This site uses cookies to store information on your computer. I'm fine with this Cookie information

Which virology test? Identify the correct test, sample and indication

  • For all virology testing requiring an EDTA blood sample please use a 9ml tube (e.g. VACUETTE® TUBE 9 ml K3E K3EDTA - lavender cap).
  • For all NHSGGC sites please order the 9ml EDTA bottles from the PECOS internet procurement manager, search for Item No./Mfr No. 455036
  • Viral PCR Sample Solution (VPSS)

Key:

  1. BAL:  Bronchoalveolar lavage in a universal container
  2. Clotted blood: 9ml yellow biochemistry bottle
  3. CSF:   Cerebrospinal fluid in a universal container
  4. EDTA blood:  9mL purple cross matching/FBC bottle
  5. Gargle: 5-10mL of gargled tap water in a universal container
  6. NPA:  Nasopharyngeal aspirate in a universal container
  7. VPSS: Viral PCR sample solution

 


Anthrax: Bacillus anthracis

EDTA Blood AND clotted blood

Plus as appropriate in a Sterile (universal) container

  • Tissue biopsy
  • Eschar
  • Lesion washings
  • Post mortem tissue -

Health Protection Scotland: Anthrax

Public Health England: Anthrax: guidance, data and analysis

If testing is required please complete the Rare and Imported Pathogens Laboratory (RIPL) request form

TrakCare item: Other virology / virus testing requests


Central nervous system testing (CSF)

Cerebrospinal fluid (CSF) in a universal container

  • TrakCare item: CSF viral PCR screen (this item tests for 
    • Herpes simplex virus-1/2 (HSV-1/2)
    • Varicella zoster virus (VZV)
    • Enterovirus
    • Parechovirus

An HIV test should be performed on all patients with encephalitis or with suspected encephalitis irrespective of interpretation of possible risk factors:

EDTA blood

  • TrakCare item: HIV antibody / antigen screen

In all patients with suspected viral encephalitis, enterovirus PCR on GI tract samples should be considered. This will increase the diagnostic yield.

Faeces in Sterile (universal) container OR a rectal swab in VPSS AND a throat swab in VPSS.

TrakCare item: Enterovirus / parechovirus PCR

Swabs should also be sent from vesicles, if present:

Please note, varicella zoster virus IgM is no longer available at the WoSSVC

Sample type: Vesicle/ulcer swab in VPSS

  • TrakCare item: Vesicle rash PCR - Set (this set includes tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus and enterovirus / parechovirus)

When there is a recent or concomitant respiratory tract infection send a respiratory sample

When there is suspicion of mumps, buccal swabs should be sent for PCR:

PLEASE NOTE: Mumps IgM is no longer available at the WoSSVC

Buccal (inner cheek) mouth swab in VPSS


Eye testing

Eye specimens:

  1. Conjunctival Swab in VPSS
  2. Aqueous humor in VPSS
  3. Vitreous humor in VPSS
  • TrakCare item: Eye PCR screen - viral / chlamydia (this item tests for
    • Adenovirus
    • Herpes simplex virus-1/2 (HSV-1/2)
    • Varicella zoster virus (VZV)
    • Chlamydia trachomatis
  • TrakCare item: Eye PCR - Neisseria gonorrhoeae

 

  1. GP electronic request (ICE / EMIS / Vision) item: Eye PCR - HSV VZV adenovirus Chlamydia this item tests for:

 

  1. Adenovirus
  2. Herpes simplex virus-1/2 (HSV-1/2)
  3. Varicella zoster virus (VZV)
  4. Chlamydia trachomatis

 

  1. GP electronic request (ICE / EMIS / Vision) item: Eye PCR - Neisseria gonorrhoeae

 

Ocular toxoplasmosis

EDTA Blood

TrakCare item: Toxoplasma IgG - past infection

If Toxoplasma IgG is 'Not detected' then Toxoplasmosis is excluded. If Toxoplasma IgG is 'DETECTED' then the WoSSVC will send the sample directly to the Scottish Toxoplasma Reference Laboratory for further testing.

 

Ocular syphilis

EDTA Blood

  • TrakCare item: Syphilis Serology Screen
  • GP electronic request (ICE / EMIS / Vision) item: Syphilis serology screen - blood

Gastrointestinal testing


Diarrhoea and vomiting

Faeces - Sterile (universal) container

Rectal swab in VPSS

Vomit - Sterile (universal) container

Please note: Testing for rotavirus, astrovirus, adenovirus and saporovirus is restricted to immunocompromised patients and children under ten years old. Virology testing in all other individuals with diarrhoea is limited to norovirus.

  • TrakCare item: Norovirus PCR
  1. GP electronic request (ICE / EMIS / Vision) item: Norovirus PCR - Faeces
  2. GP electronic request (ICE / EMIS / Vision) item: Norovirus PCR - Rectal Swab
  3. GP electronic request (ICE / EMIS / Vision) item: Norovirus PCR - Vomit

 

  • TrakCare item: Faeces viral PCR screen (this item tests for adenovirus, sapovirus, astrovirus and rotavirus, it does NOT include norovirus, which must be requested separately)
  1. GP electronic request (ICE / EMIS / Vision) item: Viral Diarrhoea PCR (not noro)-Faeces
  2. GP electronic request (ICE / EMIS / Vision) item: Viral Diarrhoea PCR (not noro)-Rectal

Hepatitis


Acute viral hepatitis testing (ALT >100 U/L)

EDTA Blood

Unless an appropriate indication is provided (e.g. ALT, jaundice) the hepatitis A and hepatitis E will be declined by the laboratory and HCV IgG will be substituted for antigen.

