Culture, Viral

Culture, Viral

Synonym/acronym: N/A.

Common use

To identify infection caused by pathogenic viral organisms as evidenced by ocular, genitourinary, intestinal, or respiratory symptoms. Commonly identified are cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus (HSV), HIV, human papillomavirus (HPV), respiratory syncytial virus (RSV), and varicella zoster virus.

Specimen

Urine, semen, blood, body fluid, stool, tissue, or swabs from the affected site.

Normal findings

(Method: Culture in special media, enzyme-linked immunoassays, direct fluorescent antibody techniques, latex agglutination, immunoperoxidase, PCR techniques) No virus isolated.

Description

Viruses, the most common cause of human infection, are submicroscopic organisms that invade living cells. They can be classified as either RNA- or DNA-type viruses. Viral titers are highest in the early stages of disease before the host has begun to manufacture significant antibodies against the invader. Specimens need to be collected as early as possible in the disease process. The subspecialty of microbiology has been revolutionized by molecular diagnostics. Molecular diagnostics involves the identification of specific sequences of DNA. The application of molecular diagnostics techniques, such as PCR, has led to the development of automated instruments that can identify a single infectious agent or multiple pathogens from a small amount of specimen in less than 2 hr. The instruments can detect the presence of bacteria and viruses commonly associated with viral infections.

This procedure is contraindicated for

    N/A

Indications

    Assist in the identification of viral infection

Potential diagnosis

Positive findings in:

  • AIDS
    • HIV
  • Acute respiratory failure
    • Hantavirus
  • Anorectal infections
    • HSV
    • HPV
  • Bronchitis
    • Parainfluenza virus
    • RSV
  • Cervical cancer
    • HPV
  • Condylomata
    • HPV
  • Conjunctivitis/keratitis
    • Adenovirus
    • Epstein-Barr virus
    • HSV
    • Measles virus
    • Parvovirus
    • Rubella virus
    • Varicella zoster virus (shingles)
  • Croup
    • Parainfluenza virus
    • RSV
  • Cutaneous infection with rash
    • Enteroviruses
    • HSV
    • Varicella zoster virus
  • Encephalitis
    • Enteroviruses
    • Flaviviruses
    • HSV
    • HIV
    • Measles virus
    • Rabies virus
    • Togaviruses
    • West Nile virus (mosquito-borne arbovirus)
  • Febrile illness with rash
    • Coxsackieviruses
    • Echovirus
  • Gastroenteritis
    • Norwalk virus
    • Rotavirus
  • Genital herpes
    • HSV-1
    • HSV-2
  • Genital warts
    • HPV
  • Hemorrhagic cystitis
    • Adenovirus
  • Hemorrhagic fever
    • Ebola virus
    • Hantavirus
    • Lassa virus
    • Marburg virus
  • Herpangina
    • Coxsackievirus (group A)
  • Infectious mononucleosis
    • CMV
    • Epstein-Barr virus
  • Meningitis
    • Coxsackieviruses
    • Echovirus
    • HSV-2
    • Lymphocytic choriomeningitis virus
  • Myocarditis/pericarditis
    • Coxsackievirus
    • Echovirus
  • Parotitis
    • Mumps virus
    • Parainfluenza virus
  • Pharyngitis
    • Adenovirus
    • Coxsackievirus (group A)
    • Epstein-Barr virus
    • HSV
    • H1N1 influenza virus (swine flu)
    • Influenza virus
    • Parainfluenza virus
    • Rhinovirus
  • Pleurodynia
    • Coxsackievirus (group B)
  • Pneumonia
    • Adenovirus
    • H1N1 influenza virus (swine flu)
    • Influenza virus
    • Parainfluenza virus
    • RSV
  • Upper respiratory tract infection
    • Adenovirus
    • Coronavirus
    • H1N1 influenza virus (swine flu)
    • Influenza virus
    • Parainfluenza virus
    • RSV
    • Rhinovirus

Critical findings

  • Positive RSV, influenza, and varicella zoster cultures should be reported immediately to the requesting health-care provider (HCP).

  • Note and immediately report to the HCP positive results and related symptoms.

  • It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). Lists of specific organisms may vary among facilities; specific organisms are required to be reported to local, state, and national departments of health.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

  • Viral specimens are unstable. Prompt and proper specimen processing, storage, and analysis are important to achieve accurate results.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in identification of the organism causing infection.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s gastrointestinal, genitourinary, immune, reproductive, and respiratory systems; symptoms; and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Note any recent medications that can interfere with test results.
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 min. Address concerns about pain and explain that there may be some discomfort during the specimen collection.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.

Intratest

  • Potential complications: N/A
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate collection containers with the corresponding patient demographics, date and time of collection, exact site, contact person for notification of results, and other pertinent information (e.g., patient immunocompromised owing to organ transplant, radiation, or chemotherapy).
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instructions regarding the appropriate transport materials for blood, bronchial washings, sputum, sterile fluids, stool, and tissue samples should be obtained from the laboratory. The type of applicator used to obtain swabs should be verified by consultation with the testing laboratory personnel.
  • The appropriate viral transport material should be obtained from the laboratory. Nasopharyngeal washings or swabs for RSV testing should be immediately placed in cold viral transport media.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Nutritional Considerations: Dehydration can been seen in patients with viral infections due to loss of fluids through fever, diarrhea, and/or vomiting. Antipyretic medication includes acetaminophen to decrease fever and allow for adequate intake of fluids and foods. Do not give acetylsalicylic acid to pediatric patients with a viral illness because it increases the risk of Reye’s syndrome.
  • Sensitivity to social and cultural issues: Offer support, as appropriate, to patients who may be the victims of rape or sexual assault. Educate the patient regarding access to counseling services. Provide a nonjudgmental, nonthreatening atmosphere for discussing the risks of sexually transmitted diseases. It is also important to address problems the patient may experience (e.g., guilt, depression, anger).
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Provide information regarding vaccine-preventable diseases where indicated (e.g., encephalitis, H1N1 flu, seasonal influenza,). Provide contact information, if desired, for the Centers for Disease Control and Prevention (www.cdc.gov/vaccines/vpd-vac). Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include alveolar/arterial gradient, β-2-microglobulin, barium enema, biopsy (cervical, intestinal, kidney, liver, lung, lymph node, muscle, skin), blood gases, bronchoscopy, CD4/CD8 ratio, CSF analysis, Chlamydia group antibody, chest x-ray, cultures (anal, blood, ear, eye, fungal, genital, mycobacteria, skin, sputum, stool, throat, urine, wound), CBC, cytology (sputum, urine), gallium scan, gastric emptying scan, lung perfusion scan, lung ventilation scan, Pap smear, pericardial fluid analysis, plethysmography, pulse oximetry, PFT, slit-lamp biomicroscopy, syphilis serology, TB tests, and viral serology tests (hepatitis, HIV, HTLV, infectious mononucleosis, mumps, rubella, rubeola, varicella).
  • Refer to the Gastrointestinal, Genitourinary, Immune, Reproductive, and Respiratory systems tables at the end of the book for related tests by body system.
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