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. 1993 Feb;31(2):198–202. doi: 10.1128/jcm.31.2.198-202.1993

Cryptosporidiosis: multiattribute evaluation of six diagnostic methods.

D W MacPherson 1, R McQueen 1
PMCID: PMC262735  PMID: 8432802

Abstract

Six diagnostic methods (Giemsa staining, Ziehl-Neelsen staining, auramine-rhodamine staining, Sheather's sugar flotation, an indirect immunofluorescence procedure, and a modified concentration-sugar flotation method) for the detection of Cryptosporidium spp. in stool specimens were compared on the following attributes: diagnostic yield, cost to perform each test, ease of handling, and ability to process large numbers of specimens for screening purposes by batching. A rank ordering from least desirable to most desirable was then established for each method by using the study attributes. The process of decision analysis with respect to the laboratory diagnosis of cryptosporidiosis is discussed through the application of multiattribute utility theory to the rank ordering of the study criteria. Within a specific health care setting, a diagnostic facility will be able to calculate its own utility scores for our study attributes. Multiattribute evaluation and analysis are potentially powerful tools in the allocation of resources in the laboratory.

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Selected References

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  1. Anderson B. C. Patterns of shedding of cryptosporidial oocysts in Idaho calves. J Am Vet Med Assoc. 1981 May 1;178(9):982–984. [PubMed] [Google Scholar]
  2. Arrowood M. J., Sterling C. R. Comparison of conventional staining methods and monoclonal antibody-based methods for Cryptosporidium oocyst detection. J Clin Microbiol. 1989 Jul;27(7):1490–1495. doi: 10.1128/jcm.27.7.1490-1495.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Baxby D., Blundell N. Sensitive, rapid, simple methods for detecting Crysporidium in faeces. Lancet. 1983 Nov 12;2(8359):1149–1149. doi: 10.1016/s0140-6736(83)90669-4. [DOI] [PubMed] [Google Scholar]
  4. Bird R. G., Smith M. D. Cryptosporidiosis in man: parasite life cycle and fine structural pathology. J Pathol. 1980 Nov;132(3):217–233. doi: 10.1002/path.1711320304. [DOI] [PubMed] [Google Scholar]
  5. Bronsdon M. A. Rapid dimethyl sulfoxide-modified acid-fast stain of Cryptosporidium oocysts in stool specimens. J Clin Microbiol. 1984 Jun;19(6):952–953. doi: 10.1128/jcm.19.6.952-953.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carter W. B., Beach L. R., Inui T. S. The flu shot study: using multiattribute utility theory to design a vaccination intervention. Organ Behav Hum Decis Process. 1986 Dec;38(3):378–391. doi: 10.1016/0749-5978(86)90007-5. [DOI] [PubMed] [Google Scholar]
  7. Current W. L., Garcia L. S. Cryptosporidiosis. Clin Microbiol Rev. 1991 Jul;4(3):325–358. doi: 10.1128/cmr.4.3.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Current W. L., Reese N. C., Ernst J. V., Bailey W. S., Heyman M. B., Weinstein W. M. Human cryptosporidiosis in immunocompetent and immunodeficient persons. Studies of an outbreak and experimental transmission. N Engl J Med. 1983 May 26;308(21):1252–1257. doi: 10.1056/NEJM198305263082102. [DOI] [PubMed] [Google Scholar]
  9. Dolan J. G., Isselhardt B. J., Jr, Cappuccio J. D. The analytic hierarchy process in medical decision making: a tutorial. Med Decis Making. 1989 Jan-Mar;9(1):40–50. doi: 10.1177/0272989X8900900108. [DOI] [PubMed] [Google Scholar]
  10. Dolan J. G. Medical decision making using the analytic hierarchy process: choice of initial antimicrobial therapy for acute pyelonephritis. Med Decis Making. 1989 Jan-Mar;9(1):51–56. doi: 10.1177/0272989X8900900109. [DOI] [PubMed] [Google Scholar]
  11. Fayer R., Ungar B. L. Cryptosporidium spp. and cryptosporidiosis. Microbiol Rev. 1986 Dec;50(4):458–483. doi: 10.1128/mr.50.4.458-483.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Forgacs P., Tarshis A., Ma P., Federman M., Mele L., Silverman M. L., Shea J. A. Intestinal and bronchial cryptosporidiosis in an immunodeficient homosexual man. Ann Intern Med. 1983 Dec;99(6):793–794. doi: 10.7326/0003-4819-99-6-793. [DOI] [PubMed] [Google Scholar]
  13. Gaginella T. S., O'Dorisio T. M. Octreotide: entering the new era of peptidomimetic therapy. Drug Intell Clin Pharm. 1988 Feb;22(2):154–155. doi: 10.1177/106002808802200214. [DOI] [PubMed] [Google Scholar]