  • TrakCare item: Acute Hepatitis Screen - Set
    • Hep A IgM - acute infection
    • Hep B screen - HBsAg - current infection
    • Hep C - HCV antigen
    • Hep E IgM screen - acute infection

 

  1. GP electronic request (ICE / EMIS / Vision) items: Acute Hepatitis testing
    1. Hepatitis A IgM - acute infection
    2. Hep B screen - HBsAg - current infection
    3. Hep C - HCV antigen
    4. Hep E IgM screen - acute infection

 

Chronic viral hepatitis testing

EDTA Blood

For screening use

  • TrakCare item: Hep B screen - HBsAg - current infection

AND

  • TrakCare item: Hep C antibody screen

OR 

  • TrakCare item: HIV, Hep B, Hep C screen - Set
  1. GP electronic request (ICE / EMIS / Vision) items: Chronic Hepatitis testing

If testing a person who injects drugs (PWID), please include PWID in the clinical details:

  • TrakCare item: Hep C - HCV antigen request

Hepatitis A virus (HAV)

EDTA Blood

Please note: HAV is now rare in Scotland. HAV IgM is only offered in jaundiced patients or those with an ALT greater than 100 U/L. Please include the details of the hepatitis (inc maximum ALT), travel history (with dates), food risk history and clinical features if HAV testing is required or the request will be declined.

  • TrakCare item: Hep A IgM - acute infection request
  1. GP electronic request (ICE / EMIS / Vision) items: Acute Hepatitis testing

Please note if HAV IgM is appropriate then HEV IgM should also be requested along with HBsAg and HCV antigen. All of which are available in:

  • TrakCare item: Acute Hepatitis Screen - Set
  1. GP electronic request (ICE / EMIS / Vision) items: Acute Hepatitis testing

 

Post HAV vaccine antibody (IgG) checks are not recommended. Test is for natural immunity (very high levels) and not normally sensitive enough for vaccine induced immunity. Follow manafacturer's guidelines for duration of immunity and timing of booster doses.

  • TrakCare item: Hep A IgG - past infection
  1. GP electronic request (ICE / EMIS / Vision) items: Hepatitis A virus IgG - past HAV

Hepatitis B virus (HBV) & hepatitis delta virus (HDV)

EDTA Blood

For screening use

  • TrakCare item: Hep B screen - HBsAg - current infection

or

  • TrakCare item: HIV, Hep B, Hep C screen - Set
  1. GP electronic request (ICE / EMIS / Vision) items: Chronic Hepatitis testing

 

To determine past natural HBV status, to assess the risk of reactivation in the immunocompromised, or the requirement for immunisation:

  • TrakCare item: Hep B - anti-HBc IgG request
  1. GP electronic request (ICE / EMIS / Vision) item: Anti-HBc IgG-past natural HBV infection

 

 

Post primary HBV immunisation course or 1-3 months post booster to assess immunity:

  • TrakCare item: Hep B - anti-HBs - post vaccine
  1. GP electronic request (ICE / EMIS / Vision) item: Anti-HBs-post HBV immunisation

 

Available for request to specialist services only:

  • TrakCare item: Hep B - anti-HBe request
  • TrakCare item: Hep B - HBeAg request
  • TrakCare item: Hep B anti-viral resistance (Indication must be provided or will be declined)
  • TrakCare item: Hep B - Quantitative HBsAg (Indication must be provided or will be declined)
  • TrakCare item: Hep B viral load ( PCR )
  • TrakCare item: Hep D viral load ( PCR )

 


Hepatitis C virus (HCV)

 

EDTA Blood

For screening use

  • TrakCare item: Hep C antibody screen

or

  • TrakCare item: HIV, Hep B, Hep C screen - Set
  1. For screening use GP electronic request (ICE / EMIS / Vision) item: Chronic Hepatitis testing

 

If testing a person who injects drugs (PWID), please include PWID in the clinical details:

  • TrakCare item: Hep C - HCV antigen request

 

Available for request to specialist services only:

  • TrakCare item: Hep C anti-viral resistance
  • TrakCare item: Hep C genotyping
  • TrakCare item: Hep C viral load ( PCR )

 


Hepatitis E virus (HEV)

EDTA Blood

HEV testing is only offered in jaundiced patients or those with an ALT greater than 100 U/L. Please note if HEV IgM is appropriate then HAV IgM should also be requested along with HBsAg and HCV antigen.

Please include the details of the hepatitis (inc maximum ALT), travel history (with dates and destination if genotype 1 is suspected), food risk history and clinical features if HEV testing is required or the request will be rejected.

TrakCare item: Hep E IgM screen - acute infection

TrakCare item: Acute Hepatitis Screen - Set

GP electronic request (ICE / EMIS / Vision) item: Acute Hepatitis testing

 

TrakCare item: Hep E viral load ( PCR ) (this item is restricted to use in immunocompromised patients)


Hand, foot and mouth disease

Sample type: Vesicle/ulcer swab (or throat swab or rectal swab) in VPSS

  • TrakCare item: Enterovirus / parechovirus PCR
  • TrakCare item: Vesicle rash PCR - Set (this set includes tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus and enterovirus / parechovirus)
  1. GP electronic request (ICE / EMIS / Vision) items: Other virology requests
  2. GP electronic request (ICE / EMIS / Vision) item: Maculopapular rash PCR-current infection

Immunocompromised host


Antiviral drug resistance

Please call the clinical staff at the WoSSVC to discuss any request for antiviral drug resistance, tel: 38722 (0141 201 8722).


