Test Id : LCMSP
Microsporidia species, Molecular Detection, PCR, Varies
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting Enterocytozoon bieneusi and Encephalitozoon species in fecal and urine specimens to support the clinical diagnosis of microsporidiosis
Highlights
This test is intended to be used for patients who are immunocompromised and have persistent, watery diarrhea. See the Parasitic Investigation of Stool Specimens Algorithm.
This test is intended to be used for the detection of Enterocytozoon bieneusi and Encephalitozoon species DNA in fecal and urine specimens to support the clinical diagnosis of microsporidiosis. Other sources should be tested using MTBS / Microsporidia Stain, Varies.
A negative result indicates the absence of detectable DNA from E bieneusi and Encephalitozoon species in the specimen but does not rule out ongoing microsporidiosis. See Interpretation for more information.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
The following algorithms are available:
Method Name
A short description of the method used to perform the test
Real-Time Polymerase Chain Reaction (PCR)/DNA Probe Hybridization
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Encephalitozoon
Enterocytozoon
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
The following algorithms are available:
Specimen Type
Describes the specimen type validated for testing
Varies
Ordering Guidance
For specimens other than feces or urine, MTBS / Microsporidia Stain, Varies should be ordered since it will detect other microsporidia not targeted by this assay.
Necessary Information
Specimen source is required.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| MSPS | Specimen Source |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Submit only 1 of the following specimens:
Preferred:
Specimen Type: Unpreserved feces
Supplies:
-Stool container, Small (Random), 4 oz (T288)
-Stool Collection Kit, Random (T635)
Container/Tube: Fecal container
Specimen Volume: 5 g
Specimen Type: Preserved feces
Supplies:
-ECOFIX Stool Transport Vial (Kit) (T219)
-Stool Collection Kit, Random (T635)
Container/Tube: ECOFIX preservative
Specimen Volume: 5 g
Specimen Type: Urine
Container/Tube: Sterile container
Specimen Volume: 5 mL
Collection Instructions: Mid-stream, clean-catch, suprapubic aspirates and catheterization collections are acceptable. Submit in a clean, sterile container free from preservatives. The first portion of the voided urine (first void) is also acceptable.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-Microbiology Test Request (T244)
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
Feces: 1 g
Urine: 0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Urine containing preservatives Prostate secretions and samples Feces in preservatives other than ECOFIX | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Refrigerated (preferred) | 7 days | |
| Ambient | 7 days | ||
| Frozen | 7 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting Enterocytozoon bieneusi and Encephalitozoon species in fecal and urine specimens to support the clinical diagnosis of microsporidiosis
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
The following algorithms are available:
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Microsporidia are highly specialized fungi that cause a wide variety of clinical syndromes in humans. The most common microsporidia are Enterocytozoon bieneusi and Encephalitozoon intestinalis, which infect the gastrointestinal tract and cause a diarrheal illness, and Encephalitozoon cuniculi and Encephalitozoon hellem, which can infect the conjunctiva, respiratory tract, and genitourinary system. Human infections have been reported most frequently in patients with AIDS but can also occur in other patients who are immunocompromised, including solid organ allograft recipients and, sporadically, immunocompetent hosts. Less commonly, other microsporidia, such as Vittaforma corneae and Brachiola species, can cause disseminated or organ-specific disease. This assay detects only the most common microsporidia, E bieneusi and Encephalitozoon species, and not microsporidiosis due to other species.
For other diagnostic tests that may be of value in evaluating patients with diarrhea, see Parasitic Investigation of Stool Specimens Algorithm and Laboratory Testing for Infectious Causes of Diarrhea.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Negative
Interpretation
Provides information to assist in interpretation of the test results
A positive result indicates the presence of Enterocytozoon bieneusi and Encephalitozoon species DNA and is consistent with an active or recent infection. Since microsporidia DNA may be present in feces or urine in the absence of clinical symptoms, results should be correlated with clinical presentation.
