Abstract
Detection of intestinal parasites from fecal samples is routinely performed by direct wet mount examination. This method requires skilled personnel, and it is time consuming. The aim of this work is to demonstrate the usefulness of the newer automated urinary sediment analyser sediMAX 2 for a fast detection of intestinal protozoa in stool samples. A total of 700 consecutively preserved samples consisting of 70 positives and 630 negatives were analyzed. SediMAX 2 takes digital images of each sediment sample, and analysis was conducted using a dilution of stool specimens, allowing determination of typical morphology. Compared to manual microscopy, sediMAX 2 showed sensitivity and specificity of 100 % in the detection of intestinal parasites, as also recently demonstrated for sediMAX 1. However, all clinically important human protozoa were detected using only 15 images for each specimen, compared to 30 images required in sediMAX 1 analysis. Moreover, changing manually the focus, it is possible to carry out a discrimination between morphologically identical Entamoeba complex members, including the pathogenic E. histolytica and the non-pathogenic E. dispar, E. moshkovskii and E. Bangladeshi, from the non-pathogenic Entamoeba coli based on the number of nuclei present in the cells. This study presents sediMAX 2 as an automatic aid to traditional microscopy.
References
Okhuysen PC, White AC (1999) Parasitic infections of the intestine. Curr Opin Infect Dis 12:467–472
Petri WA, Haque R, Lyerly D, Vines RR (2000) Estimating the impact of amebiasis on health. Parasitol Today 16:320–321
Davis AN, Haque R, Petri WA (2002) Update on protozoan parasites of the intestine. Curr Opin Gastroenterol 18:10–14
Haque R (2007) Human intestinal parasites. J Health Popul Nutr 25:387–391
Jones KE et al (2008) Global trends in emerging infectious diseases. Nature 451:990–993
Fletcher SM, Stark D, Harkness J, Ellis J (2012) Enteric protozoa in the developed world: a public health perspective. Clin Microbiol Rev 25:420–429
Khanna V, Tilak K, Rasheed S, Mukhopadhyay C (2014) Identification and preservation of intestinal parasites using methylene blue-glycerol mount: a new approach to stool microscopy. J Parasitol Res 672018. doi:10.1155/2014/672018
McHardy IH, Wu M, Shimizu-Cohen R, Couturier MR, Humphries RM (2014) Detection of intestinal protozoa in clinical laboratory. J Clin Microbiol 52:712–720
Stark D, Al-Qassab SE, Barratt JL, Stanley K, Roberts T, Marriott D, Harkness J, Ellis JT (2011) Evaluation of multiplex tandem real-time PCR for detection of Cryptosporidium spp., Dientamoeba fragilis, Entamoeba histolytica, and Giardia intestinalis in clinical stool samples. J Clin Microbiol 49(1):257–262
Kurt Ö, Doğruman Al F, Tanyüksel M (2016) Eradication of Blastocystis in humans: really necessary for all? Parasitol Int. doi:10.1016/j.parint.2016.01.010
Garcia LS (2009) Practical guide to diagnostic parasitology, 2nd edn. ASM Press, Washington DC
Branda JA, Lin TY, Rosenberg ES, Halpern EF, Ferraro MJ (2006) A rational approach to the stool ova and parasite examination. Clin Infect Dis 42(7):972–978
Yansouni CP, Merckx J, Libman MD, Ndao M (2014) Recent advances in clinical parasitology diagnostics. Curr Infect Dis Rep 16:434–442
Nazer H, Greer W, Donnelly K, Mohamed AE, Yaish H, Kagalwalla A, Pavillard R (1993) The need for three stool specimens in routine laboratory examinations for intestinal parasites. Br J Clin Pract 47:76–78
Hiatt RA, Markell EK, Ng E (1995) How many stool examinations are necessary to detect pathogenic intestinal protozoa? Am J Trop Med Hyg 53:36–39
Stark D, Roberts T, Ellis JT, Marriott D, Harkness J (2014) Evaluation of the EasyScreen™ enteric parasite detection kit for the detection of Blastocystis spp., Cryptosporidium spp., Dientamoeba fragilis, Entamoeba complex, and Giardia intestinalis from clinical stool samples. Diagn Microbiol Infect Dis 78(2):149–152
Zaman Z, Fogazzi GB, Garigali G, Croci MD, Bayer G, Kranicz T (2010) Urine sediment analysis: analytical and diagnostic performance of sediMAX® - a new automated microscopy image-based urine sediment analyzer. Clin Chim Acta 411:147–154
Intra J, Taverna E, Sala MR, Falbo R, Cappellini F, Brambilla P (2016) Detection of intestinal parasites by use of the cuvette-based automated microscopy analyser sediMAX®. Clin Microbiol Infect 22(3):279–284
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 bases for use in Schaudinn fixative. J Clin Microbiol 17:1092–1095
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 31:307–310
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 36:1974–1976
Pietrzak-Johnston SM, Bishop H, Wahlquist S, Moura H, Da Silva ND, Nguyen-Dihn P (2000) Evaluation of commercially available preservatives for laboratory detection of helminths and protozoa in human fecal specimens. J Clin Microbiol 38:1959–1964
Stephan C, Wesseling S, Schink T, Jung K (2003) Comparison of eight computer programs for receiver-operating characteristic analysis. Clin Chem 49:433–439
CLSI (2005) Procedures for the recovery and identification of parasites from the intestinal tract; approved guideline-Second edition. CLSI Document M28-A2. Clinical and Laboratory Standards Institute, Wayne
Koltas IS, Akyar I, Elgun G, Kocagoz T (2014) Feconomics®: a new and more convenient method, the routine diagnosis of intestinal parasitic infections. Parasitol Res 113(7):2503–2508
Kehl KC, Cicirello H, Havens PL (1995) Comparison of four different methods for the detection of Cryptosporidium species. J Clin Microbiol 33:416–418
Garcia LS, Shimizu RY (1997) Evaluation of nine immunoassays kits (enzyme immunoassay and direct fluorescence) for detection of Giardia lamblia and Cryptosporidium parvum in human fecal specimens. J Clin Microbiol 35:1526–1529
Acknowledgments
We gratefully acknowledge Colombo Laura, Savarino Cinzia, Santambrogio Marco, and Caimi Silvio of Desio Hospital for technical support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No specific funding was used for this research.
Conflict of interest
The authors declare that they have no competing interests.
Ethical approval
This article did not contain any studies with human participants and/or animals.
Informed consent
Not applicable.
Rights and permissions
About this article
Cite this article
Intra, J., Sala, M.R., Falbo, R. et al. Improvement in the detection of enteric protozoa from clinical stool samples using the automated urine sediment analyzer sediMAX® 2 compared to sediMAX® 1. Eur J Clin Microbiol Infect Dis 36, 147–151 (2017). https://doi.org/10.1007/s10096-016-2788-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-016-2788-4