Evaluation of Parasight All-in-One system for the automated enumeration of helminth ova in canine and feline feces.

BACKGROUND:  Digital imaging combined with deep-learning-based computational image analysis is a growing area in medical diagnostics, including parasitology, where a number of automated analytical devices have been developed and are available for use in clinical practice. METHODS: The performance of Parasight All-in-One (AIO), a second-generation device, was evaluated by comparing it to a well-accepted research method (mini-FLOTAC) and to another commercially available test (Imagyst). Fifty-nine canine and feline infected fecal specimens were quantitatively analyzed by all three methods. Since some samples were positive for more than one parasite, the dataset consisted of 48 specimens positive for Ancylostoma spp., 13 for Toxocara spp. and 23 for Trichuris spp. RESULTS: The magnitude of Parasight AIO counts correlated well with those of mini-FLOTAC but not with those of Imagyst. Parasight AIO counted approximately 3.5-fold more ova of Ancylostoma spp. and Trichuris spp. and 4.6-fold more ova of Toxocara spp. than the mini-FLOTAC, and counted 27.9-, 17.1- and 10.2-fold more of these same ova than Imagyst, respectively. These differences translated into differences between the test sensitivities at low egg count levels (< 50 eggs/g), with Parasight AIO > mini-FLOTAC > Imagyst. At higher egg counts Parasight AIO and mini-FLOTAC performed with comparable precision (which was significantly higher that than Imagyst), whereas at lower counts (> 30 eggs/g) Parasight was more precise than both mini-FLOTAC and Imagyst, while the latter two methods did not significantly differ from each other. CONCLUSIONS: In general, Parasight AIO analyses were both more precise and sensitive than mini-FLOTAC and Imagyst and quantitatively correlated well with mini-FLOTAC. While Parasight AIO produced lower raw counts in eggs-per-gram than mini-FLOTAC, these could be corrected using the data generated from these correlations.

Comparison of traditional copromicroscopy with image analysis devices for detection of gastrointestinal nematode infection in sheep.

Sustainable parasite control practices are necessary to combat the negative effects of gastrointestinal nematodes on animal health and production while reducing the selection pressure for anthelmintic resistance. Parasite diagnostic tests can inform treatment decisions, the timing and effectiveness of treatment and enable livestock breeding programmes. In recent years new diagnostic methods have been developed, some incorporating machine learning (ML), to facilitate the detection and enumeration of parasite eggs. It is important to understand the technical characteristics and performance of such new methods compared to long standing and commonly utilised methods before they are widely implemented. The aim of the present study was to trial three new diagnostic tools relying on image analysis (FECPAKG2, Micron and OvaCyte) and to compare them to traditional manual devices (McMaster and Mini-FLOTAC). Faecal samples were obtained from 41 lambs naturally infected with gastrointestinal nematodes. Samples were mixed and separated into 2 aliquots for examination by each of the 5 methods: McMaster, Mini-FLOTAC, FECPAKG2, Micron and OvaCyte. The techniques were performed according to their respective standard protocols and results were collected by trained staff (McMaster and Mini-FLOTAC) or by the device (FECPAKG2, Micron and OvaCyte). Regarding strongyle worm egg count, McMaster values varied from 0 to 9,000 eggs per gram (EPG). When comparing replicate aliquots, both the Mini-FLOTAC and Micron methods displayed similar repeatability to McMaster. However, we found FECPAKG2 and OvaCyte significantly less precise than McMaster. When comparing parasite egg enumeration, significant positive linear correlations were established between McMaster and all other methods. No difference was observed in EPG between McMaster and Mini-FLOTAC or FECPAKG2; however, Micron and OvaCyte returned significantly higher and lower EPG, respectively, compared to McMaster. The number of eggs ascribed to other parasite species was not sufficient for performing a robust statistical comparison between all methods. However, it was noted that FECPAKG2 generally did not detect Strongyloides papillosus eggs, despite these being detected by other methods. In addition, Moniezia spp and Trichuris spp eggs were detected by OvaCyte and Mini-FLOTAC, respectively, but not by other methods. The observed variation between traditional and new methods for parasite diagnostics highlights the need for continued training and enhancing of ML models used and the importance of developing clear guidelines for validation of newly developed methods.

