Training Module 1

Fecal Flotation

By Jacquelyn H. Burns, DVMCopyright Jacquelyn H. Burns 2011

Fecal Flotation

•THE most important laboratory test in veterinary medicine

What Exactly Does a “Fecal” test for?

• Parasite ova (eggs) are detected by the fecal• The feces is mixed in a salt or sugar solution• The eggs are lightweight and the solution is

supersaturated (heavy), so the eggs “float” to the top

• The ova cling to the coverslip that is on the meniscus

• The coverslip is put on a slide and a tech or the vet read the slide under a microscope

Why do we do it?

• Fecal flotations detect– Roundworms– Hookworms– Whipworms– Coccidia– Sometimes tapeworms– Sometimes lungworms

• Fecal flotations do not always detect:– Tapeworms– Whipworms– Immature roundworms and hookworms– Giardia, Trichomonas, Spirochete bacteria

• Fecal flotations never detect:– Heartworms. They require a blood test

So why do we want a fecal on all first puppy & kitten visits when it is

standard for us to give Pyrantel Pamoate (“Strongid”)?

• “Strongid” is a great product for mild to moderate cases of hookworms and roundworms!

• The vet wants to screen for Coccidia, which require an additional medicine, Albon, for 10 days

• The vet wants to see relative numbers of parasite ova– Heavier infestations of hookworms may be better treated with

Panacur daily for 3 days.– If tapeworms are seen, the vet will likely choose Virbantel for puppies

or Drontal for kittens

Some Vets Don’t Do It!

• At some vet hospitals, they don’t routinely check fecals, they just deworm routinely with a general purpose dewormer

• We think they risk missing some things or risk failing to assess how serious the situation is!

It’s VERY important

• Example: Last week we saw a first puppy visit from a breeder. The breeder paperwork gave 7 dates the puppy had been dewormed with Pyrantel Pamoate, basically once a week from the time it was two weeks old. Guess what? It still had hookworms!

• In a case like this, the vet is very likely to choose a different deworming strategy for this puppy and to explain worm life cycles to the client

Some vets do an even more accurate version of the fecal

• Fecal centrifugation test– Feces is mixed in a fecal solution and put in a

centrifuge and spun for a certain amount of time before the cover slip is put on and the sample is read

– It is more accurate—especially with regard to whipworms

– Worm ova rise to the top from both the spinning and the concentration of the solution

We routinely check fecals on many different types of patients

– Sick adult pets • Vomiting• Diarrhea• Vague symptoms or no identified symptoms, especially dogs

that are not on heartworm preventative• Typically, we would not do a fecal on a pet presented for a

respiratory complaint such as coughing or sneezing, skin or ear problems and injuries

– Annual Wellness Checks– All puppy and kitten visits, whether sick or wellness– All initial visits for Strays—they almost always have

worms

Ask owner if they brought a fecal specimen

• Ask early in the visit so that the fecal may be running while you are doing other things to prepare the patient

• “Mrs. Smith, did you bring a fecal specimen from Fluffy today?”

• Ask this question even if you know Mrs. Smith brought a specimen. Why? Because saying it reinforces in the clients the importance of bringing the specimen

• It’s also a good idea to ask the owner if they’ve seen any worms. Sometimes they may have seen tapeworms, and our specimen may read negative for them.

Obtaining the Fecal Specimen

• Presented by owner• Collected from floor or yard here• Obtained by probing the patient– Calm, easygoing patient, may be done without

restraint or minimal restraint– More energetic patient, a second person is needed to

restrain the pet– Fractious patient – may ask owner to bring specimen

back • Best if they pre-pay to assure that they comply

Patients that should not be probed

• Manx cats and kittens—NEVER PROBE A MANX• Pets where the presenting complaint is rectal pain.• Pets with rectal trauma• Pets with rectal swellings or sores• Pets with rectums that are scalded from diarrhea• Pets with rectal foreign bodies• Pets with rectal tumors

Rare Patients that we Probe Last

• Patients known to become very agitated when their temperature is taken, tail is handled or fecal probing is done

• We do everything else to these patients and take the fecal specimen last

• That way, the easy things are done first and the thing most likely to make the patient angry is done last.

