Specimen Collection, Transport, and Processing: Virology

Michael S. Forman; Alexandra Valsamakis

doi:10.1128/9781555816728.ch76

Chapter 76 : Specimen Collection, Transport, and Processing: Virology

Authors: Michael S. Forman, Alexandra Valsamakis

Content Type: Reference

Publication Year: 2011

Category: Clinical Microbiology

Book DOI: 10.1128/9781555816728

Chapter DOI: 10.1128/9781555816728.ch76

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Abstract:

In recent years, there have been many advances in diagnostic virology, including improvements in cell culture methods and the development of viral antigen (Ag) and nucleic acid (NA) assays. Regardless of the detection method chosen, accurate test results rely on preanalytical steps, including specimen selection, collection, transport, and processing, that are described in this chapter. General guidelines for these procedures are described. Collection and processing of specific specimen types are then discussed in detail. A final section on specimen transport containing general information and selected topics of importance is included. The use of viral transport medium (VTM) during specimen collection is highly dependent on specimen source. Important specimen information that should be provided includes patient data, ordering physician, specimen source, specific viruses suspected, time and date of specimen collection, and specific diagnostic tests requested. Manufacturers of commercials assays for NA or Ag detection either supply transport media or make recommendations for transport systems that are compatible with their assays. The manufacturer's package insert should therefore be consulted for information on appropriate collection and transport systems. Currently, the majority of diagnostic or clinical specimens can be shipped as biological substances, category B. Only specimens that have or may have a category A pathogen are classified as infectious substance. However, as the field of diagnostic virology evolves, new collection devices, transport systems, and processing methods that enhance detection will continue to be developed.

Citation: Forman M, Valsamakis A. 2011. Specimen Collection, Transport, and Processing: Virology, p 1276-1288. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch76

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References

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1. Abu-Diab, A.,, M. Azzeh,, R. Ghneim,, M. Zoughbi,, S. Turkuman,, N. Rishmawi,, A. E. Issa,, I. Siriani,, R. Dauodi,, R. Kattan,, and M. Y. Hindiyeh. 2008. Comparison between pernasal flocked swabs and nasopharyngeal aspirates for detection of common respiratory viruses in samples from children. J. Clin. Microbiol. 46: 2414– 2417.

2. Ahluwalia, G.,, J. Embree,, P. McNicol,, B. Law,, and G. W. Hammond. 1987. Comparison of nasopharyngeal aspirate and nasopharyngeal swab specimens for respiratory syncytial virus diagnosis by cell culture, indirect immunofluorescence assay, and enzyme-linked immunosorbent assay. J. Clin. Microbiol. 25: 763– 767.

3. Baba, M.,, R. Pauwels,, J. Balzarini,, J. Arnout,, J. Desmyter,, and E. De Clercq. 1988. Mechanism of inhibitory effect of dextran sulfate and heparin on replication of human immunodeficiency virus in vitro. Proc. Natl. Acad. Sci. USA 85: 6132– 6136.

4. Behzadbehbahani, A.,, P. E. Klapper,, P. J. Vallely,, and G. M. Cleator. 1997. Detection of BK virus in urine by polymerase chain reaction: a comparison of DNA extraction methods. J. Virol. Methods 67: 161– 166.

5. Bennion, D. W.,, L. J. Wright,, R. A. Watt,, A. A. Whiting,, and J. F. Carlquist. 1998. Optimal recovery of cytomegalovirus from urine as a function of specimen preparation. Diagn. Microbiol. Infect. Dis. 31: 337– 342.

6. Blow, J. A.,, D. J. Dohm,, D. L. Negley,, and C. N. Mores. 2004. Virus inactivation by nucleic acid extraction reagents. J. Virol. Methods 119: 195– 198.

7. Brambilla, D.,, C. Jennings,, G. Aldrovandi,, J. Bremer,, A. M. Comeau,, S. A. Cassol,, R. Dickover,, J. B. Jackson,, J. Pitt,, J. L. Sullivan,, A. Butcher,, L. Grosso,, P. Reichelderfer,, and S. A. Fiscus. 2003. Multicenter evaluation of use of dried blood and plasma spot specimens in quantitative assays for human immunodeficiency virus RNA: measurement, precision, and RNA stability. J. Clin. Microbiol. 41: 1888– 1893.