Development and performance of an automated fecal egg count system for small ruminant strongylids.

An automated equine fecal egg count test, known as the Parasight System, was modified for use with small ruminants. Modifications included the introduction of a short centrifugation step in a floatation medium, an adjustment in pre-test sample filtering, and training of an image analysis-based egg counting algorithm to recognize and enumerate trichostrongylid eggs. In preliminary assessments, the modified method produced trichostrongylid egg counts comparable to manual McMaster analyses of the same samples from both ovine and caprine sources. The coefficient of determination (R2) for the linear correlation between McMaster and automated counts from these samples was 0.958, and there were no significant differences when comparing counts using feces from either sheep or goats. More extensive comparison utilized ovine samples split into three groups based on trichostrongylid egg content: Low (201-500 EPG), Medium (501-1000 EPG) and High (1001 or greater EPG). Each group contained 5 samples, each of which was used to produce individual slurries that were counted 8 times each using both McMaster and the automated method. This, again, showed no difference in accuracy between the techniques, but revealed significantly higher precision, as assessed by coefficients of variation (CoV), for the automated method for determining egg counts in the Low and Medium groups. The CoV of the McMaster method was 2.2, 2.5 and 1.3 times greater than the automated in the Low, Medium and High groups, respectively. Overall, the automated egg counting system showed good linear agreement with trichostrongylid egg counts determined with the McMaster method, and demonstrated significantly better precision. This technology reduces operator error and the results presented here illustrate its utility for determination of small ruminant trichostrongylid fecal egg counts.

The Kubic FLOTAC microscope (KFM): a new compact digital microscope for helminth egg counts.

The Kubic FLOTAC microscope (KFM) is a compact, low-cost, versatile and portable digital microscope designed to analyse fecal specimens prepared with Mini-FLOTAC or FLOTAC, in both field and laboratory settings. In this paper, we present the characteristics of the KFM along with its first validation for fecal egg count (FEC) of gastrointestinal nematodes (GINs) in cattle. For this latter purpose, a study was performed on 30 fecal samples from cattle experimentally infected by GINs to compare the performance of Mini-FLOTAC either using a traditional optical microscope (OM) or the KFM. The results of the comparison showed a substantial agreement (concordance correlation coefficient = 0.999), with a very low discrepancy (−0.425 ± 7.370) between the two microscopes. Moreover, the KFM captured images comparable with the view provided by the traditional OM. Therefore, the combination of sensitive, accurate, precise and standardized FEC techniques, as the Mini-FLOTAC, with a reliable automated system, will permit the real-time observation and quantification of parasitic structures, thanks also to artificial intelligence software, that is under development. For these reasons, the KFM is a promising tool for an accurate and efficient FEC to improve parasite diagnosis and to assist new generations of operators in veterinary and public health.

Diagnostic performance of McMaster, Wisconsin, and automated egg counting techniques for enumeration of equine strongyle eggs in fecal samples.

