GUIDE TO SERVICES

Alberta Health Services The Provincial Laboratory for Public Health (ProvLab)

Calgary Site:

Edmonton Site:

3030 Hospital Drive NW Calgary, Alberta T2N 4W4

Walter Mackenzie Health Sciences Centre University of Alberta Hospital 8440-112 Street Edmonton, Alberta T6G 2J2

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TABLE OF CONTENTS Preface ........................................................................................................................... 5 Laboratory Contact Information .................................................................................. 6 Services Available......................................................................................................... 7 Diagnostic Testing ............................................................................................. 7 Investigation of Outbreaks ................................................................................ 7 Identification of Isolates Referred From Other Laboratories.......................... 8 Calgary Site Specific Information .............................................................................. 10 Hours of Operation........................................................................................... 10 Specimen Deliveries......................................................................................... 10 Hours of Operation for Environmental Waters Laboratory........................... 10 Specimen Collection Kits/Requisition Order Form ....................................... 10 Map: Provlab – Calgary Site ............................................................................ 11 Edmonton Site Specific Information.......................................................................... 12 Hours of Operation........................................................................................... 12 Specimen Deliveries......................................................................................... 12 Hours of Operation for Environmental Microbiology Laboratory ................ 12 Specimen Collection Kit Order Form .............................................................. 12 Map: Provlab – Edmonton Site........................................................................ 13 General Test Ordering and Specimen Collection Information ................................ 14 Clinical Specimens........................................................................................... 14 Requisitions ........................................................................................... 14 STAT Requests ...................................................................................... 15 GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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Specimen Collection, Labelling, and Submission .............................. 15 Specimen Rejection............................................................................... 16 Water and Ice Samples ............................................................................................... 16 Requisitions ...................................................................................................... 16 Special Notes Regarding Water Requisitions ................................................ 17 How to Collect a Water Sample for Bacteria Testing .................................... 17 Ordering Supplies ............................................................................................ 17 Water and Ice Sample Labelling...................................................................... 17 Water and Ice Sample Delivery........................................................................ 17 Requests for Examination of Specific Pathogens in Water Samples (i.e. Salmonella or E. coli O157:H7, Giardia or Cryptosporidium) ....................... 18 Water Samples for Legionella ......................................................................... 18 Submission of Ice Samples for Analysis........................................................ 18 Sample Rejection.............................................................................................. 18 Biological Indicators (BI)[Spore Strips and Vials].................................................... 19 Requisitions ...................................................................................................... 19 Special Notes Regarding Biological Indicator Requisitions......................... 19 Ordering Supplies ............................................................................................ 19 Sample Rejection.............................................................................................. 19 Food Samples.............................................................................................................. 20 Acceptance Criteria.......................................................................................... 20 Rejection Criteria.............................................................................................. 20 Guidelines for Submitting Food Samples to the Provincial Laboratory for Public Health ................................................................................... 20 Requisition ........................................................................................................ 21 GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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Sample Submission ......................................................................................... 21 Transportation .................................................................................................. 21 Transport Media................................................................................................ 22 Transport of Diagnostic Specimens and Infectious Substances............................ 23 Packaging for Transport: Diagnostic Specimens and Infectious Substances ..... 23 Guide to Specimen Collection ................................................................................... 24 Index for Guide to Specimen Collection ................................................................. 133

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PREFACE The Guide to Services is a comprehensive reference resource produced by the Provincial Laboratory for Public Health (ProvLab) for our partners in acute and community health care. ProvLab works to provide critical support to health zones and government through testing, research, education and surveillance activities. The Guide contains information on appropriate sampling, use of collection devices, and transport requirements for specimens tested to support acute care microbiology at the University of Alberta Hospital, specialized and reference testing services, outbreak investigation, and public health programs throughout the province. Every effort has been made to provide an all-inclusive list of disease processes and associated specimen collection guidelines so that laboratory investigations are complete and timely for optimal patient care and public health action. This website-based document will be updated on a regular basis to ensure you have access to current testing information and collection requirements. Our laboratories are committed to excellence, and strive to provide you with the highest quality of service. We welcome your comments and suggestions for improvement. Please feel free to address any concerns with our Webmaster, Deborah Green at 780-407-3303 or by email at [email protected] .

Graham Tipples PhD FCCM D(ABMM) Medical Scientific Director ProvLab

Marie Louie MD FRCPC Associate Medical Director ProvLab

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LABORATORY CONTACT INFORMATION-------------CALGARY PRIMARY INQUIRIES (To all departments and/or staff) MICROBIOLOGIST/VIROLOGIST ON CALL (MOC/VOC) (Clinical Consultation) PRENATAL RESULTS HOTLINE SPECIMEN COLLECTION KIT ORDERS

Ph: 403-944-1200 Fax: 403-270-2216 Ph: 403-944-1200 (ask for MOC/VOC)

Packing Area: Ph: 403-944-2583 Fax 403-944-2317

EDMONTON Ph: 780-407-7121 Fax: 780-407-3864 Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC/VOC) Ph: 780-407-8667 Distribution Centre: Ph: 780-407-8971 Fax: 780-407-8984

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SERVICES AVAILABLE DIAGNOSTIC TESTING The Provincial Laboratory for Public Health (ProvLab) hereafter called the Laboratory, provides the following laboratory testing services*:     

Bacteriology Mycology Mycoplasma Parasitology Environmental Microbiology (Water, Ice and Biological Indicators [BI])

    

Food Microbiology Serology Molecular Diagnostics Virus Isolation Mycobacteriology

* Some services provided by the Edmonton Site Laboratory may not be available to customers outside the Edmonton Health Zone. Please refer to the laboratory service provider defined by zone contracts for testing. Turnaround times have been established for all tests performed in the Laboratory, and are one of the quality indicators used internally to measure our performance. Turnaround times are tracked from the time specimens are time stamped upon receipt, and are monitored on a regular basis. Results of turnaround time audits are available to our clients on request. INVESTIGATION OF OUTBREAKS: HOW TO ESTABLISH AN EXPOSURE INVESTIGATION (EI) The Laboratory provides support for investigation of outbreaks of suspected bacterial, viral, parasitological or fungal origin. All investigations must be coordinated through local Public Health or Environmental Heath services. When an outbreak is suspected: 1. Contact the local Medical Officer of Health, Health Zone Offices or Environmental Health Officer for the zone or other appropriate health official. 2. The local Medical Officer of Health, Health Zone Offices or Environmental Health Officer for the zone or other appropriate health official will contact the Laboratory at Calgary or Edmonton and ask for the Microbiologist/Virologist On Call (MOC/VOC). Please refer to Laboratory Contact Information. 3. The local Medical Officer of Health, Health Zone Offices or Environmental Health Officer for the zone or other appropriate health official will provide, in consultation with the MOC/VOC, the following details: a. External contact person (External Investigator) for the outbreak (name, telephone, fax) b. Zone where the outbreak has occurred c. Type of outbreak (respiratory, gastrointestinal, sexually transmitted disease or rash related) d. Type of facility involved (long term care facility, school, restaurant, etc.) and location e. Number of persons ill and at risk f. Date of onset of infection and predominant clinical symptoms g. Number and type of samples to be submitted There may be more information required as each outbreak is unique unto itself. Additional information required will be determined in consultation with the MOC/VOC. CON’T… GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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4. The MOC/VOC will provide the External Investigator with a laboratory derived tracking number (“EI number”), which will be used to clearly label all specimens and requisitions that are submitted for laboratory investigation. 5. The MOC/VOC will assign a Laboratory Point Person who will be responsible for all follow-up contact with the External Investigator and will ensure that the appropriate laboratory and public health are notified. This data will be incorporated into the EI format on the ProvLab Extranet. 6. The External Investigator will arrange to have the appropriate specimens (based on the type of outbreak) collected from symptomatic persons and submitted to the Laboratory as discussed with the MOC/VOC. 7. The External Investigator will contact the Laboratory Point Person if information is required regarding laboratory results, and notify the Laboratory when the investigation is complete and the “EI number” can be closed. IDENTIFICATION OF ISOLATES REFERRED FROM OTHER LABORATORIES The Laboratory provides various specialized reference functions to assist in the identification and/or typing of clinically relevant microorganisms isolated in other medical microbiology laboratories.  Please use appropriate requisitions for Streptococcus or Mycology reference isolates. These requisitions are available from the Laboratory or the ProvLab website.  Submit isolates in PURE CULTURE as lyophilized or frozen cultures, or on slants of appropriate media, or in charcoal transport media.  For anaerobic identification, swab a PURE 48 hour culture of the organism and submerge in anaerobic transport medium or chopped meat broth.  DO NOT use petri dishes to transport specimens; the agar may become dislodged and contamination frequently occurs. Serotyping/serogrouping for the following bacteria is available: Escherichia coli O157:H7 Haemophilus influenzae Legionella pneumophila* Listeria monocytogenes* Neisseria meningitidis* Salmonella

Shigella Streptococcus agalactiae (Group B) Streptococcus pneumoniae Streptococcus pyogenes (Group A) Vibrio cholerae Yersinia enterocolitica**

*Referred to the National Microbiology Laboratory, Winnipeg, Manitoba. ** Referred to the Public Health, Ontario (Laboratories).

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If the isolate submitted for identification/confirmation is suspected to be a Risk Group 3 agent, contact the Microbiologist/Virologist On Call before submitting the isolate. Risk Group 3 agents include but are not limited to: Bacillus anthracis Blastomyces dermatitidis Brucella species Burkholderia pseudomallei Burkholderia mallei Coccidioides immitis Francisella tularensis Histoplasma capsulatum Paracoccidioides brasiliensis Yersinia pestis Suspected Risk Group 3 agents must be transported as infectious substances, in compliance with applicable regulations. Refer to Transport of Diagnostic Specimens and Infectious Substances. For suspected Risk Group 4 investigations (e.g. smallpox, viral hemorrhagic fevers etc.) consult the Microbiologist/Virologist On Call prior to collecting and sending samples.

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CALGARY SITE SPECIFIC INFORMATION HOURS OF OPERATION 0700 to 2300 Hours Monday to Friday 0700 to 1800 Hours Saturday 0700 to 1700 Hours Sunday and statutory holidays NOTE:

Emergency service is available 24 hours daily. Please contact the Microbiologist/Virologist On Call at 403-944-1200 (ask for MOC/VOC) to access this testing.

SPECIMEN DELIVERIES ProvLab 3030 Hospital Drive NW Calgary, Alberta T2N 4W4

Telephone 403-944-1200

Entrance is located on the West side of Foothills Hospital, Special Services Building. Hours of access for this entrance are: 0700 – 2300 Hours Monday to Friday * 0700 to 1800 Hours Saturday 0700 to 1700 Hours Sunday and statutory holidays

* There is a phone outside the front door, west entrance, which can be used to contact an employee for specimen pick-up after 1900 Hours, Monday to Friday. NOTE: For Water Samples Only: HOURS OF OPERATION for Environmental Waters Laboratory: 0800 to 1630 hours 7 days a week and statutory holidays Samples submitted for routine testing, received in the laboratory after 1600 hours, are processed the next day; exceptions may apply for special investigative or follow-up sampling. If water samples must be processed after regular hours, on weekends or statutory holidays, contact the Environmental Waters Laboratory at 403-944-1215, press “5”, during regular working hours to make special arrangements. Specimen Collection Kit/Requisition Order Form

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MAP: PROVLAB – CALGARY SITE

Provincial Laboratory for Public Health (ProvLab) – Calgary Site

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EDMONTON SITE SPECIFIC INFORMATION HOURS OF OPERATION 24 Hour service available on a daily basis NOTE:

For clinical consultation please contact the Microbiologist/Virologist On Call at 780-407- 8822 (UAH Switchboard) or 780-407-7121 (Laboratory).

SPECIMEN DELIVERIES ProvLab and Medical Microbiology Laboratory, UAH Walter Mackenzie Health Sciences Centre University of Alberta Hospitals 8440-112 Street Edmonton, Alberta T6G 2J2 Telephone: 780-407-7121 Use the Provincial Laboratory Entrance, South end of Walter Mackenzie Health Sciences Centre (83 Avenue) Hours of access for this entrance are 0500 to 1800 Hours Monday to Friday 0500 to 1300 Hours weekends and statutory holidays After hours, specimens may be hand delivered to Room 2B4.04 by using the Emergency entrance to the University Hospital. Security personnel will be located at the Emergency entrance after 2100 hours every night. You will need to inform them that you will be coming to Microbiology (Room 2B4.04) to drop off specimens. (Security may ask for some form of identification). NOTE: For Water Samples Only: HOURS OF OPERATION for Environmental Microbiology Laboratory: 0700 to 1630 hours Monday to Friday 0745 to 1600 hours Saturday, Sunday and statutory holidays Samples submitted for routine testing received in the laboratory after 1600 hours are processed the next day; exceptions may apply for special investigative or follow-up sampling. If water samples must be processed after regular hours, on weekends or statutory holidays, contact the Environmental Microbiology Laboratory at 780-407-8925, press “4” during regular working hours to make special arrangements. Specimen Collection Kit/Requisition Order Form

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MAP: PROVLAB – EDMONTON SITE

Provincial Laboratory for Public Health (ProvLab) – Edmonton Site

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GENERAL TEST ORDERING AND SPECIMEN COLLECTION INFORMATION 1.

CLINICAL SPECIMENS: a. Requisitions: Provide the following information:  Complete name of patient including first and last name  Personal Health Number (PHN) including province name. If PHN is not available, provide RCMP, Military, Hospital, Medical Record or Clinic Number.  Date of Birth (dd/mm/yyyy)  Gender  Patient’s home address and phone number  Complete name and address of ordering physician/health care provider  Report destination (please use location code if known)  Specimen type and anatomical source  Date and time of collection  Specific test(s) requested  Diagnosis or clinical information: - Antimicrobial therapy - Dates of onset of illness and therapy - Clinical diagnosis - Recent immunization history if relevant - Risk factors for disease e.g. HCV, HIV - Specification of “source” versus “recipient” for occupational exposure - Travel history including visits to tropical countries or endemic areas  Third party billing (non public health, insurance, occupational, VISA, etc. requirements)  If carbon copy of report is requested, provide the receiver’s first and last name and complete address  If fax report is requested, provide the receiver’s first and last name and the fax number with area code If information on the requisition is incomplete, a delay in testing and/or reporting may occur.

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b. STAT Requests: A clearly indicated STAT request must be submitted with complete patient, specimen and test request information on the requisition. Include name and telephone number of the person to contact with results. Phone the Laboratory (Calgary 403-944-1200 or Edmonton 780-407-7121) to notify staff of the STAT request, and provide the following information:  Name of submitting facility  Name of patient  Tests requested – type of specimen  Method of delivery and expected time of arrival  Name and phone number of contact person (for tracking specimen if necessary and phoning results). The specimen must be properly packaged for transport and must be “flagged” as STAT so it will be obvious to the receiver (use red ribbon or tape). Transport STAT specimens IMMEDIATELY to the Laboratory.

c. Specimen Collection, Labelling, and Submission: For test specific collection requirements, refer to the: Index for Guide to Specimen Collection. Accurate and complete specimen labelling is a laboratory requirement. All specimens must be labelled with:  Complete name of patient including first and last name  Personal Health Number (PHN) – if PHN is not available, provide RCMP, Military, Hospital, Medical Record or Clinic Number.  Specimen type and anatomical source  Time and date of collection Unlabelled or unmatched specimens will not be processed. Prompt delivery of specimens is necessary to ensure minimum delay in processing. For packaging and transport information, refer to: Transport of Diagnostic Specimens and Infectious Substances.

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d. Specimen Rejection Rejection criteria are designed to ensure the provision of valid and timely laboratory results in the delivery of quality patient care. Specimens and requisitions should be labelled in accordance with the Alberta Health Service Specimen Acceptance Policy. For more information about the policy as well as test request (requisition) requirements, please see Alberta Health Services Laboratory Bulletin, August 22, 2011 ‘Reminder: Laboratory Policy – Acceptance of Laboratory Samples and Test Requests’ Specimens may be rejected for the following reasons:     

      2.

Specimens lacking two unique identifiers Improperly labelled specimen Unlabelled specimen Incomplete information on the requisition Sub-optimal specimen, i.e.: - Leaking - Inappropriate specimen container - Insufficient quantity of specimen

- Inappropriate collection device - Inappropriate transport medium

Duplicate microbiology samples received on the same day, i.e. multiple stool, sputum specimens Integrity of sample compromised by effects of uncontrolled transport temperatures, i.e. freezing, heating Specimen delayed in transit Test no longer available/performed by the Laboratory Specimen submitted is inappropriate for test requested. No specimen source indicated

WATER AND ICE SAMPLES: a. Requisitions: Provide the following:  Sample Collection Details o Date and time of collection; including AM OR PM (mandatory) o Name and daytime contact phone number (including area code) of sample collector  Collection Site Details o Access Number (if applicable) o AESRD Approval Number (if applicable) o Feature Code Number (First Nations only) o Complete name, address and phone number of facility or homeowner o Collection site (e.g. kitchen tap) o Legal land description and/or GPS coordinates (if a private homeowner) o Name and address of Health Agency where the laboratory report is to be sent  Remarks / Requests o Study Number (if applicable) o AESRD Reference Number (if applicable) o Other comments (as applicable) CON’T… GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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Special Notes Regarding Water Requisitions:    

Check ONE sample box only which represents the type of water being submitted Check the appropriate box if a resample is being submitted due to previous coliform contamination For pools designed to be maintained at a temperature greater than 30°C (e.g. whirlpools), check the appropriate box Non Drinking Source Water represents either surface water or groundwater that will undergo treatment before being consumed

b. How to Collect a Water Sample for Bacteriological Analysis Refer to the link found in the “Water: Microbiological Analysis” item on the Education page of our Website www.ProvLab.ab.ca ; Click Services then Education or click on the following link to go to the Education page http://www.provlab.ab.ca/education.htm c. Ordering Supplies:  Use only sample bottles / ice jars and requisition forms available from your local Alberta Health Services (AHS) Environmental Health Zone / Agency.  For locations refer to the link found in the “Water: Microbiological Analysis” item on the Education page of our Website www.ProvLab.ab.ca ; Click Services then Education or click on the following link to go to the Education page http://www.provlab.ab.ca/education.htm  For those areas serviced by Edmonton ProvLab, these supplies may also be ordered though the Distribution Centre; Phone 780 407 8971 d. Water and Ice Sample Labelling: Detach the identification number label from the requisition form and affix to the corresponding sample bottle /ice jar. Note: Unlabeled bottles and ice jars will not be tested. e. Water and Ice Sample Delivery: 

Samples are to be delivered to the laboratory between Monday and Friday. For hours of operation refer to the ProvLab Guide to Services table of contents. When circumstances or follow-up investigations require delivery after hours or on weekends, contact the laboratory beforehand (phone numbers below).



Samples are accepted at your local AHS Environmental Public Health Zone / Agency or at ProvLab at the address locations listed below.



Deliver samples to the laboratory as soon as possible. If there will be a delay of more than six hours, samples must be refrigerated (not frozen). Transport samples in a cooler with frozen cold packs to maintain a temperature of 2°C to 8°C until they reach the laboratory. Samples received by the Environmental Microbiology laboratory more than 24 hours after collection will be rejected. CON’T… GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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

Arrange to have samples delivered to your nearest ProvLab site: 8440 – 112 Street Edmonton, AB T6G 2J2 Tel: 780 407 8925 Fax: 780 407 8984

3030 Hospital Drive NW Calgary, AB T2N 4W4 Tel: 403 944 1215 Fax: 403 270 2216

f. Requests for Examination of Specific Pathogens in Water Samples (i.e. Salmonella, E. coli O157:H7, Giardia or Cryptosporidium): The Program Leader (Dr. Norman Neumann, 780-901-5991, [email protected] ) or the Microbiologist/Virologist On Call at Calgary or Edmonton must be consulted prior to submission of samples requesting examination for specific pathogens. g. Water Samples for Legionella: Refer to Guide to Specimen Collection Water: Legionella h. Submission of Ice Samples for Analysis: Bacteriological analysis of packaged ice is provided when authorized by Environmental Public Health personnel. Samples should be submitted in sterile ice collection jars which are available from the Laboratory by contacting: - Calgary Packing Room 403-944-2583 - Edmonton Distribution Center 780-407-8971 i.

Sample Rejection: Rejection criteria are designed to ensure the provision of valid and timely results. Samples are rejected for the following reasons:  Sample was not in the standard microbiological container  No identification number on the bottle or ice jar  Identification number on the requisition does not match the number on the bottle or ice jar  Water sample was frozen  Water/Ice sample was received more than 6 hours after collection without coolant  Water/Ice sample was received more than 24 hours after collection  Date and/or time of collection was not indicated  Date and time of collection is LATER than the date and time of receipt in the Laboratory  Sample leaked in transit  Test request is not related to water quality for human health  Bacteriological testing of water related to sale of property is requested  Insufficient amount of sample received  Insufficient information provided to verify sample

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3.

