CLINICAL PARASITOLOGY (LABORATORY) MODULE 2: ROUTINE FECALYSIS

ROUTINE FECALYSIS PRESENCE OF MUCUS IN STOOLS

MACROSCOPIC EXAMINATION
• Translucent gelatinous
BASED ON COLOR
material clinging to
Color Interpretation surface of stool.
Brown Normal/Stercobilinogen • Produced by colonic
Bleeding in upper GIT (proximal to mucosa in response to
Black and tarry cecum) Drugs (iron salts, bismuth parasympathetic
salts,charcoal) stimulation.
Lower GIT bleeding/tumors, • Seen in
inflammatory process Anal fissure, o Severe constipation
Red
hemmorhoids, tumors Undigested
o Mucous colitis
tomatoes or beetroot.
Yellow or yellow
Diarrhoea
green
Clay-colored PRESENCE OF MUCUS AND BLOOD IN STOOLS
Biliary obstruction
(gray-white)
Seen in
Silvery Carcinoma of ampulla of Vater

• Bacillary dysentery
• Ulcerative Colitis
BASED ON APPEARANCE
• Intestinal tuberculosis
Appearance Interpretation • Amoebiasis
Certain strains of Escherichia coli, • Enteritis
Watery
Rotavirus enteritis, Cryptosporidiosis
Rice water Cholera Mucus with blood clinging to stool is seen in
Unformed with Bacillary dysentery, Ulcerative Colitis,
• Lower GIT malignancy.
blood, mucus, and Intestinal tuberculosis, Amoebiasis,
pus Enteritis • Inflammatory lesions of anal canal

Unformed, frothy,
foul smelling,
Steatorrhoea
which float on
water
Pale color stool with Pancreatic deficiency due to CHEMICAL EXAMINATION
greasy appearance malabsorption

BASED ON ODOR

STOOL ODOUR

• Indole and skatole which are formation by bacterial

fermentation and putrefaction.
Chemical examination of feces is usually carried out for the
following tests:
FOUL ODOUR
• Occult blood
• Undigested protein & by excessive intake of carbohydrate.
• Excess fat excretion (malabsorption)
• Reducing sugars

SICKLY ODOUR • stool osmotic gap

• Urobilinogen
• Undigested lactose & fatty acids. • stool pH

Cis and Trans | BSMT 2B&C

 TEST FOR OCCULT BLOOD IN STOOLS MICROSCOPIC EXAMINATION OF STOOL SAMPLES

• Peroxidase-like activity of Hb

Principle:

• Hemoglobin has peroxidase-like activity & releases oxygen

from hydrogen peroxide.
• Oxygen molecule then oxidizes the chemical reagent
(benzidine, orthotolidine, aminophenazone, or guaiac) to
produce a colored reaction product.

• Benzidine and orthotolidine are carcinogenic and are no

longer used.
• Benzidine test is also highly sensitive and false-positive
reactions are common.
• Since bleeding from the lesion may be intermittent,
PREPARATION OF SLIDES
repeated testing may be required.

CAUSES OF FALSE-POSITIVE TESTS

1. Ingestion of peroxidase-containing foods like red meat,

fish, poultry, turnips, horseradish, cauliflower, spinach, or
cucumber. Diet should be free from peroxidase-containing
foods for at least 3 days prior to testing.
2. Drugs like aspirin and other anti-inflammatory drugs, which
increase blood loss from gastrointestinal tract in normal
persons.

CAUSES OF FALSE-NEGATIVE TESTS

1. Foods containing large amounts of vitamin C.
2. Conversion of all hemoglobin to acid hematin (which has
no peroxidase-like activity) during passage through the
gastrointestinal tract.
• A drop of normal saline is placed near one end of a glass
slide and a drop of Lugol iodine solution is placed near the
other end.
• A small amount of feces is mixed with a drop each of saline
and iodine using a wire loop, and a cover slip is placed over
each preparation separately.
• If the specimen contains blood or mucus, that portion
should be included for examination (trophozoites are more
readily found in mucus).
• If the stools are liquid, select the portion from the surface
for examination.
• Saline wet mount is used for demonstration of eggs and
larvae of helminths, and trophozoites and cysts of protozoa.
• Saline wet mount can also detect red cells and white cells.
• The iodine wet mount is useful for identification of protozoal
cysts as iodine stains glycogen and nuclei of the cysts.
• Trophozoites become non-motile in iodine mounts.
• A liquid, diarrheal stool can be examined directly without
adding saline.

Cis and Trans | BSMT 2B&C

FINDINGS RED BLOOD CELLS (RBCS)

• Leukocytes (WBCS) • Bright red stool is seen in cases of lower GIT bleeding.
• Red Blood Cells (RBCs) • Black and tarry blood are seen in cases of
• Macrophages o Upper GIT bleeding.
• Epithelial cells o Occult bleeding.
• Bacteria • Present in
• Ova/ Cysts/ Trophozoites of parasites o Dysentery
• Meat/muscle fibres o Hemorrhoids
• Fat o GIT Malignancies

LEUKOCYTES (WBCS)

• Normal stool may

contain occasional
(0-1) WBCs.
• To look for WBCs, the
smears should be
prepared from
areas of mucous or
watery stools.

MACROPHAGES

seen in

o Bacillary dysentery
o Ulcerative colitis

Increased no: of WBCs are stools is associated with

• Bacillary dysentery
• Chronic ulcerative colitis
• Shigellosis
• Salmonella infections
• Invasive E-Coli infections
• Anal/Rectal Fistula EPITHELIAL CELLS
• Localised abscess
• Amoebiasis & typhoid • Seen in inflammatory conditions
of the bowel

Cis and Trans | BSMT 2B&C

 FAT POLLEN GRAINS IN STOOLS MISTAKEN FOR HELMINTH EGGS.

Present in

• Malabsorption
• Deficiency of pancreatic
digestive enzyme
• Deficiency of bile

MEAT/MUSCLE FIBRES IN STOOLS

Their presence show impaired intraluminal digestion.

PLANT FIBRE/PLANT CELLS
• Increased amount of meat fibres are found in •
Malabsorption syndrome
• Pancreatic functional defect like cystic fibrosis.

AIR BUBBLES

MICROSCOPIC EXAMINATIONS – ARTEFACTS

• It is also important to identify artefacts during microscopic

examination of stool samples which could be confused
with ova & cysts of various protozoa & helminths

CHARCOT-LEYDEN CRYSTALS.
YEAST & FUNGAL ELEMENTS IN STOOL

REFERENCE RANGES IN STOOL EXAMINATION

• bulk: 100-200 grams/day

• Color: Brown
• Water: Up to 75%
• pH: 7.0-7.5
• Red blood cells: Absent
• White blood cells: Few
• Epithelial cells: Present
• Crystals: Calcium oxalate, triple phosphate

Cis and Trans | BSMT 2B&C