8. Brenton, S. 1997. RSV specimen collection methods: nasal vs. nasopharyngeal. Pediatr. Nurs. 23: 621– 622, 629.

9. Centers for Medicare and Medicaid Services, Department of Health and Human Services. 2004. Clinical Laboratory Improvement Act, vol. 493.1253. Standard: establishment and verification of performance specifications. 42 CFR Ch. IV Subpart K Quality System for Nonwaived Testing, Analytical Systems. Centers for Medicare and Medicaid Services, Baltimore, MD. http://edocket.access.gpo.gov/cfr_2004/octqtr/pdf/ 42cfr493.1.pdf..

10. Chan, K. H.,, J. S. Peiris,, W. Lim,, J. M. Nicholls,, and S. S. Chiu. 2008. Comparison of nasopharyngeal flocked swabs and aspirates for rapid diagnosis of respiratory viruses in children. J. Clin. Virol. 42: 65– 69.

11. Christensen, M. L. 1989. Human viral gastroenteritis. Clin. Microbiol. Rev. 2: 51– 89.

12. CLSI. 2005. Collection, Transport, Preparation, and Storage of Specimens for Molecular Methods; Approved Guideline. CLSI document MM13-A. CLSI, Wayne, PA.

13. Daley, P.,, S. Castriciano,, M. Chernesky,, and M. Smieja. 2006. Comparison of flocked and rayon swabs for collection of respiratory epithelial cells from uninfected volunteers and symptomatic patients. J. Clin. Microbiol. 44: 2265– 2267.

14. Dickover, R. E.,, S. A. Herman,, K. Saddiq,, D. Wafer,, M. Dillon,, and Y. J. Bryson. 1998. Optimization of specimenhandling procedures for accurate quantitation of levels of human immunodeficiency virus RNA in plasma by reverse transcriptase PCR. J. Clin. Microbiol. 36: 1070– 1073.

15. Duan, S. M.,, X. S. Zhao,, R. F. Wen,, J. J. Huang,, G. H. Pi,, S. X. Zhang,, J. Han,, S. L. Bi,, L. Ruan,, and X. P. Dong. 2003. Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. Biomed. Environ. Sci. 16: 246– 255.

16. Esposito, S.,, C. G. Molteni,, C. Daleno,, A. Valzano,, L. Cesati,, L. Gualtieri,, C. Tagliabue,, S. Bosis,, and N. Principi. 2010. Comparison of nasopharyngeal nylon flocked swabs with universal transport medium and rayon-bud swabs with a sponge reservoir of viral transport medium in the diagnosis of paediatric influenza. J. Med. Microbiol. 59: 96– 99.

17. Fong, C. K. Y.,, and M. L. Landry,. 1994. Specimen collection, transport, and processing for virologic studies, p. 11– 23. In G. D. Hsiung,, C. K. Y. Fong,, and M. L. Landry (ed.), Diagnostic Virology. Yale University Press, New Haven, CT.

18. Forghani, B., 2000. Laboratory diagnosis of infection, p. 351–353.. In A. M. Arvin, and A. A. Gerson (ed.), Varicella- Zoster Virus, Virology and Clinical Management. Cambridge University Press, Cambridge, United Kingdom.

19. Garcia-Lerma, J. G.,, A. McNulty,, C. Jennings,, D. Huang,, W. Heneine,, and J. W. Bremer. 2009. Rapid decline in the efficiency of HIV drug resistance genotyping from dried blood spots (DBS) and dried plasma spots (DPS) stored at 37 degrees C and high humidity. J. Antimicrob. Chemother. 64: 33– 36.

20. Ginocchio, C. C.,, X. P. Wang,, M. H. Kaplan,, G. Mulligan,, D. Witt,, J. W. Romano,, M. Cronin,, and R. Carroll. 1997. Effects of specimen collection, processing, and storage conditions on stability of human immunodeficiency virus type 1 RNA levels in plasma. J. Clin. Microbiol. 35: 2886– 2893.

21. Gleaves, C. A.,, D. H. Rice,, and C. F. Lee. 1990. Evaluation of an enzyme immunoassay for the detection of herpes simplex virus (HSV) antigen from clinical specimens in viral transport media. J. Virol. Methods 28: 133– 139.

22. Grant, P. R.,, A. Kitchen,, J. A. Barbara,, P. Hewitt,, C. M. Sims,, J. A. Garson,, and R. S. Tedder. 2000. Effects of handling and storage of blood on the stability of hepatitis C virus RNA: implications for NAT testing in transfusion practice. Vox Sang. 78: 137– 142.

23. Greenfield, L.,, and T. J. White,. 1993. Sample preparation methods, p. 122– 137. In D. H. Persing,, T. F. Smith,, F. C. Tenover,, and T. J. White (ed.), Diagnostic Molecular Biology: Principles and Applications. ASM Press, Washington, DC.