Fecal egg counts are the cornerstone of equine parasite control programs. Previous work led to the development of an automated, image-analysis-based parasite egg counting system. The system has been further developed to include an automated reagent dispenser unit and a custom camera (CC) unit that generates higher resolution images, as well as a particle shape analysis (PSA) algorithm and machine learning (ML) algorithm. The first aim of this study was to conduct a comprehensive comparison of method precision between the original smartphone (SP) unit with the PSA algorithm, CC/PSA, CC/ML, and the traditional McMaster (MM) and Wisconsin (MW) manual techniques. Additionally, a Bayesian analysis was performed to estimate and compare sensitivity and specificity of all five methods. Feces were collected from horses, screened with triplicate Mini-FLOTAC counts, and placed into five categories: negative (no eggs seen), > 0 - ≤ 200 eggs per gram (EPG), > 200 - ≤ 500 EPG, > 500 - ≤ 1000 EPG, and > 1000 EPG. Ten replicates per horse were analyzed for each technique. Technical variability for samples > 200 EPG was significantly higher for MM than CC/PSA and CC/ML (p <  0.0001). Biological variability for samples> 0 was numerically highest for CC/PSA, but with samples > 200 EPG, MM had a significantly lower CV than MW (p =  0.001), MW had a significantly lower CV than CC/PSA (p <  0.0001), CC/ML had a significantly lower CV than both MW and SP/PSA (p <  0.0001, p =  0.0003), and CC/PSA had a significantly lower CV than CC/SP (p =  0.0115). Sensitivity was> 98 % for all five methods with no significant differences. Specificity, however, was significantly the highest for CC/PSA, followed numerically by SP/PSA, MM, CC/ML, and finally MW. Overall, the automated counting system is a promising new development in equine parasitology. Continued refinement to the counting algorithms will help improve precision and specificity, while additional research in areas such as egg loss, analyst variability at the counting step, and accuracy will help create a complete picture of its impact as a new fecal egg count method.

Helminth Egg Automatic Detector (HEAD): Improvements in development for digital identification and quantification of helminth eggs and their application online.

Helminths are parasitic worms that constitute a major public health problem. Conventional analytical techniques to evaluate helminth eggs in environmental samples rely on different steps, namely sedimentation, filtration, centrifugation, and flotation, to separate the eggs from a variety of particles and concentrate them in a pellet for direct observation under an optical microscope. To improve this process, a new approach was implemented in which various image processing algorithms were developed and implemented by a Helminth Egg Automatic Detector (HEAD). This allowed identification and quantification of pathogenic helminth eggs of global medical importance and it was found to be useful for relatively clean wastewater samples. After the initial version, two improvements were developed: first, a texture verification process that reduced the number of false positive results; and second, the establishment of the optimal thresholds (morphology and texture) for each helminth egg species. This second implementation, which was found to improve on the results of the former, was developed with the objective of using free software as a platform for the system. This does not require the purchase of a license, unlike the previous version that required a Mathworks® license to run. After an internal statistical verification of the system was carried out, trials in internationally recognized microbiology laboratories were performed with the aim of reinforcing software training and developing a web-based system able to receive images and perform the analysis throughout a web service. Once completed, these improvements represented a useful and cheap tool that could be used by environmental monitoring facilities and laboratories throughout the world; this tool is capable of identifying and quantifying different species of helminth eggs in otherwise difficult environmental samples: wastewater, soil, biosolids, excreta, and sludge, with a sensitivity and specificity for the TensorFlow (TF) model in the web service values of 96.82% and 97.96% respectively. Additionally, in the case of Ascaris, it may even differentiate between fertile and non-fertile eggs.

Kankanet: An artificial neural network-based object detection smartphone application and mobile microscope as a point-of-care diagnostic aid for soil-transmitted helminthiases.

BACKGROUND: Endemic areas for soil-transmitted helminthiases often lack the tools and trained personnel necessary for point-of-care diagnosis. This study pilots the use of smartphone microscopy and an artificial neural network-based (ANN) object detection application named Kankanet to address those two needs. METHODOLOGY/PRINCIPAL FINDINGS: A smartphone was equipped with a USB Video Class (UVC) microscope attachment and Kankanet, which was trained to recognize eggs of Ascaris lumbricoides, Trichuris trichiura, and hookworm using a dataset of 2,078 images. It was evaluated for interpretive accuracy based on 185 new images. Fecal samples were processed using Kato-Katz (KK), spontaneous sedimentation technique in tube (SSTT), and Merthiolate-Iodine-Formaldehyde (MIF) techniques. UVC imaging and ANN interpretation of these slides was compared to parasitologist interpretation of standard microscopy.Relative to a gold standard defined as any positive result from parasitologist reading of KK, SSTT, and MIF preparations through standard microscopy, parasitologists reading UVC imaging of SSTT achieved a comparable sensitivity (82.9%) and specificity (97.1%) in A. lumbricoides to standard KK interpretation (97.0% sensitivity, 96.0% specificity). The UVC could not accurately image T. trichiura or hookworm. Though Kankanet interpretation was not quite as sensitive as parasitologist interpretation, it still achieved high sensitivity for A. lumbricoides and hookworm (69.6% and 71.4%, respectively). Kankanet showed high sensitivity for T. trichiura in microscope images (100.0%), but low in UVC images (50.0%). CONCLUSIONS/SIGNIFICANCE: The UVC achieved comparable sensitivity to standard microscopy with only A. lumbricoides. With further improvement of image resolution and magnification, UVC shows promise as a point-of-care imaging tool. In addition to smartphone microscopy, ANN-based object detection can be developed as a diagnostic aid. Though trained with a limited dataset, Kankanet accurately interprets both standard microscope and low-quality UVC images. Kankanet may achieve sensitivity comparable to parasitologists with continued expansion of the image database and improvement of machine learning technology.

