Archived Issues

2002, Volume 13, Number 1

Virology ordering guidelines based upon specimen type and possible symptoms.

Specimen
Type		 Possible
Symptoms		 Suspect
Agents		 DFA
Testing		 Suggested Test Acceptable
Specimens
Amnionic Fluids Failure to thrive, Intrauterine growth retardation (IUGR), miscarriage Cytomegalovirus (CMV), enterovirus,
Herpes simplex virus (HSV), varicellazoster virus (VZV), rubella virus		 None CVC Amniotic fluids in sterile container.
Blood
Bone Marrow
Bone Marrow Biopsy		 Fever of unkown origin,
AIDS, ARC		 CMV, enterovirus,
HSV, measles,
mumps, VZV		 None CVC

Blood or bone marrow in heparin (green top) or EDTA (purple top) tubes.

Tissues in sterile saline.

Broncho-
alveolar
Lavage		 Pneumonia,
respiratory
distress		 Adenovirus, Chlamydia pneumoniae, Chlamydia psittaci, CMV, HSV, VZV, enteroviruses, influenza, measles, parainfluenza, respiratory syncytial virus (RSV), rhinovirus

RVD

RSV
(RSV)

RVC

Bronchoalveolar lavage/wash in sterile leak-proof container.

Cerebrospinal
Fluid (CSF)

Brain
Biopsies

Meningitis,
encephalitis,
fever, confusion,
drowsiness,
convulsions		 Adenovirus, CMV,
enteroviruses, HSV,
mumps, measles,
rubella, VZV		 None

CVC

Submit at least 1 mL of CSF.

Brain biopsies in sterile saline.
Dermal
Lesions		 Vesicular or maculopapular
rash,
lesions,
fever,
chickenpox,
shingles		 Adenovirus, VZV,
enteroviruses,
HSV

DVD

HSVD
(HSV)

VZD
(VZV)

DVC

CVC
(enterovirus or adenovirus)

HSVC(herpes)


VZVC
(VZV only)

 Vesicle fluid, swab of lesion, and basal cell scraping (all three in the same vial is preferred).

Fecal Specimen

Rectal
Swab

Fever,
headache,
malaise,
meningitis,
diarrhea, vomiting, cold,
Bornholm
disease

Enteroviruses,
poliovirus,
adenovirus,
rotavirus,
Clostridium difficile toxin, HSV (rectal swab)		 HSVD
(HSV)		 CVC

Stool in clean container or Cary Blair medium. Do not use fixatives or preservatives.

Rectal swab in viral transport medium.

Ocular Specimens Pain and swelling
of eyelids,
ocular discharge,
uveitis,
conjunctivitis,
keratitis, acute hemorrhagic conjunctivitis		 Adenovirus,
Chlamydia
trachomatis,
CMV,
enteroviruses,
HSV,
VZV 		CDF (Chlamydia)

CVC

CHC (Chlamydia culture)

DVC
(HSV & VZV)

HSVC (HSV)

VZVC (VZV)

Conjunctival swabs or scrapings in viral transport medium.

Aqueous or vitreous fluids; vitreous washings; or corneal biopsy specimens in viral transport medium.

Products of Conception Failure to thrive,
IUGR,
miscarriage
 CMV, enterovirus,
HSV, virus VZV,
rubella virus.		 None CVC Tissues in sterile saline.
Respiratory Specimens Bronchitis/
bronchiolitis,
cold, croup,
influenza syndrome, pneumonia/
pneumonitis,
sinusitis,
otitis media		 Adenovirus,
Chlamydia pneumoniae, Chlamydia psittaci, CMV,
enteroviruses,
HSV,
influenza,
measles,
parainfluenza, respiratory
syncytial virus
(RSV),
rhinovirus, VZV

RVD

CDF

RVC

CHC (Chlamydia culture)

 

Nasopharyngeal swab and a throat swab in one tube of viral transport medium (preferred).

Nasal washes in sterile tube or cup.

Nasal aspirates in Lukens trap.

Throat swabs in viral transport medium (low yield when submitted without an NP swab)

Tissues in sterile saline
Urine Cystitis,
urethritis,
viral exanthem,
dysuria,
urethral
discharge,
cytomegalic
inclusion disease		 Adenovirus,
Chlamydia trachomatis,
CMV, measles, mumps,
polyomaviruses, Neisseria
gonorrhoeae		  

CVC

CHLCR
(Chlamydia)

GCLCR
(gonorrhoeae)

First void urine is preferred for chlamydia and gonorrhoea.

Random urine or catherized urines may be used for culture.

Urine specimens must be submitted in clean containers with no preservatives.
Urogenital Specimens Urethritis,
cervicitis,
lesions,
vaginal or urethral discharge,
painful urination,
PID,
vesicular lesion		 Adenovirus, CMV, HSV, mumps, Chlamydia trachomatis,
Neisseria gonorrhoeae,
human
papillomavirus
(HPV)

HSVD
(lesion)

CHF

Chlamydia trachomatis

HSVC(herpes)

CHC (Chlamydia culture)

CVC (viruses other than HSV)

CHLCR (Chlamydia)

GCLCR
HPV

Urethral swab, cervical swab or brush, lesion scraping in viral transport for culture.

Cervical or urethral swab in Abbott UriProbe transport tube for LCR assay.

Cervical brushings for HPV in Digene transport or ThinPrep vial.