the need for individuals who are familiar with diagnostic parasitology. With many laboratories decreasing staff size as a cost-containment measure, we are also seeing more “generalists” who are rotating throughout many sections of the laboratory, not just microbiology. Although necessary because of managed-care constraints and continued growth of capitated contracts, this approach contributes to the difficulties in maintaining well-trained staff in some of the specialty areas of microbiology. It becomes even more important to provide well-written laboratory protocols and to standardize test methods for consistency. There has also been increased awareness within the medical community of the need for additional training in the area of infectious diseases for the clinician and laboratory technician alike. This need has been reflected in the number of workshops, seminars, and publications that are available. The integration of information among all members of the health care team has certainly improved in terms of overall patient care.
The field of microbiology has taken on additional relevance and importance for a number of other reasons. Improved means of travel has made the world a smaller place. An individual’s chances of exposure to parasites not endemic to his or her homeland and the possibility of acquiring or transmitting certain infections have been increasing. These facts emphasize the need to take a correct and complete history from a patient. It is important to be aware of the organisms commonly found within certain areas of the world and the makeup of the patient population being serviced at any particular health facility.
The most important step in the diagnosis of parasitic infections is the selection and submission of the appropriate clinical specimen within specified time lines and according to set protocols (21–23).
It is also important for the physician to know the efficacy of any diagnostic technique for parasite recovery and eventual diagnosis. Our approach to testing is undergoing continuous review, particularly within the current health care environment and cost-containment initiatives. The issue of patient care becomes particularly important when we begin to examine the number and types of compromised patients now being seen in all facilities. The increased publicity concerning immunocompromised patients has led to a greater awareness of parasitic infections in this patient population, regardless of the original cause of the immune deficiencies. Many of these patients with immune system defects are particularly at risk, whether because of previously acquired infections that have remained latent for many years or because of susceptibility to new infections. Many of these infections may present with unusual symptoms, and some are relatively new disease entities or those that are less commonly encountered (microsporidiosis, granulomatous amebic encephalitis, and infection with Cyclospora cayetanensis).
Often in other areas of microbiology, therapy is begun on the basis of patient history and symptoms. This approach is generally not recommended or used in cases of parasitic infection. Thus, the understanding of the characteristics of any parasitic infection (general geographic range, life cycle, clinical disease, diagnostic methods, therapy, epidemiology, and control) and the use of appropriate diagnostic procedures accompanied by a complete understanding of the limitations of each procedure become very important. Because of this approach to patient care, the general consensus among individuals within the field of diagnostic medical parasitology is that the use of certain incomplete procedures may result in incorrect information for the physician and may ultimately compromise patient care.
The main emphasis should be on the importance of understanding and recognizing potential parasitic infections, submitting the appropriate number and type of clinical specimens, knowing what procedures may provide confirmation of the diagnosis, and recognizing the implications and limitations of information provided to the physician. With the current emphasis on the development and use of molecular methods, understanding the benefits and limitations of these procedures will be critical to patient care outcomes. If there is an incomplete understanding of the requirements for high-quality diagnostic testing, incomplete information will be transmitted to the clinician. It is the responsibility of both the laboratory and the clinician to develop a greater awareness of the importance of these requirements.
References
1. Garcia LS (ed). 2010. Clinical Microbiology Procedures Handbook, 2nd ed. ASM Press, Washington, DC.
2. Isenberg HD (ed). 2004. Clinical Microbiology Procedures Handbook, 2nd ed., p. 9.0.1–9.10.8.3. ASM Press, Washington, DC.
3. Isenberg HD (ed). 1995. Essential Procedures for Clinical Microbiology. ASM Press, Washington, DC.
4. Garcia LS, Johnston SP, Linscott AJ, Shimizu RY. 2008. Cumitech 46, Laboratory procedures for diagnosis of blood-borne parasitic diseases. Coordinating ed, Garcia LS. ASM Press, Washington, DC.
5. Garcia LS, Smith JW, Fritsche TR. 2003. Cumitech 30A, Selection and use of laboratory procedures for diagnosis of parasitic infections of the gastrointestinal tract. Coordinating ed, Garcia LS. ASM Press, Washington, DC.
6. Committee on Education, American Society of Parasitologists. 1977. Procedures suggested for use in examination of clinical specimens for parasitic infection. J Parasitol 63:959–960.
7. Parasitology Subcommittee, Microbiology Section of Scientific Assembly, American Society for Medical Technology. 1978. Recommended procedures for the examination of clinical specimens submitted for the diagnosis of parasitic infections. Am J Med Technol 44:1101–1106.
8. College of American Pathologists. 2012. Commission on Laboratory Accreditation Inspection Checklist. College of American Pathologists, Chicago, IL.
9. Clinical and Laboratory Standards Institute. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract, 2nd ed. Approved guideline M28-A2. Clinical and Laboratory Standards Institute, Wayne, PA.
10. Clinical and Laboratory Standards Institute. 2005. Protection of Laboratory Workers from Occupationally Acquired Infection, 3rd ed. Approved guideline M29-A3. Clinical and Laboratory Standards Institute, Wayne, PA.
11. Clinical and Laboratory Standards Institute. 2000. Laboratory Diagnosis of Blood-borne Parasitic Diseases. Approved guideline M15-A. Clinical and Laboratory Standards Institute, Wayne, PA.
12. Clinical and Laboratory Standards Institute. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved guideline M28-A2. Clinical and Laboratory Standards Institute, Wayne, PA.
13. Clinical and Laboratory Standards Institute. 2004. Clinical Use and Interpretation of Serologic Tests for Toxoplasma gondii. Approved guideline M36-A. Clinical and Laboratory Standards Institute, Wayne, PA.
14. Clinical and Laboratory Standards Institute. 2012. Clinical Laboratory Safety. Approved guideline GP17-A3. Clinical and Laboratory Standards Institute, Wayne, PA.
15. Clinical and Laboratory Standards Institute. 2009. Training and Competence Assessment. Approved guideline GP21-A3. Clinical and Laboratory Standards Institute, Wayne, PA.
16. Clinical and Laboratory Standards Institute. 2011. Clinical Laboratory Waste Management, 3rd ed. Approved guideline GP5-A3. Clinical and Laboratory Standards Institute, Wayne, PA.
17. Code of Federal Regulations. 1987. Update May 27, 1992. Title 29, parts 1910.1200 and 1910.1296. U.S. Government Printing Office, Washington, DC.
18. Code of Federal Regulations. 1989. Title 29, part 1910.106. U.S. Government Printing Office, Washington, DC.
19. Code of Federal Regulations. 1989. Title 29, part 1910.1200. U.S. Government Printing Office, Washington, DC.
20. Code of Federal Regulations. 1989. Title 29, part 1910.1450. U.S. Government Printing Office, Washington, DC.
