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Table 2 (1 Of 4) Specimen Selection 1 Disease/ Agent Specimen ...

TABLE 2 (1 of 4)
SPECIMEN SELECTION1
TIME AND
SPECIMEN PLATING
DISEASE/
SPECIMEN SELECTION
TEMP
AND PROCESSING
AGENT
Transport
Storage
SBA
CA
MAC
STAIN
OTHER
Vesicular Stage: collect fluid from intact
2 h
24 h
X
X
X
Gram
India Ink for capsule
vesicles on sterile swab(s). The organism is best
RT
RT
stain
Cutaneous
demonstrated in this stage.
Anthrax
Eschar Stage: without removing eschar, insert
2 h
24 h
X
X
X
Gram
India Ink for capsule
swab beneath the edge of eschar, rotate and
RT
RT
stain
collect lesion material.
Stool: collect 5-10 g in a clean, sterile, leak-
1 h
24 h
Inoculate routine stool plating
Minimal recovery
Gastro-
proof container.
RT
4°C
media plus CNA or PEA.
Intestinal
Blood: collect per institution’s procedure for
2 h
Blood culture bottles
Positive in late stages of
routine blood cultures.
RT
disease.
Sputum: collect expectorated specimen into a
2 h
24 h
X
X
X
Gram
Minimal recovery
Inhalation
sterile, leakproof container.
RT
4°C
stain
Blood: collect per institution’s procedure for
2 h
Blood culture bottles
Positive in late stages of
routine blood culture.
RT
disease
Serum: collect 10-12 cc acute phase specimen
Specimen should be
Serologic diagnosis:
as soon as possible after disease onset. Followed
~2 h
-20°C
stored and shipped
1. Single titer: 1:160
Acute,
by a convalescent specimen, obtained 21 days
RT
frozen @ -20°C
2. 4-fold rise
Brucellosis
subacute or
later.
3. IgM
chronic
Blood culture isolation rates
Blood: collect per institution’s procedure for
2 h
Blood culture bottles
vary from 15-70% depending
routine blood culture.
RT
hold 21 days
on methods and length of
incubation
X
X
X
India Ink for
Bone Marrow, Spleen or liver: collect per
15 min
24 h
Gram
capsule, and add
institution’s surgical/pathology procedure
RT
RT
stain
blood cul- ture
bottles or
enrichment broth
hold cultures for at
least 7 days
TABLE 2 (2 of 4)
SPECIMEN SELECTION
DISEASE/
SPECIMEN SELECTION
SPECIMEN
COMMENTS
AGENT
HANDLING
Clinical Syndrome
Specimen(s) of choice for confirming botulism:
Specimen
Specimen
Transpo
a. Serum
Type
volume
rt temp
b. Wound/tissue
c. Stool and incriminated food
Botulism
Foodborne
Infant
Wound
Intentional
Release
Enema Fluid
X
X
X
X
20 cc
4°C
Purge with a minimal amount of sterile nonbacterio-
static water to minimize dilution of toxin
Foods that support C. botulinum growth will have a
Food Sample
X
X
X
10-50 g
4°C
pH of 3.5-7.0, most common pH is 5.5-6.5. Submit
food in original container, placing individually in leak
proof sealed transport devices.
Gastric Fluid
X,A
20 cc
4°C
Collect up to 20 cc
Intestinal Fluid
A
A
20 cc
4°C
Autopsy: intestinal contents from various areas of the
small and large intestines should be provided
For aerosolized botulinum toxin exposure, obtain
Nasal swab
X
anaerobic
RT
nasal cultures for C. botulinum and serum for mouse
swab
toxicity testing
Serum should be obtained as soon as possible after the
onset of symptoms and before antitioxin is given. A
Serum
X,A
X
X
10-12 cc
4°C
minimum of 10 cc of serum (20 cc of whole blood) is
required for mouse toxicity testing. In infants, serum
is generally, not useful, since the toxin is quickly
absorbed before serum can be obtained.
