Detection of Cryptosporidium oocysts in human fecal specimens by an indirect immunofluorescence assay with monoclonal antibodies

An indirect fluorescence assay (IFA) with monoclonal antibodies developed for the detection of Cryptosporidium oocysts in fecal smears (Meridian Diagnostics, Inc., Cincinnati, Ohio) was compared with the Zeihl-Neelsen-modified acid-fast stain (MAFS) in 119 human fecal specimens collected between 1984 and 1987. The sensitivity of the IFA was 100%; all 56 specimens positive by MAFS exhibited fluorescence. There were 63 specimens negative for Cryptosporidium sp. by MAFS; of these, 61 were negative by IFA (97% specificity). This discrepancy may reflect an increased sensitivity of the IFA to detect oocysts that were not visualized by MAFS because of faint staining or a paucity of organisms. On average, the IFA required less time than the MAFS (1 versus 5 min, respectively) when only rare or few oocysts were present. Cost comparison of reagents showed the IFA to be three times more expensive. The IFA offers a reasonable alternative to the MAFS because of its high sensitivity and specificity, the simplicity of performing it and interpreting results, and its capability of providing a definitive diagnosis of Cryptosporidium oocysts.