We don’t want to probe any patients if we don’t have to!

• We are trying to train our clients to bring specimens– All pets poop, usually more than once a day– Some Clients don’t see where they poop

• Probing is uncomfortable for many patients. • Probing is unpredictable—sometimes patients are

“empty” and we don’t get our specimen• Probing a resisting patient risks injury to the patient

as well as veterinary assistant/techs and even the owner if they won’t stay out of the way.

To probe

• Explain to owner what you are doing and that it may be a little bit uncomfortable– Some owners actually may prefer to bring a specimen

back later• Lubricate the probe with K-Y jelly• Lift the tail partially and gently insert the probe as

far as needed to obtain feces– Stop if you meet resistance or if the patient becomes

agitated!– Sometimes gently rotating the probe helps

Fecal Probes and K-Y Jelly

Before Setting Up

• Observe the specimen!!!• Note

– Color• Blood=bright blood originates in the colon• Melena (blackish)= digested blood originates upper small intestine or stomach• Dyes from pet food

– Texture• Soft, Loose, Cow patty, watery. mucousy

– Odor• Blood in a stool, even if not visible, has a distinctive odor

– Foreign objects• Yarn, cloth, plastic, bits of bone, etc.

– Parasites such as tapeworm segments

Scant?

• In our clinic, we note on the record if the fecal quantity is “scant” meaning very little feces was obtained/available for testing

• Fecal flotations are most reliable on quantities of 1 gram of feces

• Smaller amounts are usually tested:– If positive, we know we have parasites– If negative, we still could have parasites

Fecal Flotation Solution

Our laboratory dispensing bottle, left, is unlabeled. Labels won’t adhere to it and Sharpie ink won’t stay on. It is the only one we use here, so there’s no confusion.

The 1 gallon refill bottle, right, stays in the cabinet under the sink in the laboratory.

Setting up in test tube

• Fill the test tube halfway with Fecasol (aka Fecamix)• Dip the feces-containing end of the probe into the test

tube and agitate it to mix the feces into the Fecasol solution

• Finish filling the tube with Fecasol until it is brimming but almost overflowing. The rounded surface of the liquid is called the meniscus

• Place a single cover slip on top of the meniscus• Set timer for 5 to 10 minutes• The vet or a trained tech will read the test

Setting up the fecal in a test tube

• Fill test tube half full with fecasol• Insert the end of the fecal probe

containing feces• Agitate the tube up and down to

loosen the feces into the solution (rare specimens may need to be picked out with the end of a cotton-tipped applicator)

• Take out the fecal probe and finish filling the tube to create a meniscus

• Sit a cover slip on the meniscus• Set the timer for 5 minutes

Set timer for 5 minutes

Glass Slides and Cover Slips

Fecalyzer

• A container given to clients to bring fecal specimens in

• Fecals may be set up in the Fecalyzer:– Fill Fecalyzer partway with Fecasol– Agitate the inner greenish part– Finish filling to a meniscus with Fecasol– Set a cover glass on top– Set timer for 5 minutes

Fecal in test tube

Fecal in Fecalyzer

So what do those + signs mean?• You may see it noted in the record here as Rounds +, Hooks +++• Many things in veterinary medicine are assigned a semi-

quantitative assessment on a scale of 1 to 4• + or +1 means very few ova seen• ++ or +2 means a moderate number of ova seen• +++ or +3 means a lot of ova seen• ++++ or +4 means that the slide is loaded with ova• So a pet with +1 or +2 is very likely to get a routine dewormer

such as Pyrantel Pamoate and a pet with +4 is likely to get a more aggressive deworming strategy such as Panacur daily for 3 days.

What does AOTBF mean?