BIOLOGICAL INDICATORS (BI) [Spore Strips and Vials]: a. Requisitions: Provide the following information:  Access number  Facility name, address and phone number including area code.  Date and time test was run, including AM or PM  Name and daytime contact phone number (including area code) of sample collector  Lot number/expiry of control (Control and test must be the same lot/expiry)  Name/model number of unit  Sterilizer type  Sterilization cycle (temperature ºC and time in minutes) Special Notes Regarding Biological Indicator Requisitions: Follow the instructions provided on the reverse side of the Biological Indicator Requisition for completing all relevant information regarding the packaging, labelling and submission of Biological Indicators b. Ordering Supplies: 

First time submitters should contact the Environmental Laboratory to obtain an Access number and other pertinent information - Calgary - Edmonton

 

403-944-1215, press “5” 780-407-8925, press “4”

Test kits must be pre-paid based on the current price list. Receipts are provided Test kits can be ordered from the Laboratory by contacting: - Calgary Business Office 403-944-4613 - Edmonton Distribution Centre 780-407-8971

c. Sample Rejection: Rejection criteria is designed to ensure the provision of valid and timely results. Samples are rejected for the following reasons:  Leaking/broken vial  Frozen vial  No control vial or spore strip received  Vial or spore strip expired  Glassine envelope damaged  Lot # or expiry date on test(s) and control do not match  Chemical process indicator on vial unchanged  Chemical indicator on control vial indicates it has undergone sterilization  Sample received more than 5 days after collection  No access number on BI vials/spore strips CON’T… GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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4.

FOOD SAMPLES: MOC at the original receiving site provides consultation with Public Health Investigator or other Public Health Professionals as required. Consultation with the Microbiologist/Virologist On Call PRIOR to submission of samples if they fall OUTSIDE the parameters of current acceptance criteria is REQUIRED to insure prompt referral to an appropriate certified testing agency. a. Acceptance Criteria: ProvLab will process:  Food for human consumption that is collected from a patient’s residence, a restaurant or from a banquet  Food for animal consumption that has been opened and exposed to humans associated with enteric bacterial infection  Pet feces if associated with human enteric bacterial infection Samples MUST be:  Associated with human cases(s) or investigations(s) (may or may not have an EI# at time of submission) related to human infection AND  Submitted by a Medical Officer of Health (MOH) or designate (eg. PHI, EHO) b. Rejection Criteria: ProvLab will NOT process:  Commercial/retail human food products for which packaging is intact (i.e. has not been opened) even if the product has been collected from a patient’s residence.  Food samples collected from commercial retail outlets including stores, markets and manufacturing/processing plants/production lines.  Commercial animal food products for which packaging is intact (i.e. has not been opened)  Live or dead whole animal products typically used as reptile feed (e.g. mice, chicks, crickets)  Environmental swabs  Litter used to house animals suspected of being the source of human infection c. Guidelines for Submitting Food Samples to the Provincial Laboratory for Public Health All food and non-clinical sample testing associated with a public health investigation of foodborne disease is performed at ProvLab, Calgary. Samples received by ProvLab, Edmonton will be sent to Calgary the same day if:  samples arrive before 1000h Monday through Friday  samples arrive before 0900h Saturday, Sunday and holidays MOC/VOC at the original receiving site provides consultation with Public Health Investigator or other Public Health Professionals as required. CON’T… GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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e. Requisition A requisition must accompany each sample submitted for laboratory investigation. Complete ALL fields of the requisition for EACH sample submitted (FOOD SAMPLE INVESTIGATION FOR FOOD POISONING ORGANISMS). Food Guidelines and Requisition forms may be obtained by submitting a Specimen Collection Kit Order Form (Calgary see page 10 or Edmonton see page 12). f. Sample Submission      

Label a sterile WHIRL-PAK® bag or sterile leak-proof container for each sample to be submitted. Ensure Sample Type and Sample Source matches the respective requisition for each sample. Submit 100 Grams or 100mL whenever possible. If insufficient sample is submitted, bacteriological testing may need to be prioritized. Place sample in the labelled container using aseptic technique. Place the labelled WHIRL-PAK® bag or sterile leak-proof container into a larger biohazard bag and seal to prevent accidental leakage during transport. Place requisition within the external flap of the biohazard bag.

g. Transportation 1  Place all samples in a rigid-sided container or cooler and transport within 24hrs to the Laboratory.  Samples should be stored and transported as follows: - Shelf-stable samples at room temperature - Perishable samples with sufficient ice packs to maintain refrigeration temperature (eg: between 0˚C and 7˚C). - Frozen samples with sufficient ice packs to maintain freezing temperature. - Do NOT allow frozen samples to thaw during shipment.  Notify the Bacteriology laboratory when food samples are being submitted. - 403-944-1214 (ProvLab, Calgary) - 780-407-7703 (ProvLab, Edmonton) 1.

Compendium of Analytical Methods Appendix B Volumes 1-3 November 2006

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TRANSPORT MEDIA PRE-SPECIMEN COLLECTION STORAGE

POST-SPECIMEN COLLECTION TRANSPORT REQUIREMENTS

USE FOR

MEDIA

DESCRIPTION

Anaerobic organisms

Cary-Blair (anaerobic) Transport media Charcoal Transport media

Opaque media

Room temperature

Room temperature

Black swab

Room temperature

Room temperature

Clear pink

Room temperature

Refrigerate at 4C

Clear

Refrigerate at 4C

Room temperature

Plain (routine) Transport media

Clear swab

Room temperature

Refrigerate at 4C

Regan-Lowe Transport media

Black

Refrigerate at 4C

Todd Hewitt Broth (1 ml)

Straw colour

Refrigerate at 4C

Refrigerate at 4º C if transport to the Laboratory is to be delayed Room temperature

Sensitive pathogens and most cervical and urethral specimens Isolation of ureaplasma, virus or mycoplasma Acanthamoeba – available only on request Collection of routine swabs for culture and sensitivity Pertussis investigation Bronchoscopy brush collection

Universal Transport Medium (UTM) Page’s Saline

For access to transport media, contact the Packing Area (Calgary) at 403-944-2583 or the Distribution Centre (Edmonton) at 780-407-8971. NOTE: Expiry dates are indicated on each vial. Do not use after expiry date. Specimens submitted in expired transport media will NOT be processed.

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TRANSPORT OF DIAGNOSTIC SPECIMENS AND INFECTIOUS SUBSTANCES Diagnostic specimens or reference isolates sent to the Laboratory for diagnosis or investigation must be packaged in compliance with the regulations defined under the Canadian Transportation of Dangerous Goods Act and Transportation of Dangerous Goods Regulations (TDGR), including the 2005 Clear Language Amendments and subsequent updates or amendments (refer to website link: http://www.tc.gc.ca/TDG/menu.htm). Transport Canada also endorses the International Civil Aviation Organization (ICAO) Technical Instructions and the Dangerous Goods Regulations published annually by the International Air Transport Association (IATA DGR). For air transport, both the ICAO/IATA and TDG regulations must be followed. Persons packaging diagnostic specimens and infectious substances for transport must be trained and hold valid Transport of Dangerous Goods certificates. PACKAGING FOR TRANSPORT: DIAGNOSTIC SPECIMENS AND INFECTIOUS SUBSTANCES The packaging must include: 1. Inner packaging:  A watertight primary container (e.g. vacutainer, screw-capped tube, specimen bottle) reinforced with parafilm around top to prevent leakage.  A watertight secondary packaging (eg. ziplock bag, Saf-T-Pak or other polypropylene container or metal container). Several tubes may be shipped together in a single secondary packaging but must be wrapped individually to prevent contact between them or placed into racks.  An absorbent material (e.g. cotton batting, commercial absorbent) placed between the primary container and the secondary packaging. This material must be capable of absorbing the entire liquid contents of all primary containers. 2. List of contents: Enclose an itemized list of contents between the secondary packaging and the outer packaging (e.g. laboratory requisition or letter listing specimens etc). 3. Outer packaging:  Diagnostic specimens shipped via ground transport – use a fiberboard container marked with TC125-1B or an ‘equivalent’ outer packaging (e.g. cooler, toolbox, unmarked fiberboard box). However, the packaging used must not allow the escape of its contents under normal condition of handling and transport.  Diagnostic specimens shipped via air transport – use a fiberboard box marked with TC125-1B and follow IATA packing instruction 650.  Infectious substances shipped via ground or air – use a certified fiberboard container marked with TC125-1A and the approved UN marking. Shipping documents must comply with Transportation Canada regulations and/or IATA Packing Instruction 602. Documents must accompany the package at all times. Questions regarding any aspect of specimen transport may be directed to the Packing Area (Calgary) at 403-944-2583 or to the Distribution Centre (Edmonton) at 780-407-8971.

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GUIDE TO SPECIMEN COLLECTION CONTACT NUMBERS

PRIMARY INQUIRIES (To all departments and/or staff)

CALGARY SITE

EDMONTON SITE

403-944-1200

780-407-7121

MICROBIOLOGIST/VIROLOGIST 403-944-1200 (ask for MOC/VOC) ON CALL (MOC/VOC)

780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory)

(Clinical consultation)

(ask for MOC/VOC)

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

Acanthamoebae Acanthamoeba sp.

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Corneal scrapings (several) in Page’s Saline

Microscopy, culture

Parasitology

Specimens are cultured by prior arrangement; please consult the Laboratory before submitting. Page’s Saline available on request. (Collection kit attachment) DO NOT refrigerate specimens.

Acid Fast Bacilli - see: Mycobacteria Acquired Immune Deficiency Syndrome (AIDS) – see: Human Immunodeficiency Virus Actinomycosis Actinomyces israelii Actinomyces sp.

Pus, preferably with granules in Cary Blair (anaerobic) transport media

Microscopy, culture

Bacteriology

Organisms may take 10 or more days to grow in culture.

Adenovirus Infections Adenovirus (over 50 antigenic types)

Nasopharyngeal aspirate or nasopharyngeal, throat or conjunctival swab in Universal Transport Medium (UTM). 1 – 2 mL Bronchial Alveolar Lavage (BAL) in sterile container. The recommended respiratory specimen is a nasopharyngeal aspirate.

NAT (PCR) - Tested as part of respiratory virus panel

Molecular Diagnostics

Refrigerate but DO NOT freeze specimens.

Virology Molecular Diagnostics

Refrigerate at 4°C if transport will exceed 2 hours. Consultation with Microbiologist/Virologist On Call required. Con’t…

Feces in a sterile container

- specific NAT(PCR) by consultation only

- Electron microscopy - NAT (PCR)

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

4 mL blood in EDTA (lavender top) tube

Plasma PCR* Viral load (quantitative PCR) Eye infection panel

Molecular Diagnostics

Consultation with Microbiologist/Virologist On Call required.

Conjunctival/Eye swab Aqueous/vitreous fluids Lesions

Molecular Diagnostics

NAT (PCR)

Molecular Diagnostics

Microbiologist/Virologist On Call consult required.

Urine – minimum 1mL

NAT (PCR)

Molecular Diagnostics

Microbiologist/Virologist On Call consult required.

Tissues (autopsy/biopsy)

NAT (PCR)

Molecular Diagnostics

Microbiologist/Virologist On Call consult required.

AFB - see: Mycobacteria AIDS - see: Human Immunodeficiency Virus Contact the Department of Biochemistry, University of Alberta at 780-492-8159.

Algal Toxins Cyanobacteria Amoebic Dysentery - see: Diarrhea, Parasitic Entamoeba histolytica Amoebic Encephalitis, CSF Primary Naegleria sp. Acanthamoeba sp. Brain/meningeal biopsy

Microscopy, culture

Parasitology

Microscopy, culture

Parasitology

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DO NOT refrigerate CSF specimens; keep at room temperature. Contact the Laboratory before submitting.

26

LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

Amoebic Hepatitis Entamoeba histolytica

Anaerobic Infections Actinomyces sp. Bacteroides sp. (particularly B. sp. fragilis group) Clostridium sp., Eubacterium sp., Fusobacterium sp., Peptostreptococcus sp., Porphyromonas sp., Prevotella sp., Propionibacterium sp. Gas gangrene Clostridium perfringens, Clostridium septicum, Clostridium novyi, and other species

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Abscess wall section (NOT PUS) or aspirate of contents. 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Microscopy

Parasitology

Serology EIA

Parasitic Serology

Consult with Microbiologist/Virologist On Call prior to collecting specimen. Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec

Pus, from deep abscess or body cavity, preferably taken by needle aspiration from under skin flaps or from deep pockets in Cary-Blair (anaerobic) transport media

Microscopy, culture

Bacteriology

Transport specimens at room temperature – DO NOT refrigerate.

Lesion swab; necrotic tissue in Cary Blair (anaerobic) transport media

Microscopy, culture

Bacteriology

Transport specimens at room temperature – DO NOT refrigerate.

Ancylostomiasis - see: Hookworm Disease

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Anisakiasis

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology

Parasitic Serology

Referred to the Mahidol University, Bangkok, Thailand

Anthrax Bacillus anthracis (*Risk Group 3 Agent*)

Lesion swab in plain transport media (RTM)

Microscopy, culture

Bacteriology

Pustular fluid from skin lesion

Microscopy, culture

Bacteriology

If lesion is dry, moisten swab in sterile water, saline or broth and rotate beneath the edge of the eschar. Contact the Microbiologist/Virologist On Call before collecting specimens or submitting Bacillus anthracis isolates for confirmation. Please indicate on requisition if anthrax is suspected.

Sputum (pulmonary infection)

Microscopy, culture

Bacteriology

8-10 mL blood for culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

Antifungal Levels Voriconazole

1 mL serum in serum separator tube (SST)

Mycology

Send serum on ice.

Itraconazole

1 mL serum in serum separator tube (SST)

Mycology

Send serum on ice. Serology referred out.

Arbovirus Infections Eastern Equine, Western Equine, Venezuelan, encephalitis, Powassan,

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Virology

Travel and clinical history is essential. Please complete an Arbovirus Patient History Form (available from the Laboratory) and submit it with the specimens and requisitions. Con’t….

HI (hemagglutination inhibition)IFA and EIA Specify the suspected virus on the requisition.

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

Jamestown Canyon, St Louis encephalitis and Chikungunya

Submit acute and convalescent specimens.

Arbovirus Infections Dengue Fever

5 mL serum separator tube (SST) or pediatrics may use 2mL red top tube

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Serology referred to the National Microbiology Laboratory, Winnipeg, Manitoba. Serology

Virology

Travel and clinical history is essential. Please complete an Arbovirus Patient History Form (available from the Laboratory) and submit it with the specimens and requisitions.

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details) Worm (passed in feces or vomit) in a sterile container, or in sterile saline

Microscopy for eggs

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Worm Identification

Parasitology

At least 0.5-1 mL DEDICATED CSF sample in a sterile container.

NAT (PCR) CSF Panel: enterovirus, parechovirus, HSV-1, HSV-2, VZV

Molecular Diagnostics

Submit acute and convalescent specimens Ascariasis Ascaris lumbricoides

Aseptic meningitis Usually enterovirus, parechovirus, HSV-1, HSV-2 ,VZV, WNV, JC, HHV etc

West Nile virus

Specify etiology if known on the requisition. Bloody CSF is not optimal for PCR test. If specimen can be received in the Laboratory within 24 hours of collection then ship on ice/cold packs. If transportation may exceed 24 hours from collection then freeze at -70°C and transport on dry ice. Both West Nile virus and enterovirus are seasonal, and may present with a similar clinical picture. See: Enterovirus. Con’t….

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

For suspect West Nile virus infection, also request West Nile serology on a serum (SST) and submit a plasma (EDTA) tube of blood for PCR/NASBA. See: West Nile Virus. Other viruses (eg JC, HHV-6)

Microbiologist/Virologist On Call consult required.

Aspergillosis - see: Fungal Infections Aspergillus antigen detection

5 mL serum in serum separator tube (SST)

Astrovirus Infections Astrovirus

Bronchoalveolar lavage (BAL) in a sterile container Feces in a sterile container

Galactomannan

Mycology

Electron microscopy

Virology

Acceptable samples are those collected within the first 48 hours after onset of symptoms. Formed stool is of 0 no diagnostic value. Refrigerate at 4 C if not transported within 2 hours of collection. Electron microscopy by request only. The Laboratory will only report as ‘small round structured virus’ as it is not possible to identify astrovirus specifically by electron microscopy.

Attest ™– see: Biological Indicators B Virus Infection Herpesvirus simiae, also known as Herpes simiae, Cercopithecine herpesvirus 1 (B virus) (*Risk Group 4 Agent*)

Virology

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Consult Microbiologist/Virologist On Call in Calgary or Edmonton before collecting specimens of either human or animal origin. Specimens will be referred for testing to National Microbiology Laboratory, Winnipeg, Manitoba.

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

Babesiosis Babesia species Chiefly B. microti (protozoan parasites)

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Blood smears OR 5-7 mL blood in citrate (blue top) or EDTA (lavender top) tube

Microscopy

Parasitology

Submit a full travel history.

5mL serum separator tube (SST) or pediatrics may use 2 mL red top tube.

Serology

Parasitic Serology

Submit a full travel history. Serology performed at National Reference Centre for Parasitology, McGill University Centre for Tropical Disease/Centre for Disease Control, Atlanta, Georgia, U.S.A. Offered only after consultation with Microbiologist/Virologist On Call, Edmonton site.

Bacterial Antigen Detection – see: Meningitis, Bacterial Balanitis

CALGARY

Swab in charcoal transport media (CTM)

Microscopy, culture

Bacteriology

5 mL serum in a serum separator tube (SST) or pediatrics may use 2 mL red top tube. Submit acute and convalescent specimens preferably before 3rd and after 14th day of illness.

Serology

Virology

Indicate Bartonella serology on requisition. Serology referred to the National Microbiology Laboratory, Winnipeg, Manitoba for testing.

Aspirate from wound, sample of pus, fluid and/or tissue from lymph nodes or heart valve

PCR

Bacteriology

PCR testing referred to the National Microbiology Laboratory, Winnipeg, Manitoba. CSF or whole blood (EDTA) are not recommended and will be tested only after consultation with the Microbiologist/Virologist On Call. Con’t….

Balantidiasis (Balantidium coli) - see: Diarrhea, Parasitic Bartonella

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Spore Strips Attest™ vials

Culture

Environmental Microbiology

Spore strips suitable for testing dry heat, ethylene oxide or formaldehyde sterilizer. Submit two tests strips and one unprocessed control strip of the same lot#/expiry. Attest™ vials suitable for testing steam autoclaves. Submit one test vial and one unprocessed control vial of the same lot#/expiry. Access number must be attached to strips or vials. Do not expose to extreme heat or cold during transport to the laboratory

Early morning first-void urine sample in a sterile container.

Quantitative PCR

Molecular Diagnostics

Test only available for renal and bone marrow transplant patients. Consult with Microbiologist/Virologist On Call for additional testing.

Biopsy submitted in a sterile container. At least 1 ml of fluid sample is required. If swab is used, submit in clear transport medium (M40) Bilharziasis - see: Schistosomiasis Biological Indicators

BK Virus Polyomavirus – usually benign infection but important cause of renal dysfunction and graft loss in renal transplant recipients

5 – 7 mL blood in EDTA (lavender top) tube, 2 mL acceptable for infants. DO NOT centrifuge. DO NOT freeze. Transport on cold packs/ GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

Plasma will not be processed unless the urine is positive.

Con’t….

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

Blastocystis Blastocystis hominis

SPECIMEN COLLECTION REQUIREMENTS ice. Must be received in less than 48 hours of collection. Feces in SAF preservative (see: Diarrhea, Parasitic for collection details)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Microscopy

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Culture

Bacteriology

Please refer to the following link for collection instructions: Blood Culture Collection Guidelines for Phlebotomists. **Exception** If you wish to access the above link using the ProvLab network computers; click here.

Blastomycosis - see: Fungal Infections and Fungal Serology Blood Culture, Bacteriology (Edmonton site only)

See: NOTES

Blood Culture, TB – see: Mycobacteria Bone Chips

Bone chips in Cary Blair (anaerobic) transport media

Culture

Bacteriology

Immerse specimen in Cary Blair transport medium so that it is covered and anaerobes are viable. Transport specimens at room temperature – DO NOT refrigerate.

Bone Marrow Culture, Bacteriology (Edmonton Site Only)

Adults: 2 mL bone marrow in one BACTEC™ Peds Plus/F vial. Pediatrics: 1.5 mL bone marrow in one BACTEC™ Peds Plus/F vial.

Culture

Bacteriology

Inoculate 2 mL maximum into vial. BACTEC vials are stored at room temperature pre/post inoculation. Referred specimens should be incubated at 35-37°C or kept at room temperature.

Culture

Bacteriology

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

Bone Marrow Culture, Mycology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

1 mL bone marrow in Isolator tube

Culture

Mycology

Fungal culture performed by request only, please indicate on requisition. Submit bone marrow for Histoplasma in Isolator tubes. Isolator tubes can be obtained by calling the Laboratory at the Edmonton site. Submit blood for culture of other fungi in Bactec vials. (See: Blood Culture, Bacteriology for collection details).

Bone Marrow Culture, TB – see: Mycobacteria Bone Marrow: CMV VZV HSV adenovirus

2 mL bone marrow aspirate minimum in EDTA (lavender top) tube

NAT(PCR)

Molecular Diagnostics

Parvovirus B19

DEDICATED sample (2 mL) bone marrow in EDTA (lavender top) tube.

NAT(PCR)

NML

HHV-6

NML

Refrigerate until transport. DO NOT FREEZE Specify the virus, e.g. CMV, VZV, etc Microbiologist/Virologist On Call consult required. Microbiologist/Virologist On Call consult required. Parvovirus PCR is performed on immunocompromised host or specific hematological disorders only; parvovirus serology IgG and IgM are preferred tests for otherwise healthy patients. Parvovirus PCR is referred to the National Microbiology Laboratory, Winnipeg, Manitoba for testing. Submit samples to the Laboratory Monday to Wednesday to allow shipping time to reference laboratory. Microbiologist/Virologist On Call consult required.