24. Griffith, B. P.,, and D. R. Mayo. 2006. Increased levels of HIV RNA detected in samples with viral loads close to the detection limit collected in Plasma Preparation Tubes (PPT). J. Clin. Virol. 35: 197– 200.

25. Grys, T. E.,, and T. F. Smith,. 2009. Specimen requirements: selection, collection, transport, and processing, p. 18– 35. In S. Specter,, R. L. Hodinka,, S. A. Young,, and D. L. Wiedbrauk (ed.), Clinical Virology Manual, 4th ed. ASM Press, Washington, DC.

26. Hambling, M. H. 1964. Survival of the respiratory syncytial virus during storage under various conditions. Br. J. Exp. Pathol. 45: 647– 655.

27. Hoang, M. P.,, D. B. Dawson,, Z. R. Rogers,, R. H. Scheuermann,, and B. B. Rogers. 1998. Polymerase chain reaction amplification of archival material for Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, and parvovirus B19 in children with bone marrow hemophagocytosis. Hum. Pathol. 29: 1074– 1077.

28. Hodinka, R. L.,, T. Nagashunmugam,, and D. Malamud. 1998. Detection of human immunodeficiency virus antibodies in oral fluids. Clin. Diagn. Lab. Immunol. 5: 419– 426.

29. Holodniy, M.,, S. Kim,, D. Katzenstein,, M. Konrad,, E. Groves,, and T. C. Merigan. 1991. Inhibition of human immunodeficiency virus gene amplification by heparin. J. Clin. Microbiol. 29: 676– 679.

30. Huntoon, C. J.,, R. F. House, Jr.,, and T. F. Smith. 1981. Recovery of viruses from three transport media incorporated into culturettes. Arch. Pathol. Lab. Med. 105: 436– 437.

30a.. International Air Transport Association. 2010. IATA Dangerous Goods Regulations, 51st ed. International Air Transport Association, Montreal, Quebec, Canada.

31. Jennings, L.,, V. M. Van Deerlin,, and M. L. Gulley. 2009. Recommended principles and practices for validating clinical molecular pathology tests. Arch. Pathol. Lab. Med. 133: 743– 755.

32. Jensen, C.,, and F. B. Johnson. 1994. Comparison of various transport media for viability maintenance of herpes simplex virus, respiratory syncytial virus, and adenovirus. Diagn. Microbiol. Infect. Dis. 19: 137– 142.

33. Johnson, F. B. 1990. Transport of viral specimens. Clin. Microbiol. Rev. 3: 120– 131.

34. Josephson, S. L. 1997. An update on the collection and transport of specimens for viral culture. Clin. Microbiol. Newsl. 19: 57– 61.

35. Khan, G.,, H. O. Kangro,, P. J. Coates,, and R. B. Heath. 1991. Inhibitory effects of urine on the polymerase chain reaction for cytomegalovirus DNA. J. Clin. Pathol. 44: 360– 365.

36. Kran, A. M.,, T. O. Jonassen,, M. Sannes,, K. Jakobsen,, A. Lind,, A. Maeland,, and M. Holberg-Petersen. 2009. Overestimation of human immunodeficiency virus type 1 load caused by the presence of cells in plasma from plasma preparation tubes. J. Clin. Microbiol. 47: 2170– 2174.

37. Lambert, S. B.,, D. M. Whiley,, N. T. O’Neill,, E. C. Andrews,, F. M. Canavan,, C. Bletchly,, D. J. Siebert,, T. P. Sloots,, and M. D. Nissen. 2008. Comparing nosethroat swabs and nasopharyngeal aspirates collected from children with symptoms for respiratory virus identification using real-time polymerase chain reaction. Pediatrics 122: e615– e620.

38. Landry, M. L.,, S. Cohen,, and D. Ferguson. 2000. Impact of sample type on rapid detection of influenza virus A by cytospinenhanced immunofluorescence and membrane enzyme-linked immunosorbent assay. J. Clin. Microbiol. 38: 429– 430.

39. Lee, D. H.,, L. Li,, L. Andrus,, and A. M. Prince. 2002. Stabilized viral nucleic acids in plasma as an alternative shipping method for NAT. Transfusion 42: 409– 413.

40. Levin, M. J.,, S. Leventhal,, and H. A. Masters. 1984. Factors influencing quantitative isolation of varicella-zoster virus. J. Clin. Microbiol. 19: 880– 883.

