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Test Code CYCL Cyclospora Stain, Feces

Reporting Name

Cyclospora Stain

Useful For

Identifying Cyclospora cayetanensis as a cause of infectious gastroenteritis

Testing Algorithm

For other diagnostic tests that may be of value in evaluating patients with diarrhea; the following are available:

-Laboratory Testing for Infectious Causes of Diarrhea

-Parasitic Investigation of Stool Specimens Algorithm

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Fecal


Ordering Guidance


Cryptosporidium oocysts do not reliably stain with the modified safranin stain. If Cryptosporidium is suspected, the specific enzyme-linked immunosorbent assay for this organism is recommended; order CRYPS / Cryptosporidium Antigen, Feces. To detect this organism as well as other common infectious causes of diarrhea, order GIP / Gastrointestinal Pathogen Panel, PCR, Feces.



Specimen Required


Patient Preparation: Patient should avoid use of antidiarrheal medication (eg, loperamide [Imodium-AD] or Pepto-Bismol).

The presence of barium will interfere with this test.

 

Submit only 1 of the following specimens:

 

Preferred:

Specimen Type: Preserved stool

Supplies:

-ECOFIX Stool Transport Vial (Kit) (T219)

-Formalin-Meridian 10% Buffered Neutral (T466)

Container/Tube:

Preferred: ECOFIX Stool Transport Vial (Kit)

Acceptable: 10% Buffered Formalin Stool Transport (Kit), Sodium Acetate Formalin (SAF)

Specimen Volume: 10 g

Specimen Stability Information: Ambient 21 days (preferred)/Refrigerated 21 days

 

Acceptable

Specimen Type: Unpreserved stool

Supplies: Stool container, Small (Random), 4 oz (T288)

Container/Tube: Stool container

Specimen Volume: 5 g

Specimen Stability Information: Refrigerated 3 days (preferred)


Specimen Minimum Volume

Preserved stool: 1 g
Unpreserved stool: 2 g

Specimen Stability Information

Specimen Type Temperature Time
Fecal Varies

Reference Values

Negative

If positive, reported as Cyclospora cayetanensis detected.

Day(s) Performed

Monday through Saturday

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

87015

87207

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CYCL Cyclospora Stain 50313-6

 

Result ID Test Result Name Result LOINC Value
CYCL Cyclospora Stain 50313-6

Clinical Information

Cyclospora cayetanensis is an apicomplexan protozoan parasite that causes watery diarrhea, anorexia, malaise, and weight loss.(1) The extent of symptoms depends on the age and health of the host and the infectious dose of oocysts. The infection is usually self-limited, but symptoms can be severe and prolonged, particularly in immunocompromised patients. Cyclosporal diarrheal disease is endemic in many parts of the world, including parts of Asia, India, Southeast Asia, and Latin America. Although most cases of cyclosporiasis have been seen in travelers to developing countries, outbreaks in the United States are now seen each year associated with contaminated fruits and vegetables from Latin America. Transmission is via ingestion of fecally contaminated food or water. If untreated, symptoms may last for several weeks and may follow a relapsing course. The infection usually responds to treatment with a sulfamethoxazole-trimethoprim drug combination.

 

C cayetanensis oocysts are traditionally detected by modified acid-fast staining in which the oocysts stain bright pink red.(1,2) However, the modified safranin stain has been shown to provide increased sensitivity over the modified acid-fast method and produces a more rapid result. It is the method used in the Mayo Clinic Parasitology Laboratory to detect C cayetanensis oocysts in fecal sediment.

 

For more information about diagnostic tests that may be of value in evaluating patients with diarrhea see the following:

-Laboratory Testing for Infectious Causes of Diarrhea

-Parasitic Investigation of Stool Specimens Algorithm

Interpretation

A report of "Cyclospora cayetanensis detected" indicates the presence of this parasite in the patient's feces.

Cautions

The full spectrum of disease and the extent of carriage without disease have not been determined. In addition, the exact sensitivity and specificity of the stain have also not been determined.

 

Cryptosporidium oocysts do not reliably stain with the modified safranin stain. If Cryptosporidium is suspected, the specific enzyme-linked immunosorbent assay (CRYPS / Cryptosporidium Antigen, Feces) for this organism is recommended. Alternatively, the GIP / Gastrointestinal Pathogen Panel, PCR, Feces may be performed to detect this organism as well as other common infectious causes of diarrhea.

Clinical Reference

1.Centers for Disease Control and Prevention (CDC) Global Health, Division of Parasitic Diseases and Malaria. Parasites–Cyclosporiasis (Cyclospora infection). CDC; Updated March 12, 2020. Accessed October 31, 2022. Available at www.cdc.gov/parasites/cyclosporiasis/index.html

2. Garcia LS, Arrowood M, Kokoskin E, et al: Practical guidance for clinical microbiology laboratories: Laboratory diagnosis of parasites from the gastrointestinal tract. Clin Microbiol Rev. 2017 Nov 15;31(1):e00025-17

Method Description

A thin smear of the fecal concentrate is placed on a slide and allowed to air dry. The slide is then placed in acidic alcohol for 5 minutes, followed by washing with cold tap water. The slide is then placed in a Coplin jar containing safranin solution in acidified water and heated in a microwave at full power for 1 minute. Excess stain is washed off with tap water, and the slide is placed in a Coplin jar containing the counterstain (aqueous solution of either 1% methylene blue or 1% malachite green) for 1 minute. After a final rinse in tap water, the slide is dried, and a coverslip is applied. The slide is examined microscopically using high-power with oil immersion. The oocysts of Cyclospora will be clear to pink and have a somewhat refractile quality.(Visvesvara GS, Moura H, Kovacs-Nace E, Wallace S, Eberhard ML: Uniform staining of Cyclospora oocysts in fecal smears by a modified safranin technique with microwave heating. J Clin Microbiol 1997;35:730-733; Mathison BA, Pritt BS: Cyclosporiasis-Updates on clinical presentation, pathology, clinical diagnosis, and treatment. Microorganisms. 2021 Sep 2;9(9):1863. doi: 10.3390/microorganisms9091863)

Report Available

2 to 4 days

Specimen Retention Time

3 days

Reject Due To

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Method Name

Safranin Stain

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Microbiology Test Request (T244)

-Gastroenterology and Hepatology Test Request (T728)