Cytomegalovirus drug resistance

EDTA Blood

  • TrakCare item: Other virology / virus testing requests

Herpes simplex virus-1 or 2 antiviral resistance

Swab in Viral Transport Medium – this is NOT VPSS, please contact the laboratory for VTM

  • TrakCare item: Other virology / virus testing requests


Hepatitis in the immunocompromised host

EDTA Blood

  • TrakCare item: Hep E viral load ( PCR )

AND

  • TrakCare item: Acute Hepatitis Screen - Set
    • Hep A IgM - acute infection
    • Hep B screen - HBsAg - current infection
    • Hep C - HCV antigen
    • Hep E IgM screen - acute infection PLEASE DELETE THIS ITEM

AND

  • TrakCare item: Blood - CMV EBV adenovirus PCR

AND

  • TrakCare item: Herpes simplex / varicella zoster virus PCR

Human immunodeficiency virus (HIV) 

EDTA Blood

For screening use:

  • TrakCare item: HIV antibody / antigen screen

or

  • TrakCare item: HIV, Hep B, Hep C screen - Set
  1. GP electronic request (ICE / EMIS / Vision) item: HIV antibody/antigen (Ab/Ag) screen

Available for request to specialist services only:

  • HIV anti-retroviral drug resistance
  • HIV integrase drug resistance
  • HIV anti-retroviral therapeutic drug monitoring

Please see Lab21 Therapeutic Drug Monitoring Tests for the currently available anti-retroviral TDM assays

  • HIV viral load ( PCR )
  • HIV avidity
  • HIV tropism

Human T-lymphotropic virus Type I and II (HTLV-1/-2) 

EDTA Blood

Please provide the indication for the test (e.g. suspected Adult T-cell leukaemia / lymphoma or HTLV-I-associated myelopathy, also known as tropical spastic paraparesis) along with ethnicity, risk factors and clinical signs or symptoms. If the test is for organ donation or is required prior to a specific therapy please specify. Please provide the full clinical details or this test will not be performed by the laboratory and further clinical details will be requested.

TrakCare item: HTLV-1/2 antibody screen


Human herpesvirus-8

For the investigation of:

  1. Kaposi sarcoma
  2. Primary effusion lymphoma
  3. Castleman's disease

EDTA Blood and/or biopsy

If required please complete the Seromolecular Services Unit (SSU) request form, Virus Reference Department, PHE Microbiology Services Colindale

  • TrakCare item: Other virology / virus testing requests


Neurological dysfunction

CSF in Sterile (universal) container

  • TrakCare item: Immunocompromised CSF virus PCR - Set

This set contains:

  • CSF viral PCR screen (this item tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus (VZV) and enterovirus / parechovirus)
  • Human herpesvirus-6/7 PCR
  • JC virus PCR
  • Non-blood - CMV EBV adenovirus PCR

Faeces in Sterile (universal) container

OR

rectal swab in VPSS 

AND

throat swab in VPSS.

TrakCare item: Enterovirus / parechovirus PCR

 

Swabs should also be sent from vesicles, if present:

Please note, varicella zoster virus IgM is no longer available at the WoSSVC

Sample type: Vesicle/ulcer swab in VPSS

  • TrakCare item: Vesicle rash PCR - Set (this set includes tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus and enterovirus / parechovirus)

 

When there is a recent or concomitant respiratory tract infection send a respiratory sample

 

When there is suspicion of mumps, buccal swabs should be sent for PCR:

PLEASE NOTE: Mumps IgM is no longer available at the WoSSVC

Buccal (inner cheek) mouth swab in VPSS



Post-transplant lymphoproliferative disease (PTLD)

EDTA Blood (for quantitation in immunocompromised patients)

TrakCare item: Blood - CMV EBV adenovirus PCR (this item tests for cytomegalovirus, Epstein-Barr virus and adenovirus)

GP electronic request (ICE / EMIS / Vision) items: Other virology requests


Progressive multifocal leukoencephalopathy (PML)

JC polyomavirus  

Clotted blood

TrakCare item: JC virus antibody (pre-therapy, for risk assessment only)

CSF in Sterile (universal) container

  • TrakCare item: Immunocompromised CSF virus PCR - Set

This set contains:

  • CSF viral PCR screen (this item tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus (VZV) and enterovirus / parechovirus)
  • Human herpesvirus-6/7 PCR
  • JC virus PCR
  • Non-blood - CMV EBV adenovirus PCR

Faeces in Sterile (universal) container

OR

rectal swab in VPSS 

AND

throat swab in VPSS.

TrakCare item: Enterovirus / parechovirus PCR

 

Swabs should also be sent from vesicles, if present:

Please note, varicella zoster virus IgM is no longer available at the WoSSVC

Sample type: Vesicle/ulcer swab in VPSS

  • TrakCare item: Vesicle rash PCR - Set (this set includes tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus and enterovirus / parechovirus)

 

When there is a recent or concomitant respiratory tract infection send a respiratory sample

 

When there is suspicion of mumps, buccal swabs should be sent for PCR:

PLEASE NOTE: Mumps IgM is no longer available at the WoSSVC

Buccal (inner cheek) mouth swab in VPSS


Rash exposure

Please contact the laboratory to arrange urgent testing

As appropriate:

EDTA blood

Immunity to measles (IgG) is only offered in immunocompromised or pregnant patients who have been exposed to a case and would be eligible for administration of human normal immunoglobulin, all other individuals should be offered two doses of MMR if they do not have documented evidence of two previous doses. Please provide the full clinical details or this test will not be performed by the laboratory and further clinical details will be requested.

