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Specimen Collection

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Virology Specimen Collection Guidelines^a

Specimen Type	Collection
Specimen Type	Guidelines	Device and minimum vol	Transport time and temp	Replica Limits	Comments
For virus specimen selection guidelines, refer to Table 4.	In general, specimens for virus isolation should be collected within 4 days after onset of illness as virus shedding decreases rapidly after that time. With only a rare exception, virus cultures are not worthwhile for specimens collected more than 7 days after the onset of illness.	Except for body fluids (BAL, CSF, urine, blood), place all viral specimens in M4	Most viruses remain stable at 4^oC for 2-3 days and almost indefinitely at -70^oC. Do not freeze at -20^oC.		To ensure proper evaluation, the following information should accompany the specimen: (1) date of illness onset, (2) date and time specimen was collected, (3) admitting diagnosis, (4) source of specimen. Collection of acute and convalescent phase sera should always be considered.
Blood	1. Cleanse venipuncture site with 70% isopropyl alcohol. 2. Starting at the site, swab concentrically with 2% iodine tincture. 3. Allow the iodine to dry (~ 1 min). 4. Do not palpate the vein at this point. 5. Collect 8-10 ml in an anticoagulant tube (viral transport is not required). 6. After venipuncture, remove iodine from the skin with alcohol.	Heparin tube, 8-10 ml/tube. You may need to draw > 2 tubes from patients who are leukopenic.	Submit at RT	None	Commonly ordered for: CMV. Collect blood during the early, acute phase of infection. Maintain at RT. Do not refrigerate.
CSF	1. Disinfect site with 2% iodine tincture. 2. Insert a needle with stylet at L3-L4, L4-L5, or L5-S1 interspace. 3. On reaching the subarachnoid space, remove the stylet and collect 2-5 ml in a sterile leakproof tube. (M4 not required).	Sterile screw-cap tube, 1.0 ml	Submit immediately at 4^oC.	None	Frequently isolated: coxsackievirus (some), echovirus, enterovirus, mumps virus. Less frequently isolated: arboviruses, HSV, LCMV, rabies virus.
Cervical or vaginal swab^b	1. If lesions are present, swab vigorously. Place swab in M4. 2. If lesions are not present, remove mucus from the cervix with a swab and discard the swab. 3. Firmly sample the endocervix (~ 1 cm. into the cervical canal) with a fresh swab by rotating the swab for 5 s. 4. Place swab in M4. 5. Carry out a vulvar sweep using a second swab; place both swabs in the same transport tube.	Swab^b	Immediately place swab in M4. Submit at 4^oC.	1/day/ source	Frequently isolated: HSV, CMV Noncultivable: papillomavirus, molluscum contagiosum virus. Although a cervical swab sample is the specimen of choice in the monitoring of pregnant women with a history of genital HSV infection, recovery of HSV may be increased by also sampling the vulva.
Conjunctiva swab^b	1. Collect material from the lower conjunctiva with a flexible, fine-shafted swab moistened with sterile saline. 2. Place swab in M4	Swab^b	Immediately place swab in M4. Submit at 4^oC.	None	Frequently isolated: adenovirus; coxsackievirus A (some), CMV, HSV, enterovirus (including type 70), Newcastle disease virus.
Feces	1. Pass directly into a clean, dry container. 2. 2-4 g of stool to sterile, leakproof container and transport immediately to lab.	Sterile, leakproof, wide-mouth container, > 2 g	Submit at 4^oC.	1/day	Frequently isolated: adenoviruses; enteroviruses. Less frequently isolated: rotavirus Rotavirus antigen is detected by EIA.