Introduction to Fecalysis • Stool samples from therapy should be
• The normal fecal specimen contains collected prior to therapy or not until 5 – 7
bacteria, cellulose, undigested foodstuffs, days
GI secretions, bile pigments, cells from the • Patient taking antibiotics or malarial
intestinal walls, electrolytes, and water. medication should be delayed for 2 weeks
• Approximately 100 to 200 g of feces is following therapy
excreted in a 24-hour period
STOOL CONTAINER
O & P (Ova and Parasite) • Clean, watertight with tight fitting lid
• Common procedure performed in the area • 2 – 5 grams acceptable amount size of
of parasitology walnut
• Ova refers to egg stage • Urine must not contaminated the stool
• Parasite refers to morphologic forms • Labeled properly
• Fecal Sample Collection and Transport • Patient’s name
• Random samples used for cultures, ova and • Date and time of collection
parasites (O&P), microscopic examination • Identification number
for cells, fats and fibers, and detection of • Physician’s name
blood are collected in cardboard containers • Wear PPE’s
with wax-coated interiors or plastic • Biohazard hoods should be used in
containers with wide openings and screw- Laboratory
capped tops similar to those used for urine • Fresh specimen must be processed
samples. immediately to demonstrate the motility of
• Containers with preservatives may be protozoan trophozoites (within 30 minutes)
required for certain microbiology tests, • Semiformed specimens yield mixture of
including ova and parasites, and can be protozoan cyst and trophozoites
kept at room temperature.
• Kits containing reagent-impregnated filter Fixative For Preservation
paper are provided to screen for the • Substances that preserve the morphology of
presence of occult (hidden) blood. protozoa and prevent further development
• For quantitative testing, such as for fecal of certain helminth eggs and larvae.
fats and urobilinogen, timed samples are • Ratio of fixative to stool is important for the
required. successful recovery of parasites
• Large paint can–style or plastic hat–style • 3 parts of fixative to one part of stool
containers are used for collection of 72-hour • Formalin
samples for fecal fats. • POLYVINYL ALCOHOL
• Samples must be refrigerated during the • SODIUM ACETATE FORMALIN
collection time. • MODIFIED POLYVINYL ALCOHOL
• Containers that contain preservatives for
O&P must not be used to collect samples PROCESSING
for other tests. • MACROSCOPIC
• For purposes of safety, the outside of the • Check for gross abnormalities
container must not be contaminated. • Must received fresh, unpreserved stool
• Parasite are often shed multiple specimen
specimens are recommended • Notation of the gross appearance in the
• Collection protocol consist of 3 specimens actual specimen container or requisition
in 10 days form is recommended if the specimen has
• Amebiasis 6 specimens in 14 days is already a fixative
acceptable • Degree of moisture serve as an indication of
the types of potential parasite present
• Liquid stool—trophozoites SEDIMENTATION – concentrates on the sediment
• Formed stool – cysts of the tube
• Liquid or formed stool – helminths egg and FLOTATION – parasites are less dense than the
larvae solution used and float in the surface
• Color of the stool serves as an indication of Most experts recommend sedimentation technique
the condition of the patient because of more efficient and easier to perform
• Gross abnormalities adult worm, accurately
proglottids pus and mucus Chemical Testing of Feces
DUODENAL MATERIAL
May be collected by nasogastric intubation or by
Enteric capsule test (Enterotest)
MICROSCOPIC Giardia intestinalis trophozoites, Cryptosporidium
Examinations of stool for ova and parasites spp, Isospora belli, Strongyloides stercoralis and
Direct wet preparation ( preps) eggs of Fasciola hepatica or Clonorchis sinensis
Concentrated technique (concentrated wet preps) Duodenal fluid. If volume of fluid is >2ml, sediments
Permanently stained smear must be used
If stool with fixative concentrate and stained Enterotest using swallows a gelatin capsule that
smear are performed contains a coiled length of yarn. The capsule
DIRECT WET PREPARATION dissolves in the stomach and weighted string is
Aka direct wet mount carried to the duodenum.
Slide made by mixing a small portion of unfixed SIGMOIDOSCOPY MATERIALS
stool with saline or iodine for examination Colon, helpful for detecting E. histolytica
DIRECT IODINE PREPARATION Ulcers obtained by aspiration or scrapings should
To enhance detail of protozoan cyst be examined by direct wet prep and permanent
Using Lugol’s or D’ Antonis formula stains
CONCENTRATION METHODS Colon biopsy material
Provides the ability to detect small numbers of CELLOPHANE TAPE PREPARATION
parasites that might not be detected using direct Detection of Enterobius vermicularis eggs
wet preps Also evidence support the use of this technique for
To aggregate parasites present into a small volume the recovery of Taenia spp. Eggs
of the sample and to remove as much debris The specimen be collected in the morning before
Can be performed on fresh or preserved stool the patient washes or defecates
To detect protozoan cysts, oocysts, helminth eggs CULTURE METHODS
and larvae Not common means of detecting parasites
Protozoan trophozoite do not usually survive the Not usually performed in a routine laboratory
procedure ANIMAL INOCULATION AND XENODIAGNOSIS
2 types Sedimentation and Flotation Certain parasites have host specificity and require
Uses differences in specific gravity and particular animals
centrifugation
Xenodiagnosis is a technique used for the
diagnosis of Chagas’ disease an uninfected
reduviid bug is allowed to take a blood meal from
the patient and the bug’s feces is then examined to
observed for the presence of T. cruzi. This
procedure is primarily used in South America and
Mexico
REPORTING OF RESULTS AND QUALITY
CONTROL
Once the analytic phase of testing is completed, the
results are interpreted and reported.
The Post Analytic Phase of Laboratory Testing
State the scientific name (genus and species) along
with the stage that is present
The presence of certain cells should be reported
The quality assurance of parasitology is consistent
with the parameters of the Microbiology Laboratory
Procedure manuals must be up to date and readily
available
REPORTING OF RESULTS AND QUALITY
CONTROL
Reagents and solutions must be properly labeled
Controls must be included in concentration and
staining techniques
Centrifuges and ocular micrometers must be
calibrated
Refrigerator and incubator temperatures must be
recorded.
Action plans must be documented for anything
found to be out of control
The parasitology laboratory must have references
available for training and continuing education of
personnel.