Bordetella Infections - see: Pertussis Bornholm Disease - see: Enterovirus Infections

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Toxin, Culture

Bacteriology

Consult Microbiologist/Virologist On Call immediately. All requests for Clostridium botulinum culture or toxin must be approved by the Microbiologist On Call. All testing is performed at the Botulism Reference Service (BRS), Ottawa, Ontario.

Toxin Culture

Bacteriology

Laboratory investigations of infant botulism are generally limited to the analysis of toxin and culture detection of C. botulinum in stools. Reported cases with detectable toxin levels in serum are rare. The preferred specimen for confirming the diagnosis of infant botulism is the infant’s feces.

Borreliosis - see: Lyme Disease Botulism Food-borne Botulism

Infant Botulism

Suspected food in sterile container or original container. Feces (10 g), serum (from 20 mL blood), gastric contents in sterile container Infant feces (10 g) or enema fluid (15-20 mL) in a sterile container or rectal swab or soiled parts of diaper. Serum (2 mL)

Stool: Infant feces or enema fluid in a sterile container. Blood: Serum collected BEFORE administration of antitoxin (BIG). Food: Implicated food samples may be leftovers or unopened containers; for commercial foods, it is important to include the label, and manufacturer’s lot number. Food specimens should be transported on ice packs. Testing of suspect cases of infant botulism will be coordinated through the office of the Medical Officer of Health. The Microbiologist/Virologist On Call can be contacted for further information on laboratory investigations. Con’t…

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Refrigerate (4ºC) samples after collection and during transport to laboratory Wound Botulism

Swab in anaerobic transport media (Cary Blair).

Culture

Bacteriology

PCR – Respiratory Virus Panel

Molecular Diagnostics

Microscopy, culture

Bacteriology

See notes for Food-borne Botulism. Transport specimens in anaerobic transport media at room temperature. DO NOT refrigerate.

Brills Disease - see: Rickettsial Infections Bronchiolitis of Infants Respiratory Syncytial Virus (RSV), Parainfluenza Virus, Influenza Virus,(Flu A, B) Adenovirus, human meta pneumovirus, coronavirus and rhinoviruses

Nasopharyngeal (NP) swab, throat swab*, aspirate or auger suction in Universal Transport Medium (UTM) (see: Nasopharyngeal Aspirates, Viral for collection details)

Bronchitis Haemophilus influenzae, Streptococcus pneumoniae and other bacteria

Sputum

Brucellosis Brucella abortus, Brucella melitensis, Brucella suis

Acute Brucellosis: 8 - 10 mL blood for culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

(*Risk Group 3 Agent*)

Acute, subacute, and chronic Brucellosis: 2 mL

Culture

Bacteriology

Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory.

Preferably collected on waking in the morning. Sputum is an unsuitable sample for virus culture, a throat swab or nasopharyngeal sample in Universal Transport Medium (UTM) is required.

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Multiple cultures recommended. Diagnosis confirmed if culture is positive or if clinical symptoms are compatible with brucellosis and serum shows a 4-fold or greater rise in agglutination titre between acute and convalescent specimens obtained two or more weeks apart and studied at the same laboratory. Con’t….

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

bone marrow for culture (see: Bone marrow, Bacteriology for collection details)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

A presumptive acute case is one with compatible clinical symptoms and a single or stable agglutination titre of at least 1:160 in serum obtained after the onset of symptoms. Contact the Microbiologist/Virologist On Call before collecting specimens or submitting suspected Brucella isolates for confirmation. Please indicate on requisition if Brucellosis is suspected.

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube, submit acute and convalescent (at least 2 weeks apart)

Serology

Virology

Brugia sps. – see: Filariasis Burkholderia pseudomallei – see: Melioidosis Calicivirus Infections: Calicivirus, includes Norovirus – see: Diarrhea, Viral Campylobacter - see: Diarrhea, Bacterial and Food-borne Bacterial Disease/Syndrome Candidiasis - see: Fungal Infections and Genital Infections Cat Scratch Disease/Fever - see: Bartonella Cervicitis - see: Genital Infections

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

Chagas Disease - see: Trypanosomiasis Chancroid - see: Genital Infections – Chancroid Chickenpox, Varicella and Zoster (shingles) - see: Varicella Zoster Virus Infections Chinese Liver Fluke Disease - see: Clonorchiasis Chlamydial Infections, Chlamydia psittaci includes agents of psittacosis, ornithosis and various diseases of animals

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube, submit acute and convalescent

Serology Microimmunofluorescence: IgG, IgM

Virology

Serology referred to the National Microbiology Laboratory, Winnipeg, Manitoba. Clinical history including bird or animal contact is required or test will not be performed.

Endocervical Swab: Use Gen-Probe APTIMA® unisex swab specimen collection kit available from Laboratory Male Urethral Swab: Use Gen-Probe APTIMA® unisex swab specimen collection kit available from Laboratory

NAAT

Bacteriology

In females, specimens should be obtained from the cervix if possible; vaginal swabs have not been validated in the laboratory

NAAT

Bacteriology

Urethral swabs may cause discomfort to male patients. A urine is an appropriate specimen that can be taken instead of a urethral swab.

Urine (Male and Female): Use Gen-Probe APTIMA® urine

NAAT

Bacteriology

First catch urine without having voided for at least 1 hour: 20-30 ml (beginning of a stream in a sterile container). Transfer 2 ml urine to a Con’t….

Chlamydial Infections, Chlamydia trachomatis

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS specimen collection kit available from Laboratory Vagina Swabs*: Use Gen-Probe APTIMA® vaginal swab collection kit available from Laboratory Eye Swabs: Use GenProbe APTIMA® unisex swab specimen collection kit available from Laboratory

TESTS AVAILABLE

SECTION

NAAT

Bacteriology

NAAT

Bacteriology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Gen-Probe APTIMA® Urine collection kit within 24 hours of collection. *Vaginal swabs have not been validated in the Laboratory but may be processed (if the cervix is absent, or for children under 12 years of age) following consultation with the Microbiologist/Virologist On Call.

Call and speak with Microbiologist/Virologist On Call.

Other Extragenital Sites: See Notes

None of the current commercial NAAT testing platforms have Health Canada of FDA approval for extra-genital specimen testing. For non-STI clinic and non-reproductive health clinic patients, if CT/NG on other extragenital site specimens is required please contact the Microbiologist/Virologist On Call. Rectal: Use Gen-Probe APTIMA® unisex swab specimen collection kit available from Laboratory

NAAT

Bacteriology

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Lymphogranuloma Venereum (LGV)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Genital and Rectal Swab: in a GEN-PROBE APTIMA® Unisex Swab Specimen transport kit, Urine: 2mL urine in a GEN-PROBE APTIMA® urine specimen collection kit

NAAT

Bacteriology

If LGV is suspected, contact the Microbiologist/ Virologist On Call. LGV investigation referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

Microscopy for eggs

Parasitology

It is difficult to differentiate the eggs of these and related species and when in doubt they are reported as "opisthorchid" ova.

Bacteriology

Also see: Food-borne Bacterial Disease.

Tissue: in a sterile container, Bubo aspirate: in a sterile container Cholera - see: Diarrhea, Bacterial Clonorchiasis Opisthorchis Clonorchis sinensis (the Chinese liver fluke)

Feces in SAF preservative (see Diarrhea, Parasitic for collection details)

Clostridium Difficile Toxin - see: Diarrhea, Antibiotic Associated CMV - see: Cytomegalovirus Infections Coccidioidomycosis - see: Fungal Infections Colitis, Haemorrhagic Escherichia coli O157:H7

Feces in a sterile container

Culture

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Congenital Infections caused by viral and microbial agents:

For Mother: Maternal serological tests* 5 mL serum separator tube (SST)

Serology Specify virus requested e.g. Rubella, Toxoplasma

Virology

*For suspected congenital infection, parallel testing of maternal prenatal screening sample and post-partum sample for suspected viral serology can be very helpful. Contact Microbiologist/Virologist On Call in Calgary or Edmonton if testing is required.

e.g. Rubella virus, CMV, HSV, Parvovirus, Syphilis, Toxoplasma, etc.

For Neonate: Suspected CMV infection: Please collect a single urine sample in sterile container and/or throat swab in Universal Transport Medium (UTM) within first four weeks of delivery.

CMV DNA PCR NAT (PCR)

Virology Molecular Diagnostics

Urine for CMV is the gold standard. Serology (IgG and IgM) is not reliable. PCR testing has now replace shell-vial culture. Only 1 urine sample is required for testing for screening for congenital CMV

Rubella serology (IgG and IgM)

Virology

Rubella RT-PCR

NML

Suspected rubella infection: Collect 1 - 2 mL neonatal blood in red top tube (serum), Urine in sterile container and throat swab in Universal Transport Medium (UTM)**

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**Urine and throat swab will be referred to the National Microbiology Laboratory, Winnipeg, Manitoba, if clinical picture and serological result support the diagnosis of rubella infection. Con’t….

41

LABORATORY CONTACT INFORMATION

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS Suspected HSV infection: Using a single swab, collect a swab specimen from conjunctiva, oral pharynx in Universal Transport Medium (UTM) for HSV culture. Unroof and swab suspicious lesion (usually blister or superficial ulcer) vigorously and transport in Universal Transport Medium (UTM). For neonate with seizures or neurological symptoms: Submit 0.5-1 mL DEDICATED CSF sample in a sterile container for CSF panel (HSV-1/2, VZV and enterovirus/parechovirus NAT)

TESTS AVAILABLE

SECTION

HSV NAT (PCR)

Molecular Diagnostics

CSF Panel

Molecular Diagnostics

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CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Bloody CSF is not optimal for NAT (PCR) If specimen can be received in the Laboratory within 24 hours of collection then ship on ice/ cold packs. If transportation might exceed 24 hours from collection then freeze at -70°C and transport on dry ice.

Con’t….

42

LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Suspected Toxoplasma: Collect neonatal serum 1 - 2 mL in red top tube and see above for maternal serology test

Toxoplasma serology (IgG and IgM)

Virology

Please provide history.

Suspected Parvovirus: Collect neonatal serum 1 - 2 mL in red top tube and see above for maternal serology test

Parvovirus serology (IgG and IgM)

Virology

Please provide history.

Suspected Syphilis: Collect maternal serum 3 - 5 mL in red top tube or serum separator tube for initial screening. Neonatal testing may be required if maternal serological result is abnormal

EIA, RPR, INNO-LIA

Virology

Using maternal serology as initial screen can decrease the amount of blood draw from the neonate. Please provide history.

For neonate with sepsis syndrome collect 1-2 mL blood in EDTA for HSV-PCR

Congo – Crimean Hemorrhagic Fever – see: Viral Hemorrhagic Fever Conjunctivitis - see: Eye Infections

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Coronavirus Infections - see: Respiratory Infections, Viral and Atypical Bacteria Corynebacterium diphtheriae – see: Diphtheria Cowpox - see: Poxvirus Infections Coxiella burnetii - see: Rickettsial Infections Coxsackie Virus Infections – see: Enterovirus Infections Creutzfeldt-Jakob Disease Unclassified agent causing subacute spongiform encephalopathy.

Biopsy material (brain); autopsy material (brain and other organs)

(*Risk Group 3 Agent*)

CSF (a DEDICATED sample of at least 2 mL)*

Performed by Pathology

14-3-3 protein* Tau S100B

Virology

A neurology consult and clinical history is required before 14-3-3 protein testing is performed. Consult the Microbiologist/Virologist On Call before submitting specimen. Sample is referred to National Microbiology Laboratory, Winnipeg, Manitoba. Requisition must be clearly labelled to identify specimen as suspected Risk Group 3 Agent.

Cryptococcus (LA)

Bacteriology

For specimens from patients from the Calgary Zone, refer to Calgary Laboratory Services for testing.

Croup - see: Bronchiolitis of Infants Most commonly caused by Parainfluenza virus. Cryptococcal Antigen Detection Cryptococcosis

CSF 0.5 mL minimum in a sterile container Serum 2 mL in serum separator tube (SST)

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details) Water, see: Water: Parasites and Enteric Pathogens Feces in SAF preservative (see: Diarrhea, Parasitic for collection details)

Microscopy for oocysts

Parasitology

Microscopy for oocysts

Parasitology

Cysticercosis Taenia solium

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology Immunoblot

Parasitic Serology

Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease

Cytomegalovirus Infections (CMV) Cytomegalovirus e.g. heterophile negative mononucleosis, congenital infection (see: Congenital Infections caused by viral and microbial agents),

1 - 2 mL urine; BAL in sterile containers

CMV PCR and Virus Culture NAT (PCR)

Virology and Molecular Diagnostics Molecular Diagnostics

If culture for CMV is required contact the Microbiologist/Virologist On Call. Specify ‘CMV culture’ and the reason for the request e.g. ‘for ganciclovir resistance testing’ on the requisition.

Cryptococcus - see: Fungal Infections Cryptosporidiosis Cryptosporidium sp.

Cyclospora

Specimens should be delivered to the Laboratory immediately. Keep cool in transit, DO NOT freeze. Throat swab in Universal Transport Medium (UTM) (new born only)

CMV PCR

Virology

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Urine and throat swab for CMV culture within first four weeks of life are diagnostic for congenital CMV infection. Con’t….

45

LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CMV reactivation or primary infection in solid organ or bone marrow transplant recipients.

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

5-7mL EDTA (lavender top)tube 2 mL acceptable for infants.

Quantitative PCR Viral Load (Quantitative PCR)

Molecular Diagnostics

Transport on ice/cold packs and DO NOT freeze. Must be received within 48 hours of collection.

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube Autopsy material, biopsy material submitted in Universal Transport Medium (UTM)

Serology EIA: IgG, IgM

Virology

Test only available for transplant recipient patients and immunodeficient population. Consult with Microbiologist/Virologist On Call for additional testing. Serology performed 3 times/week. Please provide history. Microbiologist/Virologist On Call consult required.

Dengue Fever – see: Arbovirus Infections; Dengue Fever Dermatophytes Epidermophyton sp., Microsporum sp., Trichophyton sp.

Skin scrapings; nail clippings; hair, submit in fungus/mycology kit

Microscopy, culture

Mycology

Biopsy material in sterile container

Microscopy, culture

Mycology

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Hair - pull hair from the center and periphery of lesion. Place hair, base of shaft, and crust onto the piece of 4x4 paper supplied in the kit. DO NOT use slides, cotton wool or tubes. Nails/skin - clean site with 70% alcohol. Collect 5-6 scrapings onto the piece of 4x4 paper supplied in the kit. Fold paper 3 times and place in envelope. DO NOT use slides, cotton wool, or tubes.

46

LABORATORY CONTACT INFORMATION

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Diarrhea, Antibiotic Associated Clostridium difficile (Pseudomembranous colitis)

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Feces, fill container 1/3 full (do not contaminate with water or urine)

Toxin studies

Bacteriology

DO NOT submit feces specimens in transport media for toxin studies. DO NOT submit formed stools.

Specimens should be kept refrigerated and transported to the laboratory as soon as possible Diarrhea, Bacterial Numerous species including: Aeromonas, Campylobacter, Escherichia coli O 157:H7, Salmonella, Shigella, Yersinia

CALGARY

Feces – one specimen per day; fill container 1/3 full (do not contaminate with water or urine). Send feces containing blood or mucus if these are present. If transport of fecal sample exceeds 24 hours, submit in enteric transport media (Enteric transport media is not supplied by the Laboratory)

Repeat C. difficile testing on previous negative or positive sample within 7 days will only be performed if approved by the Microbiologist/Virologist On Call. Culture (routine)

Bacteriology

Vibrio species

Routine culture includes examination for Aeromonas, Campylobacter, Escherichia coli O157:H7, Salmonella, Shigella, and Yersinia. Multiple specimens from the same day are not processed. Stool specimens from inpatients after the third day of hospital stay are not processed without consultation.

Culture for Vibrio available on request Con’t….

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

Other enteric foodborne pathogens Bacillus cereus

Diarrhea, Parasitic Many parasites including helminths, coccidians, (ie: Cryptosporidium, Isospora, Cyclospora) and amoebae (ie: E. histolytica, Giardia lamblia, Dientamoeba fragilis)

TESTS AVAILABLE

SECTION

Culture

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Culture for specific enteric pathogens and foodpoisoning investigations is available on request. Consult the Microbiologist/Virologist On Call in the case of outbreaks.

Feces in SAF preservative. Important: Follow instructions on SAF container.

Microscopy

Parasitology

Scrapings from ulcerated bowel collected by sigmoidoscopy in SAF preservative (primary amoebic dysentery) 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Microscopy, culture

Parasitology

Serology EIA

Virology

Emulsify feces in SAF preservative immediately after collection. Submit 3 specimens at one or more day intervals (maximum one per day). Collect specimens while patient is not on antibiotics, and before administration of anti-diarrhetics and radiological dyes. Mineral oil, bismuth, antibiotics, anti-malaria agents, and non-absorbable anti-diarrheal preparations interfere with the detection of intestinal protozoa. Specimens submitted in enteric transport media are not acceptable.

Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec. Consult Microbiologist/Virologist On Call at Calgary or Edmonton.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Diarrhea, Viral Common gastroenteritis viruses: rotavirus, norovirus, sapovirus, astrovirus and adenovirus

Diphtheria Corynebacterium diphtheriae (gravis, intermedius, mitis and belfanti biotypes), and Corynebacterium ulcerans

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Feces in a sterile container

Depending on patient population*, stool samples are tested by: 1) Electron microscopy (EM), or 2) Molecular methods (PCR)

Virology (EM) and Molecular Diagnostic (PCR)

Collect feces as early in illness as possible. Refrigerate specimens and transport to the Laboratory immediately. Refrigerate but DO NOT freeze specimens. Specify on the requisition that testing for gastroenteritis virus is required and if appropriate, indicate patient is hospitalized so that PCR can be performed on the specimen.

Throat; nasal; skin lesion swab in plain transport media (RTM) 2 mL serum (red top tube)

* PCR is available only for outbreak investigations and specimens from hospitalized patients if their status is identifiable by information provided on the requisitions. Otherwise PCR is only available upon special request and approval by the virologist/ microbiologist on call. To initiate an outbreak investigation, contact your local Medical Officer of Health and Microbiologist/ Virologist On Call at Calgary or Edmonton. Microscopy, culture

Bacteriology

Culture only by request, please indicate on requisition. Consult Microbiologist/Virologist On Call for culture and suspected infection. Toxigenicity tests require an additional 48-72 hours.

Anti-toxin determination

Virology

Test performed weekly.

By EM, rotavirus and adenoviruses can be well identified. Electron microscope can also detect, as a group, small-round-structured viruses (SRSV) which includes norovirus, sapovirus and astrovirus. PCR can detect all five gastroenteritis viruses (rotavirus, norovirus, sapovirus, astrovirus and adenovirus), however one or more of the viruses will be tested depending on the current ProvLab algorithm, i.e., a tier approach is in place pending further evaluation.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Diphyllobothriasis Diphyllobothrium latum (fish tape worm)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details) Segments of worm

Microscopy for eggs and segments

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Microscopy

Parasitology

It is important that segments not be preserved. Submit in sterile container or in saline.

Microscopy

Parasitology

Dirofilaria immitis – see: Filariasis Dracunculiasis (guinea worm) Dracunculus medinenses

Adult worm extracted from skin in sterile saline

Dysentery, Amoebic - see: Diarrhea, Parasitic

Dysentery, Bacillary - see: Diarrhea, Bacterial

E. coli - see: Food-borne Bacterial Disease/Syndrome or Diarrhea, Bacterial

Ear Infections, Otitis Externa Several species of bacteria, fungi, and viruses

Ear swab in plain transport media (RTM) for bacteria, fungi; Universal Transport Medium (UTM) for viral culture (HSV/varicella).

Culture

Bacteriology Mycology

Submit swabs in appropriate transport media for culture of different organisms.

Virology

Specify HSV and varicella when appropriate.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Ear infections, Otitis Media Several species of bacteria, viruses and fungi; occasionally Mycoplasma pneumoniae

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Ear swab in plain transport media (RTM) for bacteria, fungi or Universal Transport Medium (UTM) for mycoplasma and virus culture.

Culture

Bacteriology Mycoplasma Mycology Virology

Submit swabs in appropriate transport media for culture of different organisms. Specify the culture required. PCR testing for respiratory viruses is available upon consultation with Microbiologist/Virologist On Call.

Ear aspirate; tympanocentesis aspirate in sterile container. Specify viral culture if appropriate for clinical picture. Eastern Equine Encephalitis - see: Arbovirus Infections Ebola Virus - see: Viral Hemorrhagic Fever EBV - see: Epstein-Barr Virus Infections Echinococcosis Echinococcus granulosus , Echinococcus multilocularis

Aspirated fluid from cyst; excised cyst

Microscopy for hydatid "sand" (protoscolices)

Parasitology

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA

Parasitic Serology

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Sensitivity of the test depends on cyst location, integrity and vitality. False positives are seen in other helminth infections, as well as cirrhosis or cancer of the liver. Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec.

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Identification

Parasitology

Send specimen in clean dry container or in 70% alcohol (ethanol).

NAT (PCR)

Molecular Diagnostics

Bloody CSF is not optimal for PCR tests. If specimen can be received in the Laboratory within 24 hours of collection then ship on ice/cold packs. If transportation might exceed 24 hours from collection then freeze at -70°C and transport on dry ice.

