Ova and Parasite Exam
When you have diarrhea that lasts more than a few days and/or have blood or mucus in your loose stools, especially if you have drunk unpurified water while camping or have traveled outside of the United States
A fresh stool sample transported to the lab within 2 hours or a preserved stool sample; sometimes multiple samples collected on different days
A variety of parasites can cause infections of the digestive system (gastrointestinal (GI) infections). An ova and parasite (O&P) exam is a microscopic evaluation of a stool sample that is used to look for parasites that may infect the lower digestive tract, causing symptoms such as diarrhea. The parasites and their eggs (ova) are shed from the lower digestive tract into the stool.
When thin smears of fresh or preserved stool are put onto glass slides and stained, the parasites and/or their ova or cysts, the form in which the parasite is surrounded by a resistant cover or capsule, can be detected and identified under the microscope by a trained laboratorian. Different ova and parasites have distinct shapes, sizes, and internal structures that are characteristic of their species.
There are a wide variety of parasites that can infect humans. Each type of parasite has a specific life cycle and maturation process and may live in one or more hosts. Some parasites spend part of their life in an intermediate host, such as a sheep, cow, or snail, before infecting humans. Some infect humans "by accident." There are parasites that consist of a single cell while others are worms (helminths). Most parasites have more than one form through which they develop. Many have a mature form and a cyst and/or egg (ova) form. Some also have a larval phase, which is between the egg and the mature form. Ova are hardy and can exist for some time in the environment without living in a host and remain infectious.
The majority of people who are infected by gastrointestinal parasites become infected by drinking water or eating food that has been contaminated with the ova. (For more details, read Food and Waterborne Illness.) Ova and parasites from infected people or animals are released in the stool and can then contaminate any water, food, or surfaces that come into contact with them. This contamination cannot be seen; the food and water will look, smell, and taste completely normal. People who ingest contaminated food or water can become infected and, without careful sanitation (hand washing and care with food preparation), the infection may be passed on to others.
Parasitic infections are especially a concern for certain groups such as infants, the elderly, and people with weakened immune systems. In these populations, a parasitic infection can result in serious symptoms and complications.
The most common symptoms of a parasitic infection are prolonged diarrhea, bloody diarrhea, mucus in stool, abdominal pain, and nausea. These symptoms typically arise days to weeks after exposure and persist. Some people may also have headaches and fever; others may have few or no noticeable symptoms.
If diarrhea lasts more than a few days, it may lead to weight loss, dehydration and electrolyte imbalance, dangerous conditions in children, the elderly, and those with weak immune systems. According to the World Health Organization (WHO), foodborne and waterborne diarrheal diseases, including those caused by parasites, kill about 2 million people a year.
Three of the most common parasites in the United States are the single-cell parasites Giardia species, Entamoeba histolytica, and Cryptosporidium species. Found throughout the world in even the most remote and pristine mountain streams and lakes, these parasites may infect swimming pools, hot tubs, and occasionally community water supplies.
- Giardia species are some of the most common intestinal parasites in the United States.
- Cryptosporidium (often called crypto) is one of the leading causes of recreational water-related disease outbreaks in the U.S.
- Entamoeba histolytica is common but only causes illness in about 10% to 20% of those infected.
In many cases, Giardia and Cryptosporidium cysts can survive in water for weeks or months and are resistant to low levels of chlorine. The number of those infected with these parasites tends to increase during the summer months when more people are pursuing outdoor activities such as backpacking, hiking, and swimming and they unwisely or accidentally drink untreated water or contaminated food.
Those who travel outside the U.S., especially to developing nations, may be exposed to a much wider variety of parasites. In warm climates and places where water and sewage treatment are less effective, parasites are more prevalent. Besides Giardia, Cryptosporidium, and E. histolytica, there are also a wide range of flat worms, roundworms, hookworms, and flukes that can affect the digestive tract and other parts of the body. Visitors usually become infected by eating or drinking something that has been contaminated with the parasites' ova, even something as simple as ice cubes in a drink or a fresh salad, but some of the tiny worm-like parasites can also penetrate the skin, such as through the skin of the foot when someone is walking barefoot.