TrakCare item: Measles IgG - past natural infection

GP electronic request (ICE / EMIS / Vision) items: Measles IgG - past natural infection

 

Clotted blood

TrakCare item: Varicella zoster IgG - past infection

GP electronic request (ICE / EMIS / Vision) item: Varicella zoster virus IgG - past VZV


Renal dysfunction


BK polyomavirus

EDTA Blood

  • TrakCare item: BK virus PCR

Infectious mononucleosis / glandular fever

EDTA Blood

  • TrakCare item: EBV IgM - acute infection
  • TrakCare item: CMV IgM - acute infection
  1. GP electronic request (ICE / EMIS / Vision) items: Epstein Barr virus IgM - acute EBV
  2. GP electronic request (ICE / EMIS / Vision) items: Cytomegalovirus IgM - acute CMV

Please note: It is not possible to clinically differentiate between acute cytomegalovirus and Epstein Barr virus. Testing is limited to patients with lymphadenopathy or those with a lymphocytosis. Please list the patients symptoms and signs or this test will not be performed by the laboratory and further clinical details will be requested. Isolated abnormal LFTs in patients greater than 30 years is NOT an indication for CMV / EBV IgM testing.

 


 

Mumps virus

PLEASE NOTE: Mumps IgM is no longer available at the WoSSVC

Buccal (inner cheek) mouth swab in VPSS

TrakCare item: Mumps PCR - current infection

GP electronic request (ICE / EMIS / Vision) item: Mumps PCR - current infection


Neonatal testing 


Chlamydia trachomatis

Neonatal C. trachomatis infection can cause neonatal conjunctivitis (ophthalmia neonatorum) in the first month of life.

Conjunctival Swab in VPSS

  • TrakCare item: Eye PCR screen - viral / chlamydia (this item tests for adenovirus, herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus (VZV) and Chlamydia trachomatis)

Also consider (will be tested on the same sample):

  • TrakCare item: Eye PCR - Neisseria gonorrhoeae
  1. GP electronic request (ICE / EMIS / Vision) item: Eye PCR - HSV VZV adenovirus Chlamydia (this item tests for adenovirus, herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus (VZV) and Chlamydia trachomatis)

Also consider (will be tested on the same sample):

  1. GP electronic request (ICE / EMIS / Vision) item: Eye PCR - Neisseria gonorrhoeae

Neonatal C. trachomatis infection can cause a subacute, afebrile pneumonia presenting usually between 1–3 months. 

  • TrakCare item: Respiratory - Chlamydia trachomatis PCR

 


Congenital cytomegalovirus (CMV) testing

Indications for congenital CMV infection include:

  • Laboratory diagnosed maternal CMV infection during pregnancy

Neonatal signs:

  • Rash
  • Jaundice
  • Microcephaly
  • Intrauterine growth restriction (IUGR)
  • Hepatosplenomegaly
  • Seizures
  • Retinitis

Congenital cytomegalovirus, neonate <21 days old:

Saliva soaked swab in VPSS or Urine in a sterile (universal) container  

TrakCare item: Non-blood - CMV EBV adenovirus PCR

Long term sequelae in infants/children, potentially secondary to congenital CMV syndrome:

  • Hearing loss
  • Developmental and motor delay
  • Vision loss
  • Microcephaly
  • Seizures

  

Congenital cytomegalovirus, neonate/infant >21 days old:

EDTA Blood for CMV IgG

TrakCare item: CMV IgG - past infection

Guthrie card for PCR, ONLY if CMV IgG positive, send the Guthrie card only after discussion with the WoSSVC.

TrakCare item: Other virology / virus testing requests


Herpes simplex virus-1/2 testing

It is VITAL to send ALL of the following samples in EVERY case:

  • EDTA Blood
  • Nose and throat swab expressed in the same VPSS
  • Rectal swab in VPSS
  • Eye swab in VPSS

If present it is VITAL to send the following samples:

  • Skin lesion swab in VPSS
  • Vesicle/ulcer swab in VPSS

Consider if indicated

  • CSF in a universal container

 

  • TrakCare item: Herpes simplex / varicella zoster virus PCR
  • TrakCare item: Eye PCR screen - viral / chlamydia (this item tests for adenovirus, herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus (VZV) and Chlamydia trachomatis)

 


Congenital rubella testing

If the mother has received two doses of a rubella containing vaccine (please refer to the patients GP for the vaccination history), then congenital rubella syndrome has been excluded and no testing is indicated.

If the mother has rubella IgG (antibody) results from a previous pregnancy (when rubella IgG testing was included in antenatal screening) then clinical staff in the laboratory can assess maternal immunity and advise if testing is indicated.

Congenital rubella syndrome signs:

  • Patent ductus arteriosus
  • Pulmonary artery stenosis
  • Cataract - Unilateral or bilateral
  • Retinopathy - Salt-and-pepper appearance; visual acuity unaffected; frequently unilateral
  • Microphthalmia - Common in patients with unilateral cataract
  • Blueberry muffin spots - Represents dermal erythropoiesis
    Chronic rubelliform rash - Usually generalized; lasts several weeks
  • Hepatosplenomegaly
  • Thrombocytopenia - no response to steroid therapy
  • Radiographic lucencies - Transient; most common in distal femur and proximal tibia

Please email/call the clinical team ([email protected] / 38722 / 0141 201 8722) to discuss the investigation of any suspected congenital rubella syndrome case.