Echovirus - see: Enterovirus Infections Ectoparasites Arthropods

Parasite

Ehrlichia - see: Rickettsial Infections Encephalitis, Viral Including epidemic, sporadic, and post-infectious types. Several viruses: Herpes simplex virus, enterovirus, parechovirus , West Nile virus, varicella zoster virus, arbovirus, lymphocytic choriomeningitis virus, influenza virus, rubella virus, mumps virus, measles virus, vaccinia virus, rabies virus*

If multiple PCR tests are requested on a CSF, submit at least 1 mL of DEDICATED CSF and specify the virus for PCR test request

Standard panel for viral encephalitis consists of HSV, VZV, enterovirus and parechovirus. WNV testing is available during WMV season by specific request.

Suspected HSV encephalitis: see Herpes Simplex Virus Infections.

Providing clinical information with the test request is extremely helpful for the Laboratory. Specifying the suspected virus is key to appropriate testing. * If rabies virus is suspected, consult with the Microbiologist/Virologist On Call.

Suspected enterovirus encephalitis: See Enterovirus Infections Suspected West Nile encephalitis: See West Nile Virus Infections

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Con’t….

52

LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

NAT (PCR)

Virology Molecular Diagnostics

Specify testing for influenza viruses on the requisition.

Suspected varicella encephalitis: See Varicella Zoster Virus Infections Suspected influenza related encephalitis: Collect nasopharyngeal swab in Universal Transport Medium (UTM) Biopsy / autopsy material: Discuss with Virologist on Call before submission Suspected Arbovirus encephalitis: see: Arbovirus Infections

Suspected other viruses: consult Microbiologist / Virologist On Call

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Con’t….

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Endocarditis, Bacterial Many bacterial and fungal species Coxiella burnetii (Q Fever) (*Risk Group 3 Agent*)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Blood culture (see: Blood Culture, Bacteriology for collection details) 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube, submit acute and convalescent (at least 2 weeks apart)

Culture

Bacteriology

Serology IFA: IgG

Virology

Blood for culture should be taken when patient is febrile. Multiple cultures recommended. When catheters are present, blood should be collected from other sites. Serology referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

Microscopy for ova

Parasitology

Entamoebae - see: Diarrhea, Parasitic Enteric Fever - see: Typhoid Fever Enterobiasis - Pinworms (Cellophane Tape Test) Enterobius vermicularis (pinworm)

Cellophane tape applied to peri-anal region (instruction sheet available from the Parasitology Bench, Edmonton site).

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Collect pinworm ova by folding clear cellophane tape around the end of a tongue depressor, adhesive side out. DO NOT use frosted tape. Spread buttocks and firmly press the tape on the anal area, using a rocking motion to cover as much of the peri-anal mucosa as possible. Remove tape and apply firmly to a clear glass slide. Label with the patient’s full name and a second unique identifier. The female pinworm (Enterobius vermicularis) generally migrates out to the anus to deposit her eggs at night. Take samples in the evening after the patient has been sleeping for several hours or first thing in the morning before washing or going to the bathroom. NOTE: Commercial devices can also be used in accordance with the manufacturer’s instructions.

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LABORATORY CONTACT INFORMATION

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Enterovirus Infections Poliovirus, Coxsackievirus A viruses, (Serotypes 1-22 and 24) Coxsackievirus B viruses, (Serotypes 1-6), Echoviruses. Usually seasonal with incidence highest over summer. Disease syndrome: Hand, foot and mouth disease, other types of rash illness, myocarditis, aseptic meningitis / encephalitis, sepsis-like picture in neonates and immunocompromised

Epiglottitis, Acute Haemophilus influenzae

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Stool in a sterile container

NAT (RT-PCR)

Molecular Diagnostics

Specify enterovirus testing on the requisition for all specimen types.

Throat swab in Universal Transport Medium (UTM)

NAT (RT-PCR)

Molecular Diagnostics

Vesicle * swab* in Universal Transport Medium (UTM) (stool and throat swab are preferred specimens).

NAT (RT-PCR)

Molecular Diagnostics

*Unroof new lesion and vigorously swab the lesion with a rayon swab; submit swab in Universal Transport Medium (UTM).

Mouth ulcer swab

NAT (RT-PCR)**

Molecular Diagnostics

**Oral infection panel (HSV-1, HSV-2, VZV, enterovirus, parechovirus)

One EDTA (lavender top) 4 mL tube

NAT (RT-PCR)

Molecular Diagnostics

Blood: Test only available on immunodeficient populations, myocarditis, neonates or on consultation with Microbiologist/ Virologist On Call.

DEDICATED CSF sample (0.5-1 mL minimum) in a sterile container

NAT (RT-PCR)

Molecular Diagnostics

CSF Panel (HSV-1, HSV-2, VZV, enterovirus, parechovirus

Molecular Diagnostics

Bloody CSF is not optimal for molecular tests. If specimen can be received in the Laboratory within 24 hours of collection then ship on ice/cold packs. If transportation might exceed 24 hours from collection then freeze at -70°C and transport on dry ice.

Nasopharyngeal; throat swab in plain transport media (RTM)

Culture

Bacteriology

Specify diagnosis and culture request.

Con’t…

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Epstein-Barr Virus Infections Epstein-Barr Virus

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Blood culture (see Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

For acute EBV infection: 5 mL serum (red top or serum separator (SST) tube)

Panel EBV IgM, EBV VCA IgG and EBNA IgG

Virology

EBV VCA IgG AND IgM and EBNA IgG performed.

For pre-transplant assessment: 5 mL serum (red top or serum separator (SST) tube)

Panel EBV IgM, EBV VCA IgG and EBNA IgG

Virology

EBV VCA IgG AND IgM and EBNA IgG performed.

For transplant recipients only: 4 – 7 mL blood in EDTA (lavender top) tube. 1 mL acceptable for infants.

Viral Load

Molecular Diagnostics

DO NOT centrifuge the specimen and refrigerate until ready to transport. Transport on ice/cold pack and DO NOT freeze. The specimen must be received within 48 hours from time of collection. Please provide clinical history and/or use surveillance fax form. Viral load is available ONLY for suspected acute EBVrelated illness in solid organ or bone marrow transplant patients. Test available only when there is clinical evidence of PTLD or for monitoring. Consult with Microbiologist/ Virologist On Call for additional testing.

Erlichiosis - see: Rickettsial Infections Erysipelas - see: Streptococcal Infections

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Erysipeloid Erysipelothrix rhusiopathiae

Inject saline into lesion and aspirate; biopsy

Culture

Bacteriology

Eye Infections, Bacterial/ Fungal/Parasitic

Conjunctival swab in plain transport media (RTM)

Microscopy, culture

Bacteriology Mycology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Swabs must be taken prior to the application of topical anaesthetics. Submit samples to the laboratory within 24 hours. Use anaerobic transport media for aqueous/vitreous aspirates if anaerobic culture is indicated. Aqueous/vitreous aspirates should be transported to the laboratory within 2 hours.

Conjunctival scrapings

Culture

Mycology

Also See: Acanthamoeba**

Eye Infections, Chlamydial Chlamydia trachomatis

**Consult the Laboratory, Edmonton site, prior to specimen collection. Appropriate culture media will be supplied for inoculation at the bedside. Use Gen-Probe APTIMA® unisex swab specimen collection kit available from Laboratory.

NAAT

Bacteriology

Swabs must be taken prior to the application of topical anaesthetic.

Conjunctival swab or scrapings in Universal Transport Medium (UTM)

Panel test for adenovirus

Molecular Diagnostics

Refrigerate culture specimens at 4° C and Transport immediately. Swabs must be taken prior to the application of topical anaesthetic.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Eye Infections, Viral

Fasciolopsiasis Fasciolopsis buski

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Conjunctival swab or scrapings in Universal Transport Medium (UTM)

NAT (PCR) NAT (RT-PCR) Eye infection panel (HSV, VZV, enterovirus, parechovirus and adenovirus) NAT (PCR) Panel tests for HSV 1/2 VZV and CMV

Molecular Diagnostics

Consult Microbiologist/Virologist On Call for other viruses. Specify the virus suspected on the requisition.

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details)

Microscopy for eggs

Parasitology

Emulsify feces in SAF preservative immediately after collection.

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology

Parasitic Serology

Serology performed in Puerto Rico

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details)

Microscopy for eggs

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Eye Fluids (aqueous, vitreous)

Fascioliasis Fasciola gigantica Fasciola hepatica

CALGARY

Favus - see: Dermatomycosis Fifth Disease - see: Parvovirus Infections

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Filariasis Wuchereria bancrofti Brugia sps. Loa Loa Mansonella sps. Onchocerca volvulus Dirofilaria immitis

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Thick and thin blood films in slide mailer OR 5 - 7 mL blood with anticoagulant sodium citrate (blue top) tube or EDTA (lavender top) tube.

Microscopy for microfilariae

Parasitology

Microfilariae are usually present in very small numbers in blood during the daytime with peak parasitemia occurring around midnight. To detect nocturnal species, collect blood between 2200 Hours and 0200 Hours. To detect a sub periodic species, blood may be drawn at any time; however, peak filariasis occurs in late afternoon.

Parasitic Serology

Note: For optimal diagnosis, use specialized collection kits available through the Laboratory by prior arrangement (phone 780407-7031).

Microfilaria of Loa Loa have diurnal periodicity, and blood should be drawn between 1000 Hours and 1400 Hours. If species of filarial is not known collect two specimens(between 1000 Hours and 1400 Hours and between 2200 – 0200 Hours) Procedure for Collection of Blood for Detection of Microfilaria

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube.

Serology EIA

Parasitic Serology

Serology referred to the National Institute of Health, Bethesda, Maryland, USA. Travel history and clinical details must be provided on special history form available from the Laboratory.

Food Poisoning - see: Food-borne Bacterial Disease/Syndrome

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Food-borne Bacterial Disease/Syndrome Bacillus cereus, Campylobacter, Clostridium botulinum *, Clostridium perfringens Escherichia coli O157:H7, Listeria* Salmonella Shigella Staphylococcus aureus Yersinia Vibrio*

Specific pathogens*

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

Feces in sterile container

Culture (routine)

SECTION

Food samples should be accompanied by feces from the case and a detailed history when possible.

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Fecal and suspect food samples associated with foodpoisoning are routinely examined for Aeromonas, Bacillus cereus, Campylobacter, Clostridium perfringens, Escherichia coli O157:H7, Salmonella, Shigella, Staphylococcus aureus, and Yersinia. For outbreak investigations, please call Microbiologist/Virologist On Call to coordinate appropriate testing and set up EI #

Follow the Guidelines for Submitting Food Samples to the Provincial Laboratory for Public Health

Follow the Guidelines for Submitting Food Samples to the Provincial Laboratory for Public Health

CALGARY

Food samples are accepted for investigation ONLY when associated with human cases(s) or investigations(s) (may or may not have and EI# at time of submission) related to human infection AND Submitted by a Medical Officer of Health (MOH) or designate (eg. PHI, EHO) Specific pathogens* culture as requested.

*Culture of food samples for Listeria is referred to the Listeriosis Reference Laboratory, Ottawa, Ontario. *Culture of food samples and feces for Clostridium botulinum is referred to the Botulism Reference Service, Ottawa, Ontario.

Also See: Botulism and Listeriosis

Francisella - see: Tularemia

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Fungaemia Yeast

Blood in Bactec vials or Isolator tubes

Microscopy, culture

Bacteriology Mycology

Submit blood for Histoplasma in Isolator tubes. Isolator tubes can be obtained by calling the Laboratory at the Edmonton site. Submit blood for culture of other fungi in Bactec vials. (See: Blood Culture, Bacteriology for collection details).

Fungal Infections Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus, Fusarium, Histoplasma, Mucor, Rhizopus and other fungi

1 - 2 mL sputum; respiratory aspirate in sterile container

Microscopy, culture

Mycology

CSF 1 mL minimum in sterile container

Antigen Detection, culture

Mycology

2 - 10 mL urine in sterile container

Microscopy, culture

Mycology

Biopsy material; pus with granules in a sterile container

Microscopy, culture

Mycology

Ear swab, mouth swab, lip swab, lesion swab in plain transport media (RTM) 1 mL bone marrow in a citrated tube (blue top tube)

Microscopy, culture

Mycology

Microscopy, culture

Mycology

Nail; skin scraping or scales; hair

Microscopy, culture

Mycology

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See: Dermatophytes for collection of hair, skin and nails. Con’t…

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Blastomycosis, Coccidioidomycosis, and Histoplasmosis

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Corneal or conjunctival scraping

Microscopy, culture

Mycology

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Blastomycosis (ID), Coccidioidomycosis (EIA, ID), Histoplasmosis (ID) Please specify

Virology

Culture

Bacteriology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Galactomannan - see: Aspergillus Antigen Detection Gas Gangrene - see: Anaerobic Infections Gastritis Helicobacter pylori

Gastric or peptic ulcer biopsy submitted in a sterile container with 1mL sterile normal saline

Transport to lab ASAP (within 2 hours)

Gastroenteritis - see: Food-borne Bacterial Disease/Syndrome and Diarrhea, Parasitic and Diarrhea, Viral Genital Infections Bacterial Vaginosis

Vaginal smear and/or vaginal swab in plain transport media (RTM) Air dry slide, DO NOT fix

Microscopy, (Culture is not routinely performed)

Bacteriology

Only specimens with relevant clinical details will be cultured, after consultation with Microbiologist/Virologist. Only bacteria known to be pathogenic in the female genital tract are reported. The presence of Trichomonas or yeast may be reported from the smear.

Genital Infections Candidiasis

Vaginal or urethral smear AND swab in plain transport media (RTM)

Microscopy

Bacteriology

Only genital specimens with relevant clinical details are cultured for Candida sp.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Genital Infections Chancroid (soft chancre) Haemophilus ducreyi

Bubo pus – Bubo aspirate is obtained using needle and syringe to aspirate pustular material from the bubo. Place aspirate into securelyclosed sterile unbreakable tube. Dacron or cotton swab – Best collected by cleansing the area by flushing with sterile physiological saline, and then collecting material from the base of the ulcer. Swab may be submitted dry, or placed into 1mL Universal Transport Medium (UTM) Hold specimen at 4ºC (refrigerate) prior to transport to ProvLab.

PCR

Bacteriology

Specimens are referred to the National Microbiology Laboratory, Winnipeg Manitoba.

Genital Infections Chlamydia, Mycoplasma and Ureaplasma Infections Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis

Urethral, vaginal, cervical swabs in Universal Transport Medium (UTM)

Mycoplasma Culture Ureaplasma Culture

Bacteriology

Routine culture of Mycoplasma hominis and Ureaplasma urealyticum is not performed without relevant clinical diagnosis.

Urethral, vaginal, endocervical specimens *

Chlamydia NAAT

Bacteriology

* See Chlamydia Infections, Chlamydia trachomatis for collection details. Con’t…

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GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Prostatic fluid, amniotic fluid, endometrial tissue in sterile containers

Mycoplasma culture

Bacteriology

Ureaplasma may be implicated in non-gonococcal urethritis, Reiter’s syndrome and infertility. Susceptibility testing not routinely performed.

Chlamydia trachomatis only

PCR

See Chlamydia Infections, Chlamydia trachomatis

Genital Infections Gonorrhea Neisseria gonorrhoeae including infections of the urethra, vulva, vagina, cervix, rectum, conjunctiva, joints, throat Endocervical Swab: Use Gen-Probe APTIMA® unisex swab specimen collection kit available from Laboratory

NAAT

Bacteriology/ Virology

In females, specimens should be obtained from the cervix if possible; vaginal swabs have not been validated in the laboratory.

Male Urethral Swab: Use Gen-Probe APTIMA® unisex swab specimen collection kit available from Laboratory

NAAT

Bacteriology/ Virology

Urethral swabs may cause discomfort to male patients. A urine is an appropriate specimen that can be taken instead of a urethral swab.

Urine (Male and female): Use Gen-Probe APTIMA® collection kit available from Laboratory

NAAT

Bacteriology/ Virology

First catch urine without having voided for at least 1 hour: 20-30 ml (beginning of a stream in a sterile container). Transfer 2 ml urine to a Gen-Probe APTIMA® Urine collection kit within 24 hours of collection. Con’t…

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Vaginal swabs*: Use Gen-Probe APTIMA® vaginal swab specimen collection kit available from Laboratory Extragenital sites: See Notes *

NAAT

Bacteriology/ Virology

* Vaginal swabs have not been validated in the laboratory but may be processed (if the cervix is absent, or for children under 12 years of age) following consultation with the Microbiologist/Virologist On call.

Genital swab: Endocervical and male urethral

Culture

Bacteriology

Ano-rectal: swab in charcoal transport media (CTM)

Culture

Bacteriology

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* None of the current commercial NAAT testing platforms have Health Canada or FDA approval for extra-genital specimen testing. For non-STI clinic and non-reproductive health clinic patients, if CT/NG on extra-genital specimens is required, in addition to or instead of culture, please contact the Microbiologist/Virologist On Call. Swabs: Specimens should be collected with Dacron or Rayon swabs and submitted in charcoal transport medium. Calcium alginate swabs may be toxic to gonococci and therefore they should be avoided. Cervical - insert swabs into endocervical canal exposed with a speculum moistened with warm water (no other lubricant). Allow 10-20 seconds for absorption of exudate. Male urethral swab - swab anterior 3 cm of urethra using thin tipped swab - wipe orifice dry, massaging urethra towards it to express exudate. Ano-rectal - swab crypts inside anal ring, allowing 10 seconds for absorption of pus. Con’t…

65

LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Conjunctival swab: in charcoal transport media (CTM)

Culture

Bacteriology

Throat: swab in charcoal transport media (CTM)

Culture

Bacteriology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Vaginal - not acceptable for culture from adults but may be sent from children (12 years and younger) with suspected vulvovaginitis or from post-hysterectomy patients. Organisms may not survive if transit exceeds 12 hours. If transport delayed, keep specimens in CTM at room temperature – DO NOT refrigerate. Joint aspirate in a sterile container

Microscopy, culture

Bacteriology

Genital Infections - Herpes Simplex Virus

Cervical, urethral, lesion swab in Universal Transport Medium (UTM)

NAT (PCR)

Virology

Genital Infections Trichomoniasis Trichomonas vaginalis

Urethral, vaginal, cervical swab in plain transport media (RTM)

Culture available in selected cases

Bacteriology

Vaginal smear

Microscopy

Bacteriology

Vigorously swab base of lesion. Specimen must contain basal epithelial cells. Place swab in Universal Transport Medium (UTM). Refrigerate but DO NOT freeze specimens.

German Measles - see: Rubella

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GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

Giardiasis Giardia lamblia

Gnathosomiasis

Granuloma Inguinale (venereum) Calymmatobacterium granulomatis

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details) Water: see: Water: Parasites and Enteric Bacteria 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Microscopy for trophozoites and cysts

Parasitology

Emulsify feces in SAF preservative immediately after collection. Specimens taken in the acute stage are usually positive but occasionally the parasite is not detectable during the first week or two of the disease.

Serology

Parasitic Serology

Referred to the Mahidol University, Bangkok, Thailand

Biopsy (punch) granulation tissue from edge of lesion

Microscopy

Bacteriology

Microscopy for the characteristic intracellular Donovan bodies.

Smears from undersurface of biopsy

Microscopy

Bacteriology

Culture

Bacteriology

Feces from HUS cases will be cultured for routine bacterial enteric pathogens including Escherichia coli O157:H7 and Shigella.

PCR – Verotoxin genes

Molecular Diagnostics

PCR can be performed on feces directly or on bacterial isolates. Testing available only on consultation with the Microbiologist/Virologist On Call. Con’t…

Guinea-Worm Disease - see: Dracunculiasis Haemolytic Uremic Syndrome (HUS)

Feces in a sterile container. When transport of feces exceeds 24 hours, submit in enteric transport media.

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

If Streptococcus pneumoniae is the suspected agent of HUS, consult Microbiologist/Virologist On Call. Haemophilus ducreyi - see: Genital Infections – Chancroid Haemophilus influenzae - see: Meningitis, Bacterial and Epiglottitis Hand-foot-and-mouth Disease - see: Enterovirus Infections Hantavirus Adult Respiratory Distress Syndrome (Sin Nombre virus is the etiologic agent of HPS)

7 mL blood, clotted (red top tube)

Serology EIA, IgM, IgG

5 mL blood (EDTA, lavender top tube)

PCR

Virology

Clinical, recent rodent exposure and travel history is required on requisition. Testing is performed on symptomatic patients only. For STAT testing please consult the Microbiologist/Virologist On Call at Calgary or Edmonton. Specimens are referred to the National Microbiology Laboratory, Winnipeg, Manitoba. Sin Nombre virus is the etiologic agent of hantavirus pulmonary syndrome (HPS) in North America. For patients with suspected hemorrhagic fever with Renal Syndrome (HFRS), Hantavirus (Cardio-) Pulmonary Syndrome (HPS or HCPS), or related hantavirus infections, consult the Microbiologist/Virologist On Call at Calgary or Edmonton. PCR testing available in highly suspect cases. Consult the Microbiologist/Virologist On Call at Calgary or Edmonton.

Helicobacter pylori - see: Gastritis

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Hepatitis A Virus (Infectious Hepatitis, HAV) Hepatitis A virus

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA: HAV IgM, HAV IgG

Virology

Specify HAV IgM for suspected acute illness or HAV IgG for immunity determination. IgM may be negative if the patient is tested in the first 3 - 5 days after onset. Consider retesting 7 - 10 days later if Hepatitis A is suspected. Note: HAV IgM antibody may be detectable after the patient has been recently immunized. For assessment of immunity to Hepatitis A, request HAV IgG. Testing after two doses of the vaccine is not required unless the patient is immunocompromised or there are reasons to ensure immunity.