Rapid assessment of faecal egg count and faecal egg count reduction through composite sampling in cattle.

BACKGROUND: Faecal egg counts (FEC) and the FEC reduction test (FECRT) for assessing gastrointestinal nematode (GIN) infection and efficacy of anthelmintics are rarely carried out on ruminant farms because of the cost of individual analyses. The use of pooled faecal samples is a promising method to reduce time and costs, but few studies are available for cattle, especially on the evaluation of different pool sizes and FECRT application. METHODS: A study was conducted to assess FEC strategies based on pooled faecal samples using different pool sizes and to evaluate the pen-side use of a portable FEC-kit for the assessment of FEC on cattle farms. A total of 19 farms representing 29 groups of cattle were investigated in Italy and France. On each farm, individual faecal samples from heifers were collected before (D0) and two weeks after (D14) anthelmintic treatment with ivermectin or benzimidazoles. FEC were determined individually and as pooled samples using the Mini-FLOTAC technique. Four different pool sizes were used: 5 individual samples, 10 individual samples, global and global on-farm. Correlations and agreements between individual and pooled results were estimated with Spearman's correlation coefficient and Lin's concordance correlation coefficients, respectively. RESULTS: High correlation and agreement coefficients were found between the mean of individual FEC and the mean of FEC of the different pool sizes when considering all FEC obtained at D0 and D14. However, these parameters were lower for FECR calculation due to a poorer estimate of FEC at D14 from the faecal pools. When using FEC from pooled samples only at D0, higher correlation and agreement coefficients were found between FECR data, the better results being obtained with pools of 5 samples. Interestingly, FEC obtained on pooled samples by the portable FEC-kit on-farm showed high correlation and agreement with FEC obtained on individual samples in the laboratory. This field approach has to be validated on a larger scale to assess its feasibility and reliability. CONCLUSIONS: The present study highlights that the pooling strategy and the use of portable FEC-kits on-farm are rapid and cost-effective procedures for the assessment of GIN egg excretion and can be used cautiously for FECR calculation following the administration of anthelmintics in cattle.

An advanced protocol for the purification of whipworm eggs from feces for use as therapeutic agents.

Recent studies have attempted to treat autoimmune diseases using Trichuris suis. whipworm) eggs. Large quantities of eggs can be obtained efficiently by collecting from the feces of the porcine hosts rather than by extracting from the female worm uterus. However, it is difficult to process large amounts of feces using the current methods. In the present study, we propose a method to collect the eggs from bulk feces more efficiently. Collecting the eggs using washing meshes (25 µm sieve) yields 65.7% (56.0-70.7) of eggs (median, min-max) from 100 g feces. Our method, which uses ethyl acetate and simulated gastric fluid, yielded 91.4% (91.4-94.0) of the eggs from 100 g feces into the separated aqueous solution. Egg collection using simulated gastric fluid (SGF) method was also 60 min faster than that using the sieve method. As the SGF used in the experiment is a strongly acidic reagent with a pH of 1-2, embryonation of the eggs was induced by the rapid pH change. As a result, 37.1% (8.0-77.8) of the eggs had embryonated two months after SGF stimulation. Using the developed method, we could process the feces quickly and efficiently. Furthermore, after purification, egg embryonation could be induced without any harmful reagent treatment. This method is expected to be helpful for further research using Trichuris suis eggs.

