A broadcast was sent on July 13, 2011, explaining that viral cultures and herpes simplex virus (HSV)/ varicella-zoster (VZV) direct fluorescence antibody (DFA) tests are no longer being performed in-house at University of Iowa Hospitals and Clinics (UIHC) clinical laboratories. Since then, there have been some questions raised with regards to the mail-out tests available for viral cultures and DFA testing. We have addressed those issues by updating the mail-out tests that we refer to ARUP Laboratories.

The table below outlines the tests that are now orderable in Epic, along with information on collection devices for each sample type. Please note that samples must be kept cold (2-8°C) after collection and should be immediately delivered on ice to Specimen Control, 6240 RCP. Importantly, samples that need to be in viral transport media (VTM) must be placed into that media before delivery to the laboratory. If they are not placed in VTM, sample integrity may be compromised and the sample likely rejected. Samples delivered to the Specimen Control by 2pm Monday through Friday will be sent to ARUP Laboratories later that day. Those received after 2pm Friday and over the weekend will be sent-out the following business day.

Two important additional notes:

1) CMV Rapid Culture on rectal swabs or stool is not performed by ARUP Laboratories and will no longer be orderable. Culturing for CMV in stool has very low sensitivity and lacks clinical utility. For example, there were no CMV positive stool/rectal swab samples in the UIHC laboratory in over 20 years of testing. Viral culture for enteroviruses and adenovirus will still be available (Viral Culture, Rectal Swab or Stool. See Table below). However, culturing of stool samples for these viruses only rarely provides useful clinical information.

2) While respiratory specimens are acceptable sample types for viral culture, in most clinical situations the preferable test is Respiratory Virus PCR (Epic Test Code LAB7366) or Influenza A/B Panel PCR (Epic Test Code LAB7455) that are both performed in-house. The respiratory virus assay detects Influenza A (including H1N1), influenza B, parainfluenza viruses 1, 2, 3, adenovirus, respiratory syncytial virus (RSV), and human metapneumovirus. For CMV testing on BAL specimens, order the CMV Qualitative PCR test (Epic Test Code LAB5840) that is also performed in-house.

Questions concerning viral testing can be directed to Stacey Klutts, MD, PhD (ext. 356-2990), Aaron Bossler (ext. 384-9566) or Matthew Krasowski, MD, PhD (ext. 384-9380).

Epic Test Name	Epic Test Code	Sample Type	Collection Device
Viral Culture & CMV Rapid CultureE	LAB7553F	All Swabs (Not Rectal)	Viral Transport MediaA
		All Tissues	Viral Transport MediaB
		NP Wash	Sterile Leakproof ContainerC
		Sterile Body Fluid	Sterile Leakproof ContainerC
		Tracheal Aspirate	Sterile Leakproof ContainerC
Viral Culture & CMV Rapid Culture, UrineE	LAB7551G	Urine	Sterile Leakproof ContainerC
Cytomegalovirus Rapid Culture	LAB7552	All Swabs	Viral Transport MediaA
		All Tissues	Viral Transport MediaB
		NP Wash	Sterile Leakproof ContainerC
		Sterile Body Fluid	Sterile Leakproof ContainerC
		Tracheal Aspirate	Sterile Leakproof ContainerC
CMV Rapid Culture, Urine	LAB7550	Urine	Sterile Leakproof ContainerC
Viral Culture, Rectal Swab or Stool	LAB7521	Stool	Sterile Leakproof ContainerC
		Rectal Swab	Viral Transport MediaA
HSV DFA with Reflex to Culture	LAB7540	All Swabs	Viral Transport MediaA
		Vesicle Fluid	Viral Transport MediaA
		All Tissues	Viral Transport MediaB
		BAL Fluid	Sterile Leakproof ContainerC
		Sterile Body FluidD	Sterile Leakproof ContainerC
VZV DFA with Reflex to Culture	LAB7541	Vesicle Fluid/Swab	Viral Transport MediaA
		Tissue	Viral Transport MediaB
		Skin Scraping	Viral Transport MediaB
VZV/HSV DFA with Reflex to Cultures	LAB7542	Vesicle Fluid/Swab	Viral Transport MediaA
		Tissue	Viral Transport MediaB
		Skin Scraping	Viral Transport MediaB

AHospital Stores Number 33595(NP Swab Only) or 33625(All Other Swabs); Swab kits with transport media

BHospital Stores Number 923740; Universal transport Media

CHospital Stores Number 37778; Sterile leakproof container

DNot the appropriate test for CSF.  Order HSV by PCR for CSF and send to Molecular Patholgy.

EViruses that can be detected:  enteroviruses, herpes simplex virus, influenza A & B, parainfluenza types  1, 2, 3, adenovirus, varicella-zoster virus, cytomegalovirus, and RSV.  CMV rapid culture is done by shell vial.

FReplaces VIRAL CULTURE (LAB7521)