Hepatitis B Virus (Serum Hepatitis, HBV) Hepatitis B virus

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA*: HBsAg, antiHBs, anti-HBc total, anti HBc IgM, HBeAg, antiHBe, Please specify.

Virology

* For diagnosis of acute or chronic Hepatitis B carrier status, request HBsAg. *For diagnosis of previous exposure to hepatitis B virus, request total antibody to hepatitis B core antigen, HBsAg and anti-HBs. *For assessment of immunity to Hepatitis B, request anti-HBs. IgM antibody to core (core IgM Ab) is helpful in assessing an acute infection or if the patient is in the “window period” when HBsAg is absent and anti-HBs is not yet detectable, or reactivation of IgM in chronic carriers. Con’t…

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

HBV e antigen and anti-HBe are helpful in the evaluation of a chronically infected patient for treatment or monitoring. 5 mL serum separator tube (SST) or pediatrics

Serology EIA: quantitative HBsAg (qHBsAg)

Serology

Note: This test can only be ordered by a select list of specialist hepatologist/ ID physicians that manage chronic HBV infections on a regular basis. Such patients will be already on treatment with interferon or nucleos(t)ide analogues, for whom this test (in conjunction with the HBV VL test) will be helpful in managing their antiviral therapy.

HBV DNA PCR (Quantitative)

Virology

The HBV-DNA assay is a measure of the viral replication and is indicated for the monitoring of patients who are on treatment or are being evaluated for treatment. Samples submitted for molecular investigations must be DEDICATED specimens to avoid contamination or degradation of the viral nucleic acid.

may use 2 mL red top tube

Two full DEDICATED 4 mL EDTA (lavender top) tubes. Pediatric only: Collect one full DEDICATED 2 mL EDTA (lavender top) tube. DO NOT centrifuge. DO NOT open tubes. Ship on ice/cold pack (NOT FROZEN). Must reach the Laboratory within 24 hours of collection. A special requisition requesting specific clinical information is

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Con’t…

70

LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA: HCV Ab

Virology

Hepatitis C virus HCV antibody testing is an assessment for exposure to and infection with HCV. Detection of antibody to hepatitis C can be due to a chronic infection or a recent infection.

Blood: at least 3 mL/tube in two DEDICATED serum separator tubes (SST) Centrifuge at 3000 RPM for 10 minutes, DO NOT pour off, refrigerate until transport. Transport on ice, must be received within 24 hours of collection.

HCV RNA PCR (quantitative) and HCV genotyping

Virology

HCV RNA PCR (quantitative) and HCV genotyping testing are performed only if the patient is being assessed for treatment or is on treatment. The molecular assay is helpful in diagnosis of the presence or absence of viraemia, especially for a patient with indeterminate serology.

required for ordering of HBV DNA PCR test. Please contact the Distribution Centre, Edmonton site, to obtain this requisition. Hepatitis C Virus (HCV)

Samples submitted for molecular investigations must be DEDICATED specimens to avoid contamination or degradation of the viral nucleic acid.

For pediatric collection: at least one 2 mL DEDICATED red top tube. DO NOT spin. DO NOT pour off. Ship on ice/cold packs GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

Con’t…

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Clinical history required. Patient must be HBsAg positive before further testing for Hepatitis D. HDV infections are rare in Canada. Referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

(NOT FROZEN). Must be received within 6 – 8 hours of collection. A special requisition requesting specific clinical information is required for ordering of HCV PCR test. Please contact the Distribution Centre, Edmonton Site to obtain this requisition. Hepatitis Delta Virus – see: Hepatitis D Virus Hepatitis D Virus (Delta Hepatitis, Delta Agent, HDV) Hepatitis delta virus

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA: anti-HDV

Virology

NAT

Molecular Diagnostics

Hepatitis E Virus (HEV) Hepatitis E virus

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA: HEV

Virology

Relevant travel history is required on the requisition. HEV infections are not endemic to Canada or the USA. Exclude other common causes of hepatitis e.g., HAV and HBV if not travel-related. Referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

Herpangina – see: Enteroviruses

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

Lesion swab* in Universal Transport Medium (UTM)

NAT (PCR)

Virology

Swab base of lesion and place swab in Universal Transport Medium (UTM). Refrigerate but DO NOT freeze specimens. Swab of lesion (blister) for PCR is more specific and a more appropriate specimen than serology.

Bronchoscopy

HSV, NAT (PCR)

Virology

For suspected aseptic meningitis or encephalitis: At least 0.51mL DEDICATED CSF sample for CSF panel PCR tests in a sterile container

NAT (PCR) CSF Panel (HSV, VZV, enterovirus, parechovirus)

Molecular Diagnostics

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA: HSV IgG Type specific HSV serology**

Virology

For visceral disseminated disease of the newborn or the immunodeficient 1 – 2 mL blood in EDTA(Lavender top) tube

NAT (PCR)

Molecular Diagnostics

Herpes Simiae Virus Infections - see: B Virus Infections Herpes Simplex Virus Infections (HSV)

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Bloody CSF is not optimal for PCR tests. Providing clinical information with the test request is extremely helpful for the Laboratory. Refrigerate CSF until transport. If specimen can be received in the Laboratory within 24 hours of collection then ship on ice/cold packs. If transportation might exceed 24 hours from collection then freeze at -70°C and transport on dry ice. ** Specify HSV type specific serology on the requisition. Provide clinical history and indication of testing. Contact the Laboratory prior to collection. HSV IgM serology is no longer available.

Con’t…

73

LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Biopsy material/ autopsy material in a sterile container

NAT (PCR)

Molecular Diagnostics

Consult Microbiologist/Virologist On Call

Herpes Zoster Virus - see: Varicella Zoster Virus Infections Heterophile Negative Mononucleosis - see: Cytomegalovirus Infections Heterophyiasis Feces in SAF Microscopy for eggs Parasitology preservative (see Heterophyes heterophyes, Diarrhea, Parasitic for Metagonimus yokogawai (opisthorchids) collection details) Histoplasmosis (Histoplasma capsulatum)- see: Fungal Infections and Fungal Serology

Emulsify feces in SAF preservative immediately after collection.

HIV - see: Human Immunodeficiency Virus Hookworm Disease Feces in SAF preservative (see: Ancylostoma duodenale, Diarrhea, Parasitic for Necator americanus, Trichostrongylus sp. collection details) HSV - see: Herpes Simplex Virus Infections

Microscopy for eggs and/or larvae

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Molecular Quantification

* Indications for HHV6 testing according to the National Microbiology Laboratory (Public Health Agency of Canada) testing criteria:

HTLV I/II - see: Human T Cell Leukaemia/Lymphoma Virus HTLV III - see: Human Immunodeficiency Virus Human Herpesvirus Type 6 (HHV6)

Plasma – collect > 2 mL blood in EDTA (lavender top) tube only. DO NOT USE heparin as an anti-coagulant.

Quantitative PCR detection of Human Herpesvirus 6 (HHV-6) DNA.

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

 Primary infection or reactivation in Immunocompromised individuals: Plasma.  Encephalitis cases: CSF

CSF – Minimum 500 uL. Testing performed according to guidelines*.

FOR CSF-If specimen can be received in the laboratory within 24 hours of collection then ship on ice pack/ice. If transportation might exceed 24 hours from collection then freeze at -70º C and transport on dry ice. Referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

Human Immunodeficiency Virus (HIV 1 and 2, HTLV III, LAV, AIDS, ARC)

HIV serology: Collect 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube.

HIV Antibody Serology screen by EIA, and confirmation by Western blot*

Virology

* Provide risk factor information on the requisition. All samples are jointly screened for HIV 1 and 2 antibodies by EIA, and reactive samples after initial screen are confirmed by Western blot for the first cases. All patients must be counselled appropriately prior to testing for HIV, which is a notifiable disease in Alberta.

Human Immunodefiency Virus 1 and 2

HIV viral load: for monitoring of patients on therapy (to be ordered under guidance of Infectious Disease Specialist only):

HIV PCR-viral load (quantitative)

Virology

Specify on the requisition the ID specialist involved. Samples submitted for molecular investigations must be specific DEDICATED specimens to avoid degradation of the viral nucleic acid.

Two full DEDICATED 4 mL EDTA (lavender GUIDE TO SERVICES Version 6.13 – 2015 February 02 UNCONTROLLED PRINT COPY VALID ONLY FOR 5 DAYS FROM PRINT DATE. Visit www.provlab.ab.ca/guide-to-services.pdf for the most current version of this document.

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

top) tubes. Pediatric only: One full DEDICATED 2 mL EDTA (lavender top) tube. DO NOT centrifuge. Ship on ice or cold pack (NOT FROZEN). Must reach the Laboratory within 8 hours of collection. OR Remote Areas: Two full DEDICATED 5 mL PPT (Plasma Preparation Tubes) Centrifuge both tubes. DO NOT open or pour off. Refrigerate until transport. Ship on ice or cold pack. (For outside Calgary Zone and Edmonton Zone PPT may be ordered from the Distribution Centre, Edmonton Site.

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Blood: as much as possible in two 4 mL EDTA (lavender top) tubes. Preferred collection on Monday and Tuesday to allow shipping of whole blood before Wednesday.

HIV Clade Test HIV proviral DNA PCR

Virology

Consult Microbiologist/Virologist On Call at Calgary or Edmonton before collecting specimens for HIV proviral DNA or Clade Test. Testing is referred to the National Laboratory for HIV Reference Services in Ottawa, Ontario.

HTLV Antibody Serology screen by EIA, confirmation by Western Blot.

Virology

History is required. Samples are screened at the Laboratory for HTLV I and II, and reactive sera are referred to the National Laboratory for HIV Reference Services in Ottawa, Ontario for Western blot. Follow-up blood samples for molecular analysis may be required depending upon serology results.

Microscopy for eggs

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Microscopy, culture

Bacteriology

Human Metapneumovirus – see: Respiratory Infections, Viral and Atypical Bacteria Human T Cell Leukemia/Lymphoma Virus Type I HTLV I, Virus Type II – HTLV II

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Hydatid Disease - see: Echinococcosis

Hymenolepiasis Hymenolepis nana Hymenolepis diminuta

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details)

Ice - see: Water: Bottled and Packaged Ice Impetigo Streptococcus pyogenes Staphylococcus aureus

Lesion swab in plain transport media (RTM)

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

Infectious Mononucleosis - see: Epstein-Barr Virus Infections

Influenza Influenza viruses types A,B

Nasopharyngeal swab or aspirate, or throat swab* in Universal Transport Medium (UTM)

Respiratory Virus Panel NAT (PCR)

Molecular Diagnostics

Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory.

Aspirated material from respiratory tract in original collection device, or bronchoscopy

Respiratory Virus Panel NAT (PCR)

Molecular Diagnostics

For suspected outbreak, please contact the Zone Medical Officer of Health and consult with the Microbiologist/Virologist On Call at Calgary or Edmonton to obtain an EI number.

Autopsy or biopsy material (lung) in sterile container

Respiratory Virus Panel NAT (PCR)

Molecular Diagnostics

Consult Microbiologist/Virologist On Call.

Molecular Diagnostics

Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory.

Itraconazole Levels - see: Antifungal Levels

Kala Azar - see: Leishmaniasis Kaposi’s Varicelliform Dermatitis - see: Herpes Simplex Virus Infections Keratomycosis - see: Fungal Infections Laryngitis, Viral Several viruses including adenovirus, parainfluenza virus, respiratory syncytial virus, influenza virus,

Nasopharyngeal (NP) swab (rayon swab) or aspirate or auger suction in Universal Transport Medium (UTM) (see:

NAT (PCR) – Respiratory Virus Panel

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rhinovirus, echovirus and coronavirus

Echovirus: see Enterovirus

SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

NAT (PCR) – Respiratory Virus Panel

Molecular Diagnostics

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube. Submit acute before day 8 and convalescent after day 22.

Serology IFA

Virology

Serology performed only when suitably spaced sera and relevant history, including onset of symptoms, are received. Incomplete specimens held for 3 months.

Lung tissue; 1 - 2 mL pleural fluid; tracheal aspirate; bronchoscopy specimen in sterile container. Sputum is not recommended.

DFA, Culture

Bacteriology

Transport culture specimens to the Laboratory immediately. If stored, keep at 4°C. Samples in formalin or saline acceptable for direct fluorescent antibody (DFA) only. DFA performed by prior arrangement with Microbiologist/Virologist On Call only.

Nasopharyngeal Aspirates, Viral for collection details) Throat swab can also be collected in Universal Transport Medium (UTM)

Lassa Fever – see: Viral Hemorrhagic Fever Legionnaires Disease Legionella sp.

Calgary clients should submit requests for clinical Legionella investigation to Calgary Laboratory Services. Please use CLS requisition. Con’t…

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Leishmaniasis, Cutaneous Form Leishmania tropica

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Blood culture: See: Notes

Culture

Bacteriology

If blood stream infection is suspected, contact the Microbiologist/Virologist On Call for collection details.

Biopsy or aspirate from edge of lesion

Microscopy, culture

Parasitology

Culture performed only by prior arrangement with Microbiologist/Virologist. Material from the surface or from necrotic areas of the ulcer is unsuitable for detection of the parasite. For details see Leishmania Specimen Collection Instructions Note: Serology is unsuitable for diagnosis of cutaneous Leishmaniasis.

Leishmaniasis, Mucocutaneous Form Leishmania brasiliensis Leishmania mexicana

Leishmaniasis, Visceral Form (Kala Azar) Leishmania donovani

Biopsy or aspirate from edge or bed of lesion

Microscopy, culture

Parasitology

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube Tissue smears of liver, spleen, lymph nodes in a slide mailer

Serology

Parasitic Serology

Microscopy, culture

Parasitology

Microscopy, culture

Parasitology

Bone marrow films in a slide mailer

Culture performed only by prior arrangement with Microbiologist/Virologist. Material from the surface or from necrotic areas of the ulcer is unsuitable for detection of the parasite. For details see Leishmania Specimen Collection Instructions Serology performed at National Reference Centre for Parasitology, McGill University Centre for Tropical Disease/Centre for Disease Control, Atlanta, Georgia, U.S.A. Culture performed only by prior arrangement with Microbiologist/Virologist.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology

Parasitic Serology

Serology performed at National Reference Centre for Parasitology, McGill University Centre for Tropical Disease/Centre for Disease Control, Atlanta, Georgia, U.S.A.

Biopsy of affected tissue, usually skin nodes; nasal scrapings; submit in sterile screw cap tube

Microscopy

Mycobacteriology

Slit skin smear in slide mailer

Microscopy

Mycobacteriology

Mycobacterium leprae can be identified only by microscopic morphology; it does not grow in cultures which are performed in order to exclude other mycobacterial infections. Repeated skin biopsies, every 3 months, are a valuable index of therapeutic response in diagnosed cases under treatment. Contact Mycobacteriology at 780-407-8989 for further inquiries. Consult with Microbiologist/virologist On Call prior to submission.

Leptospirosis Leptospira sp.

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube Submit acute and convalescent 4-5 weeks apart.

Serology

Virology

Most infections are diagnosed serologically. Serology referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

Listeriosis

CSF in sterile container

Microscopy, Culture

Bacteriology

May cause meningitis, or granulomatous disease in the newborn; abortion and fetal death, and meningitis in adults.

Blood culture (see Blood Culture for collection details)

Culture

Bacteriology

Leprosy Mycobacterium leprae

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

NOTES

Isolate in plain transport media (RTM) or blood agar slant (BAS) Suspected food in sterile WHIRL-PAK® bag or original package. Submit at least 100 grams or mL whenever possible. (see: Foodborne Disease/Syndromes for more collection details)

Serotyping

Serotyping is referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

Culture

Suspect foods are referred for culture to the Listeriosis Reference Laboratory, Ottawa, Ontario.

Lung Abscess Various bacteria, especially anaerobes, often in mixed culture

1 - 2 mL bronchoscopy specimens; transtracheal aspirate

Microscopy, culture

Bacteriology

Lyme Disease Borrelia burgdorferi, afzelii and garinii

5 mL serum separator tube (SST)

EIA

Virology

Consult Microbiologist/Virologist On Call for testing.

Loiasis – See: Filariasis Loa loa

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The screening EIA detects antibodies to the three genospecies of Lyme disease; B. burgdorferi, afzelii and garinnii. Sera that screen positive and equivocal are referred to the National Microbiology Laboratory, Winnipeg, Manitoba for Western Blot confirmation. B. burgdorferi is only found in North America, hence travel history and/or residency outside of North America must be provided for testing to the European Con’t…

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

genospecies (B. afzelii and garinii) to be performed Sera collected within the first two weeks of acute onset or if the patient is treated in this phase can result in negative serology. Repeat testing is indicated if the patient is untreated and clinical suspicion is high. Punch biopsy from EM in Viral transport medium

PCR

Virology

Tick for identification in sterile container

Tick Speciation

Parasitology

In specific cases a punch biopsy taken from the margin or centre of the erythema migrans (EM) can be sent for PCR testing for this agent, before treatment is initiated. Sensitivity is 50 to 70%. Consult the Microbiologist/Virologist On Call before sending samples. The tick will be speciated if clinically indicated. Consult the Microbiologist/Virologist On Call if further testing is necessary under specific circumstances. For details on tick collection from environmental sources (NOT clinical samples),see: Alberta Government "Surveillance of Ticks On Humans and in the Environment"

Lyme neuroborreliosis

Paired CSF (2mL) and 5 mL serum separator tube (SST)

Comparative IgG levels between serum and CSF

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Testing performed at National Microbiology Laboratory, Winnipeg, Manitoba in strongly suspected cases of neuroborreliosis Must be confirmed to be serologically positive for LD. Total IgG and albumin levels must accompany these samples. PCR on CSF is available but the yield is =3 months from case isolate.

B. Nontuberculous Mycobacterial (NTM) infections -susceptibility tests to established drugs are routinely done on sterile site specimens or by request to the Microbiologist On Call

If at least 5 mL blood

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Gastric Wash: Phosphate buffer kits for gastric washes are available from the Distribution Centre 780-407-8971(Edmonton) or 403-944-2583 (Calgary) Swabs of clinical material are NOT recommended. If necessary, dry swabs are preferred (DO NOT use transport media)

If nontuberculous Mycobacteria/ atypical (NTM) infection suspected, please provide clinical details to facilitate appropriate selection of laboratory culture/media/incubation parameters to optimize recovery of fastidious species. NEW direct smear positive cases and NEW culture positive TB complex cases are telephoned immediately to the appropriate public health agencies. TB smear results are routinely available within 24 hours of specimen receipt. If STAT Testing is required please notify the Laboratory at: Con’t…

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

cannot be obtained for culture, BACTEC Myco/F Lytic vials may be inoculated at the patient bedside**

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

780-407-7121 403-944-1200

TB PCR results are available within 48 hours of specimen receipt; reports are phoned or faxed as soon as they are available. *To obtain SPS tubes, please contact the Laboratory Distribution Centre (Edmonton) or Calgary Laboratory Services (Calgary)

Mycobacterium leprae see: Leprosy

Ureaplasma spp. infections, respiratory- neonatal or infants (≤3 months)

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Edmonton: Calgary:

Bone marrow 1-5 mL in a SPS* (yellow top) Culture only

Mycoplasma Infections, Respiratory Mycoplasma pneumoniae, (atypical pneumonia)

CALGARY

**To obtain BACTEC Myco/F Lytic vials, please contact the Mycobacteriology Dept. (Calgary or Edmonton) 1 - 2 mL Tracheal aspirate; bronchial wash; auger suction in Universal Transport Medium (UTM)

Culture

Bacteriology

Mycoplasma pneumoniae causes “primary atypical pneumonia". Culture results may not be available for up to four weeks. “Routine” Mycoplasma culture from respiratory specimens is not recommended.

PCR

Bacteriology

Ureaplasma spp. Have been associated with respiratory disease in neonates and infants (≤3 months) Mycoplasma pneumoniae and other Mycoplasma species as well as Ureaplasma urealyticum and Ureaplasma parvum (previously known as Con’t…

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

U. urealyticum biovar 1) can be identified using PCR at National Microbiology Laboratory, Winnipeg, Manitoba Mycoplasma and Ureaplasma spp. PCR done only with sufficient clinical history and discussion with Microbiologist/Virologist-On-Call at Calgary or Edmonton

Mycoplasma Infections, Ureaplasma Infections, Genital and NonRespiratory Sites Ureaplasma urealyticum Mycoplasma genitalium, Mycoplasma hominis Ureaplasma spp

Urethral; vaginal; cervical swabs in Universal Transport Medium (UTM)

Culture

Bacteriology

Routine culture of Mycoplasma hominis or Ureaplasma urealyticum is not performed without relevant clinical diagnosis. Ureaplasma strains may be implicated in nongonococcal urethritis, Reiter's syndrome and infertility. Mycoplasma and Ureaplasma spp. PCR done only with sufficient clinical history and discussion with Microbiologist/Virologist On Call at Calgary or Edmonton. Mycoplasma pneumoniae and other Mycoplasma species as well as Ureaplasma urealyticum and Ureaplasma parvum (previously known as U. urealyticum biovar 1) can be identified using PCR at National Microbiology Laboratory, Winnipeg, Manitoba

Myiasis Larvae of various flies, commonly Wohfahrtia species (flesh flies)

Tissue biopsy or living larvae (maggots) in sterile screw capped container

Microscopy

Parasitology

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Myocarditis/Pericarditis, Viral Coxsackie B viruses and other enteroviruses, M pneumoniae adenovirus, parvovirus, CMV and rarely influenza virus

Nasopharyngeal Aspirate, Viral Upper Respiratory Infections

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Throat swab in Universal Transport Medium (UTM)

NAT (RT-PCR) for enteroviruses

Molecular Diagnostics

Refrigerate but DO NOT freeze specimens. Specify enterovirus for appropriate viral testing of throat swab and stool specimen.