Composite Fasciola hepatica faecal egg sedimentation test for cattle.

Options for diagnosing Fasciola hepatica infection in groups of cattle are limited. Increasing the opportunities for herd-level diagnosis is important for disease monitoring, making informed treatment decisions and for flukicide efficacy testing. The sensitivity of a simple sedimentation method based on composite faecal samples for the detection of fluke eggs in cattle was assessed through a combination of experimental and statistical modelling techniques. Initially, a composite sample method previously developed for sheep was used to investigate the sensitivity of composite sample testing compared with individual counts on the same samples in cattle. Following this, an optimised, validated, qualitative (presence-absence) composite sample field test was developed for cattle. Results showed that fluke egg counts obtained from a composite sample are representative of those expected from individual counts. The optimal sampling strategy was determined to be 10 individual 10 g samples (100 g composite sample) from which a 10 g subsample is taken for sedimentation. This method yielded a diagnostic sensitivity of 0.69 (95 per cent CI 0.5 to 0.85). These results demonstrate the validity and usefulness of a composite faecal egg sedimentation method for use in the diagnosis and control of F. hepatica in groups of cattle, with the caveat that a negative test should be followed up with a second test due to limitations relating to test sensitivity.

Determination of the specific gravity of eggs of equine strongylids, Parascaris spp., and Anoplocephala perfoliata.

Given the ever-increasing levels of anthelmintic resistance in livestock parasites globally, it is recommended to use parasite fecal egg counts to make treatment decisions and to evaluate treatment efficacy. The consensus in equine parasitology is to use a flotation medium with a specific gravity (SG) of ≥ 1.20 to float the main parasite egg types of interest in egg counting techniques. However, the density of common equine endoparasite eggs has been sparsely investigated. Equine tapeworm eggs are known to be particularly difficult to determine and count in fecal samples. It is unknown whether this could be because of differences in egg density. The aim of this study was to provide estimates of relative densities for equine ascarid, strongyle, and tapeworm eggs. Six aqueous glucose-salt solutions with specific gravities ranging from 1.06 to 1.16 were made and placed from most to least dense into thirteen 15 mL centrifuge tubes. Concentrated aqueous suspensions of the three types of endoparasite eggs were placed on top of each tube. These tubes were then centrifuged at 800 g for 20 min and each layer of flotation solution was carefully pipetted and transferred to a McMaster egg counting slide. Egg type and count were recorded for each specific gravity layer. Each egg was assigned a specific gravity based on the specific gravity layer it was observed in. In a second trial of this study, five similar flotation media were made ranging from 1.02 to 1.10 and were used in four subsequent replicates. In total between the two trials, the mean egg SGs of Anoplocephala perfoliata (n = 3811), Parascaris spp. (n = 3478), and strongylid type eggs (n = 9291) were 1.0636 (95% confidence interval (CI): 1.0629-1.0642), 1.0903 (95% CI: 1.0897-1.0909), and 1.0453 (95% CI: 1.0448-1.0458), respectively. The three egg types were statistically different from each other (p < 0.0001). This is the first time that the specific gravity of equine strongylid and Anoplocephala perfoliata eggs has been determined. With a tapeworm egg density demonstrated to be between that of strongylids and Parascaris spp., the poor recovery of tapeworm eggs in equine fecal samples must have other explanations.

Comparison between McMaster and Mini-FLOTAC methods for the enumeration of Eimeria maxima oocysts in poultry excreta.