  14. Garcia L. S., Brewer T. C., Bruckner D. A. Fluorescence detection of Cryptosporidium oocysts in human fecal specimens by using monoclonal antibodies. J Clin Microbiol. 1987 Jan;25(1):119–121. doi: 10.1128/jcm.25.1.119-121.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Garcia L. S., Bruckner D. A., Brewer T. C., Shimizu R. Y. Techniques for the recovery and identification of Cryptosporidium oocysts from stool specimens. J Clin Microbiol. 1983 Jul;18(1):185–190. doi: 10.1128/jcm.18.1.185-190.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Henriksen S. A., Pohlenz J. F. Staining of cryptosporidia by a modified Ziehl-Neelsen technique. Acta Vet Scand. 1981;22(3-4):594–596. doi: 10.1186/BF03548684. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Heyman M. B., Shigekuni L. K., Ammann A. J. Separation of cryptosporidium oocysts from fecal debris by density gradient centrifugation and glass bead columns. J Clin Microbiol. 1986 Apr;23(4):789–791. doi: 10.1128/jcm.23.4.789-791.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Human cryptosporidiosis. N Engl J Med. 1983 Nov 24;309(21):1325–1327. doi: 10.1056/NEJM198311243092114. [DOI] [PubMed] [Google Scholar]
  19. Hunt D. A., Shannon R., Palmer S. R., Jephcott A. E. Cryptosporidiosis in an urban community. Br Med J (Clin Res Ed) 1984 Sep 29;289(6448):814–816. doi: 10.1136/bmj.289.6448.814. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Isaacs D., Hunt G. H., Phillips A. D., Price E. H., Raafat F., Walker-Smith J. A. Cryptosporidiosis in immunocompetent children. J Clin Pathol. 1985 Jan;38(1):76–81. doi: 10.1136/jcp.38.1.76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Katz M. D., Erstad B. L., Rose C. Treatment of severe cryptosporidium-related diarrhea with octreotide in a patient with AIDS. Drug Intell Clin Pharm. 1988 Feb;22(2):134–136. doi: 10.1177/106002808802200206. [DOI] [PubMed] [Google Scholar]
  22. Ma P., Soave R. Three-step stool examination for cryptosporidiosis in 10 homosexual men with protracted watery diarrhea. J Infect Dis. 1983 May;147(5):824–828. doi: 10.1093/infdis/147.5.824. [DOI] [PubMed] [Google Scholar]
  23. McNabb S. J., Hensel D. M., Welch D. F., Heijbel H., McKee G. L., Istre G. R. Comparison of sedimentation and flotation techniques for identification of Cryptosporidium sp. oocysts in a large outbreak of human diarrhea. J Clin Microbiol. 1985 Oct;22(4):587–589. doi: 10.1128/jcm.22.4.587-589.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Meisel J. L., Perera D. R., Meligro C., Rubin C. E. Overwhelming watery diarrhea associated with a cryptosporidium in an immunosuppressed patient. Gastroenterology. 1976 Jun;70(6):1156–1160. [PubMed] [Google Scholar]
  25. Moodley D., Jackson T. F., Gathiram V., van den Ende J. A comparative assessment of commonly employed staining procedures for the diagnosis of cryptosporidiosis. S Afr Med J. 1991 Mar 16;79(6):314–317. [PubMed] [Google Scholar]
  26. Navin T. R., Juranek D. D. Cryptosporidiosis: clinical, epidemiologic, and parasitologic review. Rev Infect Dis. 1984 May-Jun;6(3):313–327. doi: 10.1093/clinids/6.3.313. [DOI] [PubMed] [Google Scholar]
  27. Perez-Schael I., Boher Y., Mata L., Perez M., Tapia F. J. Cryptosporidiosis in Venezuelan children with acute diarrhea. Am J Trop Med Hyg. 1985 Jul;34(4):721–722. doi: 10.4269/ajtmh.1985.34.721. [DOI] [PubMed] [Google Scholar]
  28. Reese N. C., Current W. L., Ernst J. V., Bailey W. S. Cryptosporidiosis of man and calf: a case report and results of experimental infections in mice and rats. Am J Trop Med Hyg. 1982 Mar;31(2):226–229. doi: 10.4269/ajtmh.1982.31.226. [DOI] [PubMed] [Google Scholar]
  29. Sherwood D., Angus K. W., Snodgrass D. R., Tzipori S. Experimental cryptosporidiosis in laboratory mice. Infect Immun. 1982 Nov;38(2):471–475. doi: 10.1128/iai.38.2.471-475.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Sloper K. S., Dourmashkin R. R., Bird R. B., Slavin G., Webster A. D. Chronic malabsorption due to cryptosporidiosis in a child with immunoglobulin deficiency. Gut. 1982 Jan;23(1):80–82. doi: 10.1136/gut.23.1.80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Stibbs H. H., Ongerth J. E. Immunofluorescence detection of Cryptosporidium oocysts in fecal smears. J Clin Microbiol. 1986 Oct;24(4):517–521. doi: 10.1128/jcm.24.4.517-521.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. TRUANT J. P., BRETT W. A., THOMAS W., Jr Fluorescence microscopy of tubercle bacilli stained with auramine and rhodamine. Henry Ford Hosp Med Bull. 1962 Jun;10:287–296. [PubMed] [Google Scholar]
  33. Weber R., Bryan R. T., Bishop H. S., Wahlquist S. P., Sullivan J. J., Juranek D. D. Threshold of detection of Cryptosporidium oocysts in human stool specimens: evidence for low sensitivity of current diagnostic methods. J Clin Microbiol. 1991 Jul;29(7):1323–1327. doi: 10.1128/jcm.29.7.1323-1327.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Zierdt W. S. Concentration and identification of Cryptosporidium sp. by use of a parasite concentrator. J Clin Microbiol. 1984 Nov;20(5):860–861. doi: 10.1128/jcm.20.5.860-861.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]

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