41. Lipson, S. M.,, L. H. Falk,, and S. H. Lee. 1996. Effect of leukocyte concentration and inoculum volume on the laboratory identification of cytomegalovirus in peripheral blood by the centrifugation culture-antigen detection methodology. Arch. Pathol. Lab. Med. 120: 53– 56.

42. Navarro-Mari, J. M.,, S. Sanbonmatsu-Gamez,, M. Perez-Ruiz,, and M. De La Rosa-Fraile. 1999. Rapid detection of respiratory viruses by shell vial assay using simultaneous culture of HEp-2, LLC-MK2, and MDCK cells in a single vial. J. Clin. Microbiol. 37: 2346– 2347.

43. Nesbitt, S. E.,, L. Cook,, and K. R. Jerome. 2004. Cytomegalovirus quantitation by real-time PCR is unaffected by delayed separation of plasma from whole blood. J. Clin. Microbiol. 42: 1296– 1297.

44. Nozawa, N.,, S. Koyano,, Y. Yamamoto,, Y. Inami,, I. Kurane,, and N. Inoue. 2007. Real-time PCR assay using specimens on filter disks as a template for detection of cytomegalovirus in urine. J. Clin. Microbiol. 45: 1305– 1307.

45. Payne, C. M.,, C. G. Ray,, V. Borduin,, L. L. Minnich,, and M. D. Lebowitz. 1987. An eight-year study of the viral agents of acute gastroenteritis in humans: ultrastructural observations and seasonal distribution with a major emphasis on coronavirus-like particles. Adv. Exp. Med. Biol. 218: 579– 580.

46. Peyton, C. L.,, M. Schiffman,, A. T. Lorincz,, W. C. Hunt,, I. Mielzynska,, C. Bratti,, S. Eaton,, A. Hildesheim,, L. A. Morera,, A. C. Rodriguez,, R. Herrero,, M. E. Sherman,, and C. M. Wheeler. 1998. Comparison of PCR- and hybrid capture-based human papillomavirus detection systems using multiple cervical specimen collection strategies. J. Clin. Microbiol. 36: 3248– 3254.

47. Ratnamohan, V. M.,, A. L. Cunningham,, and W. D. Rawlinson. 1998. Removal of inhibitors of CSF-PCR to improve diagnosis of herpesviral encephalitis. J. Virol. Methods 72: 59– 65.

48. Rebeiro, P. F.,, A. Kheshti,, S. S. Bebawy,, S. E. Stinnette,, H. Erdem,, Y. W. Tang,, T. R. Sterling,, S. P. Raffanti,, and R. T. D’Aquila. 2008. Increased detectability of plasma HIV-1 RNA after introduction of a new assay and altered specimen-processing procedures. Clin. Infect. Dis. 47: 1354– 1357.

49. Roberts, T. C.,, R. S. Buller,, M. Gaudreault-Keener,, K. E. Sternhell,, K. Garlock,, G. G. Singer,, D. C. Brennan,, and G. A. Storch. 1997. Effects of storage temperature and time on qualitative and quantitative detection of cytomegalovirus in blood specimens by shell vial culture and PCR. J. Clin. Microbiol. 35: 2224– 2228.

50. Romanowski, E. G.,, S. P. Bartels,, R. Vogel,, N. T. Wetherall,, C. Hodges-Savola,, R. P. Kowalski,, K. A. Yates,, P. R. Kinchington,, and Y. J. Gordon. 2004. Feasibility of an antiviral clinical trial requiring cross-country shipment of conjunctival adenovirus cultures and recovery of infectious virus. Curr. Eye Res. 29: 195– 199.

51. Salimnia, H.,, E. C. Moore,, L. R. Crane,, R. D. Macarthur,, and M. R. Fairfax. 2005. Discordance between viral loads determined by Roche COBAS AMPLICOR human immunodeficiency virus type 1 Monitor (version 1.5) standard and ultrasensitive assays caused by freezing patient plasma in centrifuged Becton-Dickinson Vacutainer brand plasma preparation tubes. J. Clin. Microbiol. 43: 4635– 4639.

52. Schafer, P.,, W. Tenschert,, M. Schroter,, K. Gutensohn,, and R. Laufs. 2000. False-positive results of plasma PCR for cytomegalovirus DNA due to delayed sample preparation. J. Clin. Microbiol. 38: 3249– 3253.

