○ Collect 1 specimen per day (1 Yellow top and 1 White top container) for 3 days in each vial for a total of six (6) specimens per patient with suspected parasitic infection (Stool collection).
○ Ensure patient avoids anti-diarrheal medications, radiological dye (barium) and antibiotics prior to producing the specimen as they may interfere with parasite detection (stool collection).
○ Indicate appropriate clinical information on requisition (e.g. travel history or country of origin if refugee, returned traveller or recent immigrant, eosinophilia, HIV, immunocompromise, critical illness, or previous parasite infection)
○ Non-stool specimens should be ordered if disseminated disease suspected
○ Stool: Parasitology Kit (3 each of SAF yellow top vial, white top sterile vial) ○ Bronchial washings/sputum/BAL/CSF/urine: sterile container ○ Whole blood/serum: serum separator tube (clotted blood) (min volume 5 mL)
Stool ○ Collect stool immediately after bowel movement in a dry, clean container (e.g. Chamber pot, wide-mouth jar, pie plate, newspaper, or saran wrap on toilet seat). Follow instructions below to add specimen to BOTH yellow and white capped containers. Specimen should not be contaminated with urine or toilet water. Container 1 SAF (Yellow top) vial: ○ Use plastic spork attached to lid to add sample (from beginning, middle and end of stool) to yellow capped bottle so that the preservative fluid level is approximately ¾ full. Mix thoroughly by shaking. Ratio should be 1 part solid stool to 3 parts SAF or 1 part liquid faeces to 1 part SAF.
Container 2 Sterile (White top) vial: ○ Using plastic spork, Add stool directly to sterile white capped container
Bronchial washing/brush specimens ○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). For washings, inject aliquots of approximately 20 to 30 mL of 0.85% sterile saline (nonbacteriostatic) for adults or 5 mL for children. Suction washings into a sterile container. ○ For brushings, instill brush to collect cellular material from bronchial epithelial wall. Place protected brush sample in sterile container with 1 mL of saline.
BAL ○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). Instill a large volume of 0.85% sterile saline (nonbacteriostatic) into the airway lumen. Discard the initial fluid recovered (likely contaminated). Collect remaining fluid in a clean, sterile container via suction.
Sputum ○ Collect sputum by expectoration or by tracheal aspiration in sterile container.
CSF ○ Decontaminate skin, collect at least 0.5 mL of CSF via lumbar puncture in sterile container
Urine ○ Collect urine into a clean, sterile container.
Whole blood/serum ○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine, collect at least 5 mL of blood in appropriate container
Refer to section Sample Processing / Delivery
PHOL
○ Microscopy: Up to 5 days (same day if disseminated infection suspected) ○ Serology: Up to 7 days
416-586-4800 extension 4629
YES; notify the laboratory if this agent is suspected
○ Label specimen container. Place specimens in biohazard bag and seal..
○ Specimens should be stored at room temperature (20-25˚C) and transported to the UHN/SH Microbiology Laboratory ASAP after collection. For stool, keep Yellow top tube (SAF vial) at room temperature while the White-top vial should be refrigerated (2-8˚C) prior to transport. Serologic specimens should be stored at refrigeration temperature.
○ The specimen will be referred to the Public Health Ontario Laboratory for testing