Ova and Parasite, Stool for Cyclospora & Isospora (Cystoisospora) Stain  

IMPORTANT! Pre-approval needed from state or local health department. Local or State Health Department. Send approval to NPHL@unmc.edu or call (402) 559-9444.

NPHL has moved to an electronic ordering system, NUlirt, and it is now the preferred method to order all tests. Once ordered, print a "batch list" (see NUlirt Guide).

Forms Required - Nulirt batch list or NPHL Test Request Form (completed in entirety) must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history. Testing will not be performed without all required information.

Please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459 for further clarification.


Test: Ova and Parasite, Stool for Cyclospora & Isospora (Cystoisospora) Stain  
Synonym: Parasitology Stain by Modified Acid-Fast 
Method: Concentration procedure with modified acid-fast stain  
Availability: Monday, Wednesday, Friday; results within 24 hours (Frequency may be increased during outbreak testing)  
Specimen: Stool  
Collection Device: Fresh stool or if transport > 2 hours use Proto-fix vial for preservation and add stool to fill line marked on Proto-fix vial. Seal and shake vigorously. Add bloody or watery portions of stool if present. Stools fixed in 10% formalin are also acceptable.  
Volume: Walnut size stool specimen or 10 ml of stool in preservative.  
Storage/Transport: Ambient  
Unacceptable: Specimens preserved in PVA (polyvinyl alcohol), dry specimens, leaking containers, specimens contaminated with oil, barium, or urine, multiple specimens in 24 hour period, rectal swabs, delayed transport to the laboratory, specimens other than stool.  
Specimen Stability: Preserved specimen stable for up to 9 months at ambient conditions.  
Reference Interval: No ova or parasites seen  
Reportable Disease: Detection of Cryptosporidium species or Cyclospora cayetanensis is reportable. 
Comments: Proto-fix vials available from Regional Pathology Services.

This test is recommended for the examination of stool for the presence of Cyclospora or Isospora (Cystoisospora) by modified acid-fast stain. Recommended testing for Cryptosporidium is by use of the Giardia/Cryptosporidium Antigen EIA test.

If an unequivocal identification of the parasite cannot be made, the stool specimen can be analyzed using PCR. Fresh stool specimen (to include stool in Cary-Blair transport medium) collected in the absence of preservatives and stored either refrigerated (4°C) or frozen or stool mixed in 2.5% potassium dichromate (1:1 dilution) and refrigerated are the optimal specimens. Alternately, studies have shown that stool preserved in modified PVA (PVA containing zinc and not mercury chloride) can be used for PCR testing, although these samples are NOT acceptable for modified acid-fast staining. When submitting any sample for molecular analysis, also include the original modified acid-fast stain.

Microscopic examination of a concentrated stool specimen following modified acid-fast staining is considered the “gold standard” for the diagnosis of a Cyclospora/Cystoisospora-caused disease. 
Revised: 8/16/2013 
If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459.