PROCESSING OF

STOOL
 Outline
■ Possible pathogens

■ Commensal

■ Collection & transport of faeces

■ Lab examination of faeces

■ Summary
 Possible pathogens
BACTERIA:
Gram positive
1.Clostridium perfringens types A & C
2.Clostridium difficile
3.Bacillus cereus (toxin)
4.Staphylococcus aureus
■ Also M. tuberculosis
Gram negative
1. Shigella species
2. Salmonella serovars
3. Campylobacter sp.
4. Yersinia enterocolitica
5. E.coli (toxin) (ETEC,
EIEC, EPEC, EHEC)
6. Vibrio cholerae 01, 0139
7. Other Vibrio species
8. Aeromonas species
 Possible pathogens
VIRUSES:
 Mainly rotaviruses & occasionally Norwalk agent, Adenoviruses,
Astrovirus, Calcivirus & Coronavirus

PARASITES:
 Entamoeba histolytica
 Giardia lamblia
 Intestinal coccidia (Isospora, Cryptosporidium, Cyclospora)
 Other protozoan enteric pathogens
 Possible pathogens
■ Acute infective diarrhoea & gastroenteritis (diarrhoea + vomiting)~ ill
health & premature death in developing countries ~ CONTAMINATED
water supplies & POOR sanitation
■ Loss of water & electrolytes from the body ~ SEVERE DEHYDRATION
– if untreated can be rapidly fatal in young children, especially
those that are malnourished, hypoglycaemic & in poor health

■ Invasive Mo’s (Shigellae, Campylobacters, some Salmonellae & E.

histolytica) are associated with DYSENTERY (blood & mucus in stools)
■ Organisms such as Rotaviruses, V. cholerae & ETEC cause WATERY
(SECRETORY) DIARRHOEA
 Possible pathogens
■ Diarrhoea may also be caused by:
– Intestinal worms
– Post-infective tropical malabsorption
– Lactase deficiency
– Antibiotic or other drug therapy which alters the intestinal NF
– Dietary causes including gluten intolerance
 Possible pathogens
■ Diarrhoea is also associated with:
– HIV disease
– Malaria
– Severe malnutrition
– Pneumonia
– Hepatitis
– Cirrhosis of the liver
– Inflammation of the pancreas
– TB of the intestine
– Colitis
– Previous surgery of the bowel
– Malignant diseases of the IT
 Possible pathogens
■ Shigella sp. (S. dysenteriae, S. flexneri, S. boydii & S. sonnei)
– Dysentery caused by Shigellae = BACILLARY DYSENTERY OR
SHIGELLOSIS
– WHO estimates that Shigella sp. cause at least 50% of the cases
of bloody diarrhoea in young children in developing countries
– S. dysenteriae serotype 1 (Sd 1) is VIRULENT, causing endemic &
epidemic dysentery with high death rates
■ It is highly infectious
 Possible pathogens
■ Salmonella sp.
– S. typhi & S. paratyphi cause enteric fever (typhoid & paratyphoid)
which is endemic in many tropical & developing countries
– Other Salmonellae cause food poisoning & bacteraemia

■ Campylobacter sp.
– C. jejuni & C. coli are common causes of enteritis in young children
in developing countries
 Possible pathogens
■ Vibrio sp.
■ V. cholerae serogroups 01 (biotype El Tor) & 0139 cause endemic &
epidemic cholera
– Severe dehydration, vomiting, abdominal pain & acidosis ~ action
of an exotoxin (cholera toxin) ~ causes water & electrolytes to flow
into the bowel lumen
– In severe infections, ‘rice water’ stools containing many vibrios are
passed continuously~ urgent fluid replacement therapy to prevent
collapse & death

■ V. parahemolyticus cause food poisoning (via contaminated seafood)

in many parts of the world (Africa, Asia, America & Europe)
 Possible pathogens
■ Strains of E. coli
– Cause diarrhoeal disease
– include ETEC, EPEC, EIEC & EHEC

