial systems for generating microaerobic environments and the approximate atmospheric content

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table3.8.2-4
Table 3.8.2–4
Phenotypic reactions of clinically important and species
Generic image for table
Table 3.8.2–4

Phenotypic reactions of clinically important and species

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table0004
Single wavelength
Single wavelength
Generic image for table
Single wavelength

Single wavelength

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table0005
Untitled
Generic image for table
Untitled

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8
/content/10.1128/9781555818814.chap3.8.table0006
Untitled
Generic image for table
Untitled

Citation: Pillai D. 2016. Fecal and Other Gastrointestinal Cultures and Toxin Assays, p 3.8.1.1-3.8.6.4. In Leber A (ed), Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch3.8

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