This document provides information on performing and interpreting fecal flotation tests. It discusses how the test works to detect parasite eggs, why it is important to perform on puppies and kittens, how to collect and prepare samples, and what the results may indicate. Key points covered include that fecal flotation detects parasite eggs but not adult worms, tapes, or certain immature forms, and that a positive result means eggs were seen while a negative result does not rule out an infection when samples are scant.

1. Training Module 1 Fecal Flotation By Jacquelyn H. Burns, DVM Copyright Jacquelyn H. Burns 2011

2. Fecal Flotation THE most important laboratory test in veterinary medicine

3. 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

4. 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

5. 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

6. 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!

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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

13. 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.

14. 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.

15. 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

16. Fecal Probes and K-Y Jelly

17. 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

18. 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

19. 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.

20. 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

22. Insert the end of the fecal probe containing feces

23. 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)

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

25. Sit a cover slip on the meniscus

27. Glass Slides and Cover Slips

28. 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

29. Fecal in test tube Fecal in Fecalyzer

30. 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.

31. 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

32. 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

33. 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!

34. 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

35. 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

36. Our Deworming Products 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

37. Quiz: Fecal flotation solution is Kept under the surgery prep sink A concentrated salt solution A flaky mess to deal with Also used as heartworm test buffer If Mrs. Smith consistently forgets to bring a specimen from Chloe, you should: Make her feel like a criminal Ream Chloe with the probe to make her scream so Mrs. Smith will feel guilty Gently remind her to bring a specimen each visit Ask her to bring back a specimen C & D

38. Quiz…continued We test all new puppies and kittens because It makes us more money The breeders lie about deworming the puppies they sell We don’t want to miss Coccidia We don’t want to misjudge the severity of the infestation C & D A meniscus is A pad of cartilage in the stifle A device for collecting a fecal specimen The rounded surface of the fecasol in a properly filled test tube A device for measuring the number of ova on a slide

39. Quiz…continued Which of the following is not a type of fecal test? Fecal Centrifugation TLI Direct fecal smear Giardia ELISA test ++++Hooks, + Rounds on a fecal test result means: No worms seen Heavy roundworm infestation, light hookworm infestation Heavy hookworm ova, light roundworm ova Specimen was too scant to evaluate

40. Quiz, continued The fecal flotation detects Adult worms A protein secreted by adult female worms Worm larva Worm ova The fecal flotation always detects Adult Hookworms Tapeworms Whipworms B & C None of the above

41. Fecals should be done on all except All sick pets All puppy and kitten visits Annual wellness checks B & C Sneezing cats Quiz…continued Which pets should never be probed? English bulldogs Calico Cats Boxers Manx cats Dogs with rectal trauma D & E

42. 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