■ Y. enterocolitica
– Cause gastroenteritis in Africa, Japan, Europe & Canada
– The organism is invasive & some strains are toxigenic
 Possible pathogens
■ Clostridium sp.
■ C. perfringens type A ~ food-poisoning by secreting enterotoxin in the
intestine during sporulation
– Alpha toxin is the main lethal toxin produced
■ C. perfringens type C ~ severe jejunitis (enteritis necroticans) or pigbel
– cause of death in young children especially in Papua New Guinea,
China, Solomon Islands, Bangladesh & some parts of East Africa
– Infection is by the ingestion of contaminated pig meat
– A lethal beta-toxin is produced
■ C. difficile ~ antimicrobial associated diarrhoea & sometimes PMC, a
rare & occasionally fatal condition
 Possible pathogens
■ S. aureus food-poisoning
– Ingestion of preformed toxin in contaminated food (often dairy
products)
– Occasionally, staphylococcal enterocolitis ~ complication of broad-
spectrum antibiotic therapy

■ B. cereus food-poisoning
– ingestion of preformed toxin usually in rice or other cereals which
have been cooked & then stored for several days in warm temp
 Possible pathogens
■ Rotavirus
– Commonest cause of acute secretory diarrhoea in young children (6 months–
3 years)
– Diarrhoea is the result of loss of extracellular fluid, due to impaired absorption
– Diarrhoea & vomiting ~ severe dehydration
– Most infections are accompanied by fever
■ Persistent diarrhoea
– Often leads to diarrhoea-wasting syndrome (‘slim disease’) ~ common in AIDS
– Due in part to opportunistic protozoal pathogens ~ Cryptosporidium,
Cyclospora, Isospora & Microsporidia
– Bacterial infections associated with diarrhoea in HIV/AIDS patients include
Salmonella, Campylobacter, Shigella & Mycobacteria
 Commensals
■ The NF of the GIT is greatly influenced by DIET
■ Mo’s which may form part of this NF include:
– Coliform bacilli
– Proteus
– Pseudomonas
– Clostridium
– Bacteroides
– Enterococcus
– Lactobacilli
– Also:
■ Mycoplasma
■ Candida sp.
■ A variety of protozoa & viruses
 Collection & transport of faeces
■ Faeces should be collected during the acute stage of diarrhoea
In a hospital with a MB Lab
1. Give the patient a clean, dry, disinfectant-free bedpan or suitable
wide-necked CONTAINER to pass a specimen
■ The container need NOT be sterile
■ Ask the patient to avoid contaminating the faeces with urine
2. Transfer a portion (about a spoonful) of the specimen, especially
that which contains mucus, pus or blood into a clean, dry, leak proof
container
 Collection & transport of faeces
In a hospital with a MB Lab Cont’d
Worms & tapeworm segments:
■ If present, transfer to a separate container & send
them to the lab for ID
3. Write on the request form the colour of the
specimen & whether it is formed, semi formed,
unformed or fluid.
■ Report also if blood, mucus, worms, or tapeworm
segments are present
4. Label the specimen & send it with a request form
to reach the lab within 1 hr
■ If delay > 1 hr is anticipated, collect the specimen
in Cary-Blair medium
 Collection & transport of faeces
In a hospital with a MB Lab Cont’d
Rectal swabs:
■ Only when it is NOT possible to obtain faeces, collect a specimen using
a COTTON WOOL SWAB. Insert the swab in the rectum for about 10
secs
■ Care should be taken to avoid unnecessary contamination of the
specimen with bacteria from the anal skin
Important:
■ When the specimen contains blood or amoebic dysentery is suspected,
deliver it to the lab ASAP
– A fresh specimen is required to demonstrate actively motile
amoebae & also to isolate shigellae
 Collection & transport of faeces
In a health centre for transport to a MB Lab
1. Request a specimen from the patient

2. Transfer a portion of the faeces to a cotton wool swab

■ Insert the swab in a container of STERILE CARY-BLAIR TRANSPORT
MEDIUM , breaking off the swab stick to allow the bottle top to be
replaced tightly
 Collection & transport of faeces
In a health centre for transport to a MB Lab Cont’d
■ Salmonella serovars, Shigella, Vibrio & Yersinia sp. survive
well in Cary-Blair medium ~up to 48 hrs
■ Campylobacter survive in Cary-Blair medium ~ up to 6 hrs
■ Merthiolate iodine formaldehyde (MIF) solution must NOT
be used b/c MIF kills living organisms
– MIF is used as a fixative for protozoal parasites
■ When CHOLERA is suspected:
– Transfer about 1 ml of specimen into 10 ml of STERILE
ALKALINE PEPTONE WATER & label
– Specimen should reach the Lab within 8 hrs of
collection
 Collection & transport of faeces
In a health centre for transport to a MB Lab Cont’d
3. Write a DESCRIPTION OF THE SPECIMEN on the request form
■ When worms or tapeworm segments are present, transfer these
(using forceps) to a container of PHYSIOLOGICAL SALINE & send to
the lab for ID
Lab examination
of faeces
Role of MB lab in investigating infective diarrhoeal disease
■ With most patients, diarrhoea is self-limiting ; treated with rehydration
& other supportive therapy w/o the need for antimicrobials & MB
investigations