If a person's illness is uncomplicated and goes away within a few days, a healthcare practitioner may not order testing. However, if symptoms are severe, if there is bloody diarrhea or mucus present in the stool, or if it is continuing unabated, then a stool culture may be ordered. This is especially true if the person has been outside the U.S. and/or has eaten or drunk anything that has also made someone close to them ill.
To aid diagnosis, an ova and parasite exam may be done in conjunction with or following a GI pathogens panel that simultaneously tests for multiple disease-causing bacteria, viruses, and parasites. Other tests that may be done include a stool culture and antigen tests to identify specific microbes.
How is the sample collected for testing?
A fresh stool sample is collected in a clean container. The stool sample should not be contaminated with urine or water. Once it has been collected, the stool should either be taken to the laboratory within two hours after collection or transferred into special transport vials containing preservative solutions.
Often, multiple samples are collected and tested. These should be collected at different times on different days because parasites are shed intermittently and may not be in the stool at all times. Multiple samples can increase the likelihood that parasites will be detected.
How is it used?
The ova and parasite (O&P) exam is used to detect the presence of parasites in a stool sample and help diagnose an infection of the digestive system (gastrointestinal, GI tract). Since there are many causes of GI infections, an O&P may be used in conjunction with other tests, such as a gastrointestinal (GI) pathogens panel or a stool culture, to help establish a diagnosis.
A GI pathogens panel is performed on a stool sample to simultaneously test for the viruses, bacteria, and parasites that are common causes of GI infections. These panels are relatively new and laboratories and healthcare practitioners are still determining how to utilize them to provide the optimum patient results while being cost-effective. An O&P and a stool culture may also be done if a microbe is not identified by the panel and/or if there is suspicion of a parasite or bacteria other than those included in the GI panel.
Many GI infections in the U.S. resolve with no specific treatment, with only supportive care, and may not require testing. In otherwise healthy individuals, the infections are considered common illnesses that are not serious and sometimes thought of as "food poisoning" or "stomach flu." However, there are cases where it is useful to perform testing that identifies the cause of the GI infection – to guide its treatment, eliminate its source, and limit its spread.
O&P tests may also be ordered to monitor the effectiveness of treatment for a parasitic infection.
Other tests for parasites may be used in conjunction with an O&P to help make a diagnosis. A healthcare practitioner may order a Giardia, Cryptosporidium, or Entamoeba histolytica antigen test if it is suspected that one of these parasites may be causing a patient's infection. These tests detect protein structures on the parasites and can identify an infection, even if no actual parasites or ova are seen in the stool. Since antigen tests only detect a few specific parasites, they are not replacements for the complete O&P, which will detect a wider variety of parasites.
When is it ordered?
- Prolonged diarrhea
- Abdominal pain, cramping
- Nausea, vomiting
- Blood and mucus in the stool
Not everyone who has these symptoms will necessarily have testing done or be treated. In people who have healthy immune systems, these infections often resolve with supportive care and without treatment. An O&P is more likely to be ordered when a person:
- Has severe symptoms, dehydration, electrolyte imbalance, and/or other complications
- Is very young, elderly, or has a weakened immune system
- Has prolonged signs and symptoms and/or infections that do not resolve without treatment
- Has an illness during and following travel outside the U.S., especially to emerging nations; the Centers for Disease Control and Prevention (CDC) estimates that 30% to 70% of those who travel outside of the U.S. will get a GI infection.
- Has recently consumed stream or lake water
- Has been exposed to someone who has a parasitic infection (like a family member)
O&P tests may also be ordered when someone has been diagnosed with a parasitic infection to monitor the effectiveness of treatment.
What does the test result mean?
If there are no ova or parasites seen, then a person's diarrhea may be due to another cause. There may also be too few parasites to detect in the sample tested. A healthcare practitioner may order additional O&P tests to confirm this finding and/or may order other tests to search for the cause of the persistent symptoms.