Feces in a sterile container

NAT (RT-PCR) for enteroviruses

Molecular Diagnostics

Refrigerate but DO NOT freeze

NP Swab

Respiratory viruses

One 4 mL EDTA (lavender top) tube for molecular assays

NAT (PCR) for adenoviruses, CMV NAT (RT-PCR) for enteroviruses NAT Parvovirus

Molecular Diagnostics Molecular Diagnostics NML

Sample referred to National Microbiology Laboratory, Winnipeg, Canada.

Myocardial biopsy (if available) in sterile container or Universal Transport Medium (UTM)

Molecular Diagnostics

*NAT (PCR) test available for adenovirus, CMV and parvovirus, NAT (RT-PCR) for enterovirus if specifically requested. Consult Microbiologist/Virologist On Call.

Pericardial fluid in sterile container

Molecular Diagnostics

Secretions in Universal Transport Medium (UTM)

PCR – Respiratory Virus Panel. Specify specimen source and suspected virus on the requisition.

Molecular Diagnostics

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Use the smallest available feeding tube (preferably a size 6) and attach it to a 3 or 5 mL syringe. Measure the distance from the corner of the nose to the front of the ear and insert the feeding tube for half this length into the posterior nasopharynx. Con’t…

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Gently apply suction on the syringe and pull the inserted tube out at the same time. Note: insertion of the tube usually induces a cough. Place the inserted end of the feeding tube into the transport medium and use gentle suction with the syringe to rinse the feeding tube a few times. Use scissors to cut the end of the feeding tube so that it does not protrude above the rim of the transport medium container. Ensure that the lid of the container is screwed on tight. Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory. Nasopharyngeal aspirates are NOT appropriate for routine bacterial culture. NGU - (non-gonococcal urethritis) see: Genital Infections and Chlamydia (Trachomatis) and Mycoplasma Infections

Nocardiosis Nocardia asteroides Nocardia sp.

Respiratory specimen in a sterile container

Culture

Mycology

Cutaneous specimen – submit in a fungus/mycology kit

Culture

Mycology

Norovirus see: Diarrhea, Viral (renamed from Norwalk Virus, Norwalk agent, Norwalk-like viruses)

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Onchocerciasis Onchocerca volvulus Dipetalonemia (Mansonella) Dipetalonema Streptocerciasa

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Aspirated material from skin nodules; excision of nodule; skin snips

Microscopy for microfilariae and adult worm

Parasitology

See also Filariasis.

5 mL serum separator tube (SST) or pediatrics use 2 mL red top tube

EIA

Parasitic Serology

Test performed at National Institute of Health, Bethesda, Maryland, USA.

Staphylococcus aureus is the most common agent.

Onychomycosis - see: Fungal Infections and Dermatophytes Orchitis - see: Mumps Orf - see: Poxvirus Infections Ornithosis - see: Chlamydia Infections Osteomyelitis, Acute Staphylococcus aureus and other bacterial species

Ova and Parasites

Blood culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

Purulent skin/lesion discharge; aspirated pus; lesion swab in plain transport media (RTM)

Microscopy, culture

Bacteriology

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details)

Microscopy

Parasitology

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Panencephalitis (subacute sclerosing) (SSPE) – see: Measles Papillomavirus see: Human Papillomavirus

Papovavirus Infections see: Human Papillomavirus, Progressive Multifocal Leukoencephalopathy, BK Virus

Paragonimiasis Paragonimus westermani

Parainfluenza Virus Infections Parainfluenza viruses (types 1-4)

Paralytic Illnesses, Viral Several viruses especially poliovirus and other enteroviruses, West Nile Virus and herpesviruses,

Feces in SAF preservative Sputum; respiratory secretions, aspirates or biopsies in a sterile screw cap container Nasopharyngeal swab or aspirate, or throat swab* in Universal Transport Medium (UTM)

Microscopy for eggs

Parasitology

Adult parasite identification Microscopy for eggs

Parasitology

NAT (PCR)– Respiratory Virus Panel

Virology Molecular Diagnostics

Aspirated material from respiratory tract in original collection device, or bronchoscopy

NAT (PCR)– Respiratory Virus Panel

Virology Molecular Diagnostics

Autopsy or biopsy material (lung) in a sterile container. If multiple PCR tests are requested on a CSF, submit at least 1 mL of DEDICATED CSF to The Laboratory and specify

PCR – Respiratory Virus Panel

Molecular Diagnostics

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Emulsify feces in SAF preservative immediately after collection. Referred to National Reference Centre for Parasitology, McGill University Centre for Tropical Disease/Centre for Disease Control, Atlanta, Georgia, U.S.A. Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory. Microbiologist/Virologist On Call consult required.

Providing clinical information with the test request is extremely helpful for the Laboratory. If specimen can be received in the Laboratory within Con’t…

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and as part of encephalomyelitis, or ascending myelitis syndromes. In HIV infected patient, consider CMV-related myelitis. Consult Microbiologist/Virologist-On Call at Calgary or Edmonton before submitting CSF for CMV testing.

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

the virus for PCR test request.

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

24 hours of collection then ship on ice/cold packs. If transportation might exceed 24 hours from collection then freeze at -70°C and transport on dry ice.

Suspected enterovirus encephalitis: See: Enterovirus Infections

Suspected HSV Panel testing (enterovirus, myelitis: HSV-1/2 and VZV) DEDICATED CSF sample in a sterile container (at least 1 mL) for HSV PCR Suspected West Nile Virus encephalitis: See: West Nile Virus Infections Paralytic Shellfish Poisoning - see: Shellfish Poisoning

Molecular Diagnostics

Paratyphoid Fever - see: Typhoid Fever Parvovirus Infections Human parvovirus Fifth Disease

For Immunity Determination: Collect 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA: Parvovirus IgG only

Virology

Con’t…

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GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

For Suspected Acute Disease: Provide clinical history on requisition and collect 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Parvovirus IgG, IgM*

Virology

*IgM will only be performed if clinical history of suspected rash illness or acute infection is provided on the requisition. Acute serum collected in the first 3 days of rash may test as falsely negative. A follow-up sample should be sent at least 5 days after onset to verify the initial negative IgM, especially if the initial IgG is negative. For immunocompromised patients, e.g. transplant recipients, the IgM serological response may be absent. Suspected parvovirus infection, usually in the form of chronic anemia or neutropenia, can be diagnosed by PCR testing of a bone marrow aspirate.

Pediculosis Pediculus humanus capitis Pediculus humanus corporis Phthirus pubis Pemphigus Staphylococcus aureus

Collect 1 – 2 mL bone marrow or whole blood in EDTA (lavender top) tube or 5 mL serum separator tube (SST). DO NOT centrifuge.

Parvovirus PCR **

Virology

**Clinical history is required for Parvovirus PCR test. Parvovirus PCR is referred to the National Microbiology Laboratory, Winnipeg, Manitoba for testing. Consult with the Microbiologist/Virologist On Call at Calgary or Edmonton if molecular testing is required. Send samples on Monday, Tuesday or Wednesday to allow for shipping due to the time sensitive nature of the test (unless it is a STAT holiday).

Parasites or eggs in hair or underclothing

Microscopic identification

Parasitology

Submit lice or nits in a clear dry container (may be submitted in 70% ethanol).

Vesicle fluid swab in plain transport media (RTM)

Microscopy, culture

Bacteriology

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SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

PCR

Molecular Diagnostics – Edmonton

Collect nasopharyngeal swab using nylon flocked swab provided in collection kit. Gently insert swab straight into nostril, near the septum and below the turbinates, until it reaches the posterior nares. Leave in place for a few seconds. Patient may cough from the tickling sensation. If resistance is encountered, try the other nostril.

Pericarditis, Viral - see: Myocarditis/Pericarditis, Viral Pertussis Bordetella pertussis

One nasopharyngeal swab collected with nylon flocked/plastic shaft swab placed into Regan Lowe Transport Medium (RLTM)

Bacteriology Calgary

Check expiry date on RLTM. Place swab into RLTM; break shaft at the score mark to insure that the cap can be securely tightened. If RLTM is not available or expired, submit swab in charcoal transport media. Refrigerate specimen if transport to the Laboratory is to be delayed. Please notify the Laboratory if an outbreak is suspected. Bordetella pertussis culture NOT routinely performed. If required please contact the Microbiologist/Virologist On Call at Calgary or Edmonton. Bordetella parapertussis

As above

Culture

Bacteriology

Pharyngitis, Bacterial Typically Streptococcus pyogenes

Throat swab in plain transport media (RTM)

Culture

Bacteriology

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Vigorously swab inflamed areas, both tonsillar areas and posterior pharyngeal wall. Routinely cultured for beta-haemolytic streptococci only. Culture for Corynebacterium diphtheriae only on request.

101

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CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Pharyngitis, Viral Respiratory viruses e.g. adenovirus, parainfluenza virus, influenza virus, RSV, rhinovirus and coronavirus. Non-respiratory virus including enteroviruses and herpesvirus (usually present with blister lesion)

Depending on clinical picture, collect throat swab in Universal Transport Medium (UTM) for: respiratory virus, enterovirus or HSV.

Virus culture – HSV NAT (PCR)– Respiratory Virus Panel

Virology Molecular Diagnostics

Refrigerate but DO NOT freeze specimens. Specify suspected viral pathogen for appropriate testing.

Epstein-Barr virus (EBV)

For Suspected EBV: Submit 5 mL serum separator tube (SST) or for pediatrics 2 mL (red top tube) Serum, 2 mL (red top tube) or 5 mL serum separator tube (SST)

EBV VCA IgM

Virology

EBV VCA IgM

Virology

NAT (PCR)– enterovirus, parechovirus

Molecular Diagnostics

Provide clinical history on requisition for CMV IgM request.

Picornavirus Infections – see: Enterovirus Infections, Rhinovirus Infections, and Hepatitis A Virus 5 mL serum separator Syphilis Serology: tube (SST) or pediatrics EIA, RPR, INNO-LIA may use 2 mL red top tube Pinworm Disease - see: Enterobiasis - Pinworms (Cellophane Tape Test) Pinta Treponema carateum

Virology

Antibodies to the treponema of pinta are indistinguishable from those to the treponema of syphilis by all the diagnostic tests in current use.

PJP (Pneumocystis jiroveci pneumonia) - see: Respiratory Infections, Acute Bacterial

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Plague Yersinia pestis

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Pus from buboes; sputum in sterile container

Microscopy, culture

Bacteriology

Contact the Microbiologist/Virologist On Call before collecting specimens or submitting suspected Yersinia pestis isolates for confirmation. Please indicate on requisition if plague is suspected.

Blood culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

1 - 2 mL sputum, aspirated respiratory secretions, auger suction, bronchoscopy specimens in sterile container.

Microscopy, Culture

Bacteriology

Blood culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

(*Risk Group 3 Agent*)

Pneumonia, Bacterial Several bacterial species

CALGARY

The quality of sputa is assessed on cell content. Deep cough sputum and auger suction are best collected in the early morning before eating. Saliva specimens are not suitable.

Pneumonia, Viral and Atypical Bacteria - see: Respiratory Infections, Viral and Atypical Bacteria. Poliomyelitis – (Polioviruses types 1, 2, and 3) - see: Enterovirus Infections Pontiac Fever - see: Legionnaires Disease Post Perfusion Syndrome - see: Cytomegalovirus Infections

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

Other poxviruses: Cowpox, vaccinia, Orf, Milker’s nodules, and molluscum contagiosum Progressive Multifocal Leukoencephalopathy JC virus (a human papovavirus)

Vesicle fluid; skin crusts; scrapings from skin lesions on a microscope slide (unfixed)

Electron microscopy

Biopsy or autopsy material (brain) in sterile container or DEDICATED CSF sample in sterile container.

JC Virus PCR*

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

Virology

Immediately consult the Zone Medical Officer of Health before collecting any specimens from patients with suspected smallpox or monkey pox.

Poxvirus Infections Smallpox and monkey pox viruses are *Risk Group 4 Agents*

CALGARY

Virology PCR test is referred to the National Microbiology Laboratory, Winnipeg, Manitoba.

PCR

Virology

Please indicate on requisition if PML is suspected. Specimen will be referred to National Microbiology Laboratory, Winnipeg, Manitoba for PCR testing. * Contact Microbiologist/Virologist On Call at Calgary or Edmonton before collecting this specimen.

(*Risk Group 2 Agent*) Pseudomembranous Colitis - see: Diarrhea, Antibiotic Associated Psittacosis - see: Chlamydial Infections Puerperal Fever Usually group A streptococci

High vaginal swab in charcoal transport media (CTM)

Culture

Bacteriology

Nose swab and throat swabs from mother in plain transport media (RTM)

Culture

Bacteriology

2 - 10 mL urine in sterile container

Culture

Bacteriology

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If streptococcal infection is suspected, take nose and throat swabs from the mother and umbilical swab from baby. Include clinical information.

Con’t….

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Pyoderma Staphylococcus aureus sometimes accompanied by Streptococcus pyogenes or Corynebacterium diphtheriae

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Umbilical swab from baby in plain transport media (RTM)

Microscopy, Culture

Bacteriology

Blood culture (see: Blood Culture, Bacterial for collection details)

Culture

Bacteriology

Swab in plain transport media (RTM)

Microscopy, Culture

Bacteriology

Serology RFFIT (rapid fluorescent focus inhibition test)

Virology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Q Fever - see: Rickettsial Infections Rabies Rabies virus

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

For the determination of immunity please include the date of immunization and type of vaccine. Serology (RFFIT) is referred to the National Microbiology Laboratory, Winnipeg, Manitoba. An adequate response after vaccination is >= 0.5 IU/mL. Although there have been no cases of human rabies in Alberta in the past 10 years, animal rabies does occur, especially in skunks and insectivorous bats as the prime reservoirs. Con’t…

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Consult the Microbiologist/Virologist On Call at Calgary or Edmonton before sending human autopsy material or if STAT testing for suspected rabies is required. For examination of suspected rabid animals, contact District Veterinarian, Health of Animals Branch, Canada Agriculture.

(*Risk Group 3 Agent*)

Autopsy material (brain, spinal cord, salivary glands) in a sterile container

Rat-bite Fever (Haverhill Fever) Streptobacillus moniliformis

Primary lesion exudate; fluid from lymph glands; pus in sterile container

Microscopy, Culture

Bacteriology

Blood culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

Primary lesion exudate

Microscopy and animal inoculation

Bacteriology

Blood smears in a slide mailer

Microscopy

Bacteriology

Rat-bite Fever(Sodoku) Spirillum minus (minor)

CALGARY

Consult the Microbiologist/Virologist On Call at Calgary or Edmonton prior to specimen collection.

Consult the Microbiologist/Virologist On Call at Calgary or Edmonton prior to specimen collection.

Red Measles - see: Measles Reiter’s Syndrome - see: Mycoplasma Infections

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Relapsing Fever, Louse or Tick-borne Borrelia species, especially Borrelia recurrentis, Borrelia hermsii

Respiratory Infections, Acute Bacterial Several bacterial species, especially Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Legionella pneumophila Pneumocystis carinii (PCP)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Blood films in a slide mailer

Microscopy

Bacteriology

5 - 7 mL blood in citrate anticoagulant (yellow top tube)

Microscopy

Bacteriology

Although of low incidence, tick-borne relapsing fever is endemic throughout the western USA and British Columbia.

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

EIA

Virology

Louse borne relapsing fever is primarily endemic in Africa and South America.

Sputum; aspirated respiratory secretion in sterile container

Microscopy, culture

Bacteriology

Throat swab in plain transport media (RTM)

Culture

Bacteriology

Blood culture: (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

1-2 mL bronchial specimen; BAL; bronch brush/wash; induced sputum; lung tissue in a sterile container. Specify if PCP suspected.

Microscopy

Parasitology

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For suspect diphtheria, page Microbiologist/virologist On Call at Calgary or Edmonton immediately.

Non-induced sputum specimens are NOT acceptable for PCP.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Respiratory Infections, Viral and Atypical Bacteria Numerous viruses including classic respiratory virus e.g., adenovirus, influenza virus, parainfluenza virus, metapneumovirus, coronaviruses, respiratory syncytial virus, entero/rhino virus, varicella-zoster virus, cytomegalovirus and herpes simplex virus may be found in immunocompromised hosts. Coxiella burnetii (Q fever)

Mycoplasma pneumoniae

SARS – Coronavirus (SARS-CoV) MERS-CoV Herpes Viruses (HSV, CMV, VZV)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Nasopharyngeal (NP) swab (rayon swab) or aspirate or auger suction in Universal Transport Medium (UTM) (see: Nasopharyngeal Aspirates, Viral for collection details.

RSV, Flu A NAT(PCR)– Respiratory Virus Panel

Molecular Diagnostics

Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory.

Throat swab can also be collected in Universal Transport Medium UTM)

NAT(PCR)– Respiratory Virus Panel

Molecular Diagnostics

Acute and convalescent serum samples: 5mL serum separator tube (SST) or pediatrics may use 2 mL red top tube. 5mL serum separator tube (SST) or pediatrics may use 2 mL red top tube.

EIA and IFA

Virology

Serology is referred to the National Microbiology Laboratory, Winnipeg, Manitoba for testing.

EIA: IgM

Virology

IgM may be falsely negative if collected within first 6 days of illness.

See: SARS – Severe Acute Respiratory Syndrome

Must contact Zone Medical Officer of Health and the Microbiologist/Virologist On Call prior to sample collection. NAT (PCR)

Molecular Diagnostics

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Consult Microbiologist/Virologist On Call for additional tests if required.

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Nasopharyngeal swab or aspirate or throat swab* in Universal Transport Medium (UTM).

PCR – Respiratory Virus Panel

Molecular Diagnostics

Aspirated material from respiratory tract in original collection device, or bronchoscopy.

PCR – Respiratory Virus Panel

Virology Molecular Diagnostics

Autopsy or biopsy material (lung) in a sterile container.

PCR – Respiratory Virus Panel

Molecular Diagnostics

Rheumatic Fever Sequelae to upper respiratory tract infections with Streptococcus pyogenes

Throat swab in plain transport media (RTM)

Culture

Bacteriology

Rhinovirus Infections Rhinoviruses (over 100 different types), common cold, coryza

Nasopharyngeal swab or aspirate or throat swab in Universal Transport Medium (UTM).

PCR – Respiratory Virus Panel

Molecular Diagnostics

Rhinoviruses and enteroviruses are members of the picornovirus family.

Aspirated material from respiratory tract in original collection device or bronchoscopy. Autopsy or biopsy

PCR – Respiratory Virus Panel

Molecular Diagnostics

PCR – Respiratory Virus

Molecular

Respiratory Syncytial Virus Infections, (RSV) Respiratory syncytial virus, bronchiolitis, croup, pneumonia

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory.

Refrigerate but DO NOT freeze specimens. Send immediately to the Laboratory. Results from respiratory specimens are reported as picornavirus positive or negative as there is no routine test to differentiate rhinoviruses from enteroviruses.

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Con’t…

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Rickettsial Infections Rickettsia prowazekii, Rickettsia mooseri, Rickettsia rickettsii, Rickettsia akari, Rickettsia tsutsugamushi, Erlichiosis, Rocky Moutain Spotted Fever, and other species Q fever (Coxiella burnetii)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

material (lung) in sterile container.

Panel

Diagnostics

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology IFA: IgG

Virology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Immunofluorescence Assay (IFA) - IgG referred to the National Microbiology Laboratory, Winnipeg, Manitoba. Please indicate suspected diagnosis, onset travel history and animal contact.

Submit acute and convalescent, preferably before 6th and after 21st day.

Please indicate on requisition if Q Fever is suspected.

Ringworm - see: Dermatomycosis Roseola Infections - see: Human Herpesvirus Type 6 (HHV6) Rotavirus Infections Rotavirus (at least 2 types)

Feces in a sterile container

0

Electron microscopy

Virology

Refrigerate at 4 C if transport will exceed 2 hours. Electron microscopy by request only. Optimal samples are those collected within the first 48 hours after onset of symptoms. Formed stools are of no diagnostic value.

Serology EIA Rubella IgG only

Virology

*IgM will only be performed if clinical history of suspected rash illness or acute infection is provided on the requisition.

RSV - see: Respiratory Syncytial Virus Rubella abortion, congenital rubella syndrome, rubella virus, German measles

For immunity determination: Collect 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

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Con’t…

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SPECIMEN COLLECTION REQUIREMENTS

For suspected acute disease: Contact Zone Medical Officer of Health, provide clinical history on requisition, and collect: 5 mL serum separator

TESTS AVAILABLE

Rubella IgG, IgM*

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

Virology

tube (SST) or pediatrics may use 2 mL red top tube

NOTES

For enhanced provincial surveillance for rash illness, parvovirus IgG and IgM and rubella IgG and IgM will be performed on request for measles IgG and IgM in the presence of acute illness. Acute serum collected in the first 3 days of rash may test as falsely negative. A follow-up sample should be sent at least 5 days after onset to verify the initial negative IgM, especially if the initial IgG is negative.

