1887

Abstract

To assess the level of practice consistent with UK national standards for testing, an audit was performed of 156 publicly funded clinical microbiology laboratories in England and Wales between August 2013 and April 2014. Responses were received from 85 (54 %) laboratories. First line diagnostic methods used were mainly microscopy with modified Ziehl–Neelsen (mZN) or auramine phenol (AP) staining (68/85, 80 %), enzyme immunoassays (EIAs) (16/85, 19 %) or in-house PCR (1/85, 1 %). The use of EIAs was more widespread than reported previously. Various methods were used for confirmation of positive EIA reactions and laboratories frequently resorted to sending samples to the national reference laboratory for this purpose, indicating that guidance is required for performance monitoring and confirmation of positive reactions. Laboratory positivity rates were related to the diagnostic test used, with highest median rates reported by those using PCR, EIAs or AP microscopy, and the lowest by those using mZN microscopy. One-third of responding laboratories (28/85, 33 %) routinely tested all stools for . However, 16 (19 %) laboratories used stool consistency to decide whether to test for this parasite. Other selection criteria included patient age ( = 18; 21 % laboratories), history or clinical details ( = 40; 47 %), duration of hospitalization ( = 18; 21 %) or clinician requests ( = 25; 29 %). To encourage laboratories to test all stools submitted for the investigation of diarrhoeal illness for revision of the guidance in the national standards is under way. This will enable improved assessment of the burden of illness and ability to monitor outbreaks, and measure changes in reported cases.

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2015-07-01
2019-10-18
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References

