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Virological Clinical Syndromes: Appropriate Specimens and Tests

System

Syndrome

Specimen and tests to consider

Please note

Generalised

Fever including flu like

Viral throat swab and stool for virus

Serology of limited value,

 

symptoms

detection if clinically indicated

especially in

 

 

 

immunocompromised individuals.

 

 

 

 

 

 

Immunocompromised host:

 

 

 

consider EDTA blood for CMV

 

 

 

PCR

 

 

 

 

 

 

Maculopapular rash /

Clotted blood for Parvovirus

Discuss with Virology

 

childhood exanthems

B19 IgM / IgG Rubella

Consultant.  PCR may be

 

 

IgM / IgG , Oral Throat swab for Measles PCR

necessary to diagnose parvovirus

 

 

 

infections in immunocompromised

 

 

Stool for detection of Enteroviruses

hosts.  Arthropathy suggestive of

 

 

 

parvovirus (rubella much less

 

 

 

likely). * Rubella IgM will be done

 

 

 

in cases of arthritis with a

 

 

 

suggestive rash or if the patient is

 

 

 

pregnant.

 

 

 

 

 

"Glandular Fever"

Paul Bunnell or Monospot test in

Positive EBNA IgG rules out

 

 

Haematology is first line test

primary EBV infection.

 

 

 

 

 

 

Clotted blood for EBNA IgG,

 

 

 

Toxoplasma IgG and CMV

 

 

 

IgM

 

 

 

 

 

 

 

Consider HIV infection

 

 

 

 

 

 

Congenital infection /

CMV IgM / IgG

Discuss withVirology

 

obstetric complications

Rubella IgM / IgG

Consultant.

 

 

Parvovirus IgM / IgG

 

 

 

Toxoplasma IgG

 

 

 

 CMV PCR

 

 

HIV infection

Clotted blood for HIV antibody and

The test should only be requested

 

 

p24 antigen

after counselling.  A second

 

 

 

sample is required to confirm an

 

 

 

initial positive result.

 

 

 

 

 

HIV seroconversion

Clotted blood for HIV antibody and

Testing of serial samples required.

 

ilness

p24 antigen.

 

 

Vertical HIV

EDTA blood for HIV Viral load

 

 

transmission

 

 

 

 

 

 

 

HIV viral load and CD4

4 x EDTA blood

Samples for HIV viral load must be

 

 

 

kept at room temperature and

 

 

 

reach the lab within 4 hours of

 

 

 

collection, and by 3pm on a

 

 

 

weekday.  Ideally should not be

 

 

 

sent on Fridays.

 

 

 

 

CNS

Meningitis

Usually tested for HSV, VZV and

In patients on Aciclovir therapy,

 

Encephalitis

enterovirus.  Please contact lab if

this should be stated on the form

 

Transverse myelitis

other tests required, e.g. Mumps,

to ensure correct tests are done.

 

Radiculopathy

Mycoplasma, Borrelia.  Consider

If viral PCR required, please

 

Guillan Barre syndrome

JC, CMV, Toxo, EBV.  In

discuss with Microbiologist.

 

 

immunocompromised and children

 

 

 

consider HHV6.

 

 

 

 

 

Eye

Conjunctivitis

Eye swab for viral culture / PCR

CMV and Toxoplasma to be

 

Keratitis

for Herpes simplex, Adenovirus,

considered in the

 

Retinitis

Enterovirus, Varicella zoster.

immunocompromised.

 

 

 

 

 

 

Aqueous, vitreous fluid or tissue

PCR will only be performed after

 

 

biopsy for PCR analysis.

discussion with Microbiologist.

 

 

 

 

 

 

Chlamydia - Aptima collection tubes

 

 

 

 

 

 

 

 

Cardiovascular

Pericarditis

Virus culture of stool, rectal swab

Culture negative endocarditis

 

Myocarditis

 

consider Coxiella, Bartonella, and

 

Endocarditis

 

Chlamydia pneumoniae.  Clotted

 

Cardiomyopathy

 

bloods required taken at least 10

 

 

 

days apart.

 

 

 

 

Respiratory

URTI or LRTI where

NPA,Green viral nose and throat

PCR or typing may be applicable

 

Influenza A and B or

swab for Influenza A and B,

in certain situations - discussion

 

RSV suspected

Respiratory Syncytial Virus.

with Microbiologist if required.

 

 

 

 

 

 

 

 

Atypical pneumonia

Clotted blood for Mycoplasma,

 

 

 

C.burnetti

 

 

 

 

 

 

Other respiratory viruses

 

 

 

may be tested for during the winter

 

 

 

months.

 

 

 

 

 

 

 

Immunocompromised patients:

 

 

 

BAL for CMV PCR, BAL and NPA

 

 

 

for respiratory pathogens PCR.

 

 

 

 

 

Skin

Vesicular rash

Swab for viral PCR

Serology of little value in acute

 

 

 

chickenpox or shingles.

 

 

 

 

 

 

 

 

 

Hand, foot and mouth

Throat swab for viral PCR

 

 

disease

Stool for viral PCR

 

 

 

 

 

 

T-cell lymphoma

Clotted blood for HTLV-1 serology

 

 

(HTLV-)

 

 

 

 

 

 

Baseline

 

Hep C, HBsAg, total HBcore, HIV Ab / Ag, Hep A IgG

 

Haematology

 

 

screen pre

 

 

transplant

 

 

 

 

 

 

Virology Specimens

Virocult swabs (green-top)

  • Virocult swabs (green-top) must be used for taking specimens for viral investigations as they contain antibiotics to suppress bacterial overgrowth.  The samples should be transported to the lab as soon as possible.

Cerebrospinal fluid

  • See bacteriology section.  If herpes PCR required, aciclovir therapy should be started or discussed with a Microbiologist.
  • Results of viral PCR tests from CSF are available from Bacteriology.
  • Request for investigation for neurosyphilis must be accompanied by a serum specimen collected at the same time as the lumbar puncture (for CSF) is performed.

Blood for polymerase chain reaction (PCR)

  • 2 x 4.5 ml EDTA tubes are required for most viral PCRs including meningococcal PCR.   

Chlamydia

  • Aptima Collection Kits