Virology ordering guidelines based upon specimen type and possible symptoms.

2002, Volume 13, Number 1

Specimen
Type
Possible
Symptoms
Suspect
Agents
DFA
Testing
Suggested TestAcceptable
Specimens
Amnionic FluidsFailure to thrive, Intrauterine growth retardation (IUGR), miscarriageCytomegalovirus (CMV), enterovirus,
Herpes simplex virus (HSV), varicellazoster virus (VZV), rubella virus
NoneCVCAmniotic fluids in sterile container.
Blood
Bone Marrow
Bone Marrow Biopsy
Fever of unkown origin,
AIDS, ARC
CMV, enterovirus,
HSV, measles,
mumps, VZV
NoneCVCBlood 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), rhinovirusRVDRSV
(RSV)
RVCBronchoalveolar 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
NoneCVCSubmit 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
DVDHSVD
(HSV)VZD
(VZV)
DVCCVC
(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 SpecimenRectal
Swab
Fever,
headache,
malaise,
meningitis,
diarrhea, vomiting, cold,
Bornholm
disease
Enteroviruses,
poliovirus,
adenovirus,
rotavirus,
Clostridium difficile toxin, HSV (rectal swab)
HSVD
(HSV)
CVCStool in clean container or Cary Blair medium. Do not use fixatives or preservatives.Rectal swab in viral transport medium.
Ocular SpecimensPain and swelling
of eyelids,
ocular discharge,
uveitis,
conjunctivitis,
keratitis, acute hemorrhagic conjunctivitis
Adenovirus,
Chlamydia
trachomatis
,
CMV,
enteroviruses,
HSV,
VZV
CDF (Chlamydia)CVCCHC (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 ConceptionFailure to thrive,
IUGR,
miscarriage
CMV, enterovirus,
HSV, virus VZV,
rubella virus.
NoneCVCTissues in sterile saline.
Respiratory SpecimensBronchitis/
bronchiolitis,
cold, croup,
influenza syndrome, pneumonia/
pneumonitis,
sinusitis,
otitis media
Adenovirus,
Chlamydia pneumoniaeChlamydia psittaci, CMV,
enteroviruses,
HSV,
influenza,
measles,
parainfluenza, respiratory
syncytial virus
(RSV),
rhinovirus, VZV
RVDCDFRVCCHC (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
UrineCystitis,
urethritis,
viral exanthem,
dysuria,
urethral
discharge,
cytomegalic
inclusion disease
Adenovirus,
Chlamydia trachomatis,

CMV, measles, mumps,
polyomaviruses, Neisseria
gonorrhoeae
 CVCCHLCR
(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 SpecimensUrethritis,
cervicitis,
lesions,
vaginal or urethral discharge,
painful urination,
PID,
vesicular lesion
Adenovirus, CMV, HSV, mumps, Chlamydia trachomatis,
Neisseria gonorrhoeae
,
human
papillomavirus
(HPV)
HSVD
(lesion)CHFChlamydia 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.