Stool Culture

Definition

Stool culture is a test to identify bacteria in patients with a suspected infection of the digestive tract. A sample of the patient's feces is placed in a special medium where bacteria is then grown. The bacteria that grow in the culture are identified using a microscope and biochemical tests.

Purpose

Stool culture is performed to identify bacteria or other organisms in persons with symptoms of gastrointestinal infection, most commonly diarrhea. Identification of the organism is necessary to determine the treatment of the patient's infection or to trace the cause of an outbreak or epidemic of certain types of diarrhea.

According to the Centers for Disease Control and Prevention (CDC), doctors are most likely to order a stool culture for patients with any of the following characteristics: AIDS, bloody stools, diarrhea lasting longer than three days, high fever, history of recent travel abroad, or severe dehydration.

Precautions

Stool culture is performed only if an infection of the digestive tract is suspected. The test has no harmful effects.

Description

Stool culture may also be called fecal culture. To obtain a specimen for culture, the patient is asked to collect a stool sample into a special sterile container. In some cases, the container may contain a transport solution. Specimens may need to be collected on three consecutive days. It is important to return the specimen to the doctor's office or the laboratory in the time specified by the physician or nurse. Laboratories do not accept stool specimens contaminated with water, urine, or other materials.

The culture test involves placing a sample of the stool on a special substance, called a medium, that provides nutrients for certain organisms to grow and reproduce. The medium is usually a thick gel-like substance. The culture is done in a test tube—or on a flat round culture plate—which is incubated at the proper temperature for growth of the bacteria. After a colony of bacteria grows in the medium, the type of bacteria is identified by observing the colony's growth, its physical characteristics, and its microscopic features. The bacteria may be dyed with special stains that make it easier to identify features specific to particular bacteria.

The length of time needed to perform a stool culture depends on the laboratory where it is done and the culture methods used. Stool culture usually takes 72 hours or longer to complete. Some organisms may take several weeks to grow in a culture.

An antibiotic sensitivity test may be done after a specific bacterium is identified. This test shows which antibiotics will be most effective for treating the infection.

Although most intestinal infections are caused by bacteria, in some cases a fungal or viral culture may be necessary. The most common bacterial infections of the digestive tract are caused by Shigella, Salmonella, Campylobacter, and Yersinia. Patients taking certain antibiotics may be susceptible to infection with Clostridium difficile. In some cases, as with Clostridium difficile, the stool culture is used to detect the toxin (poison or harmful chemical) produced by the bacteria.

Patients with AIDS, or other immune system diseases, may also have gastrointestinal infections caused by such fungi as Candida, or viral organisms including cytomegalovirus.

Several intestinal parasites may cause gastrointestinal infection and diarrhea. Parasites are not cultured, but are identified microscopically in a test called "Stool Ova and Parasites."

Insurance coverage for stool culture may vary among different insurance plans. This common test usually is covered if ordered by a physician approved by the patient's insurance plan, and if it is done at an approved laboratory.

Alternative methods

Newer methods of testing stool samples for specific disease organisms include various forms of polymerase chain reaction (PCR) assays. One type that has been used to test for several different types of intestinal viruses at the same time is the RT-PCR, which stands for reverse transcriptase polymerase chain reaction. This assay measures changes in an organism's messenger RNA. RT-PCR assays have several advantages over standard stool cultures: they require only very small samples of material; they can be performed much more rapidly; and they can be used to test environmental water for virus contamination as well as human stool samples.

Preparation

The physician or other healthcare provider will ask the patient for a complete medical history and perform a physical examination to determine possible causes of the gastrointestinal problem. Information about the patient's diet, any medications taken, and recent travel may provide clues to the identity of possible infectious organisms.

Stool culture normally doesn't require any special preparation. Patients do not need to change their diet before collecting the specimen. Intake of some substances can contaminate the stool specimen and should not be taken the day before collection. These substances include castor oil, bismuth, and laxative preparations containing psyllium hydrophilic mucilloid.

Normal results

Bacteria that are normally found in the intestines include Pseudomonas and Escherichia coli. These enteric bacteria (bacteria of the gastrointestinal system) are considered normal flora and usually do not cause infection in the digestive tract.

Abnormal results

Bacteria that do not normally inhabit the digestive tract, and that are known to cause gastrointestinal infection include Shigella, Salmonella, Campylobacter, and Yersinia. Clostridium difficile produces a toxin that can cause severe diarrhea. Other bacteria that produce toxins are Staphylococcus aureus, Bacillus cereus, and enterotoxigenic (producing disease in the digestive system) Escherichia coli. Although Escherichia coli is a normal bacteria found in the intestines, the enterotoxigenic type of this bacteria can be acquired from eating contaminated meat, juice, or fruits. It produces a toxin that causes severe inflammation and bleeding of the colon.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Disturbances in Newborns and Infants." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Grimm, A. C., J. L. Cashdollar, F. P. Williams, and G. S. Fout. "Development of an Astrovirus RT-PCR Detection Assay for Use with Conventional, RealTime, and Integrated Cell Culture/RT-PCR." Canadian Journal of Microbiology 50 (April 2004): 269-278.

