Internal Quality Assurance Status of Stool Examination as Assessed by a Questionnaire in Korean Clinical Laboratories

This study aimed to survey the status of quality control (QC) assurance for stool examinations at clinical laboratories in Korea. We sent a questionnaire related to QC practices in stool examination by electronic mail to Korean clinical laboratories that performed stool examination. Overall, 20 of the 39 laboratories (51.3%) reported performing stool concentration methods, and 28 (71.8%) examined the slides using only saline. A large proportion (74.4%) of respondents did not check the internal QC because of the restriction of appropriate control materials. Only four laboratories (10.3%) checked the reactivity of the dye solution routinely. For appropriate external QC systems, QC slides (43.6%) were preferred, followed by QC materials (30.8%), virtual slides (17.9%), and a combination of the above options (7.7%). The most commonly observed parasites in stool samples at the clinical laboratories were Clonorchis sinensis (75%), followed by Endolimax nana, Enterobius vermicularis, and Entamoeba coli. The present study describes the difficulties in internal QC assessment due to the absence of standardized QC materials and systems. We hope the findings of this report will provide a foundation for a QC assessment program for stool examinations in the near future.

Infections of Soil-Transmitted Helminth in Refugees from North Korea

Soil-transmitted helminthiases (STH) are now no longer public health problems in the Republic of Korea (South Korea), but their status are unavailable in the residents of North Korea (NK) despite the expectation of large scale traffic and future reunification of the Korean Peninsula. A total of 20 female refugees from NK who had been admitted to the Division of Gastroenterology, Dankook University Hospital, were subjected in this study. Among them, 15 refugees were examined by the colonoscopy and 10 ones were examined with the stool examination (formalin-ether sedimentation). Both diagnostic methods were commonly adopted in 5 patients. Eggs of Trichuris trichiura were detected in 7 out of 10 refugees in the stool examination. In the colonoscopy, T. trichiura worms were found in 6 (40.0%) out of 15 refugees. Total 9 (45.0%) peoples were confirmed to be infected with human whipworms. Additionally, 1 case of clonorchiasis was diagnosed in the stool examination and a worm of Ascaris lumbricoides was discovered from a trichuriasis case. These findings suggested that STH is highly prevalent in NO, in which living conditions are not so good in the aspect of general hygiene and medical care.

Sensitivity and specificity of the circulating cathodic antigen rapid urine test in the diagnosis of Schistosomiasis mansoni infection and evaluation of morbidity in a low- endemic area in Brazil

Abstract INTRODUCTION: The Kato-Katz technique is the standard diagnostic test for Schistosoma mansoni infection in rural areas. However, the utility of this method is severely limited by the day-to-day variability in host egg excretion in the stool. In high-transmission areas, the point-of-care circulating cathodic antigen (POC-CCA) urine assay has proven to be a reliable test. However, investigations of the reliability of the POC-CCA assay in low-transmission regions are under way. This study aimed to evaluate the sensitivity and specificity of the POC-CCA assay and the morbidity of schistosomiasis in a low-endemic area in Brazil. METHODS: Pains City is a low-transmission zone for schistosomiasis. A total of 300 subjects aged 7-76 years were randomly selected for the POC-CCA cassette test. For S. mansoni diagnosis, three stool samples on six slides were compared with one urine sample for each subject. The sensitivity and specificity in the absence of a gold standard were calculated using latent class analysis. Clinical examinations and abdominal ultrasounds were performed in 181 volunteers to evaluate morbidity associated with schistosomiasis. RESULTS: The sensitivity and specificity of the Kato-Katz technique were 25.6% and 94.6%, respectively. By contrast, the sensitivity and specificity of the POC-CCA assay were 68.1% and 72.8%, respectively. Hepatosplenic schistosomiasis was diagnosed in two patients (1.1%). CONCLUSIONS: Overall, the POC-CCA urine assay proved to be a useful test for diagnosing S. mansoni in a low-endemic area in Brazil. Severe clinical forms of schistosomiasis can be present even in such low-endemic areas.

Intestinal Parasitic Infections among HIV/AIDS Patients with Diarrhoea at Rural Tertiary Care Teaching Hospital Of Maharashtra.