■ The MB examination of faecal specimens is mainly undertaken:

– To investigate outbreaks of Dysentery (Shigellosis) , Cholera, &
other acute bacterial infective diarrhoeal disease of public health
concern
– To assist the central public health lab in the surveillance of
endemic SS (including susceptibility of pathogens to
antimicrobials)
– To diagnose symptomatic Amoebic dysentery, Giardiasis & other
locally IMP intestinal parasitic infections
 Lab examination of faeces: Day 1
1. Describe the appearance of the specimen
■ Colour of the specimen
■ Whether it is formed, semi-formed, unformed or fluid
■ Presence of blood, mucus or pus
■ Presence of worms:
– E.g.
■ Enterobius vermicularis
■ Ascaris lumbricoides
■ Tapeworm segments
– E.g. Taenia sp.
 Appearance of faecal specimens in some diseases
APPEARANCE POSSIBLE CAUSE
Unformed, containing pus & mucus mixed with blood Shigellosis, EIEC dysentery, Campylobacter enteritis
Unformed with blood & mucus (acid pH) Amoebic dysentery
Unformed or semi formed, often with blood & mucus Schistosomiasis
Bloody diarrhoea (without pus cells) EHEC 0157 infection (haemorrhagic colitis)
Watery stools ETEC, EPEC diarrhoea, Cryptosporidiosis, Rotavirus
enteritis
Rice water stools with mucous flakes Cholera
Unformed/ watery & sometimes with blood, mucus & Salmonella infection
pus
Unformed, pale coloured, frothy, unpleasant smelling Giardiasis, other conditions that cause malabsorption
stools that float on water (high fat content) e.g. post-infective tropical malabsorption
Fluid stools (containing lactose with pH below 6) Lactase deficiency
Unformed/ semi formed black stools (+ve occult Melaena (gastrointestinal bleeding), Hookworm
blood) disease, Iron therapy
 Lab examination of faeces: Day 1
1. Describe the appearance of the specimen Cont’d
■ Blood can also be found in the stools of patients with:
– Haemorrhoids
– Ulcerative colitis
– Tumors of the IT

■ Normal faeces:
– Appear brown & formed or semi formed
– Infant faeces are yellow-green & semi formed
 Lab examination of faeces: Day 1
2. Examine the specimen microscopically
SALINE & EOSIN prep to detect E. histolytica & other parasites
■ Place a drop of fresh PHYSIOLOGICAL SALINE on one end of a slide & a
drop of EOSIN STAIN on the other

– Using a piece of stick or wire loop, mix a small amount of fresh

specimen (especially mucus & blood) with each drop

– Cover each prep with a cover glass

■ The eosin prep must NOT be too thick otherwise it will NOT be
possible to see AMOEBAE OR CYSTS
 Lab examination of faeces: Day 1
2. Examine the specimen microscopically
SALINE & EOSIN prep to detect E. histolytica & other parasites
Cont’d
■ Examine the prep using t X10 & X40 objectives with the
condenser iris closed sufficiently to give good contrast. Look
especially for :
– Motile E. Histolytica trophozoites containing red cells

– Motile G. lamblia trophozoites

– Motile Strongyloides larvae

– The eggs & cysts of parasitic pathogens

 Lab examination of faeces: Day 1
2. Examine the specimen microscopically : ADDITIONAL
Methylene blue prep to detect faecal leucocytes when
the specimen is unformed
■ Place a drop of MB stain on a slide. Mix a small
amount of specimen with the stain & cover with a
cover glass

