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Journal of Clinical Microbiology, July 2008, p. 2200-2205, Vol. 46, No. 7
0095-1137/08/$08.00+0     doi:10.1128/JCM.01666-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Detection of Pathogenic Protozoa in the Diagnostic Laboratory: Result Reproducibility, Specimen Pooling, and Competency Assessment{triangledown}

M. D. Libman,1* T. W. Gyorkos,1,2 E. Kokoskin,1 and J. D. MacLean1

McGill University Centre for Tropical Diseases, Montreal General Hospital,1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada2

Received 21 August 2007/ Returned for modification 21 October 2007/ Accepted 23 April 2008

Stool microscopy as performed in clinical parasitology laboratories is a complex procedure with subjective interpretation. Quality assurance (QA) programs often emphasize proficiency testing as an assessment tool. We describe a result reproducibility assessment tool, which can form part of a broader QA program, and which is based on the blinded resubmission of selected clinical samples, using concordance between the reports of the initial and resubmitted specimen as an indicator. Specimens preserved in sodium acetate-acetic acid-formalin can be stored for several months for use in such a program. The presence of multiple protozoa in one specimen does not affect concordance. Some dilution of specimens occurs in this process, and this may explain poor concordance when specimens with low protozoal concentrations are resubmitted. Evaluation of this tool in a large parasitology laboratory revealed concordance rates for pathogenic protozoa (Entamoeba histolytica/Entamoeba dispar, Giardia lamblia, and Dientamoeba fragilis) of about 80%, which may be considered for use as a benchmark value. We also used this tool to demonstrate that when pairs of specimens from one patient are pooled to create a single specimen, concordance between the results of the individual and pooled specimens is high.

* Corresponding author. Mailing address: McGill University Centre for Tropical Diseases, Montreal General Hospital, Room D7-153, 1650 Cedar Avenue, Montréal, Québec, Canada H3G 1A4. Phone: (514) 934-1934, ext. 42811. Fax: (514) 934-8423. E-mail: michael.libman{at}mcgill.ca

{triangledown} Published ahead of print on 30 April 2008.

Journal of Clinical Microbiology, July 2008, p. 2200-2205, Vol. 46, No. 7
0095-1137/08/$08.00+0     doi:10.1128/JCM.01666-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.





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