Congenital Toxoplasmosis testing

 Signs of Congenital toxoplasmosis:

  • Pyrexia
  • Lymphadenopathy
  • Hepatitis
  • Retinochoroiditis
  • Hydrocephalus
  • Encephalitis
  • Intracranial calcifications

Congenital toxoplasmosis can be excluded by a current maternal sample for:

EDTA Blood

TrakCare item: Toxoplasma IgG - past infection

If maternal Toxoplasma IgG is 'Not detected' then congenital Toxoplasmosis is excluded in the neonate. If maternal Toxoplasma IgG is 'DETECTED' then please send neonatal blood to the WoSSVC:

EDTA Blood

TrakCare item: Toxoplasma IgG - past infection

Please email/call the clinical team ([email protected] / 38722 / 0141 201 8722) to let them know that the neonatal sample is coming, so that it can be sent directly to the Scottish Toxoplasma Reference Laboratory, along with the current and antenatal maternal samples.


'TORCH' testing

When should the ‘TORCH’ study be requested?

It is never appropriate to request a ‘TORCH screen’. ‘TORCH’ screening as a 'single test' was recommended to be abolished in 1993 in the UK, due to poor clinical utility and low diagnostic yield. (Public Health Laboratory Service Working Party on congenital infections. TORCH screening reassessed. 2nd edn. Public Health Laboratory Service, London; 1993.)

Please see the indications for testing individually for congenital/neonatal toxoplasmosis, rubella, varicella zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV) and syphilis under Neonatal testing.


Congenital syphilis

A current maternal sample can exclude congenital syphilis if seronegative. If antibody is detected in the mother then a neonatal sample should be sent.

EDTA blood

  • TrakCare item: Syphilis Serology Screen
  • GP electronic request (ICE / EMIS / Vision) item: Syphilis serology screen - blood

Congenital varicella syndrome

 

 


Q-fever (Coxiella burnettii ) 

EDTA blood, clotted blood, tissue, heart valve

We restrict Q-fever (Coxiella burnetii ) testing to specific clinical pictures, please see: Public Health England: Q-fever

IF APPROPRIATE please complete and send the Rare and Imported Pathogens Laboratory request form to the WoSSVC including details of exposure/risk factor and symptoms including the date of onset. The expected turnaround time is approximately seven working days.

 


Rash testing 


Maculopapular rash

Please note that rubella IgM, measles IgM and rubella IgG are no longer routinely available.

Throat swab in VPSS

  • TrakCare item: Adult maculopapular rash - virus PCR - Set contains:
  1. Measles / rubella virus PCR - current infection
  2. Enterovirus / parechovirus PCR
  3. Parvovirus B19 PCR
  • TrakCare item: Paediatric maculopapular rash - virus PCR - Set 

Contains:

  1. Measles / rubella virus PCR - current infection
  2. Human herpesvirus-6/7 PCR
  3. Enterovirus / parechovirus PCR
  4. Parvovirus B19 PCR

or choose from (please note that viral rash illnesses are rarely able to be differentiated clinically, the above ordersets are recommended):

  • TrakCare item: Measles / rubella virus PCR - current infection
  • TrakCare item: Enterovirus / parechovirus PCR
  1. GP electronic request (ICE / EMIS / Vision) item: Maculopapular rash PCR-current infection

Please note rubella is rare in Scotland and limited to imported cases and their unvaccinated contacts. The last Scottish laboratory confirmed case was in a single individual in 2013 (correct as of 12/11/18).

Clinical diagnosis requires acute onset of generalised maculopapular rash AND fever (>37.2 °C) AND cervical, suboccipital or postauricular adenopathy or arthralgia/arthritis. Cases in Scotland are imported. Please provide the patient's rubella/MMR vaccination history, recent international travel and contact date with a similar illness.

EDTA Blood

  • TrakCare item: HIV antibody / antigen screen
  1. GP electronic request (ICE / EMIS / Vision) item: HIV antibody/antigen (Ab/Ag) screen
  • TrakCare item: Syphilis Serology Screen
  1. GP electronic request (ICE / EMIS / Vision) item: Syphilis serology screen - blood

 

Parvovirus B19 IgM testing is limited to symptomatic patients with a maculopapular rash, acute onset arthralgia or acute anaemia and asymptomatic pregnant patients three weeks after exposure to a rash illness. Please state the rash onset date or the date of rash contact in pregnant women along with the current gestation. Please provide the full clinical details or this test will not be performed by the laboratory and further clinical details will be requested.

  • TrakCare item: Parvovirus B19 IgM - acute infection
  1. GP electronic request (ICE / EMIS / Vision) item: Parvovirus B19 IgM - acute infection

 


Vesicular rash / ulcer testing

Please note, varicella zoster virus IgM is no longer available at the WoSSVC

Sample type: Vesicle/ulcer swab in VPSS

  • TrakCare item: Vesicle rash PCR - Set (this set includes tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus and enterovirus / parechovirus)

or

  • TrakCare item: Herpes simplex / varicella zoster virus PCR
  1. GP electronic request (ICE / EMIS / Vision) item: HSV/VZV PCR - Non-genital ulcer/vesicle

and / or

  • TrakCare item: Herpes simplex - Syphilis PCR ( GUM ) (this item tests for herpes simplex virus-1/2 (HSV-1/2) and Treponema pallidum)
  1. GP electronic request (ICE / EMIS / Vision) item: HSV / syphilis PCR - Genital ulcer

Contact with a maculopapular rash

Measles IgG testing is only offered for some immunocompromised, pregnant patients or infants under six months old, who have been exposed/possibly exposed and would be eligible for administration of human normal immunoglobulin. All other individuals should be offered two doses of MMR if they do not have documented evidence of two previous doses. Please call the WoSSVC 9am-5pm Monday-Friday 38722 (0141 201 8722), 9am-5pm Saturday-Sunday ask for Virologist on call via switchboard (0141 211 4000). Please have the patients diagnosis, treatment details, date and time of the exposure and details of the exposure e.g. face to face, same room etc. Please have the full clinical details or this test will not be performed by the laboratory and further clinical details will be requested.