Monitoring Eimeria shedding has become more important due to the recent restrictions to the use of antibiotics within the poultry industry. Therefore, there is a need for the implementation of more precise and accurate quantitative diagnostic techniques. The objective of this study was to compare the precision and accuracy between the Mini-FLOTAC and the McMaster techniques for quantitative diagnosis of Eimeria maxima oocyst in poultry. Twelve pools of excreta samples of broiler chickens experimentally infected with E. maxima were analyzed for the comparison between Mini-FLOTAC and McMaster technique using, the detection limits (dl) of 23 and 25, respectively. Additionally, six excreta samples were used to compare the precision of different dl (5, 10, 23, and 46) using the Mini-FLOTAC technique. For precision comparisons, five technical replicates of each sample (five replicate slides on one excreta slurry) were read for calculating the mean oocyst per gram of excreta (OPG) count, standard deviation (SD), coefficient of variation (CV), and precision of both aforementioned comparisons. To compare accuracy between the methods (McMaster, and Mini-FLOTAC dl 5 and 23), excreta from uninfected chickens was spiked with 100, 500, 1,000, 5,000, or 10,000 OPG; additional samples remained unspiked (negative control). For each spiking level, three samples were read in triplicate, totaling nine reads per spiking level per technique. Data were transformed using log10 to obtain normality and homogeneity of variances. A significant correlation (R = 0.74; p = 0.006) was observed between the mean OPG of the McMaster dl 25 and the Mini-FLOTAC dl 23. Mean OPG, CV, SD, and precision were not statistically different between the McMaster dl 25 and Mini-FLOTAC dl 23. Despite the absence of statistical difference (p > 0.05), Mini-FLOTAC dl 5 showed a numerically lower SD and CV than Mini-FLOTAC dl 23. The Pearson correlation coefficient revealed significant and positive correlation among the four dl (p ≤ 0.05). In the accuracy study, it was observed that the Mini-FLOTAC dl 5 and 23 were more accurate than the McMaster for 100 OPG, and the Mini-FLOTAC dl 23 had the highest accuracy for 500 OPG. The McMaster and Mini-FLOTAC dl 23 techniques were more accurate than the Mini-FLOTAC dl 5 for 5,000 OPG, and both dl of the Mini-FLOTAC were less accurate for 10,000 OPG counts than the McMaster technique. However, the overall accuracy of the Mini-FLOTAC dl 23 was higher than the McMaster and Mini-FLOTAC dl 5 techniques.

Evaluation of Parasite Egg and Cyst Recovery Using Devices Designed for Centrifugal or Stationary Flotation.

Two new devices (OT, ST), were recently introduced for the recovery of parasite eggs and cysts for microscopic examination. These devices, two stationary flotation devices, and a standard double-centrifugal sugar-flotation were compared using common flotation solutions and methods recommended by the manufacturers for the recovery of hookworm, ascaridoid, and whipworm eggs from companion animal fecal samples. Additionally, the recovery of Giardia cysts in the OT device using a zinc sulfate versus sodium nitrate solution was evaluated. Double-centrifugal sugar-flotation (1.30 specific gravity) was the most sensitive method for the recovery of the nematode eggs from feces of companion animals. Overall, centrifugation increased the recovery of eggs as compared with standing flotation methods, with the ST performing equivalently to the OT. Although these more recently introduced tests have good sensitivities for the nematodes tested, egg recovery was routinely markedly less than that achieved by standard double-centrifugal sugar-flotation, and false-negatives did occur. Still, the OT and ST generally have increased recoveries over the two standing flotation devices, and are significantly better than these for the recovery of ascaridoid and whipworm eggs from dog and cat samples. Zinc sulfate (1.18 specific gravity) is recommended for the recovery of Giardia cysts when using the OT device.

Efficiency of two sewage treatment systems (activated sludge and natural lagoons) for helminth egg removal in Morocco.