Hennessy, T. W., R. Marcus, V. Deneen, et al. "Survey of Physician Diagnostic Practices for Patients with Acute Diarrhea: Clinical and Public Health Implications." Clinical Infectious Diseases 38, Supplement 3 (April 15, 2004): s203-S211.

Heryford, A. G., and S. A. Seys. "Outbreak of Occupational Campylobacteriosis Associated with a Pheasant Farm." Journal of Agricultural Safety and Health 10 (May 2004): 127-132.

Rohayem, J., S. Berger, T. Juretzek, et al. "A Simple and Rapid Single-Step Multiplex RT-PCR to Detect Norovirus, Astrovirus and Adenovirus in Clinical Stool Samples." Journal of Virological Methods 118 (June 1, 2004): 49-59.

Sloan, L. M., J. R. Uhl, E. A. Vetter, et al. "Comparison of the Roche LightCycler vanA/vanB Detection Assay and Culture for Detection of Vancomycin-Resistant Enterococci from Perianal Swabs." Journal of Clinical Microbiology 42 (June 2004): 2636-2643.

ORGANIZATIONS

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. 〈http://www.cdc.gov〉.

KEY TERMS

Bismuth— A substance used in medicines to treat diarrhea, nausea, and indigestion.

Enteric— Pertaining to the intestine.

Enterotoxigenic— Refers to an organism that produces toxins in the gastrointestinal tract that cause such things as vomiting, diarrhea, and other symptoms of food poisoning.

Feces— Material excreted by the intestines.

Flora— Refers to normal bacteria found in a healthy person.

Gastrointestinal— Referring to the digestive tract; the stomach and intestines.

Psyllium hydrophilic mucilloid— A plant material contained in some laxatives.

Sterile— Free of microorganisms.

Toxin— A poison; usually refers to protein poisons produced by bacteria, animals, and some plants.

Stool Fat Test

Definition

Stool fats, also known as fecal fats, or fecal lipids, are fats that are excreted in the feces. When secretions from the pancreas and liver are adequate, emulsified dietary fats are almost completely absorbed in the small intestine. When a malabsorption disorder or other cause disrupts this process, excretion of fat in the stool increases.

Purpose

This test evaluates digestion of fats by determining excessive excretion of lipids in patients exhibiting signs of malabsorption, such as weight loss, abdominal distention, and scaly skin.

Precautions

Drugs that may increase fecal fat levels include enemas and laxatives, especially mineral oil. Drugs that may decrease fecal fat include Metamucil and barium. Other substances that can affect test results include alcohol, potassium chloride, calcium carbonate, neomycin, kanamycin, and other broad-spectrum antibiotics.

Description

Excessive excretion of fecal fat is called steatorrhea, a condition that is suspected when the patient has large, "greasy," and foul-smelling stools. Both digestive and absorptive disorders can cause steatorrhea. Digestive disorders affect the production and release of the enzyme lipase from the pancreas, or bile from the liver, which are substances that aid digestion of fats; absorptive disorders disturb the absorptive and enzyme functions of the intestine. Any condition that causes malabsorption or maldigestion is also associated with increased fecal fat. As an example, children with cystic fibrosis have mucous plugs that block the pancreatic ducts. The absence or significant decrease of the pancreatic enzymes, amylase, lipase, trypsin, and chymotrypsin limits fat protein and carbohydrate digestion, resulting in steatorrhea due to fat malabsorption.

Both qualitative and quantitative tests are used to identify excessive fecal fat. The qualitative test involves staining a specimen of stool with a special dye, then examining it microscopically for evidence of malabsorption, such as undigested muscle fiber and various fats. The quantitative test involves drying and weighing a 72-hour stool specimen, then using an extraction technique to separate the fats, which are subsequently evaporated and weighed. This measurement of the total output of fecal fat per 24 hours in a three-day specimen is the most reliable test for steatorrhea.

Preparation

This test requires a 72-hour stool collection. The patient should abstain from alcohol during this time and maintain a high-fat diet (100 g/day) for three days before the test, and during the collection period. The patient should call the laboratory for instructions on how to collect the specimen.

Normal results

Reference values vary from laboratory to laboratory, but are generally found within the range of 5-7 g/24 hr.

It should be noted that children, especially infants, cannot ingest the 100 g/day of fat that is suggested for the test. Therefore, a fat retention coefficient is determined by measuring the difference between ingested fat and fecal fat, and expressing that difference as a percentage. The figure, called the fat retention coefficient, is 95% or greater in healthy children and adults. A low value is indicative of steatorrhea.

Abnormal results

Increased fecal fat levels are found in cystic fibrosis, malabsorption secondary to other conditions like Whipple's disease or Crohn's disease, maldigestion secondary to pancreatic or bile duct obstruction, and "short-gut" syndrome secondary to surgical resection, bypass, or congenital anomaly.

Resources

BOOKS

Pagana, Kathleen Deska. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby, Inc., 1998.