How to Perform the Microscopic Exam

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The page below is a sample from the LabCE course Intestinal Protozoan Parasites. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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How to Perform the Microscopic Exam

Once the stool specimen is received and properly processed, the microscopic exam can be performed. The exam can be of three types - a direct wet mount, an indirect wet mount, or a permanent stained smear. Here are some notes and tips on each:
Direct Wet Mount (in saline or Lugols/D'Antoni's iodine)
  • Low power - examine entire 22mm x 22mm coverslip area
  • High dry - examine one-third to one-half 22mm x 22mm coverslip area
  • The direct wet mount is not part of routine O&Ps unless requested on a very fresh specimen
Indirect Wet Mount
  • Performed after a concentration technique (flotation or sedimentation) - yields protozoan cysts, coccidian oocysts, and micrococcidia spores, as well as helminth eggs.
  • Low power - examine entire 22mm x 22mm coverslip area
  • High dry - examine one-third to one-half 22mm x 22mm coverslip area
Permanent Stained Smear
  • Most important part of the microscopic exam
  • Examples of stains: Trichrome, Iron-hematoxylin, acid-fast stain for coccidia. The image to the right shows a trichrome stained smear of Dientamoeba fragilis. Trichrome is the most commonly used stain for permanent smears.
  • Examine on oil immersion, approximately 300 oil immersion fields recommended
3. Centers for Disease Control and Prevention. "Binucleate (left) and uninucleate (right) trophozoites of D. fragilis, stained with trichrome." CDC.gov, 22 Sep 2020, https://www.cdc.gov/parasites/dientamoeba/

Trophozoites of D. fragilis stained with trichrome (3).