What Is Stool Culture

Stool Culture

Everyone, regardless of ethnic origin, has their own distinct beliefs, habits, and ways of living, and it is important to recognize that everyone has these things. Because the sooner you recognize that everyone is unique, the easier it will be to appreciate and accept cultural differences.

Why It Is Done

A stool culture is performed in order to:

  • Determine the underlying source of the symptoms. Severe or bloody diarrhea or an increased volume of gas are some of the symptoms that might be explained by this condition. It can also aid in the determination of the reason of nausea, vomiting, lack of appetite, bloating, abdominal discomfort and cramps, and fever, among other symptoms. Locate and identify specific types of organisms that are causing illnesses or disorders, and document your findings. Food poisoning, inflammation of the large intestine (colitis), cholera, and typhoid are examples of such illnesses. Identification of an individual who may not exhibit any signs of sickness but who has germs that has the potential to transfer the infection to others This individual is referred to as a carrier. A person who is a carrier and who works in the food industry is more likely to spread the infection to others. Check to see if the therapy for an infection has been effective as expected

How To Prepare

If you have recently taken antibiotics, visited outside of the nation, or consumed untreated water, tell your doctor about it. Also inform the doctor if you have recently undergone a test with contrast material, such as a barium swallow or a barium enema.

How It Is Done

If you have recently taken antibiotics, gone abroad of the country, or consumed untreated water, tell your doctor about it. As well, inform your doctor if you have recently undergone a test that used contrast material, such as a barium swallow or a barium enema.

  • You should urinate before collecting the feces. You won’t receive any pee in your stool sample if you do it this way. Put on gloves before touching your feces so that you do not urinate when you are passing the stool. Stool may include bacteria that are capable of spreading illness. After removing your gloves, wash your hands thoroughly. Stool (but not urine) should be emptied into a dry container. It is possible that you will be provided a plastic basin to place beneath the toilet seat in order to capture the stool.
  • It is possible to collect either solid or liquid excrement
  • Using a big plastic bag attached to the toilet seat may make the collecting procedure easier if you’re suffering from diarrhea. After that, the bag is placed in a plastic container. Avoid taking the sample from the toilet bowl
  • Instead, use a cup. Do not combine the sample with any other substances such as toilet paper, water, or soap.
  • Place the container’s lid on top of it. Make a note of your name, your doctor’s name, and the date the feces was collected on the container. If you require more than one sample, place each sample in its own container. In the absence of specific instructions from your doctor, you should collect a sample just once a day.

Take the sample as quickly as possible to your doctor’s office or to the laboratory. You may be required to submit your sample to the lab within a specific time frame, generally within 30 minutes or fewer after when it was collected. Inform your doctor if you believe you will have difficulty delivering the sample to the laboratory on time. Diapers of newborns and young children may be used to collect samples from them (if the stool does not have urine mixed with it). Alternatively, a small tube may be inserted into the infant’s rectum while the baby is held on your lap.

It is necessary to enter the swab into the rectum and then gently spin it before pulling it out.

How It Feels

There is no discomfort associated with taking a stool sample. You may experience discomfort when trying to pass feces if you are constipated. In the event that your doctor obtains a stool sample with a cotton swab, you may experience some pressure or pain while the swab is being inserted into your colon.


Any stool sample may include germs that have the potential to cause disease transmission. Take precautions such as washing your hands thoroughly and using proper handling procedures to avoid spreading illness.


The results of a stool culture test are normally available in 2 to 3 days. However, certain cultures for fungi and parasites may take many weeks to provide findings.

Stool culture

Normal: No disease-causing bacteria, fungi, parasites, or viruses are present or grow in the culture.
Abnormal: Bacteria (such assalmonella, shigella, or certain types ofE. coli) grow in the culture. Fungi such as yeast are found in the stool.

If bacteria are detected in the culture, sensitivity testing may be performed to aid in the selection of the most appropriate therapy. Your faeces may also be examined under a microscope to see whether or not it contains parasites such as Giardia.


As of September 23, 2020, the information is current. Written by a member of the Healthwise staffMedical review by Adam Husney, MD – Family Medicine Dr. E. Gregory Thompson is an Internal Medicine specialist. Dr. Martin J.

Gabica specializes in family medicine. As of September 23, 2020, the information is current. Healthwise StaffMedical Review: Adam Husney, MD – Family MedicineAuthor: Healthwise Staff Dr. E. Gregory Thompson is an Internal Medicine specialist. Dr. Martin J. Gabica specializes in family medicine.

