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Diagnosing viral infections
All routine viral cultures are inoculated into cell culture tubes for viral detection. The most common specimens received for routine testing include body fluid, rectal, spinal fluid, and stool. A rapid (16-hour incubation) shell vial cell culture assay will be inoculated when specimens are designated for herpes simplex virus (HSV) or cytomegalovirus (CMV) detection, or as appropriate for source indicated.
Blood, lymph node tissue, and bone marrow/bone tissue specimens are not good sources for viral culture and are frequently toxic to cell culture lines. Most molecular methods are appropriate for these specimen types (exception is bone tissue). See individual real-time PCR assay test descriptions.
Genital, synovial fluid, wound swab or tissue (includes pus, drainage, or abscess fluid) specimens are not acceptable for viral culture.
Ocular fluids (vitreous and aqueous) are generally of inadequate volume for viral cell culture and molecular testing is typically recommended for these samples. See individual real-time PCR assay test descriptions.
Oral specimens submitted for culture should be ordered as VRESP / Viral Culture, Respiratory.
Dermal specimens are only acceptable for enterovirus culture:
-For dermal specimens for hand-foot-and-mouth disease or enterovirus, clearly indicate "enterovirus" on request.
Urine specimens are only acceptable for mumps culture. For urine specimens, clearly indicate "mumps" on request.
For requests to rule-out HSV infection in neonates (<1 month) on dermal specimens, order VHSV / Herpes Simplex Virus (HSV), Culture From Neonates.
Do not submit specimens for viral culture testing if there is a suspicion of Ebola virus or any viral hemorrhagic fever, avian influenza, severe acute respiratory syndrome (SARS), Middle Eastern Respiratory Syndrome Coronovirus (MERS-CoV), or other high-risk infectious agents. Contact your state health department for more information and testing options.
For requests for Cytomegalovirus (CMV) on bone marrow or urine specimen, see:
-LCMV / Cytomegalovirus (CMV), Molecular Detection, PCR
For requests for herpes simplex virus (HSV) or varicella-zoster virus (VZV) on genital or dermal specimen, see:
-LHSV / Herpes Simplex Virus (HSV), Molecular Detection, PCR
-LVZV / Varicella-Zoster Virus, Molecular Detection, PCR
-LHSVZ / Herpes Simplex Virus (HSV) and Varicella-Zoster Virus (VZV), Molecular Detection, PCR
Viruses are responsible for a broad spectrum of clinical symptoms and diseases. The most commonly isolated viruses are adenovirus, cytomegalovirus, enteroviruses, herpes simplex virus, and varicella-zoster virus.
Many viral infections (eg, HSV, CMV, VZV) can now be treated with antiviral drugs. Early laboratory diagnosis by isolation is very helpful in the medical management of these patients.
If positive, virus is identified.
A positive result indicates that virus was present in the specimen submitted. Clinical correlation is necessary to determine the significance of this finding.
Negative results may be seen in a number of situations including absence of viral disease, inability of the virus to grow in culture (examples of organisms not detected by this culture test include Epstein-Barr virus, rubella virus, papilloma, and Norwalk virus), and nonviable organisms submitted.
For patients with diarrhea, see Parasitic Investigation of Stool Specimens Algorithm in Special Instructions for other diagnostic tests that may be useful.
Viral isolation and detection depends on the proper collection and transport of the specimen.
Some viruses (eg, CMV) take up to 2 weeks to grow in viral cell culture. Molecular tests (ie, real-time PCR) should be used for rapid diagnosis.
This test is not useful for viruses (not listed above) that cannot be grown in cell culture (see Interpretation).
1. Clinical and Laboratory Standards Institute 2005. Viral Culture. Proposed Guideline. CLSI document M41-P. Clinical and Laboratory Standards Institute, Wayne, PA
2. Ginocchio CC, Harris PC: Chapter 17: Reagents, stains, and cell culture: Virology. In Manual of Clinical Microbiology. 10th edition. Edited by J Versalovic, KC Carroll, et al. Washington, DC, ASM Press, 2011, pp 1289-1296
3. Smith TF: Antibody-enhanced detection of viruses in cell cultures. In Manual of Clinical Laboratory Immunology. Fifth edition. Edited by NR Rose, EC de Marcio, JD Folds, et al. Washington, DC, ASM Press, 1997, pp 618-624