■ Examine the prep for faecal leucocytes using the

X40 objective with the condenser iris closed
sufficiently to give good contrast

■ Report also the presence of RBC as these are often

present with pus cells in inflammatory invasive
diarrhoeal disease
 Lab examination of faeces: Day 1
2. Examine the specimen microscopically : ADDITIONAL
Methylene blue prep to detect faecal leucocytes when the specimen is unformed
Faecal leucocytes (WBCs):
■ Look for mononuclear cells & Polymorphonuclear cells (pus cells)
■ Mononuclear cells contain a nucleus which is NOT LOBED whereas
Polymorphonuclear cells contain a nucleus which has 2 OR MORE LOBES
■ Sometimes the cells are too damaged to be recognized (do not attempt to
identify)
■ Pus cells ~associated with bacteria that cause inflammation of the large
intestine
■ Often red cells are also found
■ Mononuclear cells ~ found mainly in typhoid & in some parasitic infections
(amoebic dysentery)
 Lab examination of faeces: Day 1
Causes of inflammatory diarrhoeal disease:
1. Shigella species
2. Campylobacter species
3. Salmonella (non-typhoid serovars)
4. E. histolytica
5. EIEC
Less common:
1. B. coli
2. Y. enterocolitica
3. C. difficile
4. C. perfringens (causing pigbel)
5. Aeromonas species
 Lab examination of faeces: Day 1
2. Examine the specimen microscopically : ADDITIONAL
Basic fuchsin smear to detect Campylobacters
■ Prepare when the specimen is unformed & or contains
mucus, pus, or blood & is from a child under 2 yrs
■ Make a thin smear of the specimen on a slide. When dry,
gently heat-fix. Stain by covering the smear with 10 g/l basic
fuchsin for 10–20 secs. Wash & allow to air dry
– 10 g/l Basic fuchsin: Dissolve 1 g basic fuchsin in 100
ml of water & filter.
■ Examine the smear for Campylobacters using the X100 oil
immersion objective. Look for abundant small, delicate,
spiral curved bacteria (gull wings), S-shapes & short
spirochaetal forms
■ Examination of stained faecal smears for Campylobacters
~sensitive method for presumptive diagnosis of C.enteritis
 Lab examination of faeces: Day 1
2. Examine the specimen microscopically :
ADDITIONAL
Motility test & Gram stained smear when cholera is
suspected
■ Examine an ALKALINE PEPTONE WATER CULTURE
(sample from the surface of the culture) for vibrios
showing a rapid & darting motility
■ The prep is best examined using DF microscopy
but the vibrios can also be seen using transmitted
light
■ Experience is required to identify the characteristic
motility of V. cholerae
■ Examine also a Gram-stained smear of the culture
for GN vibrios (use 1 in 10 dilution of carbol
fuchsin as the counterstain instead of neutral red)
 Lab examination of faeces: Day 1
3. Culture the specimen
■ When the specimen is formed or semi formed,
make a thick suspension of it in about 1 ml of
sterile peptone water

Xylose lysine deoxycholate (XLD) agar

■ Inoculate a loopful of fresh emulsified faeces or a
fluid specimen on XLD agar

■ Incubate the XLD agar plate aerobically at 35–37

°C overnight.
 Lab examination of faeces: Day 1
3. Culture the specimen ~ XLD agar:
■ Selective medium used for isolation of S&S from faecal specimens
■ Contains the indicator PHENOL RED (red ~ alkaline pH & yellow ~acid pH)
■ Shigellae form PINK-RED COLONIES b/c they DONOT ferment xylose, lactose, or
sucrose (except some S. sonnei strains)
■ Salmonellae also form PINK-RED COLONIES even though they ferment xylose with
acid production
– B/c they break down LYSINE which gives an alkaline rxn
– H2S producing salmonellae form RED COLONIES WITH BLACK CENTRES
■ Some Proteus & Edwardsiella sp. form PINK-RED COLONIES WITH BLACK CENTRES
■ E. coli, Enterobacter sp. & some other Enterobacteria produce YELLOW COLONIES~
CHO fermentation
■ Less selective medium (MAC) maybe used in addition to XLD agar
 Lab examination of faeces: Day 1
3. Culture the specimen ~ XLD agar:

