Texas Department of State Health Services - Microbiology Lab Tests

Microbiology
Trypanosomiasis (Culture)
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Test Includes: Microscopic examination
Reporting
Results Available: 1-3 days	Contact #s: (512) 458-7560
Reference
Method: Microscopic examination
Turnaround Time: 3 days	Reference Range: No parasite seen
Limitations:	Interpretation: Negative specimen indicates that there were no visible parasites in the specimen submitted.
Specimen Requirements
Specimen Collection: Venipuncture	Sample Type: Whole blood, green or purple top tube.
Volume/Amount Required: 20 mL whole blood	Preferred Specimen: Whole Blood – green or purple top
Collection/Preservation: Collect by venipuncture blood in a green or purple top vacutainer. Hold at ambient temperature.	Storage Instructions: ambient temperature
Causes for Rejection: Incorrect collection tube used.	Sample Container: green or purple top vacutainer
Sample Test Kit:	Availability: Monday-Friday
Diagnostic Information: See also Chagas’ Disease.
Specimen Submission
Required Request Form: G-2B	Specimen Handling: Handle body fluids using universal precautions.
Transport Temperature: Ambient temperature	Shipping Requirements: Triple contained in accordance with federal shipping regulations for diagnostic specimens.
Billing
CPT Code: 87081	Fees:

Microbiology
Trypanosomiasis (Microscopic – Direct Giemsa stained)
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Test Includes: Microscopic examination
Reporting
Results Available: 3 days	Contact #s: (512) 458-7560
Reference
Method: Microscopic examination
Turnaround Time: 3 days	Reference Range: No parasites found
Limitations:	Interpretation: Negative specimen indicates that there were no visible parasites in the specimen submitted.
Specimen Requirements
Specimen Collection: venipuncture, biopsy, needle aspirates	Sample Type: blood, lymph node, aspirates
Volume/Amount Required: 10 mL whole blood; small piece of lymph node tissue; > 1 mL aspirate	Preferred Specimen: Blood thin and thick smears; Lymph Node; Aspirates
Collection/Preservation: Collect by venipuncture or capillary blood, blood to prepare two thick and two thin smears on a glass slide. Store at ambient temperature	Storage Instructions: Ambient temperature
Causes for Rejection:	Sample Container: Green or Purple top vacutainer
Sample Test Kit:	Availability: Monday-Friday
Diagnostic Information: See also Chagas’ Disease.
Specimen Submission
Required Request Form: G-2B	Specimen Handling: Handle body fluids using universal precautions
Transport Temperature: Ambient temperature	Shipping Requirements: Triple contained in accordance with federal shipping regulations for diagnostic specimens.
Billing
CPT Code: 87177	Fees:

Microbiology
Tuberculosis (Culture - Isolation)
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Test Includes: Isolation of mycobacteria and identification to species level
Reporting
Results Available: Positive cultures 14-21 days or earlier; Negative cultures 43 days	Contact #s: 512-458-7586 or 512-458-7318, ext 2687
Reference
Method: Primary identification test is mycolic acid analysis by high performance liquid chromatography
Turnaround Time: Negatives held for six weeks.	Reference Range: Negative
Limitations: Delay in transport of specimen could compromise isolation of organism.	Interpretation:
Specimen Requirements
Specimen Collection:	Sample Type: Clinical Specimen
Volume/Amount Required: 3 mL to 15 mL	Preferred Specimen: Sputum; Tissue; Exudate; Urine; Stool; Blood; Body Fluids
Collection/Preservation: No preservative	Storage Instructions: Transport specimen as soon as possible. If transport is delayed over one hour, refrigerate specimen, unless blood.
Causes for Rejection: Specimens received frozen, in formalin, or in culture medium will be rejected. Swabs are discouraged unless the only specimen available; submit swabs in 5 mL sterile saline. Gastric specimens must be neutralized prior to transport. Refrigerated blood specimens will be rejected.	Sample Container: Triple-contained. Sterile, leak-proof, 50 mL conical tube preferred for primary container. Add up to 10 mL sterile saline to tissue if needed to maintain moisture during transport. If blood, prefer yellow-top with ACD; may also contain SPS.
Sample Test Kit:	Availability: Tested 5 days/week: Monday-Friday
Diagnostic Information: Primary diagnostic specimens and isolates go to TDSHS Laboratory in Austin. Direct HPLC (presumptive identification only) performed on positive AFB smear initial diagnostic specimens. Nucleic acid amplification testing for M. tuberculosis complex may be performed on positive AFB smear initial pulmonary specimens if Direct HPLC testing is inconclusive. For more information telephone 512-458-7342
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: Ambient acceptable but 2-8º C preferred for non-sterile specimens.	Shipping Requirements: Triple-contained and packaged to meet requirements of DOT, USPS, PHS, and IATA for shipping of clinical specimens.
Billing
CPT Code: 87143, 87149, 87118	Fees:

Microbiology
Tuberculosis (Culture - Identification)
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Test Includes: Identification of isolate by mycolic acid analysis; biochemical testing and/or Accuprobe culture confirmation test performed as adjunct tests if necessary
Reporting
Results Available: 2-25 days	Contact #s: 512-458-7586
Reference
Method: Primary identification test is mycolic acid analysis by high performance liquid chromatography.
Turnaround Time: 2-25 days M. tuberculosis complex reports are telephoned to the submitter on previously undiagnosed patients.	Reference Range: By report
Limitations:	Interpretation:
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required:	Preferred Specimen: Pure Culture
Collection/Preservation: No preservative	Storage Instructions:
Causes for Rejection:	Sample Container: Triple-contained. Sterile, leak-proof, 50 mL conical tube preferred for primary container. Add up to 10 mL sterile saline to tissue if needed to maintain moisture during transport. If blood, must collect in Yellow-top vacutainer with SPS.
Sample Test Kit:	Availability:
Diagnostic Information: Pure culture isolates submitted to this Laboratory for definitive identification and drug susceptibilities. Molecular typing performed at regional center upon request. Definitive identification performed on positive isolates by HPLC or a combination of HPLC and biochemical testing or HPLC and genetic probe confirmation. For more information telephone 512-458-7342
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: Ambient	Shipping Requirements: Triple-contained and packaged to meet rigorous performance tests as outlined in the DOT, USPS, PHS, and IATA regulations for shipping of infectious substances.
Billing
CPT Code: 87556	Fees:

Microbiology
Tuberculosis (Culture – Susceptibility, Primary Drug Panel)
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Test Includes: Drug Susceptibility Testing of Mycobacterium tuberculosis by Indirect Drug Susceptibility Test
Reporting
Results Available: 10-28 days	Contact #s: 512-458-7586
Reference
Method: BACTEC indirect drug susceptibility test system for M. tuberculosis complex. Agar proportion indirect drug susceptibility test system for confirmation of drug resistance.
Turnaround Time: 10-28 days. Reports of drug resistance are telephoned to the submitter.	Reference Range: Susceptible
Limitations: Testing can only be performed on pure cultures of Mycobacterium tuberculosis complex.	Interpretation: Report states isolate is either susceptible or resistant to a specific drug at critical concentrations recommended by NCCLS.
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required:	Preferred Specimen: Pure Culture
Collection/Preservation: No preservative.	Storage Instructions:
Causes for Rejection:	Sample Container: Triple-contained.
Sample Test Kit:	Availability: Test is set up 5 days/week: Monday- Friday. Test is run 7 days/week.
Diagnostic Information: Pure culture isolates of M. tuberculosis complex submitted or isolated at this Laboratory for drug susceptibilities. Isolates submitted for drug susceptibilities will be identified by this Laboratory. No fee will be charged for the identification test unless the AFB ID test is requested on form G-2B. Primary Panel for M. tuberculosis complex consists of Isoniazid, Ethambutol, and Rifampin by BACTEC susceptibility testing. Resistance to any of these drugs is confirmed by the agar proportion method.
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: Ambient	Shipping Requirements: Triple-contained and packaged to meet rigorous performance tests as outlined in the DOT, USPS, PHS, and IATA regulations for shipping of infectious substances.
Billing
CPT Code: 87190, 87188	Fees:

