BIDMC Laboratory Manual

Beth Israel Deaconess Medical Center
Laboratory Manual

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GUIDELINES FOR VIROLOGY TESTING

Go directly to: culture , antigen detection or appropriate specimens

VIRAL CULTURE

Available for herpes viruses (HSV, CMV, VZV), enteroviruses (ECHO, coxsackie, polio), adenovirus, influenza and parainfluenza, and RSV. Submit specimens according to the following guidelines. All attempts should be made to collect specimens so that they will arrive in the lab Monday through Friday 8:30 am – 5:00 pm.

ALL SPECIMENS SHOULD BE SUBMITTED ON ICE.

Buffy Coat for CMV culture and Early Antigen - This testing has been replaced by Cytomegalovirus (CMV) Viral Load.
CMV antigenemia – Submit 5 ml EDTA tube. DO NOT SUBMIT ON ICE. CMV Antigenemia has been largely replaced by CMV Viral Load, now done in-house. However, CMV Antigenemia may still be needed to provide more rapid turnaround time for critically ill, immunocompromised inpatients. Before ordering CMV Antigenemia, please call Virology at 7-3018 to ascertain whether your turnaround time requirements might be met by the next scheduled run of CMV Viral Load testing.
Bone Marrow and Early Antigen - This testing has been replaced by Cytomegalovirus (CMV) Viral Load.
Tissue and Swab Specimens for viral culture - Must be placed into M4-RT transport media which is available from Lab Control, the Microbiology Laboratory, in the ED, and clinics throughout the hospital and transported immediately to the lab ON ICE.
Urine – red top tube ( without serum separator) or sterile container ON ICE.

Herpes simplex virus cultures require 1-7 days incubation. Cultures for other viruses may require up to 28 days incubation

VIRAL ANTIGEN DETECTION

CMV early antigen by shell vial culture (performed in conjunction with viral culture):  At this time only tissue and urines (neonates) for Cytomegalovirus (CMV) culture are routinely tested for the presence of CMV early antigens. For early detection of systemic CMV infection, and maximum sensitivity, CMV Viral Load is the test of choice.
HSV and VZV: Direct antigen testing for HSV and/or VZV is available. Please call 667-3018 for instructions and a collection kit. Refer to "Instructions for HSV and VZV Direct Antigen Testing ". This direct antigen test is considerably more sensitive than Tzanck prep and allows differentiation of HSV from VZV (unlike Tzanck prep). Tzanck smears are not performed in our laboratory

APPROPRIATE SPECIMENS TO SEND

DISEASE/ILLNESS	SPECIMENS
CNS DISEASE Aseptic Meningitis Encephalitis	Throat Swab, Rectal Swab/Stool, CSF (Only for enteroviruses) As for Aseptic Meningitis, Brain Biopsy, Urine (For enteroviruses)
ENTERITIS	Throat Swab, Rectal Swab/Stool
GENITAL Cervicitis Cystitis Orchitis Vulvovaginitis	Cervical Swab, Urine Urine Throat Swab, Urine, Rectal Swab/Stool Vaginal Swab
MONONUCLEOSIS-LIKE SYNDROME	Throat Swab, Urine, Acute Phase Blood for serological analysis for serological analysis
MYOCARDITIS, PERICARDITIS	Throat Swab, Rectal Swab/Stool, Pericardial Fluid or Pericardial Biopsy
OPHTHALMIC DISEASE	Eye Swab, Throat Swab
PAROTITIS	Urine, Throat Swab
PLEURODYNIA	Throat Swab, Rectal Swab/Stool
RESPIRATORY TRACT ILLNESS, (UPPER & LOWER) & CROUP	Throat or NP Aspirate/Swab, Rectal Swab/Stool, Sputum or Bronchial Lavage/Wash, Tracheal Aspirate (intubated patients only), Lung Biopsy
VIRAL EXANTHEMA Vesicular Rash Non-Vesicular Rash	Vesicle Fluid or Swab (Fluid has best yield) Rectal Swab or Stool (for Herpangina or Hand-Foot-Mouth disease) Throat Swab, Rectal Swab/Stool (if enterovirus suspected)
VIREMIA	1 tube anticoagulated blood (lavender top) for Cytomegalovirus (CMV) viral load

Reviewed 2/15/2008

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