Viral Culture, General w/ Reflex*

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Category:

Turnaround Time: 9 - 12 days
CPT Code:

87252

Test Type: 1 mL fluid or one swab in viral transport

Overview:

Aid in the diagnosis of viral diseases (eg, conjunctivitis, congenital viral infections, keratitis, chickenpox, shingles, viral pneumonia, and diseases characterized by skin vesicles and rashes).

For all practical purposes, many common viruses are not culturable: Coxsackie A viruses, hepatitis viruses, arboviruses, parvoviruses, human papillomaviruses, reoviruses, measles virus, and gastrointestinal viruses (rota, corona, calici, astro, and Norwalk). Isolation of virus may not be related to the patient's disease. Some positive cultures are sent to State Health Laboratory for specific virus identification. Infectious HSV is rarely present in CSF during encephalitis, resulting in a poor recovery by culture (<5% in adults, <50% in children). Studies have shown a >98% detection of HSV DNA in CSF by polymerase chain reaction (PCR), and this method is now considered the standard for diagnosis of HSV encephalitis. For HSV PCR testing, please order test 138651.

Give date of onset of illness, date of collection, and brief clinical description or the provisional diagnosis. For example, does the patient have a rash, a respiratory illness, or neurological symptoms?

Viral cultures: Specimens should be collected in the acute stage of the illness, kept moist, and refrigerated immediately. Stool specimens should not be placed into viral transport medium or frozen. Spinal fluid and throat washings must be kept cold and must not be frozen. Swabs of lesions or of throat should be rinsed immediately into 1 or 2 mL of viral transport medium; preferably, the swab should be broken off into the medium and sent in the medium to the laboratory. Autopsy material should be collected in sterile containers. Urine specimens for CMV culture must not be frozen; they should be packed with an ice pack or snow gel, but not with dry ice.

Belshe RB, ed. Textbook of Human Virology. Littleton, Mass: PSG Publishing Co;1984.
Drew WL. Controversies in viral diagnosis. Rev Infect Dis. 1986 Sep-Oct; 8(5):814-824. PubMed 3024292

Korones SB. Uncommon virus infections of the mother, fetus, and newborn: Influenza, mumps, and measles. Clin Perinatol. 1988 Jun; 15(2):259-272. PubMed 3288423

Lennette DA. Preparation of specimens for virological examination. In: Balows A, Hausler WJ, et al, eds. Manual of Clinical Microbiology. 5th ed. Washington, DC: ASM Press;1991:818-821.

Pfaller MA, Caliendo AM, Versalovic J. Detection of herpes simplex virus in CSF by PCR. In: Isenberg HD, ed. Clinical Microbiology Procedures Handbook. 2nd ed. Washington, DC: ASM Press: 2004:12.2.3.51-12.2.3.61.

Collection Details:

Collection Instructions:

Submit one specimen per test requested. Specify the exact specimen source/origin (eg, genital lesion). Indicate a specific test number on the request form. Age of patient, relevant vaccinations, and pertinent clinical history are helpful. Whenever a viral etiology is suspected and whenever appropriate, acute and convalescent serum should be collected for viral serology tests.

Specimen should be collected during the acute phase of the disease as follows:

Blood: Collect 5 mL whole blood into a heparinized tube; sodium heparin preferred. Send at room temperature.

Cerebrospinal fluid: Collect 1 mL CSF aseptically in a sterile dry screw-cap vial. Refrigerate immediately.

Skin lesions: Open the vesicle and absorb exudate into a dry swab and/or vigorously scrape base of freshly exposed lesion with a swab to obtain cells that contain viruses. If enough vesicle fluid is available, aspirate the fluid with a fine gauge needle and tuberculin syringe, and place the fluid into cold viral transport medium. Use viral swabs for specimen collection. Refrigerate immediately.

Eye swab or scraping: Use a viral swab to collect conjunctival material. Take conjunctival scrapings with a fine sterile spatula and transfer the scraping to a viral transport medium. Refrigerate immediately.

Genital swab: See skin. Refrigerate immediately.

Rectal swab: Insert a sterile swab 2” to 4” into the rectum and rub the mucosa. Swab may be placed into cold virus transport medium. Refrigerate immediately.

Throat swab: Carefully rub the posterior wall of the nasopharynx with a dry, sterile swab. Avoid touching the tongue or buccal mucosa. Place swab in viral transport tube.

Feces: Collect 4 to 8 g of feces (about the size of a thumbnail) and place in a clean, screw-cap container. Do not dilute the specimen or use preservatives. Viral swab is acceptable. Refrigerate immediately.

Tissue: Use a fresh set of sterile instruments to collect each tissue. Place each specimen in its own dry, sterile nontoxic screw-cap container. To prevent the tissue from drying out, add a small amount of viral transport medium to the container. Identify each tissue with the patient's name, type of tissue, and date collected. Refrigerate immediately.

Urine: Collect clean-catch, midstream urine in a screw-cap, sterile, plastic container. Refrigerate immediately.

All specimen types except blood must be kept cold and moist (refrigerated). Blood: Stored and transported at room temperature.