• You may see this abbreviation on a chart or on the appointment screen at our hospital

• It means Asked Owner To Bring Fecal– Often owners forget, but sometimes they will tell you that

nobody asked them to bring a fecal– Often the person bringing the pet in is not the person who

called and was told to bring a specimen– Some owners are just plain lazy; some are squeamish– They should be gently reminded to bring a fecal, but don’t

make them feel like a criminal if they forget• DNAOTBF means Did Not Ask Owner To Bring Fecal

For next time…

• Puppy and kitten owners need to be given a fecal container for their next visit– Again, reinforces the need to bring one

• Fecals may be submitted in non-official containers– Aluminum foil, baggies, paper cups, tupperwares

• Fecals should be relatively fresh– OK if they have some cat litter on them but if the

specimen is covered it litter and has been for several hours, it may be desiccated and too dry to use

Direct Fecal Smears• To look for motile one-celled parasites and bacteria

– Giardia– Trichomonas– Spirochete bacteria

• Done on many pets from “puppy mills”– Jockey Lot or swap meet– Breeders– Pet stores– Rescues and shelters

• A very small amount of feces is smeared onto a glass slide• Add a drop of tap water and mix into the feces to make it watery• Top with a cover slip

– The cover slip should easily be flattened out over the sample– If not, there is too much feces under it!

Other Tests Using Feces

• Parvo Elisa Test - 10 minute test run here• Giardia Elisa Test – 10 minute test sometimes run

here (alternative is to send out the test to the lab)• Tests sent to Antech Laboratories– Fecal Centrifugation tests– Parasite identification– Diarrhea Panels

• PCR test = a DNA type test for multiple agents such as bacteria, one-celled parasites

• Require a Copan swab and at least a gram of fresh feces

Tests we vets don’t often run on feces

• Trypsin digestion tests– Tests for Exocrine Pancreatic Insufficiency– No longer used because TLI blood tests are easier

and more accurate• Fecal Occult Blood– A common test in humans to screen for colon

polyps and cancer– Not accurate in our patients because they are

carnivores

Our Deworming Products“Strongid” –dogs and cats

Virbantel - DOGs

Drontal--CATS Panacur—dogs and cats

Hookworms

Roundworms

Whipworms

Tapeworms

For Coccidia—we have Albon.

For Giardia—we have Metronidazole and Panacur.

Combination heartworm products also deworm for hookworms and roundworms. Advantage Multi and Tri-heart Plus do this

Interceptor and Trifexis deworm for hookworms, roundworms and whipworms

Quiz:1. Fecal flotation solution is

a. Kept under the surgery prep sinkb. A concentrated salt solutionc. A flaky mess to deal withd. Also used as heartworm test buffer

2. If Mrs. Smith consistently forgets to bring a specimen from Chloe, you should:a. Make her feel like a criminalb. Ream Chloe with the probe to make her scream so Mrs. Smith will feel guiltyc. Gently remind her to bring a specimen each visitd. Ask her to bring back a specimene. C & D

Quiz…continued3. We test all new puppies and kittens because

a. It makes us more moneyb. The breeders lie about deworming the puppies they sellc. We don’t want to miss Coccidiad. We don’t want to misjudge the severity of the infestatione. C & D

4. A meniscus isa. A pad of cartilage in the stifleb. A device for collecting a fecal specimenc. The rounded surface of the fecasol in a properly filled test tubed. A device for measuring the number of ova on a slide

Quiz…continued5. Which of the following is not a type of fecal test?

a. Fecal Centrifugationb. TLIc. Direct fecal smeard. Giardia ELISA test

6. ++++Hooks, + Rounds on a fecal test result means:a. No worms seenb. Heavy roundworm infestation, light hookworm infestationc. Heavy hookworm ova, light roundworm ovad. Specimen was too scant to evaluate

Quiz, continued7. The fecal flotation detects

a. Adult wormsb. A protein secreted by adult female wormsc. Worm larvad. Worm ova

8. The fecal flotation always detectsa. Adult Hookwormsb. Tapewormsc. Whipwormsd. B & Ce. None of the above

Quiz…continued

9. Fecals should be done on all excepta. All sick petsb. All puppy and kitten visitsc. Annual wellness checksd. B & Ce. Sneezing cats

10. Which pets should never be probed?a. English bulldogsb. Calico Catsc. Boxersd. Manx catse. Dogs with rectal traumaf. D & E

Slide presentation courtesy of:• Jacquelyn H. Burns, DVM• Holmes Veterinary Hospital 1001 Church Street Laurens, SC 29360 www.holmesvethospital.com (864) 984-2365

Copyright © Jacquelyn H. Burns 2011