This observation is confirmed by our data, as FS4 and FS7 showed remarkably different sensitivities depending on the this research intestinal protozoon species investigated. Therefore, new research is needed to document the influence of different FSs on the visibility and differential diagnosis of intestinal protozoon cysts. Third, the effect of the fixative used for preservation of fecal samples has to be evaluated, as there is considerable debate whether a 5% or 10% formalin fixation or a SAF fixative is more appropriate for the preservation of stool samples pending Flotac, as well as FECT (8). With regard to FECT, it should be noted that in some laboratories, the use of ether is not allowed any longer, and it has been replaced by diethyl acetate, which is supposed to have no impact on diagnostic accuracy (37).

We conclude that there is a need for additional studies elucidating the influence of the chemical agents used for fecal fixation, the performance of different FSs, and the duration of stool preservation on the accuracy of intestinal protozoon and helminth diagnosis (8, 10, 15). New insights will help to facilitate, improve, and further standardize the Flotac preparation protocols, particularly for the diagnosis of intestinal protozoa. In considering the advantages and drawbacks of the Flotac technique compared to those of currently more widely used diagnostic techniques, it is too early to conclude whether broader application of the Flotac method would offer a real benefit. The observation that the intestinal protozoon E. coli, as well as the trematode S.

mansoni (15), are somewhat deformed when subjected to the Flotac technique must GSK-3 be considered. Despite these constraints, the diagnostic performance of the Flotac-400 dual technique for detection of intestinal protozoa is promising, at least when compared to that of the widely used FECT. It seems worthwhile to further develop and validate the Flotac method, particularly when considering that the technical requirements of both diagnostic tools are almost equal and that the preparation and reading time for the Flotac-processed samples is comparable to the time
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