Abstract

For many years microscopy has been considered the mainstay of the diagnosis of parasitic infections. In our laboratory, before the advent of molecular biology, the approach for the identification of parasitic infections in stools was the microscopic exam of three samples. Once we adopted molecular biology, a real-time PCR on one single sample was added to the classical coproparasitological exam of three samples. Given the high sensitivity of real-time PCR (Rt-PCR), we then decided to evaluate if a change of our routine was justified. In detail, we intended to assess if a much more practical routine, based on the analysis of a single fecal sample, was sufficiently sensitive to replace the routine described above. The new approach to be evaluated included, on the same and unique fecal sample, a classical coproparasitological exam plus Rt-PCR. The data obtained showed that the sensitivity of the new proposed approach remains very high, despite the reduction of coproparasitological exams from three to one, with the advantage of reducing costs and saving time, both for patients and for the laboratory.

Highlights

  • Microscopy is the classical procedure for diagnosing parasitic infections, including the identification of protozoan trophozoites and cysts in feces, and is still the primary, often only, test offered by most routine diagnostic services

  • A total of 277 samples were analyzed by microscopy and real-time PCR (Rt-PCR) for Blastocystis sp

  • Rt-PCR (Table 4) without microscopy resulted in 89.1% sensitivity (CI 80.9–94.7%)

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Summary

Introduction

Because several intestinal parasites are shed intermittently, patients are usually asked to deliver multiple stool samples for examination (Danciger and Lopez, 1975; Cartwright, 1999). This procedure is relatively simple, and allows for the identification of both helminth eggs and larvae, as well as protozoan cysts and vegetative forms, microscopy clearly has its limitations and is a time consuming procedure (Utzinger et al, 2010). Real-time PCR (Rt-PCR) has become widely used in many laboratories This technique allows highly sensitive and specific identification of parasite DNA.

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