Microsporidia Examination
Test Mnemonic
MICSPO
CPT Codes
- 87207 - QTY (1)
Aliases
- Encephalitozoon
- Entercytozoon
- Nosema
- Pleistophora
- Brachiola
- chromotrope stain
- Microsporidium
- modified trichrome stain
- Stool test
- STUL kit
- Vittaforma
Performing Laboratory
Cleveland Clinic Laboratories
Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| Complete to fill line | Stool | EcoFix fixative | Refrigerated | Refrigerated | Ecofix available in a STUL kit; submit stool using a STUL kit at refrigerated conditions. STUL kit can be purchased via oracle #1570140. Refer to Stool collection guide (https://clevelandcliniclabs.com/our-laboratories/laboratory-medicine/microbiology/plmi-collection-guidelines-resources/stool-specimen-collection-guide/) |
| 0.5 mL - 10 mL | Fluid, body | Sterile container | Refrigerated | Refrigerated | EBody fluids (including but not limited to GI aspirates, respiratory secretions, CSF) should be submitted to the lab in a securely tightened sterile screw-top container. A minimum volume of 0.5ml needed, however larger volumes (1-10ml) are concentrated to increase sensitivity of detection. For CSF specimens, consider reaching out to the lab or microbiology medical director prior to collection. |
Alternate Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| 5 mL | Stool | Sterile container | Refrigerated | Refrigerated | Unpreserved stool should be submitted to the lab in a securely tightened sterile screw-top container and should be limited to inpatient settings due to a significantly shorter stability window. Use of non-standard (eg. food containers) is discouraged. Refer to Stool collection guide (https://clevelandcliniclabs.com/our-laboratories/laboratory-medicine/microbiology/plmi-collection-guidelines-resources/stool-specimen-collection-guide/) |
| Complete to fill line | Stool | 10% Formalin | Refrigerated | Refrigerated | |
| Complete to fill line | Stool | SAF | Refrigerated | Refrigerated |
Minimum Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| 5 mL | All vials with preservatives need to be completed to the fill line. |
Stability
| Environmental Condition | Description |
|---|---|
| Refrigerated | Stool - Preserved: 2 months; Unpreserved: Preferred within 6 hours, acceptable within 12 hours. Body fluids - 72hours |
| Frozen | Stool and body fluids - Unacceptable |
| Ambient | Stool - Preserved: 2 months; Unpreserved: Preferred within 6 hours, acceptable within 12 hours. Body fluids - 72hours |
Days Performed
Mon - Fri
Turnaround Time
1 - 7 days
Methodology
| Name | Description |
|---|---|
| Microscopy |
Reference Range
Special Info
Recommend sending a complete STUL kit for submission of all outpatient specimens for any additional add-on testing.
Clinical Info
Microsporidia are considered obligate intracellular parasites that have since been classified within fungi. Transmission routes include ingestion, inhalation or direct inoculation of infective spores. Immunocompromised population specifically patients with AIDS or history of transplant. Infections in immunocompetent individuals have also been reported. Clinical manifestations of microsporidiosis is diverse and can vary with the causal species. Enterocytozoon bieneusi and Encephalitozoon intestinalis are the most common microsporidian species infecting humans and cause gastrointestinal symptoms including diarrhea, fever, malaise and weight loss. Infections in extraintestinal sites is possible and dissemination of infection to other sites have been reported. Microscopy is unable to differentiate and provide a species level identification.
Clinical Limitation
Due to intermittent shedding of parasites a single negative test does not rule out a parasitic infection. Recommend testing 3 different stool specimens collected in separate containers on different days (over 5-7 days), preferably at different times of day. Due to the small size of the microsporidium spores and low organism burden diagnosis by microscopy can be challenging. Molecular detection can offer improved sensitivity and speciicity and is available using the gastrointestinal pathogen panel (STGIPI) which also detects other common infectious causes of persistent diarrhea. This test does not detect other common infectious parasites that cause diarrhea; consider ordering OVAP (other parasites) and CRYSPO (for Cryptosporidia, Cyclospora and Cystoisospora).