E.coli

Salmonella
Mixed
culture of
E.coli &
Salmonella
Shigella
 Lab examination of faeces: Day 1
3. Culture the specimen Uninoculated
ADDITIONAL
Alkaline peptone water & TCBS agar when cholera is
suspected
■ Inoculate several loopfuls of specimen in alkaline (pH
8.6) peptone water & incubate at 35–37 °C for 5–8 Large, yellow colonies of
Vibrio cholerae
hrs
– Prior enrichment in alkaline peptone water is NOT
necessary if the specimen is likely to contain
large No. of vibrios (e.g. in acute cholera).
– Alkaline peptone water is a useful transport
Much smaller , yellow
medium for V. cholerae colonies of E. faecalis
■ Subculture several loopfuls of the peptone water
culture (taken from the surface) on thiosulphate
citrate bile-salt sucrose (TCBS) agar & Incubate
aerobically at 35–37 °C o/n
 Lab examination of faeces: Day 1
3. Culture the specimen
ADDITIONAL
Sorbitol MacConkey agar, when an outbreak of E. coli
0157 is suspected
■ Inoculate a loopful of specimen on sorbitol
MacConkey agar & incubate the plate aerobically at
35–37 °C o/n
Sorbitol MacConkey agar
■ Contains the CHO SORBITOL instead of lactose.
■ E. coli 0157 ~ colourless colonies ~ DOES NOT
ferment sorbitol
■ Most other E. coli strains & other Enterobacteria~
pink colonies ~ ferment sorbitol
■ A useful way of screening for E. coli 0157
 Lab examination of faeces: Day 1
3. Culture the specimen
ADDITIONAL
Blood agar & Improved Preston blood-free medium , when
Campylobacter is suspected
■ Inoculate a loopful of specimen on BA/ Preston medium
& incubate the plate at an microaerophilically (atm of
reduced O2 (5–10%) with added CO2 (about 10%)) at
35–37 °C o/n
Blood agar
■ C. jejuni & C. coli produce non-haemolytic spreading,
droplet-like colonies
■ Examine colonies microscopically for Campylobacters &
perform an oxidase test.
 Lab examination of faeces: Day 1
3. Culture the specimen
ADDITIONAL
Blood agar & Improved Preston blood-free medium , when
Campylobacter is suspected
Improved Preston blood-free medium:
■ C. jejuni ~ grey, moist, flat-spreading colonies
■ Some strains ~ green hue or a dry appearance with or
w/o a metallic sheen
■ C. coli ~ produces creamy-grey, moist, slightly raised
colonies.
– A swarming growth may occur
■ Examine the colonies microscopically & perform an
oxidase test.
 Lab examination of faeces: Day 2 & Onwards
4. Examine and report the cultures
XLD agar culture
■ Look for colonies that could be Shigella or Salmonella.
– Shigella & H2S–ve strains of Salmonella ~ 1–2 mm dia red colonies
– H2S +ve Salmonellae (e.g. strains of S. typhimurium)~ Red colonies
with black centres
■ Proteus, Providencia & Pseudomonas ~ red colonies
■ Some Proteus strains (are also H2S producing ) ~ red colonies with black centres
MacConkey agar
■ Shigellae & Salmonellae & other NLF organisms ~colourless colonies
■ E. coli & other LF ~ produce pink colonies
 Lab examination of faeces: Day 2 & Onwards
4. Examine and report the cultures
ID of suspect S&S isolates
■ Perform a urease test using urea broth
– A +ve urease test within 2–4 h indicates that the organism is
probably Proteus. No further tests are required
 Lab examination of faeces: Day 2 & Onwards
4. Examine and report the cultures
ID of suspect S&S isolates
■ Perform a urease test using urea broth
– When the urease test is -ve at 4 hrs,
proceed as follows:
1. Perform indole & lysine decarboxylase tests
2. Inoculate a tube of Kligler iron agar
■ Use a sterile straight wire, stab first the butt
& then streak the slope.
■ Close the tube with a cap & incubate at 35–
37 °C o/n
 Tests used to identify presumptively S&S
KIA Medium Reactions
Motility Indole LDC Slope Butt Black Cracks
(H2S) (Gas)
SHIGELLAE
S. dysenteriae - D - Red (Alkaline rxn) Yellow (Acid rxn) - -
S. flexneri - D - Red (Alkaline rxn) Yellow (Acid rxn) - -*
S. boydii - D - Red (Alkaline rxn) Yellow (Acid rxn) - -*
S. sonnei - - - Red (Alkaline rxn) Yellow (Acid rxn) - -