  • TrakCare item: Measles IgG - past natural infection
  1. GP electronic request (ICE / EMIS / Vision) items: Measles IgG - past natural infection

 

Parvovirus B19 IgG testing is limited to pregnant patients who are exposed to a maculopapular rash illness. Parvovirus B19 IgG is a test for immunity to parvovirus B19. If the patient has had an antenatal blood sample taken please email the WoSSVC ([email protected]) to request testing on that specimen. Please state the date of rash contact and current gestation. Please provide the full clinical details or this test will not be performed by the laboratory and further clinical details will be requested.

  • TrakCare item: Parvovirus B19 IgG - past infection
  1. GP electronic request (ICE / EMIS / Vision) item: Parvovirus B19 IgG - past infection

Contact with a vesicular rash (chickenpox/shingles contact in pregnancy or immunocompromised)

PLEASE PHONE THE WoSSVC IF TESTING IS DUE TO A VZV EXPOSURE (ext. 38722) recent blood, stored in the laboratory, can usually be used to perform the testing.

Immunity to varicella zoster virus (VZV IgG) is only offered in immunocompromised patients and their household contacts (with no past medical history of chickenpox), pregnant patients (with no past medical history of chickenpox) or health care workers (with no past medical history of chickenpox).

Please provide the gestation for pregnant women or the diagnosis of immunocompromised patients or their household contact.

  • TrakCare item: Varicella zoster IgG - past infection
  1. GP electronic request (ICE / EMIS / Vision) item: Varicella zoster virus IgG - past VZV

 

Respiratory testing

The routine respiratory screen consists of the following pathogens:

  • Influenza A
  • Influenza B
  • RSV
  • Adenovirus
  • Mycoplasma pneumonia

If a lower respiratory tract infection is present the best sample (1) for sensitivity to the worst (8) are as follows:

  1. Bronchoalveolar lavage (BAL) in a sterile universal container
  2. Induced sputum in a sterile universal container
  3. Sputum in a sterile universal container
  4. NPA in a sterile universal container
  5. Gargle in a sterile universal container
  6. Nose and throat swab both expressed in same VPSS container
  7. Throat swab in a VPSS container 
  8. Nose swab in a VPSS container 

TrakCare test name:

  • Respiratory virus + Mycoplasma pneumoniae (Influenza A/B, RSV, adenovirus)

GP ICE test names:  

  1. Resp viruses + Mycoplasma Gargle
  2. Resp viruses + Mycoplasma Sputum
  3. Resp viruses + Mycoplasma Throat Swab

An extended test containing:

  • Coronaviruses
  • Rhinovirus
  • Parainfluenza virus-1-4
  • Human metapneumovirus (HuMP)

will still be available, but will be limited to patients admitted to ICU/critical care and for patients who are immunocompromised.

Should you require these additional tests on a patients outwith the aforementioned criteria they can be requested via discussion with the WoSSVC (Tel: 38722 / 0141 201 8722). These additional tests can be added onto the sample already received by the laboratory.

Whooping cough (Bordetella pertussis)

The Scottish Microbiology Virology Nework (SMVN) review on pertussis testing states that throat swabs are the recommended sample for ages >1 yrs, these should be submitted in Viral PCR Sample Solution (VPSS). Nasopharyngeal aspirates (submitted in the sample compartment) and nasopharyngeal swabs (submitted in Viral PCR Sample Solution (VPSS)) are the recommended samples for children <1 yrs.

Testing for Bordetella pertussis should be performed for patients with an acute cough lasting for 14 days or more, without an apparent cause, plus one or more of the following:-

  1. Paroxysms of coughing
  2. Post-tussive vomiting
  3. Inspiratory whoop
  4. Undiagnosed apnoeic attacks in young infants
  5. Someone with signs and symptoms consistent with pertussis, who has been in contact with a confirmed case in the previous 21 days.
  6. Someone who is known to be part of any ongoing outbreak investigation in a specific group of people.  For example, children attending the same school or nursery where pertussis is known to be been circulating.
PCR testing SHOULD NOT BE USED for patients with symptoms of >3 weeks or 5 days of antibiotic therapy.
  • TrakCare test name: Bordetella pertussis PCR ( whooping cough )
  1. GP ICE code: Pertussis (Whooping cough)

Pneumocystis jirovecii (PCP)

If Pneumocystis jirovecii is suspected the best sample for sensitivity to the worst are as follows:

  1. Bronchoalveolar lavage (BAL) in a sterile universal container
  2. Induced sputum in a sterile universal container
  3. Sputum in a sterile universal container
  • TrakCare item: BAL screen ( Resp virus / PCP / CMV / Pertussis ) tests for:
  1. Pneumocystis jirovecii
  2. Cytomegalovirus (CMV)
  3. Bordetella pertussis
  4. Influenza A (including the H275Y oseltamivir resistance mutation)
  5. Influenza B, respiratory syncitial virus (RSV)
  6. Human metapneumovirus (HuMP)
  7. Parainfluenza-1/2/3/4
  8. Coronavirus
  9. Rhinovirus / enterovirus
  10. Adenovirus
  11. Mycoplasma pneumoiae

Chlamydia trachomatis

  • TrakCare item: Respiratory - Chlamydia trachomatis PCR

Neonatal C. trachomatis infection can cause a subacute, afebrile pneumonia presenting usually between 1–3 months. 