53. Shuster, E. A.,, J. S. Beneke,, G. E. Tegtmeier,, G. R. Pearson,, C. A. Gleaves,, A. D. Wold,, and T. F. Smith. 1985. Monoclonal antibody for rapid laboratory detection of cytomegalovirus infections: characterization and diagnostic application. Mayo Clin. Proc. 60: 577– 585.

54. Skinner, G. R.,, M. A. Billstrom,, S. Randall,, A. Ahmad,, S. Patel,, J. Davies,, and A. Deane. 1997. A system for isolation, transport and storage of herpes simplex viruses. J. Virol. Methods 65: 1– 8.

55. Smith, M. C.,, C. Creutz,, and Y. T. Huang. 1991. Detection of respiratory syncytial virus in nasopharyngeal secretions by shell vial technique. J. Clin. Microbiol. 29: 463– 465.

56. Smith, T. F., 2000. Specimen requirements: selection, collection, transport, and processing, p. 11– 26. In S. Specter,, R. L. Hodinka,, and S. A. Young (ed.), Clinical Virology Manual, 3rd ed. ASM Press, Washington, DC.

57. St. George, K.,, M. J. Boyd,, S. M. Lipson,, D. Ferguson,, G. F. Cartmell,, L. H. Falk,, C. R. Rinaldo,, and M. L. Landry. 2000. A multisite trial comparing two cytomegalovirus (CMV) pp65 antigenemia test kits, Biotest CMV Brite and Bartels/Argene CMV Antigenemia. J. Clin. Microbiol. 38: 1430– 1433.

58. Tang, Y. W.,, S. E. Sefers,, H. Li,, D. J. Kohn,, and G. W. Procop. 2005. Comparative evaluation of three commercial systems for nucleic acid extraction from urine specimens. J. Clin. Microbiol. 43: 4830– 4833.

59. Uhlenhaut, C.,, and M. Kracht. 2005. Viral infectivity is maintained by an RNA protection buffer. J. Virol. Methods 128: 189– 191.

60. Vizzi, E.,, D. Ferraro,, A. Cascio,, R. Di Stefano,, and S. Arista. 1996. Detection of enteric adenoviruses 40 and 41 in stool specimens by monoclonal antibody-based enzyme immunoassays. Res. Virol. 147: 333– 339.

61. Wadowsky, R. M.,, S. Laus,, T. Libert,, S. J. States,, and G. D. Ehrlich. 1994. Inhibition of PCR-based assay for Bordetella pertussis by using calcium alginate fiber and aluminum shaft components of a nasopharyngeal swab. J. Clin. Microbiol. 32: 1054– 1057.

62. Walsh, P.,, C. L. Overmyer,, K. Pham,, S. Michaelson,, L. Gofman,, L. DeSalvia,, T. Tran,, D. Gonzalez,, J. Pusavat,, M. Feola,, K. T. Iacono,, E. Mordechai,, and M. E. Adelson. 2008. Comparison of respiratory virus detection rates for infants and toddlers by use of flocked swabs, saline aspirates, and saline aspirates mixed in universal transport medium for room temperature storage and shipping. J. Clin. Microbiol. 46: 2374– 2376.

63. Wiedbrauk, D. L.,, and W. Cunningham. 1996. Stability of herpes simplex virus DNA in cerebrospinal fluid specimens. Diagn. Mol. Pathol. 5: 249– 252.

64. Wiedbrauk, D. L.,, J. C. Werner,, and A. M. Drevon. 1995. Inhibition of PCR by aqueous and vitreous fluids. J. Clin. Microbiol. 33: 2643– 2646.

65. Wilson, M. L. 1996. General principles of specimen collection and transport. Clin. Infect. Dis. 22: 766– 777.

66. World Health Organization. 2000. WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies. World Health Organization, Geneva, Switzerland. http:// www.who.int/csr/resources/publications/bse/WHO_CDS_ CSR_APH_2000_3/en/..

67. Young, N. S.,, and K. E. Brown. 2004. Parvovirus B19. N. Engl. J. Med. 350: 586– 597.

Tables

Specimen Collection, Transport, and Processing: Virology

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/content/10.1128/9781555816728.chap76.tab76-1

TABLE 1

Methods used for detection of viruses

a Refer to specific chapters for individual viruses; only major viral pathogens, not including rare causes of disease. LCMV, lymphocytic choriomeningitis virus; JCV, JC virus; HHV-6, human herpesvirus 6; HBV, hepatitis B virus; HTLV-1, human T-cell lymphotropic virus 1.

b Most common detection methods used. NA assays include hybrid capture, NA sequence-based assays, and PCR. IA, immunoassay (includes immunofluorescentantibody assay, enzyme-linked immunosorbent assay, and immunochromatographic tests. EM, electron microscopy; EA, enzyme (neuraminidase) assay.

c Hemorrhagic fever viruses and smallpox virus processing in BSL 4 facilities.

d PML, progressive multifocal leukoencephalopathy.

e Includes posttransplant lymphomas, immunoblastic B-cell lymphomas, and adult T-cell leukemia/lymphoma.