Stool Sample Culture Test

Depending on the severity of your stomach troubles, your doctor may prescribe a stool culture or request a stool sample from you. Bacteria, viruses, and other pathogens that might be causing your illness can be found in your stool with this test.

Why Do You Need It?

If you have any of the following symptoms, your doctor may request this test for you:

  • Prolonged diarrhea that lasts for many days or longer. Poop that contains blood or mucous
  • Nausea
  • Vomiting
  • Fever

If any of the following apply, your doctor may be more concerned:

  • You’re a child or an elderly person
  • You are suffering from a weaker immune system. Traveling outside of the United States is something you’ve done. tainted food or drink has been consumed by you
  • Your symptoms are really acute.

It is possible that you will require antibiotics to get rid of the infection or to prevent other health concerns, such as dehydration (losing too much fluid).

How Is a Stool Culture Done?

You’ll be required to provide a sample of your feces to your doctor. You will not be required to do this task at the doctor’s office. An alternative is to receive a specific container with a lid to take home with you. It’s possible that your name and birthday are printed on this. If you don’t know, you can write it down on the label. Your doctor will go through the procedure for collecting the sample as well as any specific instructions that may be required. In the majority of circumstances, you’ll follow the methods outlined below: Put something in your toilet to catch the excrement you produce.

  1. If your stool is not loose or watery, you might also place a piece of newspaper or plastic wrap over the toilet rim to prevent it from overflowing.
  2. It has the potential to take up germs that are not your own.
  3. Don’t touch anything with your hands.
  4. Don’t fill the container to the brim.
  5. Make sure to include any bleeding, slimy, or watery bits in your collection.
  6. If you need to go to the bathroom, do so before you begin.
  7. Any residual feces should be flushed into the toilet.
  8. It can be stored in your refrigerator until then, but only for a maximum of 24 hours per container.
  9. They should also be aware of any herbs, supplements, vitamins, over-the-counter medications, or illicit substances that you are using.

When Do You Get the Results?

Once your sample has arrived at the lab, it will be spread onto a specific sterile plate that will aid in the growth of bacteria. Any that do is subjected to a closer examination under a microscope. The majority of the time, you should have your findings within 1 or 2 days.

What Do the Results Mean?

If your test results come back negative, this indicates that everything is OK. There were no germs identified in your feces, and you are not infected with anything. A positive test result indicates that your feces was contaminated with a germ, virus, or other sort of bacterium during the testing process.

Your doctor will be informed of the sort of infection and which medications will be used to combat it by the lab. This can assist them in determining the best course of action.

Stool Test: Bacteria Culture (for Parents)

When a kid has a problem in the stomach, intestines, or another part of the gastrointestinal (GI) system, a stool (feces) sample can give clinicians with crucial information about what is going on. A stool culture is used to determine whether or not a bacterial infection is present in the intestines. A technician deposits tiny stool samples in sterile plastic dishes with nutrients that promote the development of certain bacteria. The samples are then tested. If the targetedbacteria are already present in the stool sample, they will not reproduce.

Why It’s Done

A stool culture may be requested by a clinician in order to check for illness-causing germs such as:

  • Shigella, salmonella, yersinia, campylobacter, and E. coli are all bacteria that can cause illness.

Other bacteria have been discovered on occasion. If your child has had diarrhea for several days or has bloody diarrhea, a stool culture may be ordered. This is especially true if there has been an outbreak of foodborne illness in your community, if your child has recently consumed undercooked meat or eggs, or unpasteurized milk, or if your child has recently traveled to certain countries outside of the United States.

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Stool samples are often collected by parents at home, rather than by health-care professionals in a hospital or clinic, in contrast to the majority of other lab tests. There is no specific preparation necessary, but please inform your doctor if your kid has recently taken antibiotics or other medications.


Written instructions on how to obtain a stool sample are normally supplied by the doctor or hospital laboratory. If you don’t have any instructions, here are some suggestions for obtaining a feces sample from your child:

  • Wearing protective gloves and washing your hands as well as your child’s hands afterward are essential. Children with diarrhea, particularly young children, are unable to notify their parents when they are about to have a bowel movement in advance. As a result, the feces specimen is collected using a hat-shaped plastic cover. For collection of the sample, this collecting device may be swiftly positioned over a toilet bowl or beneath the bottom of your child’s pants. The use of a capturing device can help to prevent the contamination of stool by toilet water in some cases. Another option for collecting a feces sample is to lay a piece of plastic wrap over the toilet seat and leave it there. After that, place the stool sample in a clean, sealable container before transporting it to the laboratory. If your child is an infant or toddler who has not yet learned to use the toilet, you can line his or her diaper with plastic wrap. If possible, the wrap should be set such that pee flows into the diaper rather than the wrap. It is not acceptable for your youngster to urinate into the container. In order to prevent the stool sample from being diluted by pee, try to have your kid empty his or her bladder before going to the bathroom before going to the bathroom. The stool should be placed into clean, dry plastic jars with screw-on lids to prevent it from drying out. It is possible that your kid will be requested to produce a stool sample on one or more occasions. This should be done within a few hours of collection in order to achieve the optimum outcomes.