Sexual Health

 

EDTA blood

  • TrakCare item: HIV antibody / antigen screen
  • GP electronic request (ICE / EMIS / Vision) item: HIV antibody/antigen (Ab/Ag) screen

 

  • TrakCare item: Hep B screen - HBsAg - current infection

or TrakCare item: HIV, Hep B, Hep C screen - Set

  • GP electronic request (ICE / EMIS / Vision) items: Chronic Hepatitis testing

 

  • TrakCare item: Syphilis Serology Screen
  • GP electronic request (ICE / EMIS / Vision) item: Syphilis serology screen - blood

 

Vesicle/ulcer swab in VPSS

  • TrakCare item: Herpes simplex - Syphilis PCR ( GUM ) (this item tests for herpes simplex virus-1/2 (HSV-1/2) and Treponema pallidum)
  1. GP electronic request (ICE / EMIS / Vision) item: HSV / syphilis PCR - Genital ulcer

 

Chlamydia/Gonorrhoea

Abbott multi-collect specimen collection kit EXCEPT for eye swabs which must be added to VPSS

Men: Urine (Abbott multi-collect specimen collection kit), urine must be provided in the Abbott Multi-Collect transpost tube.

Female: Vulvovaginal swab (Abbott multi-collect specimen collection kit) 

Rectal swab, pharyngeal swab for either sex as required (Abbott multi-collect specimen collection kit) 

TrakCare item: Chlamydia / Gonorrhoea PCR

GP electronic request (ICE / EMIS / Vision) items: Chlamydia/Gonorrhoea PCR - Urine

GP electronic request (ICE / EMIS / Vision) items: Chlamydia/Gonorrhoea PCR - Vulvovaginal

GP electronic request (ICE / EMIS / Vision) items: Chlamydia/Gonorrhoea PCR - Pharyngeal

GP electronic request (ICE / EMIS / Vision) items: Chlamydia/Gonorrhoea PCR - Rectal

Sexual health eye specimen: conjunctival swab in VPSS

  • TrakCare item: Eye PCR screen - viral / chlamydia (this item tests for adenovirus, herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus (VZV) and Chlamydia trachomatis)
  • TrakCare item: Eye PCR - Neisseria gonorrhoeae
  1. GP electronic request (ICE / EMIS / Vision) item: Eye PCR - HSV VZV adenovirus Chlamydia (this item tests for adenovirus, herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus (VZV) and Chlamydia trachomatis)
  2. GP electronic request (ICE / EMIS / Vision) item: Eye PCR - Neisseria gonorrhoeae

Human papillomavirus

Please see the Scottish Human Papilloma Virus Reference Laboratory (SHPVRL) user manual.

If testing is required please complete the appropriate form which can be found with in their current user manual on their website (link above).

  • TrakCare item: Other virology / virus testing requests

Lymphogranuloma venereum (LGV)  

Rectal swab in Abbott multi-collect specimen transport tube previously diagnosed as Chlamydia trachomatis positive. If recently positive for Chlamydia trachomatis at the WoSSVC please email to arrange LGV testing: [email protected]

If no previous testing has been undertaken please send:

Rectal swab and/or pharyngeal swab for either sex as required (Abbott multi-collect specimen collection kit) 

TrakCare item: Chlamydia / Gonorrhoea PCR 


Theraputic Drug Monitoring (TDM)


Aciclovir TDM

For patients with renal failure and/or on ECMO, in cases of suspected neurotoxicity, or suspected poor absorption.

Clotted blood for aciclovir (including valaciclovir) TDM. MARKED Pre dose sample AND a MARKED post dose sample, taken one hour after the end of iv OR two hours after oral administration

Please see the Antimicrobial Reference Laboratory for their 'Antibiotic Assay Guidelines for Users' and 'Antibiotic Assay Guideline Ranges'

TrakCare item: Aciclovir therapeutic drug monitoring

GP electronic request (ICE / EMIS / Vision) item: Other virology requests 


Ganciclovir / valganciclovir therapeutic drug monitoring: Clotted blood 

Please see the Antimicrobial Reference Laboratory for their 'Antibiotic Assay Guidelines for Users' and 'Antibiotic Assay Guideline Ranges'

TrakCare item: Ganciclovir / valganciclovir therapeutic drug monitoring


HIV Theraputic Drug monitoring: EDTA blood

Please see Lab21 Therapeutic Drug Monitoring Tests for the currently available anti-retroviral drug assays

TrakCare item: HIV anti-retroviral therapeutic drug monitoring


Travel associated testing

 

Chikungunya: EDTA Blood AND clotted blood - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Dengue virus: EDTA Blood AND clotted blood - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Eastern equine encephalitis virus (EEEV), Western equine encephalitis virus (WEEV), Venezuelan equine encephalitis virus (VEEV): EDTA blood AND Clotted blood AND CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Francisella tularensis: EDTA blood AND clotted blood, tissue, wound swab - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Hantavirus: EDTA Blood AND clotted blood, urine - Sterile (universal) container

  • TrakCare item: Hantavirus serology / PCR

AND complete the RIPL request form

Hendra virus: EDTA blood AND clotted blood, CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Japanese encephalitis virus : EDTA blood AND clotted blood, CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Junin virus - Argentine hemorrhagic fever (AHF) : EDTA blood AND clotted blood - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Kunjin virus  : EDTA blood AND clotted blood, CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Mayaro virus  : EDTA blood AND clotted blood, CSF- TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Middle East Respiratory Syndrome Coronavirus - (MERS-CoV)

Induced Sputum AND Nose and throat swab (expressed in same VPSS container) AND Clotted blood

PLEASE SEE MERS coronavirus & avian influenza

  • TrakCare item: MERS-CoV - Middle East Respiratory Syndrome Coronavirus

Murray Valley encephalitis virus: Clotted blood, CSF AND complete the RIPL request form

Nipah virus: EDTA blood AND clotted blood, CSF AND complete the RIPL request form

Orientia tsutsugamushi (Scrub typhus): EDTA blood, Clotted blood, eschar biopsy, CSF AND complete the RIPL request form

Rabies virus   

Serology post vaccination: Clotted blood

Please consult UK immunisation guidance (the ‘Green Book’ Chapter 27: Rabies) for the requirements of post-rabies vaccination testing. IF INDICATED please complete and send the VLARAB1 'Request for determination of antibodies against rabies' request form Request for determination of antibodies against rabies' to us including the indication for testing.