SALMONELLAE
S. paratyphi A + - - Red (Alkaline rxn) Yellow (Acid rxn) -* +
S. paratyphi B + - + Red (Alkaline rxn) Yellow (Acid rxn) + +
S. paratyphi + - + Red (Alkaline rxn) Yellow (Acid rxn) +* +
S. Typhi + - + Red (Alkaline rxn) Yellow (Acid rxn) + (Weak) -
Other -* - + Red (Alkaline rxn) Yellow (Acid rxn) +* D
Salmonella
serovars
D= different strains give different results, * A few exceptions
 Lab examination of faeces: Day 2 & Onwards
4. Examine and report the cultures
RESULTS
LDC
■ Shigella are LDC -ve. Salmonella serovars are LDC +ve except S. Paratyphi A
which is LDC -ve.
Indole
■ S. sonnei is indole -ve. Other shigellae give variable indole rxn. Salmonella
serovars are indole -ve.
KIA
■ SS ~ pink-red slope & yellow butt
■ Many Salmonellae ~produce blackening (H2S production) & cracks (gas
production) from glucose fermentation
■ S. typhi ~ small amount of blackening & NO cracks in the medium
Lab examination of faeces: Day 2 & Onwards
4. Examine and report the cultures
Serological ID of SS
■ Test any isolate giving rxns suggestive of SS using a slide technique
– Emulsify a small amount of growth from the KIA culture in a loopful
of physiological saline on a slide
– Mix by tilting the slide backwards & forwards for about 30 secs.
– Examine for agglutination against a dark background.
– When there is agglutination (autoagglutination), the strain is
unsuitable for serological testing.
– A NA culture should be sent for further testing to a Reference Lab
■ When there is NO autoagglutination, add one loopful of test antiserum
& mix; examine for agglutination.
■ A +ve test will show strong clear agglutination within 1 min
 Lab examination of faeces: Day 2 & Onwards
4. Examine and report the cultures: TCBS agar culture
■ V. cholerae is sucrose fermenting & produces yellow 2–3 mm in dia shiny colonies
with a yellow colour in the medium
– With prolonged incubation (48 h or >) the colonies may become green
■ V. fluvialis ~ sucrose fermenting ~ may occasionally be isolated as a pathogen
■ V. parahaemolyticus is non-sucrose fermenting ~ green-blue 2–3 mm in dia
colonies
■ V. mimicus~ non-sucrose fermenting ~ green-blue colonies & is sometimes isolated
Selectivity of TCBS
■ Very occasionally, Aeromonas sp. & enterococci produce small yellow colonies
■ Proteus strains may produce yellow or yellow-green colonies with black centres
■ Some Pseudomonas strains form small green colonies.
 Lab examination of faeces: Day 2 & Onwards
4. Examine & report the cultures
Identification of a suspect V. cholerae isolate
■ Examine a Gram stained smear of the culture for Gram negative vibrios
– The organisms may appear less curved after culture.
■ Subculture the organism on a slope of NA (use a heavy inoculum) & incubate for 4–6
hrs.
■ Perform an oxidase test on the NA culture
– It is not possible to perform an oxidase test directly from a TCBS culture b/c the
acid produced by the sucrose fermenting colonies will inhibit the oxidase rxn
– Sub culturing to nutrient agar is also required to perform serological tests
reliably.
■ Note: When the oxidase test is +ve, presume the isolate to be V. cholerae
– Tested serologically (using NA culture) to confirm the organism is V. cholerae 01
or 0139
 Summary of the MB Examination of Faecal Specimens
DAY 1
ADDITIONAL INVESTIGATIONS
1. Describe Specimen Report
– Colour
– Whether formed, semi formed, unformed, fluid
– Presence of blood, mucus, pus
– Presence of worms

2 .Examine Saline and eosin: Methylene blue:

Microscopically To detect parasites To detect WBCs when the specimen is unformed
Basic fuchsin smear:
When Campylobacter enteritis is suspected
Motility test & Gram smear:
From alkaline peptone water culture when
cholera is suspected

3. Culture XLD agar Alkaline peptone water & TCBS agar:

Specimen Incubate aerobically When cholera is suspected
MacConkey agar Sorbitol MacConkey agar
Incubate aerobically When infection with VTEC 0157 is suspected
 Summary of the MB Examination of Faecal Specimens
DAY 2 & ONWARDS
ADDITIONAL INVESTIGATIONS
Examine & XLD & MAC Cultures Examine TCBS culture
Report Look for SS: -Look for colonies that could be
Cultures – Exclude Proteus using urease test V. cholerae
– Identify presumptively: –Gram stain colonies
● LDC & indole – Subculture on nutrient agar
● Motility – Perform oxidase test
● KIA – Identify serologically
– Identify serologically Examine sorbitol MacConkey
– Perform susceptibility testing on agar culture
Shigella isolates – Look for colourless colonies that
could be EHEC
– Perform 0157 latex
agglutination test