Viral Culture, General

CPT: 87252
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Test Details

Synonyms

  • Culture, Viral, General
  • General Viral Culture
  • Mumps Viral Culture
  • Routine Viral Culture
  • Virus Culture/Isolation

Test Includes

Based on specimen source, viruses to be detected by cytopathic effect and/or antibody staining include adenovirus, CMV, enteroviruses, HSV, influenza, mumps, parainfluenza, RSV, and V-Z cell culture; identification (additional charges/CPT code[s] may apply) by fluorescent antibody or other methods if culture results warrant. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed.

Use

Aid in the diagnosis of viral diseases (eg, conjunctivitis, congenital viral infections, keratitis, chickenpox, shingles, viral pneumonia, and diseases characterized by skin vesicles and rashes)

Limitations

For all practical purposes, many common viruses are not culturable: Coxsackie A viruses, hepatitis viruses, arboviruses, parvoviruses, human papillomaviruses, reoviruses, measles virus, and gastrointestinal viruses (rota, corona, calici, astro, and Norwalk). Isolation of virus may not be related to the patient's disease. Some positive cultures are sent to State Health Laboratory for specific virus identification. Infectious HSV is rarely present in CSF during encephalitis, resulting in a poor recovery by culture (<5% in adults, <50% in children). Studies have shown a >98% detection of HSV DNA in CSF by polymerase chain reaction (PCR), and this method is now considered the standard for diagnosis of HSV encephalitis. For HSV PCR testing, please order test 138651.

Methodology

Inoculation of specimen into cell cultures, incubation of cultures, observation for characteristic cytopathic effect, and identification by DFA or other methods

Reference Interval

No virus isolated

Additional Information

Give date of onset of illness, date of collection, and brief clinical description or the provisional diagnosis. For example, does the patient have a rash, a respiratory illness, or neurological symptoms?

Viral cultures: Specimens should be collected in the acute stage of the illness, kept moist, and refrigerated immediately. Stool specimens should not be placed into viral transport medium or frozen. Spinal fluid and throat washings must be kept cold and must not be frozen. Swabs of lesions or of throat should be rinsed immediately into 1 or 2 mL of viral transport medium; preferably, the swab should be broken off into the medium and sent in the medium to the laboratory. Autopsy material should be collected in sterile containers. Urine specimens for CMV culture must not be frozen; they should be packed with an ice pack or snow gel, but not with dry ice.

Specimen Requirements

Specimen

Blood, cerebrospinal fluid (CSF), dermal, ocular, genital, mucosal, oral, rectal, respiratory, stool, tissue, urine, or biopsy

Viruses Typically Isolated From Clinical Specimens

Specimen

Virus*

*Abbreviations:

HSV − herpes simplex virus

CMV − cytomegalovirus

VZV − varicella-zoster virus

RSV − respiratory syncytial virus

†Enteroviruses: coxsackie virus, poliovirus, echovirus, and enterovirus.

‡Rarely isolated.

§Usually in immunocompromised hosts.

Blood

CMV, enteroviruses†,‡, HSV‡, VZV‡

CSF and CNS tissues

Enteroviruses, mumps virus, HSV‡, CMV

Dermal lesions

HSV, VZV, adenovirus, enteroviruses

Eye

HSV, VZV, adenovirus, enteroviruses, CMV

Genital

HSV, CMV

Mucosal

HSV, VZV

Oral

HSV, VZV

Rectal

HSV, VZV, enterovirus

Respiratory tract

upper

Adenovirus, rhinovirus, influenza, parainfluenza, enteroviruses, RSV, reovirus, HSV

lower

Adenovirus, influenza, parainfluenza, RSV, CMV§

Stool

Enteroviruses, adenoviruses

Tissues

CMV, HSV, enteroviruses

Urine

CMV, adenovirus, enteroviruses, mumps

Volume

1 mL fluid or one swab in viral transport

Container

Viral, Chlamydia, or Mycoplasma culture transport provided by LabCorp, or other appropriate transport medium; sterile screw-cap tube or container for fluids, feces, nasal washings, urine, or biopsy (no preservative); green-top (heparin) tube for blood, bone marrow, and buffy coat

Collection

Specimen should be collected during the acute phase of the disease as follows:

Blood: Collect 5 mL whole blood into a heparinized tube; sodium heparin preferred. Send at room temperature.