Suspected current infection

Please contact the laboratory for urgent clinical virology advice

  • EDTA blood

AND

  • Clotted blood

+/-

  • Skin biopsy - Sterile (universal) container
  • CSF
  • Mouth swab in VPSS

TrakCare item: Other virology / virus testing requests

Rickettsia: EDTA Blood AND clotted blood, eschar biopsy, CSF - TrakCare item: Rickettsia serology / PCR AND complete the RIPL request form

Rift Valley fever virus: EDTA blood AND clotted blood, CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Ross river virus: EDTA blood AND clotted blood - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Sandfly fever virus: EDTA blood AND clotted blood +/- CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Sinbis virus: EDTA blood AND clotted blood - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Tickborne encephalitis virus (TBEV) including European/Western tick-borne encephalitis virus, Siberian tick-borne encephalitis virus, Far eastern Tick-borne encephalitis virus (formerly known as Russian Spring Summer encephalitis virus): EDTA blood AND clotted blood +/- CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Venezuelan equine encephalitis virus (VEEV), WEEV, EEEV: EDTA blood AND Clotted blood +/- CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Viral haemorrhagic fever

EDTA Blood AND clotted blood

If suspected Lassa +/- Urine

If suspected Marburg +/- CSF

  • TrakCare item: Other virology / virus testing requests
  1. Scottish National Viral Haemorrhagic Fever (VHF) Test Request Form
  2. Scottish National Viral Haemorrhagic Fever Test Service - Brief User Guide
  3. NHSGGC Guideline: Possible Viral Haemorrhagic Fever (VHF) Management in Adults and Children

Western equine encephalitis virus (WEEV), EEEV, VEEV: EDTA blood AND clotted blood +/- CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

West Nile virus: EDTA blood AND clotted blood +/- CSF - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form

Yellow fever virus: EDTA blood AND clotted blood - TrakCare item: Other virology / virus testing requests AND complete the RIPL request form



TrakCare item: Non-blood - CMV EBV adenovirus PCR (this item tests for cytomegalovirus, Epstein-Barr virus and adenovirus)

GP electronic request (ICE / EMIS / Vision) items: Other virology requests

 

Cytomegalovirus  

Various specimens including throat swab in VPSS 

TrakCare item: Non-blood - CMV EBV adenovirus PCR

All other testing:

Herpes simplex virus-1/2 (HSV-1/2)

PCR tests are HSV combined with either Treponema pallidum (Syphilis) or varicella zoster virus

Vesicle/ulcer swab in VPSS

TrakCare item: Herpes simplex / varicella zoster virus PCR

or TrakCare item: Herpes simplex - Syphilis PCR ( GUM ) (this item tests for herpes simplex virus-1/2 (HSV-1/2) and Treponema pallidum)

or TrakCare item: Vesicle rash PCR - Set (this set includes tests for herpes simplex virus-1/2 (HSV-1/2), varicella zoster virus and enterovirus / parechovirus)

GP electronic request (ICE / EMIS / Vision) item: HSV/VZV PCR - Non-genital ulcer/vesicle

 

Herpes simplex virus past infection

 

EDTA Blood

TrakCare item: Herpes simplex IgG - past infection

Human herpesvirus-6/7 (HHV-6 / HHV-7)

Throat swab in VPSS for acute rash diagnosis in children under 5 years

TrakCare item: Paediatric maculopapular rash - virus PCR - Set

or

TrakCare item: Human herpesvirus-6/7 PCR

GP electronic request (ICE / EMIS / Vision) item: Maculopapular rash PCR-current infection

EDTA Blood in immunocompromised patients

TrakCare item: Human herpesvirus-6/7 PCR

 

 

 

Parvovirus B19  

 

Throat swab in VPSS

TrakCare item: Parvovirus B19 PCR EDTA Blood

      TrakCare item: Parvovirus B19 IgG - past infection

GP electronic request (ICE / EMIS / Vision) item: Parvovirus B19 IgG - past infection
 
GP electronic request (ICE / EMIS / Vision) item: Parvovirus B19 IgG - past infection

Clotted blood

TrakCare item: Varicella zoster IgG - past infection

GP electronic request (ICE / EMIS / Vision) item: Varicella zoster virus IgG - past VZV

 

TrakCare item: EBV VCA IgG - past infection (Epstein-Barr virus viral capsid antigen IgG)

 (this item provides a viral load in IU/mL)

Various specimens including throat swab in VPSS 

TrakCare item: Non-blood - CMV EBV adenovirus PCR

EDTA Blood

Serology (IgM/IgG) and avidity (confirmation of primary infection during pregnancy only, laboratory instigated, not available to order on TrakCare): EDTA Blood

TrakCare item: CMV IgG - past infection

TrakCare item: Blood - CMV EBV adenovirus PCR