Background and Objective: Opportunistic intestinal parasites usually cause mild and self- limiting infections in immunocompetent individuals but in the case of people living with HIV/AIDS (PLHA) they cause severe, chronic or frequent gastrointestinal disease. The spectrum of intestinal parasites causing infections in PLHA varies from country to country and region to region within the country. Therefore it is very necessary to know the relative frequencies of specific intestinal parasites causing diarrhoea in PLHA in different regions of the country to devise appropriate management strategies. The present study was conducted with an aim to document the prevalence pattern of various intestinal parasites in PLHA in rural tertiary care teaching hospital of Maharashtra. Methods: Stool samples collected from HIV infected individuals with diarrhoea were screened for the presence of intestinal parasites by standard parasitological protocol. Results and Interpretation: The incidence of HIV infection was high in age group 26-35 years followed by 16-25 years age group. The incidence of HIV infection was high in males as compared to females. Out of 124 stool samples screened, 44 (35.48%) showed presence of intestinal parasites. Cryptosporidium parvum followed by Entamoebahistolytica and Isospora belli were the most common intestinal parasite. Conclusion: Opportunistic intestinal parasitic infections still pose as a problem in rural parts of India. This underscores the importance of screening of stool samples of PLHA. It can be also suggested that along with prompt diagnosis and treatment of opportunistic infection, clean potable water supply, improved sanitation and health education is necessary for preventing opportunistic infection in PLHA.

Strongyloides Hyperinfection in Renal Transplant - diagnosis by Endoscopic Intestinal Biopsy.

Introduction: Intestinal parasites continue to be a significant health problem in renal transplantation patients. Strongyloides infection is unique that it excretes larvae and can continue life cycle by auto infective cycle also. Presentation of the case: We present a 26 years old man presented with acute cellular rejection after three months of kidney transplantation. Before transplantation stool of both recipient and donor was negative for parasites. He received three doses of intravenous methylprednisolone. After one month he presented with severe epigastric pain and vomiting. On examination he was malnourished, dehydrated and lost two kilograms of weight over one month. His serum albumin was 2.9 mg/dL. Pain did not subside with proton pump inhibitors. Stool examination was negative for parasites. As index of suspicion for parasites was high, upper GI endoscopy was done; it showed multiple ulcers in duodenum. Biopsy of the ulcer showed strongyloides infection He was treated with ivermectin. Abdomen Pain was subsided soon. He gained weight of 1.5 kilograms over next month. Conclusion: When transplant patients from developing country with recent increase of immunosupression presents with severe abdomen pain, the intestinal parasitic infection should be entertained. If stool examination is negative and serology is unavailable, early evaluation by endoscopic biopsy is helpful to diagnose strongyloides. Prolonged treatment with ivermectin and follow-up stool examinations are important for complete cure of strongyloides infection.

Detection of Cryptosporidium spp and other intestinal parasites in children with acute diarrhea and severe dehydration in Rio de Janeiro

The objective of the present study was to estimate the frequency of infection by Cryptosporidium spp and other intestinal parasites in dehydrated children with gastroenteritis who were admitted to a pediatric hospital. Stool examinations from 218 children were performed. Cryptosporidium spp was identified in eighteen out of 193 stool samples (9.3 percent) subjected to safranin-methylene blue staining. Giardia lamblia was detected in ten out of 213 (4.7 percent) samples examined via the direct or Ritchie methods. Other parasites identified were Ascaris lumbricoides (4.2 percent), Blastocystis hominis (1.4 percent), Entamoeba coli (0.9 percent), Entamoeba histolytica/Entamoeba dispar (0.5 percent), Endolimax nana (0.5 percent), Trichuris trichiura (0.5 percent) and Enterobius vermicularis (0.5 percent).

O objetivo do presente estudo foi estimar a freqüência das infecções por Cryptosporidium spp e outros parasitas intestinais em crianças desidratadas com gastroenterite, internadas em um hospital pediátrico. Exames de fezes de 218 crianças foram realizados. Cryptosporidium spp foi detectado em 18 de 193 (9,3 por cento) amostras fecais submetidas à coloração pela safranina/azul-de-metileno. Giardia lamblia foi detectada em dez de 213 (4,7 por cento) amostras submetidas ao exame direto ou ao método de Ritchie. Também foram identificados Ascaris lumbricoides (4,2 por cento), Blastocystis hominis (1,4 por cento), Entamoeba coli (0,9 por cento), Entamoeba histolytica/Entamoeba dispar (0,5 por cento), Endolimax nana (0,5 por cento), Trichuris trichiura (0,5 por cento) and Enterobius vermicularis (0,5 por cento).