Nasopharyngeal (NP) swab in Universal Transport Medium (UTM) ** Urine in sterile container**

Molecular testing

Aborted material, placenta, autopsy/biopsy material (all organs and in particular lens removal for cataract) in sterile container***

Molecular testing

Virology

** NP swab and urine will be referred to National Microbiology Laboratory, Winnipeg, Manitoba if the serological test result is indicative of acute infection.

Virology Molecular testing Virology

*** Tissue, biopsy/autopsy material may also be referred to National Microbiology Laboratory for further testing. Please consult with Microbiologist/Virologist On Call at Calgary or Edmonton.

Rubeola - see: Measles Salmonellosis - see: Typhoid Fever and Diarrhea, Bacterial and Food-borne Bacterial Disease/Syndrome

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Salpingitis - see: Genital Infections

SARS-Associated Coronavirus (SARS-CoV) MERS-CoV

See: SARS – Severe Acute Respiratory Syndrome

SARS-Severe Acute Respiratory Syndrome SARS Coronavirus Scabies (Sarcoptes scabiei)

Scrapings of skin at edge of tracks collected in sterile container, envelope with black paper to contain specimen or specimen placed between two glass slides and secured together at the ends with tape.

Must contact Zone Medical Officer of Health and the Microbiologist/Virologist On Call prior to sample collection.

PCR

Molecular Diagnostics

Microscopy for mites

Parasitology

No satisfactory test

Parasitology

Immediately consult the Zone Medical Officer of Health before collecting any specimens from patients with suspected SARS.

Scarlet Fever, Scarlatina - see: Streptococcal Infections Schistosomal Dermatitis, (Swimmer's Itch) Larvae of blood flukes of water birds

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CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Schistosomiasis

30 mL urine, final voiding in sterile container

Microscopy for eggs

Parasitology

Schistosoma haematobium

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA

Parasitic Serology

Peak egg excretion occurs between 1200 Hours and 1500 Hours. Culture performed only by prior arrangement with Microbiologist/Virologist. Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec. Diagnostic titre: EIA 1:128

Schistosoma japonicum, Schistosoma mansoni

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details) 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Microscopy for eggs

Parasitology

Serology EIA

Parasitic Serology

Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec. Diagnostic titre: EIA 1:128

Septicaemia Numerous bacteria, and fungus

Blood culture, (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

Fungus culture is accepted on BACTEC vials. Please indicate fungus culture on requisition. Contact the Canadian Food Inspection Agency at 780-495-7023, after hours 403-661-7505

Shellfish Poisoning Shigellosis - see: Diarrhea, Bacterial Shingles - see: Varicella Zoster Virus Infections

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Sinusitis Various bacteria including Streptococcus pyogenes and Staphylococcus aureus

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Aspirated fluid under aseptic conditions in a sterile container

Microscopy, culture

Bacteriology

Also see: Fungal Infections.

Microscopy, culture Fungal culture AFB (Acid Fast Bacilli) culture*

Bacteriology Mycology Mycobacteriology

Send specimens promptly to ensure viability of pathogens. Refrigerate if transport is delayed, DO NOT freeze. Collect samples in the early morning, before eating (highest concentration of disease causing organisms present). If possible have patient gargle with water (not mouthwash), to reduce oral contamination. Saliva is not a suitable sample. Bacteriology specimens will be Q (quality) scored to determine validity prior to culturing. Repeat specimens will be requested by telephone. One specimen per 72 hours will be processed unless approved by the Microbiologist. Gram stains are done on all culture and sensitivity specimens. *See: Mycobacteria for collection of sputum for AFB culture.

Smallpox - see: Poxvirus Infections Spore Strips – see: Biological Indicators Sporotrichosis - see: Fungal Infections Sputum Culture

5 - 10 mL in a sterile container

St. Louis Encephalitis - see: Arbovirus Infections Sterilization Test – see: Biological Indicators

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CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Throat swab; infected area exudate in plain transport media (RTM)

Culture

Bacteriology

Blood culture (see Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

CSF in sterile container

Microscopy, culture

Bacteriology

Isolate in charcoal transport media OR isolate on a blood agar slant (BAS).

Serotyping of invasive groups A, B, Streptococcus pneumoniae

Bacterial Typing Unit

Group B strep Streptococcus agalactiae (prenatal screen)

Combined vaginal/ rectal swab in plain transport media (RTM)

Culture

Bacteriology

Prenatal screen recommended at 35 - 37 weeks gestation. Culture performed only on specimens with clinical information indicating pregnancy. Submit swab of the distal vagina and the rectum.

Strongyloidiasis Strongyloides stercoralis

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details).

Microscopy for larvae

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Unpreserved FRESH feces in a sterile container.

Culture

Parasitology

Test performed by prior arrangement ONLY. Please consult the Microbiologist/Virologist On Call at the Edmonton site. Con’t…

Streptococcal Infections Streptococcus pyogenes (Group A streptococcus) and other groups of streptococci, especially groups B, C, and G and Streptococcus pneumoniae

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NOTES

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

See Notes

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

Parasitology

Specimens containing strongyloides larvae may be infectious upon contact with unprotected skin.

Parasitic Serology

Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease

Culture

Bacteriology

Consult the Microbiologist/Virologist On Call prior to collecting samples.

Molecular testing

Virology

Avoid sending swabs of lesions with significant oral or fecal contamination, such as rectal or buccal lesion.

Duodenal aspirate in a Culture, Microscopy sterile screw cap container. 5 mL serum separator Serology EIA tube (SST) or pediatrics may use 2 mL red top tube. Subacute Sclerosing Panencephalitis (SSPE) – see: Measles Swab Test Environmental

CALGARY

Swimmer’s Itch - see: Schistosomal Dermatitis Syphilis Treponema pallidum

Swab of lesion, rash or serous exudate sent in Universal Transport Medium.

Taeniasis (Tape Worm) Taenia saginata Taenia solium See: Cysticercosis

CSF (min volume 1mL) in sterile container

VDRL

Virology

5 mL serum separator tube (SST) or for pediatrics patients - 2 mL red top tube

Serology: EIA, RPR, INNO-LIA

Virology

Feces in SAF preservative (see: Diarrhea, Parasitic for

Microscopy for eggs

Parasitology

Consult the Laboratory prior to collecting tissues or samples from autopsies or in a suspected congenital infection. The subspecies of T. pallidum i.e., pallidum, endemicum, carateum and pertenue causing syphilis, bejel, pinta and yaws, cannot be discriminated from each other by the above serologic and molecular assays. Submit segments in sterile saline. Please note: it is important that segments are NOT preserved. Con’t…

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Worm or segments in sterile saline in a sterile container

Microscopy for eggs and identification of segments

Parasitology

Wound swab; lesion swab in Cary Blair (anaerobic) transport media

Microscopy, culture

Bacteriology

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Antitoxin determination

Virology

Tick for identification in sterile container

Tick Speciation

Parasitology

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

collection details)

Tape Worm - see: Taeniasis Tetanus Clostridium tetani

Ticks

The tick will be speciated if clinically indicated. Consult the Microbiologist/Virologist On Call if further testing is necessary under specific circumstances. For details on tick collection from environmental sources (NOT clinical samples),see: www.health.alberta.ca/ticks For more information on Lyme disease and tick surveillance see: Alberta Government "Surveillance of Ticks On Humans and in the Environment"

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Tinea Versicolor (Malassezia furfur), Tinea corporis, Tinea cruris - see: Fungal Infections (Dermatophytes)

TORCH – see: Congenital Infections

Toxic Shock Syndrome (TSS) Staphylococcus aureus

Toxic Shock-like Syndrome (TSLS) Streptococcus pyogenes (Group A)

Vaginal swab and/or cervical swab in plain transport media (RTM) Focal skin lesion swab; anterior nare swab in plain transport media (RTM)

Culture

Bacteriology

Microscopy, culture

Bacteriology

Isolate in charcoal transport media (CTM) or on a blood agar slant (BAS)

PCR for Staphylococcus enterotoxins and toxic shock syndrome toxin

Bacteriology

Blood culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

Throat swab; focus of infection swab in plain transport media (RTM)

Culture

Bacteriology

Isolate in charcoal transport media (CTM) or on a blood agar slant (BAS)

Serotyping

NCS

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Not all cases are associated with menstruation and use of tampons. It has occurred in males and after staphylococcal infection in a variety of sites.

PCR for Staphylococcus toxins referred to the National Microbiology Laboratory, Winnipeg, Manitoba

Submit isolates to the National Centre for Streptococcus (NCS) with the required clinical information.

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CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Toxocariasis (Visceral larva migrans) Toxocara canis Toxocara cati

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA

Parasitic Serology

Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec.

Toxoplasmosis Toxoplasma gondii

CSF in a sterile container

Microscopy, PCR

Parasitology

Biopsy material in a sterile container 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Microscopy, PCR

Parasitology

Serology; IgG, IgM, IgA (Other tests as required)

Parasitic Serology

Diagnostic titre: EIA 1:64. Carried out only by prior arrangement with Microbiologist/Virologist On Call. Special specimen transport conditions apply.

Serology performed 1/week.

Consult a public health inspector in your zone.

Trace Metal Testing, Water Trachoma - see: Chlamydial Infections Treponematoses - see: Pinta and Syphilis Trichinosis (Trichinellosis) Trichinella spiralis

Biopsy of muscle

Microscopy

Parasitology

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology EIA

Parasitic Serology

Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec. Diagnostic titre EIA: 1:128.

Trichomoniasis - see: Genital Infections

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Trichostrongyliasis Trichostrongylus species

Trichuriasis Trichuris trichiura (whipworm)

Trypanosmiasis, African Trypanosoma rhodesiense, Trypanosoma gambiense

American(Chagas disease) Trypanosoma cruzi

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Feces in SAF preservative (see: Diarrhea, Parasitic for collection details) Feces in SAF preservative (se: Diarrhea, Parasitic for collection details)

Microscopy for eggs

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Microscopy for eggs

Parasitology

Emulsify feces in SAF preservative immediately after collection.

Blood films, thick and thin, (unstained) in a slide mailer

Microscopy

Parasitology

Fluid aspirated from lymph nodes 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Microscopy

Parasitology

Serology

Virology

Serology performed at National Reference Centre for Parasitology, McGill University Centre for Tropical Disease/Centre for Disease Control, Atlanta, Georgia, U.S.A.

Serology

Virology

Transport specimens at room temperature (22ºC ± 5º C) to the laboratory within 16 hours. DO NOT refrigerate or freeze the blood sample.

Tuberculosis - see: Mycobacteria Tuberculosis - Latent Infection (LTBI) Mycobacterium tuberculosis

QuantiFERON® –TB Gold IT (In-Tube Method) requires 1 ml of blood into each of the following QuantiFERON® specific blood collection tubes:

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SPECIMEN COLLECTION REQUIREMENTS

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

TESTS AVAILABLE

SECTION

NOTES

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology, Agglutination

Virology

A 4-fold rise in the agglutination test on serial samples is considered diagnostic. A single titre of 1:40 or more may indicate either current or past infection.

Blood culture (see: Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

Contact the Microbiologist/Virologist On Call before collecting specimens or submitting suspected F. tularensis isolates for confirmation. Please indicate on requisition if Tularemia is suspected.

Feces in a sterile container. One specimen per day; fill container 1/3 full (do not contaminate with water or urine). Send feces containing blood or

Culture

Bacteriology

The organism must be isolated, preferably from blood. In patients who have received antibiotics before specimens are collected, bone marrow culture may be the most successful specimen.

1. NIL control (grey cap) 2. TB antigen (red cap) 3. Mitogin Control (purple cap) DO Mix tubes [shaking vigorously (10x)] for at least five seconds to ensure that the entire inner surface of the tube has been coated with blood Tularemia Francisella tularensis (*Risk Group 3 Agent*)

Typhoid Fever, Paratyphoid Fever, Enteric Fever Salmonella typhi Salmonella paratyphi A, B or C

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The Widal test (serological assay for typhoid fever) is Con’t…

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

not sensitive nor specific enough to make a definitive diagnosis of typhoid fever, and is not available at the Laboratory.

mucus if present. 15 mL urine in a sterile container

Culture

Bacteriology

Bone marrow in a sterile container (see: Bone Marrow, Bacteriology for collection)

Culture

Bacteriology

Blood culture (see: Blood Culture, Bacteriology for collection)

Culture

Bacteriology

Typhus Fever - see: Rickettsial Infections

Tzank Smear - see: Herpes Simplex Virus Infections

Undulant Fever - see: Brucellosis

Ureaplasma - see: Mycoplasma/Ureaplasma Infections

Urethritis - see: Genital Infections

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Urinary Tract Infections (Edmonton site only)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Urine inoculated into BD Vacutainer® Urine C&S Preservative Plus Plastic Tube (Grey Top).

Culture

Bacteriology

Collect midstream urine in BD Vacutainer® Urine Collection Cup and replace blue lid tightly onto cup. Peel back protective sticker on blue lid to expose rubber covered cannula. Push C&S Preservative Plus Plastic Tube (Grey Top) onto the cannula. Remove tube after it has filled (approximately 3mL draw) and invert 10 times to mix well. Place protective sticker back over the transfer port, and dispose of urine cup and lid appropriately. Label the filled Vacutainer® tube with patient name, ID number (ULI, PHN), date and time of collection. Initial requisition. Transport Vacutainer® tube and requisition to the Laboratory as soon as possible (up to 48 hours after collection). If insufficient volume (less than 10 mL in the blue cup) of urine is collected, phone the Laboratory at 780-4077121 for instructions. Inoculate urine direct from Foley Catheter using LuerLok™ Access Device into BD Vacutainer® Urine C&S Preservative Plus Plastic Tube (Grey Top).

NAT (PCR)

Molecular Diagnostics

*Unroof a fresh blister and vigorously swab base of lesion and place swab in Universal Transport Medium (UTM). Refrigerate but DO NOT freeze specimens. Con’t…

Vaccinia - see: Poxvirus Infections Vaginitis - see: Genital Infections Valley Fever, (Coccidiomycosis) - see: Fungal Infections Varicella Zoster Virus Infections Chickenpox - varicella, herpes zoster, shingles

Lesion swab* in Universal Transport Medium (UTM)

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CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Bronchoscopy,

NAT (PCR)

Molecular Diagnostics

For suspected encephalitis: DEDICATED CSF sample (at least0.5-1mL) in a sterile container for VZV PCR

NAT (PCR)CSF panel (HSV, VZV, enterovirus, parechovirus )

Molecular Diagnostics

Providing clinical information with the test request is extremely helpful for the Laboratory for PCR test. If specimen can be received in the Laboratory within 24 hours of collection then ship on ice/cold packs. If transportation might exceed 24 hours from collection then freeze at -70°C and transport on dry ice.

5 mL serum separator tube (SST)** or pediatrics may use 2 mL red top tube - Provide clinical history.

Serology EIA,: VZ IgM***, IgG

Virology

**Swab of lesion (blister) for NAT (PCR) request is more specific and a more appropriate specimen than serology. IgM can be falsely negative in the first three days of rash in primary infection. ***IgM will only be performed if clinical history of suspected rash illness or acute infection is provided on the requisition.

For visceral disseminated disease of the immunodeficient 1 – 2 mL blood in EDTA (lavender top )tube

NAT (PCR)for VZV

Molecular Diagnostics

Biopsy/autopsy material in a sterile container.

NAT (PCR)

Molecular Diagnostics

Microbiologist/Virologist On Call consult required.

Variola, Smallpox - see: Poxvirus Infections VDRL - see: Syphilis

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

Virology

Immediately consult the Zone Medical Officer of Health before collecting any specimens from patients with suspected Viral Hemorrhagic Fever. Immediately consult the Microbiologist/Virologist On Call before collecting samples.

Parasitic Serology

Serology referred to the National Reference Centre for Parasitology, McGill University Centre for Tropical Disease, Montreal, Quebec.

Venezuelan Equine Encephalitis - see: Arbovirus Infections Vibrio – see: Diarrhea, Bacterial Viral Hemorrhagic Fever Congo-Crimean hemorrhagic fever virus Ebola virus Lassa fever virus Marburg virus Argentinian hemorrhagic fever (Junin) Bolivian hemorrhagic fever (Machupo) Other South American hemorrhagic fever viruses (*Risk Group 4 Agents*) For Dengue hemorrhagic fever see: Arbovirus Infections Virus B of Monkeys - see: B Virus Infections Visceral Larva Migrans Toxocara species Ascaris species

2 mL serum (red top tube)

Serology EIA

Voriconazole Levels - see: Antifungal Levels

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VRE Vancomycin Resistant Enterococci (Edmonton site only)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

Rectal Swab in plain transport media (RTM)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

Bacteriology

Insert the swab approximately 2-3 cm into the rectum in adults, pediatrics as per size assessment (may lubricate by dipping the swab in the culture media prior to collecting the specimen). Please write “VRE Screen” on the Microbiology requisition.

Environmental Microbiology

Samples must be submitted with coolant (not loose ice) and be received at the Laboratory within 24 hours of collection.

Warts – see: Human Papillomavirus (HPV) Water: Bottled and Packaged Ice

Packaged Ice: Fill a 1 litre ice collection jar provided by the Laboratory

Presence/absence or quantitative defined substrate culture methods for E. coli and total coliforms. Culture for HPC. Samples also tested for the presence of Pseudomonas aeruginosa

Samples of bottled water and ice should be submitted for public health monitoring on finished product only.

Bottled water: 200 mL of water collected in sterile sample bottles provided by the Laboratory

Water: Distilled / Deionized / Clinical Lab Reagent Water (CLRW)

200 mL of water collected in sterile

Analysis performed based on protocols described in Standard Methods For the Examination of Water and Wastewater (Current Ed.) and Health Canada Microbiological Standards for Bottled Water and Packaged Ice. Culture for HPC

Environmental Microbiology

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Analysis performed based on protocols described in Standard Methods For the Examination of Water and Con’t…

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SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

sample bottles provided by the Laboratory

Water: Drinking (e.g. municipal drinking water, private homeowners drinking water)

200 mL water collected in sterile sample bottles provided by the Laboratory

Water: Legionella

Contact Microbiologist/ Virologist On Call at Calgary or Edmonton to discuss requirements for testing. 200 mL of water collected in sterile sample bottles provided by the Laboratory

Water: Natural Recreation (beach)

NOTES

Wastewater (Current Ed.) and Preparation and Testing of Reagent Water in the Clinical Laboratory; Approved Guideline (Current Ed.) Samples must be submitted with coolant (not loose ice) and be received at the Laboratory within 24 hours of collection. Presence/absence or quantitative defined substrate culture methods for E. coli and total coliforms

Environmental Microbiology

Analysis performed based on protocols described in Standard Methods For the Examination of Water and Wastewater (Current Ed.). Test results conform to full requirements for microbiological water quality outlined in the latest edition of the Guidelines for Canadian Drinking Water Quality. Samples must be submitted with coolant (not loose ice) and be received at the Laboratory within 24 hours of collection.

Bacteriology

Membrane filtration method for fecal coliforms

Environmental Microbiology

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Analysis performed based on protocols described in Standard Methods For the Examination of Water and Wastewater (Current Ed.). Test results conform to full requirements for the Alberta Public Health Act – Nuisance and General Sanitation Regulation. Samples must be submitted with coolant (not loose ice) and be received at Laboratory within 24 hours of collection.

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GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SECTION

NOTES

Environmental Microbiology Parasitology

Analysis performed based on protocols described in Standard Methods For the Examination of Water and Wastewater (Current Ed.) and USEPA Method 1623.

Water: Parasites and Enteric Pathogens Cryptosporidium spp. Giardia spp. E. coli O157 Campylobacter spp. Salmonella spp. Shigella spp.

Contact Microbiologist/ Virologist On Call at Calgary or Edmonton to discuss requirements for testing for water parasites and enteric pathogens

Water: Raw (i.e. lake, river, pond, etc.)

200 mL of water collected in sterile sample bottles provided by the Laboratory

Membrane filtration method for fecal coliforms, total coliforms, and/or E. coli

Environmental Microbiology

Analysis performed based on protocols described in Standard Methods For the Examination of Water and Wastewater (Current Ed.). Samples must be submitted with coolant (not loose ice) and be received at the Laboratory within 24 hours of collection.

Water: Sewage Effluent

200 mL of water collected in sterile sample bottles provided by the Laboratory

Membrane filtration method for fecal coliforms and total coliforms

Environmental Microbiology

Water: Swimming Pool or Whirlpool

200 mL of water collected in sterile sample bottles provided by the Laboratory

Presence/absence using defined substrate culture methods for total coliforms. Culture for HPC. For pools > 30ºC, water sample is also tested for the presence of Pseudomonas aeruginosa.

Environmental Microbiology

Analysis performed based on protocols described in Standard Methods For the Examination of Water and Wastewater (Current Ed.). Samples must be submitted with coolant (not loose ice) and be received at the Laboratory within 24 hours after collection. Analysis performed based on protocols described in Standard Methods For the Examination of Water and Wastewater (Current Ed.).

Samples must be submitted with coolant (not loose ice) and be received at the Laboratory within 24 hours of collection.

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Samples must be submitted with coolant (not loose ice) and be received at the Laboratory within 24 hours of collection.

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GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Weil’s Disease - see: Leptospirosis Please complete an Arbovirus Patient History Form (available from the Laboratory) and submit it with the specimens and requisitions.

West Nile Virus (WNV) Infections Acute:

At least 3 mL in a 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube AND At least 3 mL/tube in two 4 mL EDTA (lavender top) tubes.

WNV EIA: IgM*

Virology *WNV IgM can still be negative during the first week of illness and repeat serology may be advisable.