Morocco is a country known for its vulnerability of water resources because of its arid and semi-arid climate. Thus, recycled wastewater has been suggested for agricultural activities, but contamination of these wastewaters is a major concern. The current study aims to determine the occurrence of helminth eggs in urban wastewater and to evaluate the removal of these pathogens by two sewage treatment systems: activated sludge and natural lagoons. The samples of wastewater and sludge were collected from two wastewater treatment plants (WWTP) located in Marrakech and Chichaoua, Morocco. Parasitological identification, according to the Bailenger technique, showed the presence of Nematodes and Cestodes, which are pathogenic to humans and animals and are responsible for helminthiasis. The wastewater and sewage sludge samples from Marrakech carried Ascaris lumbricoïdes, Ancylostoma duodenale, Trichuris trichiura, Capillaria spp., Taenia spp. and Hymenolepis spp., while the samples from Chichaoua carried Ascaris lumbricoïdes, Ancylostoma duodenale, Trichuris trichiura and Capillaria spp. The overall removal efficiency of eggs in the treatment plants ranged from 100% in the WWTP of Marrakech using activate sludge to 94.97% in the WWTP of Chichaoua using natural lagoons. These results were discussed according to health risk and the cost-effectiveness of both wastewater treatment techniques.

A Comparative Study of Four Methods for the Detection of Nematode Eggs and Large Protozoan Cysts in Mandrill Faecal Material.

Coproscopical methods like sedimentation and flotation techniques are widely used in the field for studying simian gastrointestinal parasites. Four parasites of known zoonotic potential were studied in a free-ranging, non-provisioned population of mandrills (Mandrillus sphinx): 2 nematodes (Necatoramericanus/Oesophagostomum sp. complex and Strongyloides sp.) and 2 protozoan species (Balantidium coli and Entamoeba coli). Different coproscopical techniques are available but they are rarely compared to evaluate their efficiency to retrieve parasites. In this study 4 different field-friendly methods were compared. A sedimentation method and 3 different McMaster methods (using sugar, salt, and zinc sulphate solutions) were performed on 47 faecal samples collected from different individuals of both sexes and all ages. First, we show that McMaster flotation methods are appropriate to detect and thus quantify large protozoan cysts. Second, zinc sulphate McMaster flotation allows the retrieval of a higher number of parasite taxa compared to the other 3 methods. This method further shows the highest probability to detect each of the studied parasite taxa. Altogether our results show that zinc sulphate McMaster flotation appears to be the best technique to use when studying nematodes and large protozoa.

Assessing stool quantities generated by three specific Kato-Katz thick smear templates employed in different settings.

BACKGROUND: The Kato-Katz technique is recommended for the diagnosis of helminth infections in epidemiological surveys, drug efficacy studies and monitoring of control interventions. We assessed the comparability of the average amount of faeces generated by three Kato-Katz templates included in test kits from two different providers. METHODS: Nine hundred Kato-Katz thick smear preparations were done; 300 per kit. Empty slides, slides plus Kato-Katz template filled with stool and slides plus stool after careful removal of the template were weighed to the nearest 0.1 mg. The average amount of stool that was generated on the slide was calculated for each template, stratified by standard categories of stool consistency (i.e. mushy, soft, sausage-shaped, hard and clumpy). RESULTS: The average amount of stool generated on slides was 40.7 mg (95 % confidence interval (CI): 40.0-41.4 mg), 40.3 mg (95 % CI: 39.7-40.9 mg) and 42.8 mg (95 % CI: 42.2-43.3 mg) for the standard Vestergaard Frandsen template, and two different templates from the Chinese Center for Disease Control and Prevention (China CDC), respectively. Mushy stool resulted in considerably lower average weights when the Vestergaard Frandsen (37.0 mg; 95 % CI: 34.9-39.0 mg) or new China CDC templates (37.4 mg; 95 % CI: 35.9-38.9 mg) were used, compared to the old China CDC template (42.2 mg; 95 % CI: 40.7-43.7 mg) and compared to other stool consistency categories. CONCLUSION: The average amount of stool generated by three specific Kato-Katz templates was similar (40.3-42.8 mg). Since the multiplication factor is somewhat arbitrary and small changes only have little effect on infection intensity categories, it is suggested that the standard multiplication factor of 24 should be kept for the calculation of eggs per gram of faeces for all investigated templates.

Faecal Parasitology: Concentration Methodology Needs to be Better Standardised.