Upon arrival at the laboratory, a technician spreads feces samples on a growth-promoting material on sterile plates, which then becomes infected with the bacteria. Each of these plates is maintained at a temperature that promotes the fastest growth of the bacteria being studied. There are no bacterial colonies formed when the test is performed and there is no evidence of an infection with any germs. If, on the other hand, bacterial colonies do grow, the technician examines them under a microscope and may do chemical tests to identify them more precisely.

Getting the Results

In most cases, the results of the stool culture are available within 24 to 48 hours of taking the sample.


It is not need to worry about the safety of collecting stool samples.

Helping Your Child

Collecting a feces sample is a simple and painless procedure. Tell your youngster that collecting the feces will not be painful, but that it must be done with caution. A youngster of sufficient age may be able to collect the sample on his or her own, so avoiding humiliation. Inform your youngster on how to correctly complete this task.

If You Have Questions

If you have any queries concerning the stool culture, you should consult with your physician.

Stool Culture

Sources consulted for the current review B. Devkota is the author of this article (2014 January 16 Updated). Medications and Diseases on Medscape (Stool Culture). This resource is available online atAccessed on February 8, 2016. S. Guandalini and R. Frye are co-authors of the paper (2015 August 19 Updated). Diarrhea is a medical condition that is listed on Medscape Drugs and Diseases. This resource is available online atAccessed on February 8, 2016. Lehrer, J., et al (2014 May 15 Updated). Fecal culture is a type of feces culture.

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Available online atAccessed March 2016.

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Campylobacter Infections, according to the Centers for Disease Control and Prevention’s Division of Bacterial and Mycotic Diseases’ Disease Information.

Disease Information about Escherichia coli O157:H7 from the Centers for Disease Control and Prevention’s Division of Bacterial and Mycotic Diseases.

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Salmonella enterocolitis is a kind of intestinal inflammation caused by the bacteria Salmonella.

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Stool Culture

What is a stool culture, and how does it work? Your doctor may order a stool culture to better understand and treat disorders with your digestive tract, often known as the gastrointestinal tract. If you are experiencing painful stomach issues, there are several reasons for this to occur. Bacterial infections are the root of several of these problems. A stool culture can be ordered by your doctor to examine a sample of your stool, or feces, for the presence of dangerous microorganisms. In contrast to anova and parasite examination of the feces, a stool culture is performed on the stool.

The bacteria found in your feces will be grown or “cultured” by laboratory personnel during a stool culture.

Using special plates, they will spread a sample of your feces on them.

Then, using dye staining, microscopy examination, and other techniques, laboratory workers will attempt to identify the bacteria they have discovered.

  • Campylobacterspecies, Salmonellaspecies, Shigellaspecies are all examples of bacteria that can cause illness.

The following tests may be performed if you have recently been outside of the United States or if you have additional risk factors:

  • The following tests may also be performed if you have recently been outside of the United States or if you have additional risk factors:

They may also undertake further tests, such as a test for the Clostridium difficile (C. difficile) toxin or an ova and parasite exam to check for parasites. Other tests may be performed as well. An infection of the digestive tract can cause a variety of unpleasant symptoms. Occasionally, they can even be life threatening in nature. Many different illnesses have symptoms that are similar to one another, such as:

  • It is possible that they will undertake further tests, such as a test for the toxin caused by the bacteria Clostridium difficile (C. difficile) or an ova and parasite exam to check for parasites. An infection of the digestive tract can produce a range of unpleasant symptoms. They can even be life threatening in rare instances. Many different illnesses have symptoms that are similar to one another, such as the ones described below:

A variety of additional tests, such as a test for the Clostridium difficile toxin (C. difficile) or an ova and parasite exam to check for parasites, may also be performed. Infections in the digestive tract can cause a variety of unpleasant symptoms. They can even be life threatening in rare circumstances. Many different illnesses produce symptoms that are similar to one another, such as:

Why Might Your Healthcare Provider Order A Stool Culture?

