There is currently an outbreak of Cyclosporiasis in Iowa.  Because diarrheal symptoms may last for months clinicians may continue to want to rule out Cyclospora for some time.  The core Microbiology laboratory at UIHC does not perform stool examinations for ova and parasites.  Samples must therefore be sent to the State Hygienic Laboratory for O&P examination.  However, Cyclospora are not detected reliably by a standard O&P exam and a special stain must be ordered to reliably rule Cyclosporiasis out.  This broadcast clarifies the testing procedure for Cyclospora.

Not all patients should be tested for Cyclospora and Cyclosporiasis should not routinely be ruled out as an etiology of diarrhea outside the context of an outbreak.  As of July 18th the number of new cases is decreasing dramatically.  Cyclosporiasis should only be considered if the patient developed diarrhea before July 1st.

To obtain the special stain for Cyclospora, do the following:

1. Request an O&P kit with formalin and PVA vials from Hospital Stores (phone 356-1784; #923450).
2. Instructions for specimen collection can be found at: http://www.shl.uiowa.edu/kitsquotesforms/ovaparasitecollectioninstructions.pdf
3. Order Epic UHL52: UHL Cyclospora stain.
4. Fill out a Test Request Form for the Cyclospora examination as an add-on stain from: http://www.shl.uiowa.edu/kitsquotesforms/bacteriologyrequestform.pdf
5. Return the vials and requisition to Specimen Control for transport to the State Hygienic Lab.

For reference, a regular O&P exam is ordered through Epic test UHL49 and is collected and sent out as above.  Giardia/Cryptosporidium and Rotavirus are rapid antigen tests that are orderable in-house as add-on testing to Epic LAB5842: Microbiology: Stool/GI Aspirate.  Samples sent for in-house tests cannot be redirected for testing at the State Hygienic Laboratory.

Questions concerning this broadcast can be directed to Bradley Ford, MD, PhD,  Associate Medical Director of Microbiology, (ext. 6-2990, bradley-ford-1@uiowa.edu).