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A Review of the Importance of Stool Test in the Diagnosis of Intestinal

Parasites

Article in International Journal of Medical Parasitology and Epidemiology Sciences · March 2021
DOI: 10.34172/ijmpes.2020.09

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 IJMPES International Journal of
http://ijmpes.com
Medical Parasitology & doi 10.34172/ijmpes.2020.09
Vol. 1, No. 2, 2020, 25–28
Epidemiology Sciences eISSN 2766-6492

Review Article

A Review of the Importance of Stool Test in the

Diagnosis of Intestinal Parasites
Yagoob Garedaghi1*
1
Department of Parasitology, Tabriz Branch, Islamic Azad University, Tabriz, Iran

Abstract
Objectives: Stool test is a test used to diagnose an infection or intestinal parasitic infection. Gastrointestinal infections occur
for a variety of reasons, so this test is valuable along with other complementary tests. Common gastrointestinal infections are
commonly reported as food poisoning or stomach infections. However, diagnostic tests are useful for treating and removing the
source of the disease.
Methods: This study was reviewed by using a search of keywords including, “stool test” , “Diagnosis “, “Intestinal Parasites”,
in Google Scholar, PubMed, and Elsevier databases. Approximately 15 articles were selected that were examined thoroughly.
Results: The results of our study revealed that the direct microscopic method is more widely used in medical diagnostic
laboratories due to its time saving and simplicity of testing.
Conclusion: Stool tests are recommended for people with symptoms of a gastrointestinal infection. These symptoms include:
Prolonged diarrhea, abdominal pain (cramping), nausea and vomiting, Stools with blood and mucus. However, diagnostic tests
are useful for treating and removing the source of the disease.
Keywords: Stool test, Diagnosis, Intestinal parasites.

Received: September 30, 2019, Accepted: February 28, 2020, ePublished: April 1, 2020

Introduction asymptomatic for a long time and transmit the infection

Intestinal parasites are considered health problems in to the community. Severe gastrointestinal symptoms
many countries, especially in developing countries. One and disorders may also develop over time. Infection
of the important indicators of health and well-being of with these parasites leads to malnutrition, insufficient
any society is the status of people in that society with physical growth, anemia, and reduced learning, especially
parasitic infections (1,2). Infection with these parasites in children. Water, vegetables, and food are the most
is one of the problems and obstacles to economic and important sources of these infections (6).
social development in most countries of the world and Today, due to the diversity of climate, type of work and
despite the continuous efforts and extensive planning life of people, the use of animal and human fertilizers
of the World Health Organization, they are still one in plant breeding, the inclusion of raw vegetables in the
of the main health problems in developing countries. diet, and epidemiological, cultural, and economic criteria,
According to the World Health Organization, the rate there are a great variety of parasites in the world (7).
of infection with these agents in the world is estimated In order to control these infections, proper health
to be 3.5 billion people, which leads to 4.5 million cases services such as determining the prevalence, formulating
of clinical symptoms. Infection may be asymptomatic or policies, controlling and evaluating the operations
can lead to disability and eventually death, depending on performed should be provided, and considering
the nutritional status, health, and socioeconomic status of the pathogenic role of parasites in causing physical,
patients (3,4). psychological, economic, and social problems, the fight
Factors influencing the spread of parasitic infections against parasites is of great importance (8). Medical
in developing countries include low levels of public professionals are among the high-risk groups in terms of
awareness, poor nutritional status in terms of quantity and infection with these infectious agents.
quality, climate diversity, and uncontrolled population A stool test is a test used to diagnose an infection or
growth. Intestinal parasitic diseases are among the most intestinal parasitic infection. Gastrointestinal infections
important infectious diseases that are directly related to occur for a variety of reasons; therefore, this test is
personal and public health (5). Because intestinal parasitic valuable along with other complementary tests. Common
infections are usually chronic, an infected person may be gastrointestinal infections are commonly reported as food

*Corresponding Author: Yagoob Garedaghi, Email: [email protected], [email protected]

