Test Information

MEDLAB PATHOLOGY (IRELAND)

Microbiology

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The following tables give the repertoire of laboratory tests. It gives details of the sample volumes required, and any special precautions.

Condition or Specimen Type	Clinical Information Required	Appropriate Specimens	Containers
Meningitis / Encephalitis	Clinical presentation. Time and date of onset of symptoms. Details of any recent foreign travel. Presence of rash, respiratory signs, conjunctivitis, head injuries, operations, etc. Recent antibiotic treatment.	CSF (if more than one bottle then please label sequentially). Try to obtain at least 1ml.	Sterile bijoux or Sterile universal.
Meningitis / Encephalitis		Blood culture: add 10ml of blood to each bottle. Paediatric bottles are available if only a small volume of blood is available.	Blood culture bottles available from the lab.
Septicaemia	Clinical presentation. Time and date of onset of symptoms. Details of any recent foreign travel. Presence of rash, respiratory signs, conjunctivitis, head injuries, operations, etc. Any recent infections which may be the source of the illness. Recent antibiotic treatment.	Blood culture: add 10ml of blood to each bottle, Paediatric bottles are available if only a small volume of blood is available. Consecutive blood cultures (at least 30 minutes between) should be taken if SBE suspected.	Blood culture bottles available from the Supplies Dept.
Meningococcal sepsis	Clinical presentation. Time and date of onset of symptoms. Details of any recent foreign travel. Presence of rash, respiratory signs, conjunctivitis, head injuries, operations, etc. Any recent infections which may be the source of the illness. Recent antibiotic treatment. Vaccination history.	Blood culture: add 10ml of blood to each bottle. Paediatric bottles are available if only a small volume of blood is available.	Blood culture bottles available from the lab.

Condition or Specimen Type	Clinical Information Required	Appropriate Specimens	Containers
ENT and Eye infections
Sore throat	Clinical presentation. State if recurrent infection. Date of onset. Details of recent foreign travel. Recent antibiotic therapy.	Throat swab	Orange / Blue swab for culture. Swab in viral transport media if virus suspected.
Otitis media	Clinical presentation. Date of onset. Details of recent foreign travel. Recent antibiotic treatment.	Ear swab or tympanocentesis	Orange / Blue or Black Charcoal swab.
Conjunctivitis	Clinical presentation. Date of onset. Recent antibiotic treatment.	Eye swab	Swab in charcoal transport media. Use Chlamydia PCR swab if Chlamydia suspected. Swab in viral transport media if virus suspected.

Condition or Specimen Type	Clinical Information Required	Appropriate Specimens	Containers
Lower Respiratory Tract disease
Iobar pneumonia; atypical pneumonia; acute exacerbations of chronic bronchitis; bronchiectasis	Clinical presentation. Date of onset. Recent antibiotic therapy. Underlying disease: COAD, emphysema, Cystic fibrosis, cancer. Aspiration (anaerobes suspected). Whether immunosuppressed. Details of recent foreign travel.	Sputum - fresh sample Bronchial washings Endotracheal secretions Nasopharyngeal aspirate	Sputum pot
		Blood culture (especially lobar pneumonia)	If blood culture as for septicaemia.
		Severe acute community acquired pneumonia - urinary antigen testing available for pneumococci	White top urine container (no additives). Contact laboratory before sending.
		If Legionella spp suspected sputum for culture or urine for antigen detection of Legionella pneumophila sero group 1 (contact laboratory for advice)	Sputum pot for sputum or White top urine container (no additives) for urine. Contact laboratory before sending.
		For atypical pneumonia, clotted blood (acute & convalescent for virology)	Clotted blood sample. Minimum 5ml.
Suspected TB
Pulmonary	Relevant history including any previous isolation contacts etc.	3 independent sputum samples for pulmonary TB.	Sputum pot
Non-pulmonary	Relevant history including any previous isolation, contacts, etc.	Urine, pus, CSF, biopsy, etc., for non-pulmonary TB. If sending blood contact laboratory for advice first. Rapid PCR testing available for some specimens. Contact laboratory for advice.	Sterile containers. Citrate bottle for blood.

Condition or Specimen Type	Clinical Information Required	Appropriate Specimens	Containers
Pertussis	Vaccination history Date of onset Severity	Pernasal swab. Always contact laboratory	Pertussis swab needed. Ensure rapid transport to the laboratory.
Wound: Wound infection / abscess	Type of wound, e.g. post-operative / trauma. Give specific description of anatomic site. Clinical history including occupation if relevant to wound.	Pus. Send a swab only if aspirated pus is unavailable.	Sterile universal (for pus). Swab in charcoal transport media.
Wound: Pressure sore / ulcer.	Give specific description of anatomic site. Swabs are of little value. Send biopsy or aspirate of base.	Biopsy or aspirate. If swab is taken ensure the edge of ulcer is sampled or debride wound and swab base.	Biopsy or aspirate in sterile container. Swab in charcoal transport media.
Skin lesions: Suspected fungal infection	Date of onset. Distribution. Type of rash, site.	Skin scraping from edges of lesion. Dermapaks are available from Supplies on request.	In folded black paper inside a labelled envelope.
Skin lesions: Bacterial, e.g., Burns and superficial injuries	Give specific description of anatomic site Date of onset Distribution Type of wound	Swab Blister fluid	Blue or Black charcoal swab.
Skin lesions: Fish tank granuloma or tropical ulcers	Give specific description of anatomic site Date of onset Distribution Foreign travel	Biopsy Swab is NOT appropriate	Biopsy or aspirate in sterile container
MRSA Screens	Relevant clinical history Previous MRSA Recent antibiotic therapy	Nose swab (always) Perineum swab (if it is impractical to collect a perineum swab, such as in emergency admission areas or in mass screening, a throat swab may be sent). Specific lesions if appropriate (e.g., ulcers and surgical wounds).	Blue or black charcoal swab for culture. Do NOT use a black charcoal swab if PCR is required.