If you are experiencing digestive difficulties, such as diarrhea, you should visit your doctor. If the condition persists after visiting your doctor, you should see a gastroenterologist. When you have symptoms such as diarrhea, stomach discomfort, nausea, or vomiting, your healthcare practitioner will want to run certain tests to determine whether there is an underlying explanation for them. In some cases, a stool culture will be ordered as part of a series of tests that will be performed to determine what is causing all of the symptoms.

Fortunately, a stool test is noninvasive and, when it comes to testing, it is rather simple. Photograph courtesy of Peter Dazeley / Photographer’s Choice / Getty Images

Why It’s Used

When attempting to develop harmful bacteria from feces, a stool culture is utilized. These bacteria can cause gastrointestinal infections, which manifest as symptoms such as diarrhea, blood, or mucus in the stool, stomach discomfort, and nausea or vomiting, among other signs and symptoms. By culturing bacteria in the laboratory, it is possible to discover bacteria that cause intestinal disorders such as cholera, typhoid fever, and dysentery, among others. When it comes to identifying bacteria, other quick tests have largely supplanted stool culture.

Because there are so many different types of normal bacteria present in feces, it is possible that detecting infections will be difficult.

Prolonged diarrhea can be a sign of any of the three diseases listed above.

How to Prepare for a Stool Culture

When trying to develop harmful bacteria from feces, a stool culture is employed. These bacteria can cause gastrointestinal infections, which manifest themselves as diarrhea, blood, or mucus in the stool, stomach discomfort, and nausea or vomiting, among other symptoms. By culturing bacteria in the laboratory, it is possible to discover bacteria that cause intestinal disorders such as cholera, typhoid fever, and dysentery. When it comes to identifying bacteria, other quick tests have largely supplanted stool culture.

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Detecting infections in faeces may be difficult due to the large number of various kinds of normal bacteria present.

In all three disorders, diarrhea can last for an extended period of time.

How a Stool Sample Is Performed

Following the placement of the feces in the culture, it may take two to three days for any bacteria present in the stool to begin to develop. Afterwards, these bacteria may be separated and studied under a microscope to determine whether or not they are pathogenic.

Potential Risks

If the feces is collected when one is alone in the toilet, this test is safe, painless, and somewhat private. Even though many patients may be embarrassed or uncomfortable about submitting their stool samples to a lab, it is crucial to remember that receiving stool samples is a routine aspect of the work for lab technicians, and it is just business as usual for them. To assist ease some of the shame, placing the sample in a bag, such as a brown paper bag, and transporting it to the lab can help.

Follow-up Necessary

In a few days, you should contact your healthcare practitioner to find out the findings. A pathogen is discovered, and the test results are positive or “isolated,” it may be required to treat the patient. The type of bacteria that was discovered will determine the sort of therapy that is required. The majority of the time, only one type of bacteria will be present in the feces, but in other circumstances, there may be several pathogens present in the stool.

If no pathogen is discovered, this is referred to as a result of negative or “not isolated,” and more tests (or a repeat stool culture) may be required to determine the source of the symptoms (or the stool culture may need to be repeated).

A Word From Verywell

Stool cultures are rather humiliating, but they are not difficult to do and are very basic. The results of the test should be available within a few days, and they will assist to either confirm or rule out the presence of a bacterial infection. There will very certainly be follow-up from the test, whether the result is positive or negative, because treatment may be required in the case of a positive result, and more testing may be required in the case of a negative result. Thank you for sharing your thoughts!

There was a clerical error.

Verywell Health relies on only high-quality sources, such as peer-reviewed research, to substantiate the information contained in its articles.

  1. Michigan Medicine is affiliated with the University of Michigan. Stool culture
  2. Laboratory tests available online. Calprotectin

Fecal culture: MedlinePlus Medical Encyclopedia

A fecal culture is a laboratory test that is used to identify organisms in the stool (feces) that might cause gastrointestinal symptoms and illness. It is necessary to get a stool sample. There are a variety of options for gathering the sample. You may obtain a sample by contacting:

  • On a piece of plastic wrap. Make sure that the toilet bowl is covered loosely with the wrap and that the toilet seat is holding it in place. Place the sample in a clean container that was provided to you by your health-care professional. In a test kit that includes a specific toilet paper, the results are recorded. Place it in a clean container provided by your service provider
  • And

Do not mix the sample with any other substances such as urine, water, or toilet tissue. Children that are diapered should be dressed as follows:

  • Plastic wrap should be used to line the diaper. Placing the plastic wrap in such a way that it will prevent urine and feces from mingling is important. This will result in a more representative sample

To ensure that the sample is returned to the laboratory as soon as feasible, Toilet paper and urine should not be included in the samples. A technician in the lab collects a sample of the specimen and sets it on a separate dish. This is followed by filling the dish with a gel that encourages the development of bacteria or other pathogens. If there is growth, it is possible to identify the germs. In addition, the lab technician may do further tests in order to find the appropriate therapy. You will be provided with a container for collecting the stool samples.