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poisoning or stomach infections. However, diagnostic peak of egg-laying is between noon and 3 pm.
tests are useful for treating the disease and removing the 6. To collect the sample, a clean dry wide-mouthed
source of the disease (9). plastic container for stool and a sterile plastic
Entamoeba histolytica and Giardia lamblia are two of the container for urine should be selected.
most common pathogenic protozoa worldwide. Proper 7. Immediately after sampling, transfer the sample to
diagnosis of infection will be critical for the management the microbiology section for analysis in less than 1
of these diseases and prevention of new cases. Parasites hour. Unstable samples should be taken immediately.
that are detected in the feces of immunocompromised 8. If sampling is done outside the laboratory, the sample
individuals such as those with AIDS include should be sent to the laboratory within 15 minutes.
Cryptosporidium, Microsporidia, E. histolytica, G. lamblia, 9. The place, time, and date of sampling should be
Isospora belli, and Strongyloides stercoralis. Amoebic cysts, recorded on the test sheet.
Giardia cysts, and worm eggs can be obtained from solid 10. Keep notes of the patient’s history of travel to endemic
stools, while trophozoites are often found in loose or areas, clinical diagnosis, or suspected parasitic
watery stools (10). The observation of erythrophagocytic infection. It is important to know the patient’s use of
trophozoites in bloody mucoid stools is a good evidence contaminated water and food.
for invasive amoebiasis. In these cases, smear stained with
trichrome or iron hematoxylin confirms the presence of Additional Information About Stool Tests
E. histolytica, which is detected in only 50% of biopsy Giardia lamblia and E. histolytica are two of the most
specimens. In patients with amoebic liver abscess, the common intestinal protozoan parasites worldwide. The
amoeba are not always present in the stool and serological symptoms caused by intestinal pathogenic protozoa are
tests are more reliable in these patients (11). similar (such as diarrhea, abdominal pain, and nausea)
and are neither specific nor diagnostic. In addition, clinical
Reason for Requesting a Stool Test symptoms vary depending on the type of protozoan
Stool tests are recommended for people with symptoms infection and the patient’s immune status. Definitive
of a gastrointestinal infection. These symptoms include diagnosis of intestinal protozoan infections depends on
prolonged diarrhea, abdominal pain (cramps), nausea and microscopic examination of fecal samples (12).
vomiting, stools with blood and mucus. These symptoms
usually improve in people with a healthy immune system Best Ways to Do a Stool Test
with personal care, but a stool test may be needed in the Concentration Method
following cases: 1) disturbance of water and electrolytes Concentration method increases the chances of detecting
or severe gastrointestinal complications due to prolonged a small number of parasites by removing additional
diarrhea, 2) symptoms of gastrointestinal infection in materials. This method is divided into two techniques of
children, the elderly, or people with weakened immune flotation and sedimentation.
systems, 3) existence of symptoms of gastrointestinal In the flotation technique, higher density solutions are
infection for a long time without improvement, and 4) added to the fecal suspension rather than living organisms.
people exposed to direct contact with parasitic infections. These solutions precipitate excess fecal matter and cause
the parasites to float on the surface of the liquid. One of
Stool Sampling the disadvantages of this method is that some cysts and
1. The sample should be delivered to the laboratory eggs do not float and their walls are destroyed.
within 30 minutes to one hour and examined. Direct In the sedimentation technique, solutions with a higher
examination of motile trophozoites can only be density than living organisms are added to the fecal
performed on fresh specimens. suspension. These solutions increase the concentration
2. Watery or loose stools that cannot be delivered to of the parasite in the sediment from the centrifuge. The
the laboratory within one hour should be preserved. presence of additional materials in parasitic sediment is
Polyvinyl alcohol protects the protozoan trophozoites. one of the disadvantages of this method.
Solid stools may be stored in formalin or refrigerated
until delivery to the laboratory. Direct Microscopic Method
3. Because the presence of parasites in the stool is In this method, a certain amount of stool is mixed with
variable and may be intermittent, in cases of strong a drop of physiological serum on a clean slide. The
clinical suspicion, multiple samples should be taken movement of live trophozoites inside the suspension
over 7 to 10 days. can be seen under a microscope with a ×40 lens. In this
4. For Trichomonas vaginalis, fresh urine should be method, a certain amount of stool is mixed with a drop of
delivered to the laboratory within one hour without Lugol’s iodine on a clean slide. Iodine solution stains the
refrigeration. internal structures of parasites and cysts, which improves
5. For Schistosoma haematobium, the urinary sediment diagnostic power. The direct microscopic method is more
may contain multiple eggs trapped in the mucus. The