Condition or Specimen Type

Clinical Information Required

Appropriate Specimens

Containers

Pertussis

Vaccination history

Date of onset

Severity

Pernasal swab.

Always contact laboratory

Pertussis swab needed.

Ensure rapid transport to the laboratory.

Wound:
Wound infection / abscess

Type of wound, e.g. post-operative / trauma.

Give specific description of anatomic site.

Clinical history including occupation if relevant to wound.

Pus.

Send a swab only if aspirated pus is unavailable.

Sterile universal (for pus).

Swab in charcoal transport media.

Wound:
Pressure sore / ulcer.

Give specific description of anatomic site.

Swabs are of little value. Send biopsy or aspirate of base.

Biopsy or aspirate.

If swab is taken ensure the edge of ulcer is sampled or debride wound and swab base.

Biopsy or aspirate in sterile container.

Swab in charcoal transport media.

Skin lesions:

Suspected fungal infection

Date of onset.

Distribution.

Type of rash, site.

Skin scraping from edges of lesion.

Dermapaks are available from Supplies on request.

In folded black paper inside a labelled envelope.

Skin lesions:

Bacterial, e.g., Burns and superficial injuries

Give specific description of anatomic site

Date of onset

Distribution

Type of wound

Swab

Blister fluid

Blue or Black charcoal swab.

Skin lesions:

Fish tank granuloma or tropical ulcers

Give specific description of anatomic site

Date of onset

Distribution

Foreign travel

Biopsy

Swab is NOT appropriate

Biopsy or aspirate in sterile container

MRSA Screens

Relevant clinical history

Previous MRSA

Recent antibiotic therapy

Nose swab (always)

Perineum swab (if it is impractical to collect a perineum swab, such as in emergency admission areas or in mass screening, a throat swab may be sent).

Specific lesions if appropriate (e.g., ulcers and surgical wounds).

Blue or black charcoal swab for culture.

Do NOT use a black charcoal swab if PCR is required.

Condition or Specimen Type	Clinical Information Required	Appropriate Specimens	Containers
Bone and joint infections	Site: date of onset; presence of prosthesis; other pathology, e.g., rheumatoid arthritis, osteomyelitis	Aspiration or biopsy. Blood cultures (see as for septicaemia). Clotted blood for antistaphyloccal antibodies (ASO) by arrangement.	Sterile universal. Biopsies in saline NOT formalin. For blood cultures (see as for septicaemia). Clotted blood for ASO.
Foreign Bodies
Line tips	Specific site and type of tip. Relevant clinical data.	Tip of line.	Sterile container.
Tenckhoff	Relevant clinical data.	Line or tip.	Sterile container.
IUCD	Relevant clinical data.	IUCD	Sterile container.
Contact lens / case	Relevant clinical data.	Contact lens or case.	N/A
CSF Shunts	Relevant clinical data. Specific site. Antibiotic treatment.	The tip.	Sterile container.
Other	Relevant clinical data. Specific site and nature of foreign body. Antibiotic treatment.	Foreign body.	Sterile container.
Sterile fluids
Peritoneal Dialysis Fluids	Relevant clinical data.	2 x 25ml of dialysis fluid (do not send the bag)	Sterile container (no additives).
Joint Fluids	Relevant clinical data. Antibiotic treatment.	Aspirated fluid.	Sterile container (no additives).
Ascitic Fluids	Relevant clinical data. Antibiotic treatment.	Aspirated fluid.	Sterile container (no additives).
Pleural Fluids	Relevant clinical data. Antibiotic treatment.	Aspirated fluid.	Sterile container (no additives).
CSF (see above)

Condition or Specimen Type	Clinical Information Required	Appropriate Specimens	Containers
Urinary Tract Infection
Non-Tuberculous	Specimen type. Relevant clinical information. Any antibiotic therapy within the last 2 weeks.	Mid stream specimen. Catheter specimens (not from a bag) are not normally accepted unless patient has signs of systemic infection. Suprapubic aspirate.	Boric acid container (red top). Instruct patient on correct sample collection.
Suspected TB	Relevant clinical information. Why TB suspected?	Early morning specimen x3.	Universal container.
Diarrhoea and vomiting	Age, date, time of onset; visits abroad, affected family / friends. Antibiotic therapy prior to onset. Nature of food consumed if food poisioning suspected.	Faeces for bacteriological culture and virology if appropriate (single sample required). Also food if available and food poisoning suspected. Vomit is NOT an appropriate sample.	Sterile screw topped container.
Faecal Parasitic infections	Age, date, time of onset; visits abroad, affected family / friends.	Faeces (on 3 consecutive days if possible).	Sterile screw topped container.
Vaginal discharge
Vaginal discharge Suspected STD Pelvic inflammatory disease	Full clinical history. Serological screening for syphilis may also be advisable.	HVS for Trichomonas vaginalis and Candida spp. also other bacterial infection if appropriate. Urethral & endocervical swabs for Neisseria gonorrhoeae. Rectal & throat swabs may be indicated by history. Urethral & endocervical swabs for Chlamydia. Urine for Chlamydia.	Swab in charcoal transport media. For Chlamydia use a Chlamydia PCR swab or a urine. Please always label swabs with the specific site. White topped urine pot for Chlamydia.