AIM: To determine whether variation in the preservative, pore size of the sieve, solvent, centrifugal force and centrifugation time used in the Ridley-Allen Concentration method for examining faecal specimens for parasite stages had any effect on their recovery in faecal specimens. METHODS: A questionnaire was sent to all participants in the UK NEQAS Faecal Parasitology Scheme. The recovery of parasite stages was compared using formalin diluted in water or formalin diluted in saline as the fixative, 3 different pore sizes of sieve, ether or ethyl acetate as a solvent, 7 different centrifugal forces and 6 different centrifugation times according to the methods described by participants completing the questionnaire. RESULTS: The number of parasite stages recovered was higher when formalin diluted in water was used as fixative, a smaller pore size of sieve was used, ethyl acetate along with Triton X 100 was used as a solvent and a centrifugal force of 3,000 rpm for 3 minutes were employed. CONCLUSIONS: This study showed that differences in methodology at various stages of the concentration process affect the recovery of parasites from a faecal specimen and parasites present in small numbers could be missed if the recommended methodology is not followed.

Identification and quantification of pathogenic helminth eggs using a digital image system.

A system was developed to identify and quantify up to seven species of helminth eggs (Ascaris lumbricoides -fertile and unfertile eggs-, Trichuris trichiura, Toxocara canis, Taenia saginata, Hymenolepis nana, Hymenolepis diminuta, and Schistosoma mansoni) in wastewater using different image processing tools and pattern recognition algorithms. The system was developed in three stages. Version one was used to explore the viability of the concept of identifying helminth eggs through an image processing system, while versions 2 and 3 were used to improve its efficiency. The system development was based on the analysis of different properties of helminth eggs in order to discriminate them from other objects in samples processed using the conventional United States Environmental Protection Agency (US EPA) technique to quantify helminth eggs. The system was tested, in its three stages, considering two parameters: specificity (capacity to discriminate between species of helminth eggs and other objects) and sensitivity (capacity to correctly classify and identify the different species of helminth eggs). The final version showed a specificity of 99% while the sensitivity varied between 80 and 90%, depending on the total suspended solids content of the wastewater samples. To achieve such values in samples with total suspended solids (TSS) above 150 mg/L, it is recommended to dilute the concentrated sediment just before taking the images under the microscope. The system allows the helminth eggs most commonly found in wastewater to be reliably and uniformly detected and quantified. In addition, it provides the total number of eggs as well as the individual number by species, and for Ascaris lumbricoides it differentiates whether or not the egg is fertile. The system only requires basically trained technicians to prepare the samples, as for visual identification there is no need for highly trained personnel. The time required to analyze each image is less than a minute. This system could be used in central analytical laboratories providing a remote analysis service.

Automated parasite faecal egg counting using fluorescence labelling, smartphone image capture and computational image analysis.

Intestinal parasites are a concern in veterinary medicine worldwide and for human health in the developing world. Infections are identified by microscopic visualisation of parasite eggs in faeces, which is time-consuming, requires technical expertise and is impractical for use on-site. For these reasons, recommendations for parasite surveillance are not widely adopted and parasite control is based on administration of rote prophylactic treatments with anthelmintic drugs. This approach is known to promote anthelmintic resistance, so there is a pronounced need for a convenient egg counting assay to promote good clinical practice. Using a fluorescent chitin-binding protein, we show that this structural carbohydrate is present and accessible in shells of ova of strongyle, ascarid, trichurid and coccidian parasites. Furthermore, we show that a cellular smartphone can be used as an inexpensive device to image fluorescent eggs and, by harnessing the computational power of the phone, to perform image analysis to count the eggs. Strongyle egg counts generated by the smartphone system had a significant linear correlation with manual McMaster counts (R(2)=0.98), but with a significantly lower coefficient of variation (P=0.0177). Furthermore, the system was capable of differentiating equine strongyle and ascarid eggs similar to the McMaster method, but with significantly lower coefficients of variation (P<0.0001). This demonstrates the feasibility of a simple, automated on-site test to detect and/or enumerate parasite eggs in mammalian faeces without the need for a laboratory microscope, and highlights the potential of smartphones as relatively sophisticated, inexpensive and portable medical diagnostic devices.