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. 2024 Jan 7;17(1):13.
doi: 10.1186/s13071-023-06108-1.

High-throughput detection of parasites and ova in stool using the fully automatic digital feces analyzer, orienter model fa280

Sudarat Boonyong  1 , Saowalak Hunnangkul  2 , Sirirat Vijit  1 , Suphaluck Wattano  1 , Parwin Tantayapirak  1 , Sumas Loymek  3 , Sirichit Wongkamchai  4
Affiliations

High-throughput detection of parasites and ova in stool using the fully automatic digital feces analyzer, orienter model fa280

Sudarat Boonyong et al. Parasit Vectors. .

Abstract

Background: Intestinal parasitic infections can harm health by causing malnutrition, anemia, impaired growth and cognitive development, and alterations in microbiota composition and immune responses. Therefore, it is crucial to examine stool samples to diagnose parasitic infections. However, the traditional microscopic detection method is time-consuming, labor-intensive, and dependent on the expertise and training of microscopists. Hence, there is a need for a low-complexity, high-throughput, and cost-effective alternative to labor-intensive microscopic examinations.

Methods: This study aimed to compare the performance of a fully automatic digital feces analyzer, Orienter Model FA280 (People's Republic of China) with that of the formalin-ethyl acetate concentration technique (FECT). We assessed and compared the agreement between the FA280 and the FECT for parasite detection and species identification in stool samples. The first part of the study analyzed 200 fresh stool samples for parasite detection using the FECT and FA280. With the FA280, the automatic feces analyzer performed the testing, and the digital microscope images were uploaded and automatically evaluated using an artificial intelligence (AI) program. Additionally, a skilled medical technologist conducted a user audit of the FA280 findings. The second set of samples comprised 800 preserved stool samples (preserved in 10% formalin). These samples were examined for parasites using the FECT and FA280 with a user audit.

Results: For the first set of stool samples, there was no statistically significant difference in the pairwise agreements between the FECT and the FA280 with a user audit (exact binomial test, P = 1). However, there were statistically significant differences between the pairwise agreements for the FECT and the FA280 with the AI report (McNemar's test, P < 0.001). The agreement for the species identification of parasites between the FA280 with AI report and FECT showed fair agreement (overall agreement = 75.5%, kappa [κ] = 0.367, 95% CI 0.248-0.486). On the other hand, the user audit for the FA280 and FECT showed perfect agreement (overall agreement = 100%, κ = 1.00, 95% CI 1.00-1.00). For the second set of samples, the FECT detected significantly more positive samples for parasites than the FA280 with a user audit (McNemar's test, P < 0.001). The disparity in results may be attributed to the FECT using significantly larger stool samples than those used by the FA280. The larger sample size used by the FECT potentially contributed to the higher parasite detection rate. Regarding species identification, there was strong agreement between the FECT and the FA280 with a user audit for helminths (κ = 0.857, 95% CI 0.82-0.894). Similarly, there was perfect agreement for the species identification of protozoa between the FECT and the FA280 with user audit (κ = 1.00, 95% CI 1.00-1.00).

Conclusions: Although the FA280 has advantages in terms of simplicity, shorter performance time, and reduced contamination in the laboratory, there are some limitations to consider. These include a higher cost per sample testing and a lower sensitivity compared to the FECT. However, the FA280 enables rapid, convenient, and safe stool examination of parasitic infections.

Keywords: FA280 autoanalyzer; FECT; Formalin-ethyl acetate; Helminth; Parasitic detection; Protozoa.

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Conflict of interest statement

This study received support from Firmer Co. Ltd., who provided the Orienter Model FA280 digital feces analyzer for our investigation. However, neither the personnel nor any affiliated entities of Firmer Co. Ltd. were involved in the conduct of this study. The authors declare that there are no competing interests in relation to this research.

Figures

Fig.1
Fig.1
Graphical representation of the study design. The study was divided into two parts: A and B. In Part A of the study, 200 fresh stool samples were analyzed using the Orienter Model FA280 automatic digital feces analyzer. Species identification was evaluated by a skilled medical technologist through user audits, and the results were reported by the analyzer’s artificial intelligence program. In Part B of the study, 800 preserved stool samples were subjected to parasite detection using both the FA280 feces analyzer (with user audit) and the formalin-ethyl acetate concentration technique (FECT). All preserved stool samples were analyzed once with each method
Fig.2
Fig.2
Instrument operation procedures of the FA280 feces analyzer
Fig. 3
Fig. 3
Bar graphs showing the number and helminth species found in the test stool samples tested by the formalin-ethyl acetate concentration technique (FECT) and the FA280 feces analyzer (with user audit)
Fig. 4
Fig. 4
Bar graphs showing the number and protozoa species found in the test stool samples tested by the formalin-ethyl acetate concentration technique (FECT) and the FA280 feces analyzer (with user audit)
Fig. 5
Fig. 5
High-resolution images from the FA280 feces analyzer’s digital microscope depicting helminth eggs and larvae
Fig. 6
Fig. 6
High-resolution images from the FA280 feces analyzer’s digital microscope depicting protozoan cysts and trophozoites
None
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