Test Details
Methodology
Formalin concentrate and trichrome stain
Result Turnaround Time
3 - 7 days
Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.
Test Includes
Concentration of material and examination of specimen for ova and parasites by conventional iodine/saline and trichrome staining. This will not detect Cryptosporidium, Cyclospora cayetanensis, or Microsporidium.
Use
Establish the diagnosis of parasitic infestation
Special Instructions
Include any pertinent clinical and travel history on the test request form, which must indicate special request for Cyclospora Smear, Stool [183145] — at an additional charge. If Schistosoma haematobium infection is suspected, submit a urine specimen for Ova and Parasites Examination, Urine [008629]. See test for submission instructions.
Limitations
One negative result does not rule out the possibility of parasitic infestation. Stool examination for Giardia may be negative in early stages of infection, in patients who shed organisms cyclically, and in chronic infections.1 The sensitivity of microscopic methods for the detection of Giardia range from 46% to 95%.2 Tests for Giardia antigen may have a higher yield.3
Contraindications
Footnotes
References
Custom Additional Information
Amebas and certain other parasites cannot be seen in stools containing barium. Amebic cysts, Giardia cysts, and helminth eggs are often recovered from formed stools. Mushy or liquid stools (either normally passed or obtained by purgation) often yield trophozoites. Purgation does not enhance the yield of Giardia. Formalin will preserve protozoan cysts and larvae and the eggs of helminths. It is used for concentration procedures. PVA will preserve the trophozoite stage of protozoa. A trichrome-stained smear may be prepared from PVA-fixed material. PVA cannot be concentrated; therefore, they should always be accompanied by a portion of the specimen in formalin.
Parasites commonly identified in the stool of AIDS patients include Cryptosporidium, Isospora, Entamoeba histolytica, and Giardia lamblia.
The pathogenic nature of Blastocystis hominis, which is commonly observed in stool of healthy and symptomatic patients, is controversial. A review of the literature by Miller and Minshew indicated that there was no convincing proof of a causal relationship between B hominis and symptoms, that there was no correlation between resolution of symptoms with therapy or with the disappearance of the organism from stool, and that treatment directed at the indication of B hominis is not indicated.4
Doyle et al have observed a role for Blastocystis in acute and chronic gastroenteritis but are unable to conclude whether the role is one of association or causation.5
In a large children's hospital study of nosocomial diarrhea rotavirus, C difficile and enteric adenovirus were recovered. Stool for ova and parasites and bacterial stool cultures yielded no pathogens.6 Optimal diagnostic yield is obtained by the examination of fresh, warm stool by an experienced technologist. Formalin will preserve protozoan cysts and larvae and the eggs of helminths. It is used for concentration procedures. PVA will preserve the trophozoite stage of protozoa. A trichrome-stained smear may be prepared from PVA-fixed material. Specimens submitted in PVA cannot be concentrated; therefore, they should always be accompanied by a portion of the specimen in formalin. Formed stools may be preserved in formalin or refrigerated in a secure container until they can be added to the formalin and PVA container for transport to the laboratory.
Specimen Requirements
Specimen
Sputum or feces
Volume
3 to 4 mL sputum or 5 mL feces
Minimum Volume
3 mL (Note: This volume does not allow for repeat testing.)
Container
O & P transport container with formalin and PVA (Para-Pak® pink and gray)
Collection Instructions
Sputum: If paragonimiasis or echinococcosis is suspected, submit specimen in 10% formalin.
Feces: Submit in a parasite preservative kit. Please inoculate both the PVA and the formalin tubes. Fresh feces should not be submitted. State the preliminary diagnosis.
Other: Contact the laboratory for specific instructions.
All: Multiple specimens may be necessary to recover ova or trophozoites. Three specimens are recommended (each is charged).