26 Int J Med Parasitol Epidemiol Sci Volume 1, Number 2, 2020

 Garedaghi et al

widely used in medical diagnostic laboratories due to its travel history will be helpful in considering potential
speed and simplicity of testing (13). interference (14).

Limitations and Interfering Factors in Fecal Testing What is a Stool Culture Test?
A negative result will not rule out the possibility of parasitic In stool culture, laboratory staff identify the bacteria that
infection. Entamoeba dispar and Entamoeba moskovskii live in the stool. They put a sample of the stool on special
are morphologically similar to E. histolytica but they are plates. These plates contain a gel that acts as a growth
non-pathogenic and non-invasive. In Giardia infection, medium and promotes the growth of bacteria. Laboratory
in the early stages of the disease, patients who periodically staff will then try to identify the bacteria by staining,
excrete the organism in the feces, and in chronic cases of microscopic analysis, and other tests. For example,
the disease, a fecal test may be negative. The sensitivity laboratory staff may look for the following bacteria in
of microscopic methods for detecting Giardia is 46-95%. the stool: Campylobacter, Salmonella, and Shigella species
Artifacts should be kept in mind when examining feces (15).
(Figure 1). Stool tests for harmful organisms can help doctor
identify the cause of the symptoms. Stool cultures can
Description of Stool Test help them identify the type of harmful bacteria and
In cases of suspected Oxyuris vermicularis (Enterobius treatments that may be effective. If harmful bacteria are
vermicularis), in addition to feces, a sample taken with found in the stool, the doctor may prescribe antibiotics
Scotch glue should also be used. Urine samples may or other medications. If no dangerous bacteria are found,
be needed in the middle of the day to detect certain the symptoms may be due to other causes. The doctor
parasites. Trichomonas vaginalis, Schistosoma hematoma, may do more follow-up tests. For example, he/she may
Entamoeba histolytica, and Oxyuris vermicularis eggs look for symptoms of irritable bowel syndrome, parasitic
may be seen in the urine. Geographical location and infection, or other problems.

Figure 1. Some of the Parasites that Can Be Found in Stool Test.

Int J Med Parasitol Epidemiol Sci Volume 1, Number 2, 2020 27

 Garedaghi et al

Conflict of Interests and clinical relevance of Blastocystis spp. Clin Microbiol Rev.
None. 2008;21(4):639-665. doi:10.1128/cmr.00022-08
7. Wawrzyniak I, Poirier P, Viscogliosi E, et al. Blastocystis,
Ethical Issues an unrecognized parasite: an overview of pathogenesis
Not applicable. and diagnosis. Ther Adv Infect Dis. 2013;1(5):167-178.
doi:10.1177/2049936113504754
Acknowledgments 8. Clark CG, van der Giezen M, Alfellani MA, Stensvold CR. Recent
The author would like to express his deep gratitude to Islamic developments in Blastocystis research. Adv Parasitol. 2013;82:1-
Azad University Tabriz Branch for offering valuable theoretical 32. doi:10.1016/b978-0-12-407706-5.00001-0
and practical assistance to the researcher in the present study. 9. Poirier P, Wawrzyniak I, Vivarès CP, Delbac F, El Alaoui H. New
insights into Blastocystis spp.: a potential link with irritable bowel
Funding syndrome. PLoS Pathog. 2012;8(3):e1002545. doi:10.1371/
The author received no financial support for the research, journal.ppat.1002545
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clinical significance of Blastocystis--diagnostic limitations. Trends
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