PCR**

Molecular Diagnostics

**PCR detects approximately 50% of cases during the first week of illness, but is rarely positive after that time. Both WNV and enterovirus are seasonal and may present with similar clinical picture. See: Enterovirus. Enterovirus and parechovirus are tested automatically along with all WNV PCR requests.

OR

DO NOT spin. DO NOT freeze. Transport on ice/cold Packs. Must be received within 48 hours of collection. At least 3 mL/tube in two PPT (Plasma Preparation Tubes) (5 mL tube). OR

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Centrifuge, DO NOT pour off, refrigerate until transport. DO NOT freeze. Transport on ice/cold packs, must be received within 48 hours of collection. (For outside Calgary Zone and Edmonton Zone, PPT may be ordered from the Laboratory) Con’t…

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

DEDICATED CSF sample (at least 0.5-1mL) in a sterile container.

Convalescent:

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Centrifuge, DO NOT pour off, refrigerate until transport. DO NOT freeze. Transport on ice/cold packs, must be received within 48 hours of collection. (For outside Calgary Zone and Edmonton Zone, PPT may be ordered from the Laboratory)

For pediatric collection: at least one 2 mL EDTA (lavender top) tube.

WNV Encephalitis:

CALGARY

NAT(PCR) /NASBA***

Molecular Diagnostics

WNV EIA: IgM, IgG

Virology

Transplant:

*** West Nile Virus PCR has low sensitivity in CSF. CSF panel tests are automatically included along with all WNV PCR requests on CSF If specimen can be received in the Laboratory within 24 hours of collection then ship on ice/cold packs. If transportation might exceed 24 hours from collection then freeze at -70°C and transport on dry ice. Specify “Convalescent” on the requisition. Convalescent serology is usually unnecessary if acute IgM and blood PCR/NASBA are both negative (95% sensitivity). Transplant clinics are asked to refer to Laboratory Bulletin “ProvLab West Nile Virus Screening', dated June 4, 2013

Western Equine Encephalitis - see: Arbovirus Infections Whipworm – (Trichuris trichuria) see: Diarrhea, Parasitic Whooping Cough - see: Pertussis Worm Infections

Entire worm, proglottids in sterile saline in a sterile container

Identification

Parasitology

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Please note: it is important that tapeworm segments are NOT preserved when submitted for identification.

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DISEASE / TEST / SYNDROME CAUSAL AGENTS

Wound Infections Various species of aerobic and anaerobic bacteria

Rapid growing Mycobacteria; Mycobacterium fortuitum, and Mycobacterium chelonae Wuchereria bancrofti – see: Yaws Treponema pallidum ssp. pertenue Yersinia Infections Yersinia enterocolitica Yersinia pseudotuberculosis Yersinia pestis [see: Plague] (*Risk Group 3 Agent*)

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

NOTES

Wound swab in plain transport media (RTM) OR Cary Blair (anaerobic) transport media

Microscopy, culture

Bacteriology

If the lesion is dry, moisten the swab before use in sterile water or saline. DO NOT submit dry swabs. Include site of wound, clinical details and antibiotic usage on the requisition.

Pus in sterile screw cap container

Microscopy, culture

Bacteriology

Pus; biopsy of involved area in dry sterile screw cap container

Microscopy, culture

Mycobacteriology

Swabs are not recommended for mycobacterial examination.

Syphilis Serology: EIA, RPR, INNO-LIA

Virology

Antibodies to the treponema of yaws are indistinguishable from those to the treponema of syphilis by all the diagnostic tests in current use.

Culture

Bacteriology,

Indicate request for Yersinia culture on the requisition.

Microscopy, culture

Bacteriology

Culture

Bacteriology

Filariasis 5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube Feces in a sterile container Abscess swab in plain transport media (RTM) Excised mesenteric lymph nodes in a sterile container

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Contact the Microbiologist/Virologist On Call before collecting specimens or submitting suspected Y. pestis isolates for confirmation. Please indicate on requisition if plague is suspected. Con’t…

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LABORATORY CONTACT INFORMATION

GUIDE TO SPECIMEN COLLECTION PRIMARY INQUIRIES MICROBIOLOGIST/VIROLOGIST ON CALL( MOC or VOC)

DISEASE / TEST / SYNDROME CAUSAL AGENTS

SPECIMEN COLLECTION REQUIREMENTS

TESTS AVAILABLE

SECTION

Blood culture (see Blood Culture, Bacteriology for collection details)

Culture

Bacteriology

5 mL serum separator tube (SST) or pediatrics may use 2 mL red top tube

Serology

Serology Agglutination

CALGARY

EDMONTON

Ph: 403-944-1200 Fax: 403-270-2216

Ph: 780-407-7121 Fax: 780-407-3864

Ph: 403-944-1200 (ask for MOC or VOC)

Ph: 780-407-8822 (UAH Switchboard) or 780-407-7121 (Laboratory) (ask for MOC or VOC)

NOTES

Serology referred to the Public Health Ontario Laboratories, Ontario.

Zygomycosis - see: Fungal Infections

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INDEX FOR GUIDE TO SPECIMEN COLLECTION

A Acanthamoebae, 25 Acid Fast Bacilli. See Mycobacteria Acquired Immune Deficiency Syndrome (AIDS. See Human Immunodeficiency Virus Actinomycosis, 25 Adenovirus Infections, 25 AFB. See Mycobacteria AIDS. See Human Immunodeficiency Virus Algal Toxins, 26 Amoebic Dysentery. See Diarrhea, Parasitic Amoebic Encephalitis, Primary, 26 Amoebic Hepatitis, 27 Anaerobic Infections, 27 Ancylostomiasis. See Hookworm Disease Anisakiasis, 28 Anthrax, 28 Antifungal Levels, 28 Arbovirus Infections, 28 Ascariasis, 29 Aseptic meningitis, 29 Aspergillosis. See Fungal Infections Aspergillus antigen detection, 30 Astrovirus Infections, 30 Attest ™. See Biological Indicators

B B Virus Infection, 30 Babesiosis, 31 Bacterial Antigen Detection. See Meningitis, Bacterial Balanitis, 31 Balantidiasis. See Diarrhea, Parasitic Bartonella, 31 Bilharziasis. See Schistosomiasis Biological Indicators, 32 BK Virus, 32 Blastocystis, 33 Blastomycosis. See Fungal Infections, Fungal Serology Blood Culture, Bacteriology, 33 Blood Culture, TB. See Mycobacteria Bone Chips, 33 Bone Marrow Culture, Bacteriology, 33 Bone Marrow Culture, Mycology, 34 Bone Marrow Culture, TB. See Mycobacteria Bone Marrow,, 34 Bordetella Infections. See Pertussis Bornholm Disease. See Enterovirus Infections Borreliosis. See Lyme Disease Botulism, 35 Brills Disease. See Rickettsial Infections Bronchiolitis of Infants, 36

Bronchitis, 36 Brucellosis, 36 Brugia sps. See: Filariasis Burkholderia pseudomallei. See: Melioidosis

C Calicivirus Infections. See Diarrhea, Viral Campylobacter. See Diarrhea, Bacterial and Food-borne Bacterial Disease Syndrome Candidiasis. See Fungal Infections and Genital Infections Cat Scratch Disease/Fever. See Bartonella Cervicitis. See Genital Infections Chagas Disease. See Trypanosomiasis Chancroid. See Genital Infections, Chancroid Chickenpox, Varicella and Zoster (shingles). See Varicella Zoster Virus Infections Chinese Liver Fluke Disease. See Clonorchiasis Chlamydial Infections, Chlamydia psittaci, 38 Chlamydial Infections, Chlamydia trachomatis, 38 Cholera. See Diarrhea, Bacterial Clonorchiasis, 40 Clostridium Difficile Toxin. See Diarrhea, Antibiotic Associated CMV. See Cytomegalovirus Infections Coccidioidomycosis. See Fungal Infections Colitis, Haemorrhagic, 40 Congenital Infections, 41 Congo – Crimean Hemorrhagic Fever. See: Viral Hemorrhagic Fever Conjunctivitis. See Eye Infections Coronavirus Infections. See: Respiratory Infections, Viral and Atypical Bacteria Corynebacterium diphtheriae. See Diphtheria Cowpox. See Poxvirus Infections Coxiella burnetii. See Rickettsial Infections Coxsackie Virus Infections. See Enterovirus Infections Creutzfeldt-Jakob Disease, 44 Croup. See Bronchiolitis of Infants Cryptococcal Antigen Detection, 44 Cryptococcus. See Fungal Infection Cryptosporidiosis, 45 Cyclospora, 45 Cysticercosis, 45 Cytomegalovirus Infections (CMV), 45

D Dengue Fever, 29 Dermatophytes, 46 Diarrhea, Antibiotic Associated, 47 Diarrhea, Bacterial, 47 Diarrhea, Parasitic, 48 Diarrhea, Viral, 49

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Diphtheria, 49 Diphyllobothriasis, 50 Dirofilaria immitis. See Filariasis Dracunculiasis, 50 Dysentery, Amoebic. See Diarrhea, Parasitic Dysentery, Bacillary. See Diarrhea, Bacterial

E E. coli. See Food-borne Bacterial Disease/Syndrome or Diarrhea, Bacterial Ear Infections, Otitis Externa, 50 Ear infections, Otitis Media, 51 Eastern Equine Encephalitis. See Arbovirus Infections Ebola Virus. See Viral Hemorrhagic Fever EBV. See Epstein-Barr Virus Infections Echinococcosis, 51 Echovirus. See Enterovirus Infections Ectoparasites, 52 Ehrlichia. See: Rickettsial Infections Encephalitis, Viral, 52 Endocarditis, Bacterial, 54 Entamoebae. See Diarrhea, Parasitic Enteric Fever. See Typhoid Fever Enterobiasis - Pinworms, 54 Enterovirus Infections, 55 Epiglottitis, Acute, 55 Epstein-Barr Virus Infections, 56 Erlichiosis. See Rickettsial Infections Erysipelas. See Streptococcal Infections Erysipeloid, 57 Eye Infections, Bacterial/ Fungal/Parasitic, 57 Eye Infections, Chlamydial, 57 Eye Infections, Viral, 58

F Fascioliasis, 58 Fasciolopsiasis, 58 Favus. See Dermatomycosis Fifth Disease. See Parvovirus Infections Filariasis, 59 Food Poisoning. See Food-borne Bacterial Disease/Syndrome Food-borne Bacterial Disease/Syndrome, 60 Francisella. See Tularemia Fungaemia, 61 Fungal Infections, 61

G Galactomannan. See Aspergillus Antigen Detection Gas gangrene, 27 Gas Gangrene. See Anaerobic Infections Gastritis, 62 Gastroenteritis. See Food-borne Bacterial Disease/Syndrome, Diarrhea-Parasitic, Diarrhea, Viral Genital Infections - Bacterial Vaginosis, 62

Genital Infections - Candidiasis, 62 Genital Infections - Chancroid (soft chancre), 63 Genital Infections - Chlamydia, Mycoplasma & Ureaplasma Infections, 63 Genital Infections - Gonorrhea, 64 Genital Infections - Herpes Simplex Virus, 66 Genital Infections - Trichomoniasis, 66 German Measles. See Rubella Giardiasis, 67 Gnathosomiasis, 67 Granuloma Inguinale (venereum), 67 Guinea-Worm Disease. See Dracunculiasis

H Haemolytic Uremic Syndrome (HUS), 67 Haemophilus ducreyii. See Genital Infections - Chancroid Haemophilus influenzae. See Meningitis, Bacterial and Epiglottitis Hand-foot-and-mouth Disease. See: Enterovirus Infections Hantavirus, 68 Helicobacter pylori. See Gastritis Hepatitis A Virus (Infectious Hepatitis, HAV), 69 Hepatitis B Virus (Serum Hepatitis, HBV), 69 Hepatitis C Virus (HCV), 71 Hepatitis D Virus (Delta Hepatitis, Delta Agent, HDV), 72 Hepatitis Delta Virus. See Hepatitis D Virus Hepatitis E Virus (HEV), 72 Herpangina. See Enteroviruses Herpes Simiae Virus Infections. See B Virus Infections Herpes Simplex Virus Infections (HSV), 73 Herpes Zoster Virus. See Varicella Zoster Virus Infections Heterophile Negative Mononucleosis. See Cytomegalovirus Infections Heterophyiasis, 74 Histoplasmosis (Histoplasma capsulatum)-. See Fungal Infections HIV. See Human Immunodeficiency Virus Hookworm Disease, 74 HSV. See Herpes Simplex Virus Infections HTLV I/II. See Human T-Cell Leukaemia/Lymphoma Virus HTLV III. See Human Immunodeficiency Virus Human Herpesvirus Type 6 (HHV6), 74 Human Immunodeficiency Virus HIV 1 and 2, HTLV III, LAV, AIDS, ARC, 75 Human Metapneumovirus. See: Respiratory Infections, Viral and Atypical Bacteria Human T Cell Leukemia/Lymphoma Virus Type I HTLV I, Virus Type II – HTLV I, 77 Hydatid Disease. See Echinococcosis Hymenolepiasis, 77

I Ice. See Water: Bottled and Packaged Ice

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Impetigo, 77 Infectious Mononucleosis. See Epstein-Barr Virus Infections Influenza, 78 Itraconazole Levels. See Antifungal Levels

K Kala Azar. See Leishmaniasis Kaposi’s Varicelliform Dermatitis. See Herpes Simplex Virus Infections Keratomycosis. See Fungal Infections

L Laryngitis, Viral, 78 Lassa Fever. See Viral Hemorrhagic Fever Legionnaires Disease, 79 Leishmaniasis, Cutaneous Form, 80 Leishmaniasis, Mucocutaneous Form, 80 Leishmaniasis, Visceral Form (Kala Azar), 80 Leprosy, 81 Leptospirosis, 81 Listeriosis, 81 Loiasis. See Filariasis Lung Abscess, 82 Lyme Disease, 82 Lymphadenopathy, Mesenteric, 84 Lymphocytic Choriomeningitis, (LCM), 84 Lymphogranuloma venereum (LGV). See Chlamydial infections, Chlamydia trachomatis Lymphogranuloma Venereum (LGV), 40

M Malaria, 84 Mansonella sps. See: Filariasis Marburg Virus Disease. See: Viral Hemorrhagic Fever Measles, 86 Melioidosis, 87 Meningitis, Bacterial, 88 Meningitis, Viral or Aseptic. See Aseptic Meningitis and Encephalitis Viral MERS-CoV, 89 Metapneumovirus. See Respiratory Infections, Viral and Atypical Bacteria Metorchiasis, 89 Microsporidia, 89 Molluscum Contagiosum. See Poxvirus Infections Mononucleosis, Infectious. See Epstein-Barr Virus Infections Monospot. See Epstein-Barr Virus Infections MRSA Screen, 89 Mumps, 90 Murine Typhus. See Rickettsial Infections Mycobacteria, 91 Mycoplasma Infections, Respiratory, 93

Mycoplasma Infections, Ureaplasma Infections, Genital and Non-Respiratory Sites, 94 Myiasis, 94 Myocarditis/Pericarditis, Viral, 95

N Nasopharyngeal Aspirate, Viral Upper Respiratory Infections, 95 NGU - (non-gonococcal urethritis. See Genital Infections, Chlamydia (trachomatis), Mycoplasma Infections Nocardiosis, 96 Norovirus. See Diarrhea, Viral

O Onchocerciasis, 97 Onychomycosis. See Fungal Infections, Dermatophytes Orchitis. See Mumps Orf. See Poxvirus Infections Ornithosis. See Chlamydia Infections Osteomyelitis, Acute, 97 Ova and Parasites, 97

P Panencephalitis (subacute sclerosing) (SSPE). See Measles Papillomavirus. See Human Papillomavirus Papovavirus Infections. See Human Papillomavirus ; Progressive Multifocal Leukoencephalopathy; BK Virus Paragonimiasis, 98 Parainfluenza Virus Infections, 98 Paralytic Illnesses, Viral, 98 Paralytic Shellfish Poisoning. See Shellfish Poisoning Paratyphoid Fever. See Typhoid Fever Parvovirus Infections, 99 Pediculosis, 100 Pemphigus, 100 Pericarditis, Viral). See Myocarditis/Pericarditis, Viral Pertussis, 101 Pharyngitis, Bacterial, 101 Pharyngitis, Viral, 102 Picornavirus Infection. See Enterovirus Infections, Rhinovirus Infections, and Hepatitis A Virus Pinta, 102 Pinworm Disease. See Enterobiasis PJP (Pneumocystis jiroveci pneumonia). See Respiratory Infections, Acute Bacterial Plague, 103 Pneumonia, Bacterial, 103 Pneumonia, Viral and Atypical Bacteria. See Respiratory Infections, Viral and Atypical Bacteria Poliomyelitis. See Enterovirus Infections Pontiac Fever. See Legionnaires Disease Post Perfusion Syndrome. See Cytomegalovirus Infections

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Poxvirus Infections, 104 Progressive Multifocal Leukoencephalopathy, 104 Pseudomembranous Colitis. See Diarrhea, Antibiotic Associated Psittacosis. See Chlamydial Infections Puerperal Fever, 104 Pyoderma, 105

Q Q Fever. See Rickettsial Infections

R Rabies, 105 Rat-bite Fever (Haverhill Fever), 106 Rat-bite Fever(Sodoku), 106 Red Measles. See Measles Reiter’s Syndrome. See Mycoplasma Infections Relapsing Fever, Louse or Tick-borne, 107 Respiratory Infections, Acute Bacterial, 107 Respiratory Infections, Viral and Atypical bacteria, 108 Respiratory Syncytial Virus Infections, (RSV), 109 Rheumatic Fever, 109 Rhinovirus Infections, 109 Rickettsial Infections, 110 Ringworm. See Dermatomycosis Roseola Infections. See Human Herpes Virus 6 Rotavirus Infections, 110 RSV. See Respiratory Syncytial Virus Rubella, 110 Rubeola. See Measles

S Salmonellosis. See Typhoid Fever and Diarrhea, Bacterial and Food-borne Bacterial Disease/Syndrome Salpingitis. See Genital Infections SARS-Associated Coronavirus, 112 SARS-Severe Acute Respiratory Syndrome, 112 Scabies, 112 Scarlet Fever, Scarlatina. See Streptococcal Infections Schistosomal Dermatitis, (Swimmer's Itch), 112 Schistosomiasis, 113 Septicaemia, 113 Shellfish Poisoning, 113 Shigellosis. See Diarrhea, Bacterial Shingles. See Varicella Zoster Virus Infections Sinusitis, 114 Smallpox. See Poxvirus Infections Spore Strips. See Biological Indicators Sporotrichosis. See Fungal Infections Sputum Culture, 114 St. Louis Encephalitis. See Arbovirus Infections Sterilization Test – see Biological Indicators, 114 Streptococcal Infections, 115

Strongyloidiasis, 115 Subacute Sclerosing Panencephalitis (SSPE). See Measles Swab Test, 116 Swimmer’s Itch. See Schistosomal Dermatitis Syphilis, 116

T Taeniasis (Tape Worm). See Cysticercosis Tape Worm. See Taeniasis Tetanus, 117 Ticks, 117 Tinea Versicolor(Malassezia furfur), Tinea corporis, Tinea cruris. See Fungal Infections, (Dermatophytes) TORCH. See Congenital Infections Toxic Shock Syndrome (TSS), 118 Toxic Shock-like Syndrome (TSLS), 118 Toxocariasis, 119 Toxoplasmosis, 119 Trace Metal Testing, Water, 119 Trachoma. See Chlamydial Infections Treponematoses. See Pinta and Syphilis Trichinosis (Trichinellosis), 119 Trichomoniasis. See Genital Infections Trichostrongyliasis, 120 Trichuriasis, 120 Trypanosmiasis, 120 Tuberculosis. See Mycobacteria Tuberculosis – Latent Infection, 120 Tularemia, 121 Typhoid Fever, Paratyphoid Fever, Enteric Fever, 121 Typhus Fever. See Rickettsial Infections Tzank Smear. See Herpes Simplex Virus Infections

U Undulant Fever. See Brucellosis Ureaplasma. See Mycoplasma/Ureaplasma Infections Urethritis. See Genital Infections Urinary Tract Infections, 123

V Vaccinia. See Poxvirus Infections Vaginitis. See Genital Infections Valley Fever. See Fungal Infections Varicella Zoster Virus Infections, 123 Variola, Smallpox. See Poxvirus Infections VDRL. See Syphilis Venezuelan Equine Encephalitis. See Arbovirus Infections Vibrio. See Diarrhea, Bacteria Viral Hemorrhagic Fever, 125 Virus B of Monkeys. See B Virus Infections Visceral Larva Migrans, 125 Voriconazole Levels. See Antifungal Levels

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VRE Vancomycin Resisitant Enterococci, 126

W Warts. See Human Papillomavirus (HPV) Water Bottled and Packaged Ice, 126 Distilled / Deionized / Clinical Lab Reagent Water (CLRW), 126 Drinking, 127 Legionella, 127 Natural Recreation (beach), 127 Parasites and Enteric Bacteria, 128 Raw, 128 Sewage Effluent, 128 Swimming Pool or Whirlpool, 128 Weil’s Disease. See Leptospirosis

West Nile Virus (WNV) Infections, 129 Western Equine Encephalitis. See Arbovirus Infections Whipworm. See Diarrhea, Parasitic Whooping Cough. See Pertussis Worm Infections, 130 Wound Infections, 131 Wuchereria bancrofti. See: Filariasis

Y Yaws, 131 Yersinia Infections, 131

Z Zygomycosis. See Fungal Infections

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