Fecal specimens for parasitic examination should be collected before initiation of antidiarrheal therapy or antiparasitic therapy. The highest yield on hospitalized patients occurs when diarrhea is present on admission or within 72 hours of admission. The onset of diarrhea more than 72 hours after admission is usually caused by Clostridium difficile toxin rather than parasites or the usual stool pathogens. The following recommendations are made for efficient and cost-effective diagnosis of diarrheal disease in patients admitted with gastroenteritis.
• Submit one or two specimens per diarrheal illness immediately. Consider requesting the EIA for Giardia (see Giardia lamblia, Direct Detection EIA [182204] or Giardia lamblia, EIA and Ova and Parasites Examination [188110]) if that is the primary suspected organism.
• If those are negative, submit an additional specimen after five days.
• Patients who are immunocompromised by AIDS, malignancy, or immunosuppressive therapy may require additional testing for unusual stool pathogens (eg, Cyclospora Smear, Stool [183145]).
Reference Range
No parasites seen
Storage Instructions
Maintain specimen at room temperature.
Patient Preparation
Usual aseptic technique
Causes for Rejection
Because parasite morphology will not be preserved, specimens sent on diaper or tissue paper are not acceptable to the laboratory because of risk to lab personnel. Grossly leaking specimens may not be processed. Specimen containing interfering substances (eg, castor oil, bismuth, Metamucil®, barium specimens delayed in transit and those contaminated with urine) will not have optimal yield; unlabeled specimen or name discrepancy between specimen and test request label; expired transport device; specimen not received in O & P preservative transport containers with formalin and PVA.
LOINC® Map
| Order Code | Order Code Name | Order Loinc | Result Code | Result Code Name | UofM | Result LOINC |
|---|---|---|---|---|---|---|
| 008623 | Ova + Parasite Exam | 673-4 | 008623 | Ova + Parasite Exam | 673-4 | |
| Order Code | 008623 | |||||
| Order Code Name | Ova + Parasite Exam | |||||
| Order Loinc | 673-4 | |||||
| Result Code | 008623 | |||||
| Result Code Name | Ova + Parasite Exam | |||||
| UofM | ||||||
| Result LOINC | 673-4 |
| Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
|---|---|---|---|---|---|---|
| Reflex 1 | 080013 | Result | 080014 | Result 1 | 10701-1 | |
| Reflex 1 | ||||||
| Order Code | 080013 | |||||
| Order Name | Result | |||||
| Result Code | 080014 | |||||
| Result Name | Result 1 | |||||
| UofM | ||||||
| Result LOINC | 10701-1 | |||||
| Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
|---|---|---|---|---|---|---|
| Reflex 1 | 080013 | Result | 080015 | Result 2 | 10701-1 | |
| Reflex 1 | ||||||
| Order Code | 080013 | |||||
| Order Name | Result | |||||
| Result Code | 080015 | |||||
| Result Name | Result 2 | |||||
| UofM | ||||||
| Result LOINC | 10701-1 | |||||
| Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
|---|---|---|---|---|---|---|
| Reflex 1 | 080013 | Result | 080016 | Result 3 | 10701-1 | |
| Reflex 1 | ||||||
| Order Code | 080013 | |||||
| Order Name | Result | |||||
| Result Code | 080016 | |||||
| Result Name | Result 3 | |||||
| UofM | ||||||
| Result LOINC | 10701-1 | |||||
| Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
|---|---|---|---|---|---|---|
| Reflex 1 | 080013 | Result | 080017 | Result 4 | 10701-1 | |
| Reflex 1 | ||||||
| Order Code | 080013 | |||||
| Order Name | Result | |||||
| Result Code | 080017 | |||||
| Result Name | Result 4 | |||||
| UofM | ||||||
| Result LOINC | 10701-1 | |||||
| Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
|---|---|---|---|---|---|---|
| Reflex 1 | 080013 | Result | 080018 | Antimicrobial Susceptibility | 10701-1 | |
| Reflex 1 | ||||||
| Order Code | 080013 | |||||
| Order Name | Result | |||||
| Result Code | 080018 | |||||
| Result Name | Antimicrobial Susceptibility | |||||
| UofM | ||||||
| Result LOINC | 10701-1 | |||||