  1. If you have severe diarrhea that won’t go away or that keeps coming back, you may need to have it done.
  2. Consult with your healthcare practitioner about the significance of your specific test findings.
  3. Collection and management of specimens for the diagnosis of infectious illnesses are important tasks.
  4. and Pincus M.R., edited the book Henry’s Clinical Diagnosis and Management by Laboratory Methods (Henry’s).
  5. G.S.
  6. Woods, Medical Bacteriology.
  7. and Pincus M.R., edited the book Henry’s Clinical Diagnosis and Management by Laboratory Methods (Henry’s).

Melia JMP, Sears CL, Melia JMP et al.

Feldman, M., Friedman, L., and Brandt, L.J.

Gastrointestinal and Liver Disease by Sleisenger and Fordtran is a classic text.

11th ed.

Siddiqi HA, Salwen MJ, Shaikh MF, Bowne WB.

The authors, McPherson R.A.

The 23rd edition.

Michael M.

In addition, David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial staff examined the manuscript for accuracy.

How should I collect and store a poo (stool) sample?

To ensure that the sample is received at the laboratory as soon as feasible, The samples must not contain any toilet paper or pee. A technician in the lab collects a sample of the specimen and inserts it on a specially designed dish. This is followed by filling the dish with a gel that encourages the development of bacteria and other germs. Identifying germs is simple if there is growth. Further testing and analysis may be performed by the lab technician in order to decide the best course of action.

  1. When your doctor believes that you may be suffering from a gastrointestinal illness, he or she will order this procedure.
  2. No aberrant bacteria or other organisms have been discovered during this sampling procedure.
  3. Stool culture; stool culture; fecal culture for gastroenteritis The authors (Beavis KG and Charnot-Katsikas A) thank their colleagues for their contributions to this work.
  4. Henry’s Clinical Diagnosis and Management by Laboratory Methods, edited by McPherson RA and Pincus MR.
  5. Health-care bacteriology, by George S.
  6. Woods, Jr.
  7. The 23rd edition, published by Elsevier in Philadelphia, PA, in 2017: chap 58 John M.

Melia and Clarence L.

The diseases of infectious enteritis and proctocolitis are two examples of bacterial infections.

Gastrointestinal and Liver Disease, by Sleisenger and Fordtran.

Philadelphia, PA: Elsevier Science; 2021:chap 110 Siddiqi HA, Salwen MJ, Shaikh MF, Bowne WB.

Siddiqi HA, Salwen MJ, Bowne WB.

Henry’s Clinical Diagnosis and Management by Laboratory Methods, edited by McPherson RA and Pincus MR.


Phillips, MD, Clinical Professor of Medicine at The George Washington University School of Medicine in Washington, DC, has made the latest update.

  • Collect your poo (stool) sample in a container that has been well cleaned (sterilized)
  • If you are unable to give it in immediately, place the container in the refrigerator in a sealed plastic bag.

Collecting a stool sample

Your primary care physician or another healthcare expert, such as a nurse, should be able to explain how to obtain a sample. It should be gathered in a screw-top container that is clean and dry. Your doctor or a member of the hospital’s staff will provide you with a plastic (specimen) container to use, but you are free to use any clean container as long as it is able to be sealed properly.

Try not to collect pee (urine) or water from the toilet together with the feces, but don’t be concerned if you accidentally do. If you need to go to the bathroom, do so first before collecting the feces. The following steps must be taken in order to collect the sample:

  • Clearly mark a clean, screw-top container with your name, date of birth, and the date of the experiment
  • Placing anything in the toilet to catch the feces, such as a potty or an empty plastic food container, as well as spreading clean newspaper or plastic wrap around its rim, are all good options. Make certain that the feces does not come into contact with the toilet’s inside
  • Make use of the spoon or spatula that comes with the container to gather the feces, and then screw the lid on tightly. Try to fill approximately a third of the container if you’ve been given one
  • If you’re using your own container, try to fill roughly the size of a walnut into the container
  • Put everything you used to gather the feces in a plastic bag, tie it up, and throw it in the garbage
  • Hand washing with soap and warm running water is very recommended

Follow any additional directions that your doctor has provided you with.