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10.1128/9781555816728/tab76-1.gif

TABLE 1

Methods used for detection of viruses

c Hemorrhagic fever viruses and smallpox virus processing in BSL 4 facilities.

d PML, progressive multifocal leukoencephalopathy.

e Includes posttransplant lymphomas, immunoblastic B-cell lymphomas, and adult T-cell leukemia/lymphoma.

/content/10.1128/9781555816728.chap76.tab76-2

TABLE 2

Specimens for viral diagnostic tests

a Includes direct virus detection tests such as culture, Ag detection, and NA detection. Serology is considered separately (see Table 3 ).

b Includes throat and nasal swabs and nasal wash, nasopharyngeal aspirate, and BAL specimens.

c Includes conjunctiva, cornea, and aqueous and vitreous fluids.

d Similar specimen types for distantly related GBV virus C (also referred to as hepatitis G virus).

e Neonatal infections.

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10.1128/9781555816728/tab76-2.gif

TABLE 2

Specimens for viral diagnostic tests

a Includes direct virus detection tests such as culture, Ag detection, and NA detection. Serology is considered separately (see Table 3 ).

b Includes throat and nasal swabs and nasal wash, nasopharyngeal aspirate, and BAL specimens.

c Includes conjunctiva, cornea, and aqueous and vitreous fluids.

d Similar specimen types for distantly related GBV virus C (also referred to as hepatitis G virus).

e Neonatal infections.

/content/10.1128/9781555816728.chap76.tab76-3

TABLE 3

Serology as a primary diagnostic tool: timing of serum collection and antibody testing for relevant viruses a

a HAV, hepatitis A virus; HTLV, human T-cell lymphotropic virus; LCMV, lymphocytic choriomeningitis virus.

b Convalescent-phase antibody; includes IgG and total antibody (IgG and IgM).

c CSF IgM also useful.

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TABLE 3

Serology as a primary diagnostic tool: timing of serum collection and antibody testing for relevant viruses a

a HAV, hepatitis A virus; HTLV, human T-cell lymphotropic virus; LCMV, lymphocytic choriomeningitis virus.

b Convalescent-phase antibody; includes IgG and total antibody (IgG and IgM).

c CSF IgM also useful.

/content/10.1128/9781555816728.chap76.tab76-4

TABLE 4

Plasma processing and storage conditions for selected NA tests

a RUO, research use only; CE IVD, Conformité Européenne mark for in vitro diagnostics.

b Test also verified for serum. Storage conditions apply to HighPure and AmpliPrep extraction.

c Long-term storage of serum has not been evaluated.

d Not available in the United States.

e Once thawed, specimen may be stored at 2–8°C for ≤6 h.

f ACD, acid-citrate-dextrose.

g If viral pellets are prepared within 30 min of plasma separation.

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10.1128/9781555816728/tab76-4.gif

TABLE 4

Plasma processing and storage conditions for selected NA tests

a RUO, research use only; CE IVD, Conformité Européenne mark for in vitro diagnostics.

b Test also verified for serum. Storage conditions apply to HighPure and AmpliPrep extraction.

c Long-term storage of serum has not been evaluated.

d Not available in the United States.

e Once thawed, specimen may be stored at 2–8°C for ≤6 h.

f ACD, acid-citrate-dextrose.

g If viral pellets are prepared within 30 min of plasma separation.

/content/10.1128/9781555816728.chap76.tab76-5

TABLE 5

Commercial sources and formulations of VTM

a Product available as swab-VTM tube combination.

b Basal constituents: Hanks balanced salt solution, bovine serum albumin, l-glutamic acid, sucrose, HEPES buffer (pH 7.3), phenol red, and amphotericin B.

10.1128/9781555816728/tab76-5_thmb.gif

10.1128/9781555816728/tab76-5.gif

TABLE 5

Commercial sources and formulations of VTM

a Product available as swab-VTM tube combination.

b Basal constituents: Hanks balanced salt solution, bovine serum albumin, l-glutamic acid, sucrose, HEPES buffer (pH 7.3), phenol red, and amphotericin B.