If a parasite is identified, then the person does have a parasitic infection. Ova and parasites present in the stool samples are identified and counted. Numbers may range from many to very few or rare.
Typically a person will only have one type of parasite that is causing their symptoms, but there could be more than one. The most common and frequently detected parasites in the U.S. are:
- Giardia species—some of the most common intestinal parasites in the United States
- Cryptosporidium (often called crypto)—one of the leading causes of recreational water-related disease outbreaks in the U.S.
- Entamoeba histolytica—common but only causes illness in about 10% to 20% of those infected
Some examples of other intestinal parasites that may be detected with an O&P include the following.
Single cell parasites:
- Dientamoeba fragilis
- Balantidium coli
- Cyclospora cayetanensis
- Roundworms such as Ascaris, Strongyloides
- Tapeworms such as Hymenolepis nana, Taenia solium and Diphyllobthrium latum
- Flatworms and flukes such as Fasciolopsis buski
The type and duration of treatment will depend on what kinds of parasite(s) are found and on the person's general state of health. The number of parasites seen may give a healthcare practitioner general information about how extensive the infection is.
Is there anything else I should know?
Drug therapies are usually used to treat Giardia, E. histolytica and Cryptosporidium infections. They may resolve themselves after several weeks, but they may also cycle, with symptoms subsiding and then worsening again. In those with healthy immune systems, crypto generally goes away after a few weeks. In those with weakened immune systems (such as those with AIDS, organ transplant, cancer, etc.), however, crypto may be dangerous, becoming chronic and causing wasting and malnutrition.
How can I prevent a parasitic infection?
The best way is to avoid food and water that are potentially contaminated. This is especially true if you travel to emerging nations, where ice in a drink or a dinner salad may expose you to parasites. But the clearest mountain stream should also be suspect; it could be contaminated with Giardia. You cannot see most parasites; you won't be able to smell them or taste them in the water. If someone in your family has a parasitic infection, careful hand washing after going to the bathroom or handling soiled diapers can help prevent passing the parasite on to others. The infected person should avoid preparing food for others until that person's symptoms are gone.
Will an O&P detect all parasites?
No, only those that live in the digestive tract and whose eggs are passed through the stool; there are other tests specific for other parasites, such as pinworms, or blood parasites that cause malaria.
Why does it need to be a fresh stool sample?
Are those parasitic worms I'm seeing in my stool sample?
Most of the common parasites are much too small to be seen with the naked eye. What you are probably noticing are undigested food fibers. The only way to be sure though is to look at the sample under the microscope. Parasites have characteristic external and internal structures that fibers do not have.
Are there other ways to test for intestinal parasites besides a stool exam?
Yes, blood antibody tests may be ordered to determine whether or not someone has been exposed to a parasite in the past. A positive result may indicate a past or a chronic infection but is not used to detect a current infection. Sometimes a biopsy of the small intestines is taken and the small amount of tissue is examined for parasitic infestation.
Once I've had a parasitic infection, can I be re-infected?
Yes, you can become re-infected if exposed again. This may happen if you have a family member who has an asymptomatic parasitic infection, such as giardiasis, and continues to shed the organisms and re-infects others. The infection can be transmitted until everyone is effectively treated.
Why shouldn't I take an over the counter anti-diarrhea medicine?
You should only take this on the advice of your healthcare provider. Diarrhea is one of the methods your body uses to help rid itself of the infection. If you slow down or prevent this from happening by taking anti-diarrhea medication, you can prolong the amount of time that you are ill and may make your infection worse.
On This Site
Elsewhere On The Web
MedlinePlus Medical Encyclopedia: Parasitic Diseases
Centers for Disease Control and Prevention (CDC): Travelers Health
CDC: Healthy Swimming - Giardia
CDC: Healthy Swimming - Cryptosporidium
CDC: Giardiasis General Information
CDC: Alphabetical Index of Parasitic Diseases
Nemours Foundation, KidsHealth.org
National Institute for Allergy and Infectious Diseases