Botulism has been confirmed in infants with only
Stool
X
X
X
X
10-50 g
4°C
“pea-sized” stools. Please note: anticholinesterase
given orally, as in patients with myasthenia gravis, has
been shown to interfer with toxin testing
Vomitus
X
20 cc
4°C
Collect up to 20 cc
Exudate, tissue or swabs must be collected and
Wound/tissue
X
Anaerobic
RT
transported in an anaerobic transport system. Samples
swab or
from an enema or feces should also be submitted since
transport
the wound may not be the source of botulinum-toxin
system
Environmental
X
X
RT
Environmental swabs
sample
TABLE 2 (3 of 4)
SPECIMEN SELECTION
TIME AND
SPECIMEN PLATING
DISEASE/
SPECIMEN SELECTION
TEMP
AND PROCESSING
AGENT
Transport
Storage
SBA
CA
MAC
STAIN
OTHER
Sputum/throat: collect routine throat culture
Minimal recovery.
using a swab or expectorated sputum collected
2 h
24 h
X
X
X
Gram
Prepare smears for
into a sterile, leakproof container.
RT
4°C
stain
Wayson (and DFA
referral)
Plague
Pneumonic
Bronchial/tracheal wash: collect per
Prepare smears for
institution’s procedure in an area dedicated to
2 h
24 h
X
X
X
Gram
Wayson stain (and
collecting respiratory specimens under
RT
4°C
stain
DFA referral)
isolation/containment circumstances, i.e.,
isolation chamber/ “bubble”.
Patients with negative
Blood: collect per institution’s procedure for
2 h
Blood culture bottles
cultures
routine blood cultures.
RT
having a single titer, 1:10,
specific to F1 antigen by
agglutination would meet
presumptive criteria
Sputum/throat: collect routine throat culture
2 h
24 h
X
X
X
Gram
Minimal recovery.
using a swab or expectorated sputum colleced
RT
4°C
stain
Add a BCYE plate
into a sterile, leakproof container.
and prepare smears
Tularemia
Pneumonic
for DFA referral
Bronchial/tracheal wash: collect per
Add a BCYE plate
institution’s procedure in an area dedicated to
2 h
24 h
X
X
X
Gram
and prepare smears
collecting respiratory specimens under
RT
4°C
stain
for DFA referral.
isolation/containment circumstances, i.e.,
isolation chamber/ “bubble”
Blood cultures have rarely
Blood: collect per institution’s procedure for
2 h
Blood culture bottles.
been positive. A positive
routine blood cultures.
RT
DFA from an ulcer/wound,
tissues, and cultures OR a
positive serology test would
meet pre- sumptive criteria.
Whereas, confirmation
requires culture identification
or a 4-fold rise
TABLE 2 (4 of 4)
SPECIMEN SELECTION
DISEASE/
TIME AND
SPECIMEN HANDLING
AGENT
SPECIMEN SELECTION
TEMP
AND TRANSPORT
Transport
Storage
Biopsy specimens: aseptically place two to four
~6 h
-20°C
1. A suspected case of smallpox should be reported
portions of tissue into a sterile, leakproof,
4°C
to
immediately to the respective state health department
freezable container.
-70°C
for review
Smallpox
Rash
2. And if, after review, smallpox is still suspected,
CDC’s Poxvirus Section @ 404-639-2184 should be
contacted for approval to send
3. At this time review the packaging/shipping
requirements with CDC and request assistance in co-
ordinating a carrier for transport/shipment
Scabs: aseptically place scrapings/material into
~6 h
-20°C
a sterile, leakproof, freezable container.
4°C
to
-70°C
Vesicular fluid: collect fluid from separate
-20°C
lesions onto separate sterile swabs. Be sure to
~6 h
to
include cellular material from the base of each
4°C
-70°C
respective vesicle.
VHF
Serum: collect 10-12 cc of serum. Laboratory
~2 h
-4°C
Specific handling conditions are currently under
tests used to diagnose VHF include: antigen-
RT
development..
capture ELISA, IgG ELISA, PCR, and virus
isolation.
1 Abbreviations:
, delayed entry depends on instrument; A, autopsy; BCYE, buffered charcoal-yeast extract agar; C, centigrade; CA, chocolate agar; CNA,
colistin-nalidixic acid agar; DFA, direct fluorescent antibody; g, grams; h, hours; MAC, MacConkey agar; PEA, phenylethyl alcohol blood agar; RT, room
temperature