Storing a stool sample

Because the germs in your feces have the ability to grow, your sample of feces must be fresh. So the bacteria concentrations in your stool sample will not be the same as those in your digestive tract. If the quantities of bacteria in the samples do not match, the findings of the test may not be reliable. As soon as possible, you should give in your sample since it may not be able to be examined if it has been refrigerated – your doctor will inform you if this is the case. If you are unable to submit your sample immediately, find out how long it may be stored in the refrigerator.

If it is possible to store it in the refrigerator, place the container in a tightly wrapped plastic bag first.

What are stool samples used for?

Your primary care physician or another healthcare expert may request a stool sample from you in order to diagnose or rule out a specific health issue. Bacteria and other chemicals found in the digestive system can be found in feces as well. It is possible to determine what is going on in your digestive tract by evaluating the quantities of these compounds and bacteria in your feces. For example, the sample can be analyzed to aid in the diagnosis of the following conditions:

  • Gastroenteritis is a common condition that causes diarrhoea and vomiting, and is usually caused by a bacterial or viral stomach bug
  • Inflammatory bowel disease (IBD) includes Crohn’s disease, which is an inflammation of the lining of the digestive system, and ulcerative colitis, which is an inflammation of the colon and rectum
  • And other conditions.

Learn more about the operations, testing, and procedures that are performed.

Further information

  • What is the best way to collect and keep a pee (urine) sample? Tests for screening and evaluation
  • Lab Tests Online UK: stool analysis

The page was last reviewed on August 27, 2019. The deadline for the next review is August 27, 2022.

Stool culture

More than 90% of cases of acute diarrhoea are caused by infectious agents1 that are spread by faecal-oral transmission, either through direct human contact or through the intake of contaminated food or water.1 It is critical to be familiar with the wide variety of infections that can cause infectious diarrhoeal syndromes (Tables 1–3) in order to effectively treat patients.

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Table 1. Clinical infectious diarrhoeal syndromes

Syndrome Clinical features Epidemiology Typical pathogens
Watery diarrhoea Loose, watery stools, no blood Most common presentation
  • The following bacteria: Campylobacterspp
  • Salmonellaspp
  • Shigellaspp
  • Vibriospp
  • Yersiniaspp
  • Plesiomonasspp
  • Aeromonasspp
  • The majority of viruses and parasites
Bloody diarrhoea Bloody stools, sometimes mucous or pusOften abdominal pain, fever, tenesmus Less common
  • Escherichia coli (STEC), Shigellaspp., Campylobacterspp., Shigellaspp., Shigellaspp., Shigellaspp., Shigellaspp., Shigellaspp.
Table 2. Infectious diarrhoeal syndromes in particular epidemiological settings

Travellers’ diarrhoea Loose, watery stools sometimes bloody Visitors to developing tropical/semi-tropical countries
  • Bacteria that cause enterotoxigenic E. coli (ETEC) and enteroaggregative E. coli (EAEC) include Campylobacterspp. 8 and Salmonellaspp., viruses and parasites, and other pathogens.
Nosocomial diarrhoea Spectrum of disease; mild diarrhoea, fulminant colitis, toxic megacolonHealthcare and antibiotic associated diarrhoea 9 Risk factors: Community acquired disease (increasingly common 2)
Diarrhoea in immunocompromised patients Variable presentationCareful investigation required
  • Patient’s with HIV
  • Recipients of solid organ/bone marrow transplants
  • Cancer patients who are receiving chemotherapy
  • Patient’s with HIV
  • Recipients of solid organ or bone marrow transplants
  • Cancer patients who are receiving chemotherapy
Table 3. Bacterial pathogens that cause acute diarrhoea

