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Parasite concentration methods

Judy/Bob Dilworth dilworth at megsinet.net
Fri Mar 12 16:25:43 EST 1999

Unfortunately, it's a matter of money and government regulations.  Our
routine O&P procedure does not include a slide for Cryptosporidium. It
also takes more tech time (=money) and reagents (=money) to do this
procedure.  If the doc doesn't specify this organism, we would be "out
of compliance" with regards to Medicare and insurance companies and
could get into a lot of legal problems.  We include a comment with our
report that we do not include stains for Cryptosporidium or
Microsporidium.  We discussed this very question and that is the
compromise we had to come up with, as reimbursements are lousy as it is,
let alone have a higher cost that wouldn't be reimbursable.  Working for
an independent regional laboratory as opposed to a hospital laboratory
makes the tech much more aware of money issues.  In a hospital, you are
somewhat shielded from the nuts and bolts accounting of lab costs,
however, this is not nearly as true nowadays as in the '80's.  Costs
loom large in hospitals and the techs are feeling it more - but that's
another topic and another newsgroup.

Judy Dilworth, M.T. (ASCP)
Microbiology since 1974 

>     I am a MT (ASCP) (I also have a Masters Degree in Microbiology). When I
>     graduated from the Univ. of Illinois School of Medical Technology in
>     1967, I was taught to perform a direct saline and iodine prep, a
>     formalin-ether concentration and a stained smear(hematoxylin) on fecal
>     specimens received for parasitology work-up. I worked in hospital
>     microbiology labs for twenty years at four different hospitals in
>     different cities in Illinois. A few minor changes took place. We
>     switched from ether to ethyl acetate. We switched to a Trichrome stain
>     from HE. We added a direct acid-fast stain in the 1980's when we
>     learned about Cryptosporidia. When I left human medicine in 1990 and
>     started working in Veterinary microbiology,  I learned flotation
>     concentration techniques for the first time. My laboratory (the
>     Wisconsin Animal Health Laboratory) switched from sucrose flotations to
>     ZNSO4 floatations about five years ago. (Our observation was that ZNSO4
>     was superior to sucrose for Giardia and we occasionally found bovine or
>     feline lungworm on our ZNSO4 flotations. Yes, I know the Baermann
>     technique is best for lungworm but it is not part of our routine set-up
>     unless the submitting veterinarian suspects lungworm and specifically
>     requests a Baermann).
>     When I left human medicine in 1990, the most common parasites we found
>     in the northern Illinois hospital I was working in were Giardia and
>     Cryptosporidia (about 50-50). I find it surprising that many human
>     clinical microbiology laboratories do not include a test for
>     Cryptosporidia as part of the "routine" parasitology workup.
>     Finally, I think that many inexperienced Medical Technologists who are
>     asked to perform parasitology exams have trouble recognizing the small
>     parasites such as Giardia and Cryptosporidia. I found this to be the
>     case time and time again in hospital laboratories where I worked. Also,
>     I don't expect expertise to improve as Medical Technologists are being
>     required to perform as generalists instead of specializing in a
>     specific area of the laboratory.
>     Kathleen Strelow, MS,MT(ASCP),SM(AAM)
>     Wisconsin Animal Health Laboratory
>     Madison, WI

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