A negative result indicates absence of detectable DNA from E bieneusi and Encephalitozoon species in the specimen. Still, this does not always rule out ongoing microsporidiosis since the organism may be present at very low levels or may be sporadic.
Other tests to consider in the evaluation of a patient presenting with acute or chronic watery diarrhea include cultures or specific assays for bacterial, viral, and parasitic pathogens.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test only detects DNA from Enterocytozoon bieneusi and Encephalitozoon species and does not detect the less common microsporidia. These 2 genera are the most common causes of intestinal and renal microsporidiosis.
While this assay is designed to detect symptomatic infection with E bieneusi and Encephalitozoon species, it may detect asymptomatic carriage and should only be used for patients with a clinical history and symptoms consistent with microsporidiosis.
Supportive Data
In a study using 205 clinical specimens and 254 spiked specimens, the Microsporidia polymerase chain reaction (PCR) assay had 90% to 100% sensitivity and 100% specificity in all specimen types accepted for this assay. The limit of detection is between 500 to 5000 target DNA copies/mcL of specimen. When 10-fold dilutions of fresh stool specimens containing Enterocytozoon bieneusi spores were tested by both PCR and microscopy, PCR showed significantly greater sensitivity, with the ability to detect Enterocytozoon bieneusi at 1 to 2 dilutions lower than microscopy.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Didier ES, Weiss LM: Microsporidiosis: Not just in AIDS patients. Curr Opin Infect Dis. 2011 Oct;24(5):490-495
2. Nagpal A, Pritt BS, Lorenz EC, et al: Disseminated microsporidiosis in a renal transplant recipient: case report and review of the literature. Transpl Infect Dis. 2013 Oct;15(5):526-532
3. Verweij JJ, Stensvold CR: Molecular testing for clinical diagnosis and epidemiological investigations of intestinal parasitic infections. Clin Microbiol Rev. 2014 Apr;27(2):371-418
4. Wolk DM, Schneider SK, Wengenack NL, Sloan LM, Rosenblatt JE: Real-time PCR method for detection of Encephalitozoon intestinalis from stool specimens. J Clin Microbio. 2002 Nov;40(11):3922-3928
Method Description
Describes how the test is performed and provides a method-specific reference
Nucleic acid is extracted from feces and urine using the automated MagNA Pure bead-based system (Roche Molecular Systems). The extract is then transferred to individual self-contained capillary cuvettes for amplification. The LightCycler is a self-contained automated instrument that amplifies and monitors the development of target nucleic acid (amplicon) after each cycle of polymerase chain reaction (PCR).
The DNA target for PCR assay is the 18S ribosomal RNA gene of Enterocytozoon bieneusi, Encephalitozoon intestinalis, Encephalitozoon hellem, and Encephalitozoon cuniculi.
This assay utilizes 2 primers and 2 probes, which are specific for E bieneusi and 3 primers and 2 probes specific for Encephalitozoon species. The specific base pair DNA target sequence is first amplified by PCR using the target-specific primers. Amplicon is then detected during melting curve analysis using fluorescence resonance energy transfer probes, which utilizes one hybridization probe with a donor fluorophore, fluorescein, at the 3' end and a second hybridization probe with an acceptor fluorophore, at the 5' end. Fluorescence is produced when the 2 probes anneal to the target sequence in close proximity to one another. The LC-Red 670 emits a measurable and quantifiable light signal at a specific wavelength when E bieneusi is present, and the LC-Red 610 emits a measurable and quantifiable light signal in the presence of Encephalitozoon species.(Bernard PS, Reiser A, Pritham GH: Mutation detection by fluorescent hybridization probe melting curves. In: Meuer S, Wittwer C, Nakagawara K, eds. Rapid Cycle Real-Time PCR: Methods and Applications. Springer; 2012:11-20)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Tuesday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
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- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
87798
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| LCMSP | Microsporidia PCR | 94332-4 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| MSPS | Specimen Source | 31208-2 |
| 36744 | Encephalitozoon species | 94333-2 |
| 36745 | Enterocytozoon bieneusi | 94334-0 |