Pathogen Major modes of transmission Clinical features Epidemiological features
Campylobacter jejuni Food borne
  • Flu-like symptoms including fever and bloody diarrhoea are possible.
  • It is a widespread infection
  • It is associated with undercooked chicken and is a common cause of travellers’ diarrhoea.
  • Undercooked chicken, eggs, and other animal products are frequently contaminated with this disease.
Shigellaspp. Person-to-personFood and water borne
  • Frequently severe diarrhoea, bloody stools, fever, and stomach discomfort are all symptoms.
  • Human reservoir
  • Low infectious inoculum
  • Low infectious inoculum Cases of secondary infection are prevalent in homes
  • The most severe illness is caused by S. dysenteriae, which is primarily seen in impoverished nations.
  • Usually causes watery diarrhoea
  • However, it can also cause fever and bloody diarrhoea, and it can mimic acute appendicitis.
  • Animal reservoir (particularly pigs)
  • Associated with the production of pork products
Shiga-toxin producingE. coli(STEC), includesE. coli0157 Food borne
  • Symptoms include: watery diarrhoea, which can escalate to bloody diarrhoea
  • A significant contributing factor to haemolytic uraemic syndrome
  • Children and the elderly are particularly vulnerable.
  • It is found in cattle as a reservoir
  • It is associated with undercooked meat (particularly ground beef)
  • Associated with shellfish and other seafood (especially prominent throughout the summer months)
  • And
  • Symptoms include watery diarrhoea, bloody feces, and fever. Symptoms of severe illness are present in patients with liver disease and cancer.
  • Associated with international travel, oyster intake, and other seafood consumption
  • Acute watery diarrhoea, bloody diarrhoea, and persistent diarrhoea are all possible symptoms. Symptoms of severe illness are present in patients with liver disease and cancer.
SalmonellaentericaserovarsTyphi andParatyphi Food and water borne
  • Symptoms of systemic toxicity include stomach pain, fever with or without diarrhoea, and bacteraemia.
  • Travelers visiting underdeveloped nations are the majority of the population. Food and water that have been contaminated
  • Reservoir of human resources
Clostridium difficile Bacteria and spores in the hospital environment (eg. the hands of staff, fomites including benchtops and surfaces)
  • Diarrhoea is generally watery but can be bloody
  • The disease has a wide range of symptoms. It is possible to develop a toxic megacolon, perforation, and death.
  • Diarrhoea is normally watery, although it can occasionally be bloody. Death can result from toxic megacolon, perforation, or perforation.

Indications for testing

The majority of episodes of acute diarrhoea are mild and self-limiting, necessitating no further evaluation or treatment. Returning travelers, patients with diarrhoea that has continued for more than 4–5 days, patients with bloody stools, immunocompromised patients, and situations where there is suspicion of an epidemic of enteric disease are all candidates for investigation, regardless of the severity of their illness. Admission to the hospital is typically only necessary in the case of severe dehydration, severe toxaemia, recurrent vomiting, or severe stomach discomfort, among other things.

In patients who are experiencing severe symptoms, it may be necessary to administer empirical antibiotic medication while waiting for the findings of laboratory examinations. 1

Logical positioning of stool cultures relative to other related investigations

Before obtaining a stool culture, it is critical to conduct a comprehensive clinical history and examination. There are a number of nonbacterial causes of diarrhoea that should be explored in the differential diagnosis, including viral and parasite infections. When it comes to viruses, children are more susceptible (especially to rotavirus and adenovirus). Viruses are normally self-limiting in nature. Norovirus is also a common cause of community-acquired diarrhoea, according to the CDC. For the identification of viruses in the feces, nucleic acid amplification tests or antigen detection assays are available; however, they are seldom used in the outpatient context because of the high cost.

  1. travel, immunocompromised host).
  2. It is becoming widely recognized that Clostridium difficile is a source of community-acquired diarrhoea.
  3. 3 Should a stool specimen be submitted for culture and/or antigen screening when C.
  4. A condition known as “food poisoning” happens when a person consumes pre-formed bacterial toxins that have been present in food.

What should I tell my patient about the test?

Collected feces specimens should be loose or unformed, as many laboratories will not handle stool specimens that have been formed during the collecting procedure. Stool specimens are recommended over rectal swabs as a source of information. The patient should empty his or her feces into a clean, dry pan or a container that is attached to the toilet. Afterwards, 5 mL of diarrhoeal stool or 1–2 cubic centimetres of faeces should be collected and placed into an airtight container with a screw-top cover.

Because of the possibility of faecal-oral transmission of infections, it is essential to practice thorough hand hygiene after collecting and handling feces specimens.

It is never recommended to freeze stool specimens.

Some laboratories may reject specimens if they are received more than 2 hours after they were collected and have not been transported via a transport medium. Delays in the processing of specimens can have a negative impact on the recovery of certain bacteria, such as the Shigellaspecies of bacteria.

Timing of the test

When collecting fecal specimens, it is important to do so as early in the disease’ course as feasible because pathogen numbers drop as time passes. If more than one specimen is required, it is recommended that they be gathered on different days. The findings of the culture are normally available within three days of receiving the material in the laboratory.

Medicare eligibility and/or costs for the patient

Patients who are qualified for Medicare Benefits Schedule coverage will have no out-of-pocket expenses for faecal microscopy and culture, pathogen identification, and susceptibility testing (a single examination during a seven-day period) (MBS).

