Hence, no definitive

Hence, no definitive selleck Imatinib statement about false-positive or false-negative results can be made, as it was not feasible to verify the reported data by another independent technique, such as PCR results. The use of PCR assays would probably have revealed even higher infection rates of most intestinal protozoon species. In the absence of readily available PCR or another highly sensitive diagnostic assay, multiple stool examinations using FECT, Flotac, or another copromicroscopic technique would have been required to determine the ��true�� infection prevalence of intestinal protozoa and helminths (34). Whenever copromicroscopic diagnostic techniques are employed, it is important to ensure that all laboratory technicians involved in the examination process are well trained so that possible bias is reduced to a minimum.

In our study, all microscope slides were read by the same experienced technician to avoid interpersonal discrepancy influencing the results. Additional studies are warranted to confirm the promising results reported here and those obtained before for migrants in Italy (16) regarding the accuracy of the Flotac-400 dual technique for diagnosis of intestinal protozoa. Three observations from our study emphasize the need for validating additional FS to further improve the accuracy of the Flotac-400 dual technique. First, the microscopic analysis of the Flotac samples in the laboratory was often time consuming, as a considerable quantity of fecal debris had not been retained by the chemical agents used during the preparation phase.

The visibility of the intestinal protozoon cysts or vegetative forms was therefore limited, and the identification of subcellular structures like nucleoli became difficult. As the differentiation of some Entamoeba species is based on correct nucleolus counts, the examination of the Flotac-400 reading disk under the microscope sometimes did not permit determination of the species of intestinal protozoa, so that these results had to be excluded, decreasing the method’s sensitivity. Staining the fecal samples, e.g., by using Lugol’s iodine, may help to improve the visibility and, hence, the differential diagnosis of Entamoeba species in future investigations. Second, E. coli was destroyed by both FS employed in the current study (Fig. 2), which might indicate that the chemicals used were too aggressive for some intestinal protozoon species.

It is conceivable that the sensitivity of the Flotac-400 dual technique can be further enhanced when FSs are used that are able to retain debris more effectively and, hence, allow a more accurate identification of the parasites investigated. Indeed, a recent study suggests that FS3 may be more appropriate for the diagnosis of E. histolytica/E. dispar than the Brefeldin_A two FSs employed here (i.e., FS4 and FS7), yet it remains to be elucidated whether FS3 can be used for concurrent helminth diagnosis.

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