Cerebrospinal fluid: Collect 1 mL CSF aseptically in a sterile dry screw-cap vial. Refrigerate immediately.

Skin lesions: Open the vesicle and absorb exudate into a dry swab and/or vigorously scrape base of freshly exposed lesion with a swab to obtain cells that contain viruses. If enough vesicle fluid is available, aspirate the fluid with a fine gauge needle and tuberculin syringe, and place the fluid into cold viral transport medium. Use viral swabs for specimen collection. Refrigerate immediately.

Eye swab or scraping: Use a viral swab to collect conjunctival material. Take conjunctival scrapings with a fine sterile spatula and transfer the scraping to a viral transport medium. Refrigerate immediately.

Genital swab: See skin. Refrigerate immediately.

Rectal swab: Insert a sterile swab 2” to 4” into the rectum and rub the mucosa. Swab may be placed into cold virus transport medium. Refrigerate immediately.

Throat swab: Carefully rub the posterior wall of the nasopharynx with a dry, sterile swab. Avoid touching the tongue or buccal mucosa. Place swab in viral transport tube.

Feces: Collect 4 to 8 g of feces (about the size of a thumbnail) and place in a clean, screw-cap container. Do not dilute the specimen or use preservatives. Viral swab is acceptable. Refrigerate immediately.

Tissue: Use a fresh set of sterile instruments to collect each tissue. Place each specimen in its own dry, sterile nontoxic screw-cap container. To prevent the tissue from drying out, add a small amount of viral transport medium to the container. Identify each tissue with the patient's name, type of tissue, and date collected. Refrigerate immediately.

Urine: Collect clean-catch, midstream urine in a screw-cap, sterile, plastic container. Refrigerate immediately.

Storage Instructions

All specimen types except blood must be kept cold and moist (refrigerated). Blood: Stored and transported at room temperature.

Causes for Rejection

Bacterial swab specimen; specimen received in grossly leaking transport container; dry specimen; specimen submitted in fixative or additive; specimen received in expired transport media or incorrect transport device; inappropriate specimen transport conditions; specimen received after prolonged delay in transport (usually more than 72 hours); specimen types other than blood stored or transported at room temperature; wooden shaft swab in transport device; unlabeled specimen or name discrepancy between specimen and request label; hemolyzed blood sample

Clinical Information

Special Instructions

Submit one specimen per test requested. Specify the exact specimen source/origin (eg, genital lesion). Indicate a specific test number on the request form. Age of patient, relevant vaccinations, and pertinent clinical history are helpful. Whenever a viral etiology is suspected and whenever appropriate, acute and convalescent serum should be collected for viral serology tests.

References

Belshe RB, ed. Textbook of Human Virology. Littleton, Mass: PSG Publishing Co;1984.
Drew WL. Controversies in viral diagnosis. Rev Infect Dis. 1986 Sep-Oct; 8(5):814-824. 3024292
Korones SB. Uncommon virus infections of the mother, fetus, and newborn: Influenza, mumps, and measles. Clin Perinatol. 1988 Jun; 15(2):259-272. 3288423
Lennette DA. Preparation of specimens for virological examination. In: Balows A, Hausler WJ, et al, eds. Manual of Clinical Microbiology. 5th ed. Washington, DC: ASM Press;1991:818-821.
Pfaller MA, Caliendo AM, Versalovic J. Detection of herpes simplex virus in CSF by PCR. In: Isenberg HD, ed. Clinical Microbiology Procedures Handbook. 2nd ed. Washington, DC: ASM Press: 2004:12.2.3.51-12.2.3.61.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
008573 Viral Culture, General 6584-7 008573 Viral Culture, General 6584-7

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