How does the test work?

When the specimen is received at the laboratory, it is examined for consistency and the presence of blood or mucus on the surface of the specimen. After that, microscopy is used to check for erythrocytes and leucocytes, as well as for eggs, cysts, and parasites, among other things. If a parasitic illness is suspected, a complete investigation for eggs, cysts, and parasites should be ordered specifically, since the laboratory must treat these specimens using particular procedures to ensure that no parasites are present.

  1. Lactoferrin is an iron-binding glycoprotein present in the granules of leucocytes that is used to detect the presence of leucocytes in the feces.
  2. The term “selective and differential media” refers to media that are employed for the isolation and preliminary identification of certain organisms, respectively.
  3. Salmonella, Shigella, and Campylobacter species are frequently cultured in laboratories for identification.
  4. coli that produces Shiga toxin and Clostridium difficile, necessitates the use of specialized laboratory procedures.
  5. Salmonellaisolates are sent to a reference laboratory for serotyping in order to protect the public’s health from infection.

What do the results mean?

Stool culture is used to determine the presence of any potentially pathogenic organisms in a sample.

What won’t it tell you?

The identification of the majority of bacterial infections may typically be accomplished with a single specimen. The submission of a second specimen, on the other hand, has been demonstrated to boost the overall sensitivity of the test by around 20%. Five consecutive specimens have been found to be adequate for the detection of 99 percent of bacterial agents in the laboratory. 6 Because of this, the test cannot distinguish between colonisation (i.e., asymptomatic carrying) and illness. Some bacteria, such as Clostridium difficile and Salmonella species, are capable of causing asymptomatic carriage.

Because most infections (e.g., Campylobacter) exhibit predicted susceptibility profiles to antibiotics, the findings of antibiotic susceptibility tests are not typically published. This also has the additional benefit of discouraging unnecessary antibiotic therapy.

What are the common next steps if the test is positive?

The majority of bouts of bacterial diarrhoea are self-limiting, and the majority of treatment is supportive in nature. The use of antibiotics to treat bacterial diarrhoea is a topic that has generated a great deal of discussion and is beyond the scope of this article. However, a positive stool culture does not necessitate the use of antibiotics; good recommendations for the diagnosis and management of infectious diarrhoea are available on the website of the Infectious Diseases Society of America ().

In many jurisdictions, specific enteric pathogens that cause diarrhoea must be reported to the appropriate public health authorities.

In the laboratory report, the requirement to notify an infection should be indicated at the conclusion of the report.

What if the result is negative?

After a negative stool culture is obtained and the diarrhoea persists, consideration should be given to clinical re-evaluation and/or further investigations for nonbacterial (e.g. parasites, viruses) and noninfectious (e.g. gastrointestinal parasites) causes of diarrhoea (eg. inflammatory bowel disease or adverse effects of medication). This may involve stool examination for eggs, cysts, and parasites, antigen detection tests, nucleic acid amplification tests, blood tests (e.g., a full blood count including peripheral blood eosinophilia, parasite serology, serum chemistry), and endoscopy, among other procedures.

This is especially true when contemplating additional testing or empirical therapy.

Special features of the test

To assist the laboratory in doing the proper type of stool cultures, it is necessary to provide detailed clinical information. It is critical to ensure that these are stated in a legible manner on the application form. The age of the patient, whether or not the patient is immunocompromised, the patient’s history, the location and timing of foreign travel, recent consumption of shellfish or seafood, the presence of blood in the stools, fever or abdominal pain, and the patient’s recent antibiotic therapy are all examples of appropriate clinical information.

Reporting of results

Figure 1 is an example of a laboratory report for illustration. Illustration of a laboratory report (Figure 1).


During the examination of a patient with suspected infectious diarrhoea, stool culture is a crucial component of the inquiry. It is crucial to have a thorough grasp of the most prevalent infections and to recognize that providing proper clinical information to the laboratory is critical in order to guarantee that the right stool testing is conducted when dealing with these pathogens. Declaration: Christopher Heath has served on the Antifungal Advisory Boards of Gilead Sciences Inc (Australia), Merck SharpDohme (Australia), Pfizer, and Schering Plough, and has received reimbursement for expenses incurred while attending IDSA and ICCAC meetings from both Merck and Pfizer, among other companies.


Thanks to Mr Brian MacKenzie of the Enteric Laboratory at the Sir Charles Gairdner Hospital in Nedlands, Western Australia for his assistance. –

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