  1. Anonymous ( 2008;). Report of the Second Phase of the Review of NHS Pathology Services in England. An independent review chaired by Lord Carter of Coles. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Pathology/DH_075531 .
  2. Anonymous & PHLS Advisory Committee on Gastrointestinal Infections ( 2004;). Preventing person-to-person spread following gastrointestinal infections: guidelines for public health physicians and environmental health officers. Commun Dis Public Health 7: 362–384 15786582.
    [Google Scholar]
  3. Anon ( 2008;). Cryptosporidiosis. . In OIE Terrestrial Manual, pp. 1192–1215.
    [Google Scholar]
  4. Bauer T.M. , Lalvani A. , Fehrenbach J. , Steffen I. , Aponte J.J. , Segovia R. , Vila J. , Philippczik G. , Steinbrückner B. , other authors . ( 2001;). Derivation and validation of guidelines for stool cultures for enteropathogenic bacteria other than Clostridium difficile in hospitalized adults. JAMA 285: 313–319 doi:10.1001/jama.285.3.313 11176841 .[CrossRef]
    [Google Scholar]
  5. Casemore D.P. , Roberts C. . ( 1993;). Guidelines for screening for Cryptosporidium in stools: report of a joint working group. J Clin Pathol 46: 2–4 doi:10.1136/jcp.46.1.2 8432884 .[CrossRef]
    [Google Scholar]
  6. Casemore D.P. , Armstrong M. , Sands R.L. . ( 1985;). Laboratory diagnosis of cryptosporidiosis. J Clin Pathol 38: 1337–1341 doi:10.1136/jcp.38.12.1337 2416782 .[CrossRef]
    [Google Scholar]
  7. Chalmers R.M. , Davies A.P. . ( 2010;). Minireview: clinical cryptosporidiosis. Exp Parasitol 124: 138–146 doi:10.1016/j.exppara.2009.02.003 19545516 .[CrossRef]
    [Google Scholar]
  8. Chalmers R.M. , Campbell B. , Crouch N. , Davies A.P. . ( 2010;). Clinical laboratory practices for detection and reporting of Cryptosporidium in community cases of diarrhoea in the United Kingdom, 2008. Euro Surveill 15: 19731 12166296.
    [Google Scholar]
  9. Chalmers R.M. , Campbell B.M. , Crouch N. , Charlett A. , Davies A.P. . ( 2011;). Comparison of diagnostic sensitivity and specificity of seven Cryptosporidium assays used in the UK. J Med Microbiol 60: 1598–1604 doi:10.1099/jmm.0.034181-0 21144447 .[CrossRef]
    [Google Scholar]
  10. Chalmers R.M. , Katzer F. . ( 2013;). Looking for Cryptosporidium: the application of advances in detection and diagnosis. Trends Parasitol 29: 237–251.[CrossRef]
    [Google Scholar]
  11. Crook P. , Mayon-White R. , Reacher M. . ( 2002;). Enhancing surveillance of cryptosporidiosis: test all faecal specimens from children. Commun Dis Public Health 5: 112–113 21757501.
    [Google Scholar]
  12. Ellam H. , Verlander N.Q. , Lamden K. , Cheesbrough J.S. , Durband C.A. , James S. . ( 2008;). Surveillance of giardiasis in Northwest England 1996-2006: impact of an enzyme immunoassay test. Euro Surveill 13: pii518977 12166295.
    [Google Scholar]
  13. Hunter P.R. , Hughes S. , Woodhouse S. , Raj N. , Syed Q. , Chalmers R.M. , Verlander N.Q. , Goodacre J. . ( 2004a;). Health sequelae of human cryptosporidiosis in immunocompetent patients. Clin Infect Dis 39: 504–510 doi:10.1086/422649 Medline.[CrossRef]
    [Google Scholar]
  14. Hunter P.R. , Hughes S. , Woodhouse S. , Syed Q. , Verlander N.Q. , Chalmers R.M. , Morgan K. , Nichols G. , Beeching N. , Osborn K. . ( 2004b;). Sporadic cryptosporidiosis case-control study with genotyping. Emerg Infect Dis 10: 1241–1249 doi:10.3201/eid1007.030582 18801316 .[CrossRef]
    [Google Scholar]
  15. Jokipii L. , Jokipii A.M.M. . ( 1986;). Timing of symptoms and oocyst excretion in human cryptosporidiosis. N Engl J Med 315: 1643–1647 doi:10.1056/NEJM198612253152604 15356813 .[CrossRef]
    [Google Scholar]
  16. McHardy I.H. , Wu M. , Shimizu-Cohen R. , Couturier M.R. , Humphries R.M. . ( 2014;). Detection of intestinal protozoa in the clinical laboratory. J Clin Microbiol 52: 712–720 doi:10.1128/JCM.02877-13 15324544 .[CrossRef]
    [Google Scholar]
  17. Public Health Laboratory Service Study Group ( 1990;). Cryptosporidiosis in England and Wales: prevalence and clinical and epidemiological features. BMJ 300: 774–777 doi:10.1136/bmj.300.6727.774 2431315 .[CrossRef]
    [Google Scholar]
  18. Public Health England ( 2013;). UK Standards for Microbiology Investigations S 7: Gastroenteritis and diarrhoea. UK Standards for Microbiology Investigations. Issue 1.https://www.gov.uk/government/publications/standards-for-microbiology-investigations-smi-searchable-index .
  19. Public Health England ( 2014a;). UK Standards for Microbiology Investigations (SMI): Quality and consistency in clinical laboratories. https://www.gov.uk/uk-standards-for-microbiology-investigations-smi-quality-and-consistency-in-clinical-laboratories .
  20. Public Health England ( 2014b;). UK Standards for Microbiology Investigations B 30: Investigation of faecal specimens for enteric pathogens. Issue 8i. https://www.gov.uk/government/publications/standards-for-microbiology-investigations-smi-searchable-index .
  21. Public Health England ( 2014c;). UK Standards for Microbiology Investigations B 31: Investigation of specimens other than blood for parasites. Issue 4i. https://www.gov.uk/government/publications/standards-for-microbiology-investigations-smi-searchable-index .
  22. Public Health England ( 2014d;). UK Standards for Microbiology Investigations TP 39: Staining procedures. Issue 1.2.https://www.gov.uk/government/publications/standards-for-microbiology-investigations-smi-searchable-index .
  23. Smith A. , Reacher M. , Smerdon W. , Adak G.K. , Nichols G. , Chalmers R.M. . ( 2006;). Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992-2003. Epidemiol Infect 134: 1141–1149 doi:10.1017/S0950268806006406 24197877 .[CrossRef]
    [Google Scholar]
  24. Wood M. . ( 2001;). When stool cultures from adult inpatients are appropriate. Lancet 357: 901–902 doi:10.1016/S0140-6736(00)04230-6 2322738 .[CrossRef]
    [Google Scholar]
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