A new endemic focus of Heterophyes nocens and other heterophyid infections in a coastal area of Gangjin-gun, Jeollanam-do

To know the prevalence of heterophyid trematodes among inhabitants of a southern coastal village, i.e., Sacho-ri, Gangjin-gun, Jeollanam-do (Province), 82 stool samples were examined on helminth eggs and protozoan cysts using Kato-Katz and formalin-ether sedimentation techniques. Total 33 people (40.2%) were positive for trematodes (Heterophyes nocens; 15 people, Pygidiopsis summa; 3, Metagonimus sp.; 4, Clonorchis sinensis; 7, Gymnophalloides seoi; 6) and/or protozoa (Entamoeba coli; 3). Among intestinal trematode egg positive cases, 17 were treated with praziquantel and their whole diarrheic stools were collected after purgation. Adult flukes of H. nocens (number of specimens=1,294), P. summa (386), Stellantchasmus falcatus (5), Stictodora lari (4), and Heterophyopsis continua (1) were collected using a stereomicroscope. To know the source of human H. nocens infections in this village, metacercarial infections in mullets (10) were examined and most H. nocens metacercariae (101/105, 96.2%) were found in the trunk portion. From above results, the surveyed coastal village has been newly known as an endemic focus of human H. nocens infection and consuming raw mullets was the presumable source of human heterophyid infections.

An evaluation of a coprological technique for assessing drug efficacy in schistosomiasis japonica

A study was carried out to evaluate the reliability of the MIFC technique as a quantitative method of stool examination for S. japonicum ova. The data presented show that valid questions may be raised regarding the use of the MIFC technique for egg counting from the point of view of number and consistency of egg recovery. The results of this study further show that the MIFC method for quantitative stool examination could be improved. Thorough stirring of the whole specimen and the examination of 3 sediments per gram of stool sample instead of just one in the MIFC technique will lead to more reliable results. (Author)

Studies on schistosomiasis egg quantification in the stool: evaluation of the merthiolate-iodine-formaldehyde-concentration technique

The presentation consists of two main parts which deal on the evaluation of the Merthiolate-Iodine-Formaldehyde-Concentration (MIFC) technique of stool examination and the recommended improved method for schistosome egg counting. It is felt that studies along this line will be a practical value in the assessment of the efficacy of schistosomicidal drugs for so far, no drug against Schistosoma japonicum infection has been found to give a 100% cure rate within a span of six months follow-up. From the point of view of disease transmission, a good quantitative procedure for egg counts is likewise deemed important.(Auth. Abs.)

Nalidixic acid in the management of diarrhea enteritis in infants and children (a report on hospital cases)

Nalidixic acid was given orally to 50 infants and children, who were hospitalized for diarrhea, ranging in age from a few days to 9 years in a dose of 25 mg. per lb. per day divided into 3 or 4 doses for one week. These patients had not received an antimicrobial therapy prior to the administration of nalidixic acid. However, fluid therapy and symptomatic measures were given as indicatedAn initial blood count, stool examination and stool culture were done on each patient. Sensitivity tests followed isolation of pathogenic microorganisms. Follow-up microscopic stool examinations and cultures were done 3 and 5 days after therapy and again a week laterIn this group of 50 patients under study the following observations are enumerated: - 96% were moderately ill- A aerogenes (in 78% of the cases) and pathogenic E. Coli (in 76% of the cases) were the predominating microorganisms, although a combination of more than one organism was commonly noted- These organisms were satisfactorily sensitive to nalidixic acid (77% to 86.8% of the cases)- The clinical manifestation were observed to improve within 3 to 7 days in 94% of the cases- Similarly the microscopic stool examinations cleared up in 96% of the cases- The drug was acceptable orally so that this presented no problem- No untoward effects were noted in the course of therapy nor a week later. (Summary and Conclusions)