1. Stool Cultures for Water Samples
Julie A. Ribes, M.D., Ph.D.
UKHealthCare Clinical Microbiology Laboratory

2. What is Routine for Stool Cultures?
Salmonella spp.
Shigella spp.
Direct plating and by Selinite Broth enrichment
Edwardsiella tarda 2

3. What is Routine for Stool Cultures?
Campylobacter detection
Campy plate with Microaerophilic incubation 3

4. What is Routine for Stool Cultures?
Aeromonas sp.
Plesiomonas sp.
Bacillus cereus
All of these can be identified off of a BAP, MAC or an XLD
Aeromonas
B. cereus 4

5. What is Routine for Stool Cultures?
Toxigenic E. coli
CDC now recommends that testing for E. coli 0157H7 and the other toxigenic E. coli species be performed on all patients being evaluated for diarrheal disease, not just patients with bloody diarrhea
Sorbitol MAC and Toxin testing both should be performed 5

6. 6

7. 7

8. Testing for Giardia and Cryptosporodium
Direct Fluorescence Antibody staining (Meridian Biosciences)

9. Wolf Run Water Findings D13 BAP
Sweep oxidase to pick up
Aeromonas
Pleisiomonas
Spready colony worked up for possible Bacillus cereus

10. Wolf Run Water Findings D13 MAC
Screen all clear colony types (non-lactose fermenters {NLF}) for possible Salmonella and Shigella
Usual stools, not too many NLF

11. Wolf Run Water Findings D13 XLD
Usual coliforms are yellow
Need to screen black colonies for possible Salmonella spp.
Need to screen clear red colonies for possible Shigella spp.

12. Wolf Run Water Findings D13 MAC Sorbitol
Pink colonies are sorbitol fermenters (usual flora)
Screen all clear colonies for Shiga toxin-producing E coli 0157H7

13. Shiga toxin testing on Overnight Broth

14. Wolf Run Water Findings D13
CIN Agar
Usually not much growth
Need to screen “bulls eye” colonies with pink centers

15. Potentially Significant Organisms Isolated
D13 8/24/10 Bacillus cereus, Aeromonas sobria, Pleisiomonas shigelloides
D10 8/24/10 Aeromonas sobria, Bacillus cereus
D14 8/24/10 Bacillus cereus, Aeromonas sobria
D16 8/24/10 Aeromonas caviae, Aeromonas sobria, Bacillus cereus
D18 8/24/10 Bacillus cereus, Aeromonas hydrophila, Aeromonas schubertii, Aeromonas sobria, Aeromonas caviae

16. Potentially Significant Organisms Isolated
D03 8/31/10 Aeromonas hydrophila
D13 8/31/10 Aeromonas sp., Aeromonas sobria. Bacillus cereus
D18 8/31/10 Aeromonas sobria, Pleisiomonas shigelloides
D19 8/31/10 Aeromonas sp., Aeromonas hydrophila
D25 8/31/10 Aeromonas sobria, Aeromonas caviae

17. Wolf Run Water Findings D25 BAP
No spready colonies
Still had some Oxidase positive organisms to work up

18. Wolf Run Water Findings D25 MAC
Pink and clear colonies
Still needed to look at the clear ones

19. Wolf Run Water Findings D25 XLD
All yellow colonies, nothing to work up for Enterobacteraceae

20. Wolf Run Water Findings D25 CNA
Smattering of Gram positives, nothing significant

21. Aeromonas hydrophila
Aeromonas caviae

22. Citrobacter freundii

23. Bacillus cereus