Fecal Exam Procedures

Fecal examination procedures likely to be accepted and implemented in most veterinary practices
include flotation (centrifugal or passive), sedimentation, and direct examination (direct smear). Only
flotation and sedimentation are concentration procedures. Direct smears have poor sensitivity
because of the small amount of feces examined, but may be useful for demonstrating motile
organisms. CAPC recommends that feces be routinely screened by a centrifugal flotation method,
which is consistently more sensitive than simple flotation. Accuracy of centrifugal flotation techniques
depends on procedural details and specimen attributes.

1. Gross examination. Specimens should be examined grossly for the presence of blood,
mucus, intact worms, or tapeworm segments.

2. Sample size and preparation. Specimen size should be at least 1 gram of formed feces (1
cubic centimeter or a cube about one-half inch on a side). If feces are soft, sample size
should be 2 grams. If it is slurry-like, the sample should be 4 grams. For liquid feces, a
sample of 6 grams or greater might be appropriate. Inadequate sample size (e.g., fecal loop
sample) may result in false-negative results. To remove large fecal debris, sieving is
recommended prior to centrifugation. The sample is sieved through cheesecloth or a tea
strainer after mixing with water or flotation solution. Passive flotation kits typically include a
device that prevents larger particles from floating to the surface.

3. Flotation solution. Both the type and concentration of sugar or salt solutions used can affect
recovery of diagnostic stages of parasites from feces. Common flotation solutes include
sodium nitrate, zinc sulfate, sucrose (usually granulated sugar), magnesium sulfate, and
sodium chloride. These solutes can be mixed at varying concentrations with water to achieve
flotation solutions with different densities. Flotation solutions with higher densities are capable
of floating heavier (denser) parasite stages. However, higher density flotation solutions also
float many other fecal particles that can render preparations more difficult to examine and can
collapse thin-shelled parasite stages, making them difficult to identify or causing them to float
poorly. More viscous solutions, such as Sheather's sugar (sucrose) solution, are more
efficient for centrifugation. Most salt solutions dry very quickly, crystallizing on slides and
obscuring observation.

4. Centrifugation. Centrifugation of sieved feces may be performed in flotation solution either

with a coverslip placed on top of a filled tube or with the coverslip added after the centrifuge
has stopped. In the latter case, the tube is spun near-full, and then the tube is filled to form a
reverse meniscus, the coverslip is added, and the tube is allowed to sit a few minutes longer.
Centrifugation with the coverslip on the tube works best when a sugar flotation medium is
used. Alternate methods for sampling the reverse meniscus include loops or glass rods that
can be flamed between samples; however, this approach is less efficient than centrifuging
with the coverslip in place.

5. Slide examination. The entire area under the coverslip should be examined. It is helpful to
focus on a small air bubble to obtain the correct focal plane. The edge of the coverslip can be
sealed with nail polish to prevent drying and to allow examination of the specimen under oil
immersion. Sucrose preparations can be stored in high humidity in a refrigerator for hours to
days without significantly altering the morphology of most common helminth eggs.

Although routine fecal examination should always include centrifugation, at times, other examination
methods are needed to reach a diagnosis. For example, motile trophozoites and nematode larvae can
be observed using the direct smear method. Certain nematode, trematode, and tapeworm eggs will
not float in less dense flotation solutions and are better demonstrated using sedimentation. The
Baermann funnel method may aid in diagnosis of a feline lungworm (Aelurostrongylus abstrusus)
infection. Stained direct smears are useful for diagnosis of a protozoal infection such as giardiasis or
trichomoniasis. Specimens to be examined for protozoa can first be fixed using a commercial fixative
such as Proto-fix™ or a fixating stain such as MIF (merthiolate-iodine-formalin). Fecal antigen
detection tests are useful for diagnosis of giardiasis and cryptosporidiosis.
Albendazole

Broad Spectrum, Oral,

Pinworm (enterobius), hookworm, ascariasis, trichuriasis, strongyloidiasis

Oral > Absorbed with fatty meal > first pass of metabolism to become active metabolite

Inhibit microtubule synthesis, Larvicidal

On intraluminal = empty stomach

Tissue = With fatty meal.

Older than 2 years old = one dose 400mg. (2-3 days) heavy infection

Ivermectin

For strongyloidiasis

Paralyze nematodes and arhthropods bya intensifying GABA-mediated transmission of signal in

peripheral nerves.

12 mg

Mebendazole

Wide spectrum with low adverse effect

Usually: Ascaris, trichuriasis, hookworm and pinworm infection

Absorbsion < 10% (little adverse effect)

Inhibits microtubule synthesis.

Active form ( does not need metabolism to activate)

Increase absorption with fatty meal

Kills hookworm, ascaris, and trichuris egg.

Ascaris, trichuriasis, hookworm, = 100mg 2x/day (3days) [<2yrs old]

Piperazine

Alternate for Ascariasis

Paralysis of ascaris, = blocking acetylcholine of myoneural junction. > Mengikuti gerakan peristalsis

75mg/kg oral, 1x/day (2 days)

Pyrantel Pamoate

Broad spectrum for Pinworm, ascaria, trichostrongylus

Effective immature and mature form of helminth (yg sesuai), but not at migratory stage.

Neuromuscular blocking, release acetylcholine, and inhibition of choline-esterase, paralysis

Thiabendazole

Alternative of Ivermectin

For strongyloidiasis, and cutaneous larva migrants

Mechanism same as other benzimidazoles

25mg/kg, 2x/day (2 days) postmeal

Anti Protozoaa

Mechanism of action
It inhibits nucleic acid synthesis by disrupting the DNA of microbial cells.[1] This function
only occurs when metronidazole is partially reduced, and because this reduction usually
happens only in anaerobic cells, it has relatively little effect upon human cells or aerobic
bacteria.[29]