Microbiology
Tuberculosis (Culture – Susceptibility, Secondary Drug Panel)
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Test Includes: Drug Susceptibility Testing of Mycobacterium tuberculosis by Indirect Drug Susceptibility Test
Reporting
Results Available: 10-28 days	Contact #s: 512-458-7586
Reference
Method: BACTEC indirect drug susceptibility test system for M. tuberculosis complex. Agar proportion indirect drug susceptibility test system for confirmation of drug resistance.
Turnaround Time: 10-28 days Reports of drug resistance are telephoned to the submitter.	Reference Range: Susceptible
Limitations: Testing can only be performed on pure cultures of Mycobacterium tuberculosis complex.	Interpretation: Report states isolate is either susceptible or resistant to a specific drug at critical concentrations recommended by NCCLS.
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required:	Preferred Specimen: Pure Culture
Collection/Preservation: No preservative.	Storage Instructions:
Causes for Rejection:	Sample Container: Triple-contained.
Sample Test Kit:	Availability: Test is set up 5 days/week: Monday- Friday. Test is run 7 days/week.
Diagnostic Information: Pure culture isolates of M. tuberculosis complex submitted or isolated at this Laboratory for drug susceptibilities. Isolates submitted for drug susceptibilities will be identified by this Laboratory. No fee will be charged for the identification test unless the AFB ID test is requested on form G-2B. Secondary Panel for M. tuberculosis complex consists of Streptomycin, Ethionamide, Kanamycin, Pyrazinamide, and Ofloxacin by BACTEC susceptibility testing. Resistance to any of these drugs is confirmed by the agar proportion method. Capreomycin is available by agar proportion method only.
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: Ambient	Shipping Requirements: Triple-contained and packaged to meet rigorous performance tests as outlined in the DOT, USPS, PHS, and IATA regulations for shipping of infectious substances.
Billing
CPT Code: 87190, 87188	Fees:

Microbiology
Tuberculosis (Culture – Susceptibility, Pyrazinamide Only)
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Test Includes: Drug susceptibility testing of Mycobacterium tuberculosis complex to pyrazinamide.
Reporting
Results Available: 7-28 days	Contact #s: 512-458-7586
Reference
Method: BACTEC indirect drug susceptibility test system
Turnaround Time: 7-28 days. Reports of drug resistance are telephoned to the submitter.	Reference Range: By report
Limitations: Test can only be performed on pure cultures of M. tuberculosis complex.	Interpretation: Report states that the isolate is either susceptible or resistant to pyrazinamide at critical concentration recommended by NCCLS.
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required:	Preferred Specimen: Pure Culture
Collection/Preservation: No preservative.	Storage Instructions:
Causes for Rejection:	Sample Container: Triple-contained.
Sample Test Kit:	Availability: Test is set up 5 days/week: Monday-Friday. Test is run 7 days/week.
Diagnostic Information: Pure culture isolates of M. tuberculosis complex submitted or isolated at this Laboratory for drug susceptibilities. Isolates submitted for drug susceptibilities will be identified by this Laboratory. No fee will be charged for the identification test unless the AFB ID test is requested on form G-2B. Pyrazinamide testing is performed by BACTEC susceptibility testing.
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: Ambient	Shipping Requirements: Triple-contained and packaged to meet rigorous performance tests as outlined in the DOT, USPS, PHS, and IATA regulations for shipping of infectious substances.
Billing
CPT Code: 87188	Fees:

Microbiology
Tuberculosis (Culture – Isolation - Direct M tuberculosis Genetic Probe)
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Test Includes: Nucleic Acid Amplification Testing of Clinical Specimens by MTD Test
Reporting
Results Available: 2-5 days	Contact #s: 512-458-7586
Reference
Method: Gen-Probe MTD Test; test amplifies and detects ribosomal RNA of M. tuberculosis complex
Turnaround Time: 2-5 days. Positive reports are telephoned to the submitter.	Reference Range: By Report
Limitations: Test can only be run on undiagnosed, untreated patients on processed non-bloody pulmonary specimens. A negative test does not mean the patient does not have M. tuberculosis disease. All tests must be confirmed by culture of specimen for the presence of mycobacteria.	Interpretation: A Positive MTD test means that the probe detected ribosomal RNA of the M. tuberculosis complex in the clinical specimen.
Specimen Requirements
Specimen Collection:	Sample Type: Clinical pulmonary specimen
Volume/Amount Required: 3 mL to 15 mL	Preferred Specimen: Sputum; Bronchial Washings Specimen can not be bloody
Collection/Preservation: No preservative	Storage Instructions: Transport specimen as soon as possible. Specimen must be shipped cold.
Causes for Rejection: Specimens received frozen, in formalin, or in culture medium will be rejected. Specimens from treated and diagnosed patients will be rejected for MTD analysis.	Sample Container: Triple-contained. Sterile, leak-proof, 50 mL conical tube preferred for primary container.
Sample Test Kit:	Availability: MTD by special request. Please telephone 512-458-7342.
Diagnostic Information: Primary diagnostic specimens and isolates go to TDSHS Laboratory in Austin. Nucleic acid amplification testing for M tuberculosis complex on positive AFB smear primary pulmonary diagnostic specimens only.
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: Ship cold.	Shipping Requirements: Triple-contained and packaged to meet requirements of DOT, USPS, PHS, and IATA for shipping of clinical specimens.
Billing
CPT Code: 87149	Fees:

Microbiology
Tuberculosis (Microscopic – Truant’s Stain)
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Test Includes: Microscopic Examination of Clinical Specimen for Acid Fast Bacilli (AFB)
Reporting
Results Available: 1 day. Positive reports are telephoned to the submitter within two hours of availability.	Contact #s: 512-458-7586
Reference
Method: Truant’s Acid Fast Stain
Turnaround Time: 24 hours	Reference Range: Negative
Limitations: A negative microscopic examination does not mean that the patient’s specimen cannot be culture positive for AFB. This test is less sensitive than culture. The stain utilizes a fluorescent dye that can be taken up by the mycobacterium to different degrees depending on the species or if the patient is on antibiotic treatment. The quality of the specimen has major impact on the results of the microscopic examination.	Interpretation: The report states whether the test is Negative if No AFB are Seen or Positive if AFB are Seen on microscopic examination. If Positive, the report provides a quantitation to indicate how many AFB were seen in a high power field under the microscope. Occasionally, an examination will result in the observation of only one or two AFB in the entire test. This number of AFB (one or two) is reported but is not considered a positive result by CDC or the American Thoracic Society.
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required: 3 mL to 15 mL	Preferred Specimen: Sputum; Tissue; Exudate; Stool; Blood; Body Fluids; Urine
Collection/Preservation: No preservative	Storage Instructions: Transport specimen as soon as possible. If transport is delayed over one hour, refrigerate specimen, unless blood. This is important if the specimen is also to be cultured.
Causes for Rejection: Specimens received frozen, in formalin, or in culture medium will be rejected. Swabs are discouraged unless the only specimen available; submit swabs in 5 mL sterile saline. If swabs are submitted in transport medium, the test cannot be performed. Blood specimens less than 5 mL are unacceptable.	Sample Container: Triple-contained. Sterile, leak-proof, 50 mL conical tube preferred for primary container. Add up to 10 mL sterile saline to tissue if needed to maintain moisture during transport. If blood, must collect in Yellow-top vacutainer with SPS.
Sample Test Kit:	Availability: Tested 5 days/week: Monday-Friday
Diagnostic Information: Primary diagnostic specimens and isolates go to TDSHS Lab in Austin.
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: Ambient	Shipping Requirements: Triple-contained and packaged to meet requirements of DOT, USPS, PHS, and IATA for shipping of clinical specimens.
Billing
CPT Code: 87206	Fees:

Microbiology
Tuberculosis (Culture – DNA Fingerprinting)
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Test Includes:
Reporting
Results Available: approx. 10 business days	Contact #s: 512-458-7342 or 512-458-7580
Reference
Method:
Turnaround Time: As directed	Reference Range: By report
Limitations: Test can only be performed on pure cultures of M. tuberculosis complex.	Interpretation: contact Tuberculosis Elimination Program for guidance
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required:	Preferred Specimen: Pure Culture
Collection/Preservation:	Storage Instructions:
Causes for Rejection:	Sample Container: Triple-contained.
Sample Test Kit:	Availability:
Diagnostic Information: DNA Fingerprinting of M. tuberculosis is available at no charge from a reference laboratory. Please submit pure cultures of M. tuberculosis to this Laboratory and mark "Other" on the request form. Write the word "Genotyping" in the space for "other" tests. For more information, telephone 512-458-7342.
Specimen Submission
Required Request Form: G-2B	Specimen Handling:
Transport Temperature: ambient	Shipping Requirements: Triple-contained and packaged to meet rigorous performance tests as outlined in the DOT, USPS, PHS, and IATA regulations for shipping of infectious substances.
Billing
CPT Code:	Fees: none

Microbiology
Tularemia (Culture - Isolation)
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Test Includes:
Reporting
Results Available:	Contact #s:
Reference
Method:
Turnaround Time: 7-21 days	Reference Range: By report
Limitations:	Interpretation:
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required:	Preferred Specimen: Culture; Blood Culture; Tissue; Lymph Node
Collection/Preservation:	Storage Instructions:
Causes for Rejection:	Sample Container:
Sample Test Kit:	Availability:
Diagnostic Information: See Aerobic Bacterial Culture (Isolation) Culture for isolation must be held 21 days before the specimen can be reported as negative. Francisella tularensis is one of the agents designated as a Bioterrrorism agent. It sporadically occurs naturally. See Bioterrorism agents (Clinical -Isolation).
Specimen Submission
Required Request Form: G-2A	Specimen Handling:
Transport Temperature: 4º C, ice packs, NO dry ice.	Shipping Requirements:
Billing
CPT Code: 87040, 87046, 87070	Fees:

Microbiology
Tularemia (Culture - Identification)
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Test Includes:
Reporting
Results Available:	Contact #s:
Reference
Method:
Turnaround Time: 7-14 days	Reference Range: By report
Limitations:	Interpretation:
Specimen Requirements
Specimen Collection:	Sample Type:
Volume/Amount Required:	Preferred Specimen: Pure Culture safely contained.
Collection/Preservation:	Storage Instructions:
Causes for Rejection:	Sample Container:
Sample Test Kit:	Availability:
Diagnostic Information: Francisella tularensis is one of the agents designated as a Bioterrrorism agent. It sporadically occurs naturally. See Bioterrorism agents (Clinical -Isolation) For Referred cultures see Aerobic Bacterial Culture, (Identification).
Specimen Submission
Required Request Form: G-2A	Specimen Handling:
Transport Temperature: Ambient (Room) temperature	Shipping Requirements:
Billing
CPT Code: 87077	Fees:

Microbiology
Tularemia (Serological - Agglutination)
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Test Includes:
Reporting
Results Available: 5-7 days	Contact #s:
Reference
Method: Agglutination
Turnaround Time: 5-7 days	Reference Range: <1:80 (Nonreactive)
Limitations: May not detect a recent infection, or infection in a person with a severely compromised immune system.	Interpretation: Nonreactive indicates that the patient does not have detectable antibody to the infectious agent. Reactive indicates that the patient has detectable antibody to the infectious agent, and depending on the clinical picture, may have a current or past infection.
Specimen Requirements
Specimen Collection: Venipuncture	Sample Type: Serum
Volume/Amount Required: 2 mL Serum	Preferred Specimen: Single Serum; Paired Sera
Collection/Preservation: Red top or tiger top tube	Storage Instructions: Separated serum may be held at 2-8°C
Causes for Rejection: Discrepancy between name on tube and name on form, insufficient quantity of serum for testing	Sample Container: Red top or tiger top tube
Sample Test Kit:	Availability: Test performed once per week
Diagnostic Information: Tularemia antibody begins to appear 2-3 weeks post-onset and generally peaks 5 weeks into the disease. A titer of 1:320 or greater is significant. Serum specimens are to be collected at least 7 days apart. Fourfold titer increase is evidence of current infection. Cross-reactions occur with Brucella species. Telephone Laboratory prior to shipping specimen. The test is performed once per week.
Specimen Submission
Required Request Form: G-2A	Specimen Handling: Use Universal Precautions
Transport Temperature: Cold (2-8º C) on ice packs if received within 48 hours from time of collection. Frozen (≤-20°) on dry ice if received more than 48 hours from time of collection.	Shipping Requirements: Triple contain, separated serum may be shipped on cold packs (2-8°C), or frozen (-20°C) and mailed on dry ice.
Billing
CPT Code: 86609	Fees:

Microbiology
Typhus (Serological – Immunofluorescence)
Related Agents: Rickettsia, Murine typhus
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Reporting
Results Available: 3-5 days	Contact #s:
Reference
Method: IFA
Turnaround Time: 3-5 days	Reference Range: <1:64 (Nonreactive)
Limitations: May not detect a recent infection, or infection in a person with a severely compromised immune system.	Interpretation: Nonreactive indicates that the patient does not have detectable antibody to the infectious agent. Reactive indicates that the patient has detectable antibody to the infectious agent, and depending on the clinical picture, may have a current or past infection.
Specimen Requirements
Specimen Collection: Venipuncture	Sample Type: Serum
Volume/Amount Required: 2 mL Serum	Preferred Specimen: Single Serum
Collection/Preservation: Red top or tiger top tube	Storage Instructions: Separated serum may be held at 2-8°C
Causes for Rejection: Discrepancy between name on tube and name on form, insufficient quantity of serum for testing	Sample Container: Red top or tiger top tube
Sample Test Kit:	Availability: Test performed twice per week
Diagnostic Information: The rickettsial micro IFA test is a standard two-step sandwich immunofluorescence technique. In the first stage the Rickettsia typhi (murine typhus) antigen is overlaid with dilutions of human serum. In the second stage, the antigen is overlaid with a fluorescein-conjugates antihuman globulin, so that the antigens are rendered fluorescent by positive sera. The most convincing evidence of recent rickettsiae infection of a four-fold rise in titer between the acute serum and the convalescent serum. Single titers of 1:128 are considered the minimum for significant titers. Serum specimens must be collected 14 days apart. The test is performed twice per week.
Specimen Submission
Required Request Form: G-2A	Specimen Handling: Use Universal Precautions
Transport Temperature: Cold (2-8º C) on ice packs if received within 48 hours from time of collection. Frozen (=-20°) on dry ice if received more than 48 hours from time of collection.	Shipping Requirements: Triple contain, separated serum may be shipped on cold packs (2-8° C), or frozen (-20° C) and mailed on dry ice.
Billing
CPT Code: 86757	Fees:

Microbiology Laboratory Tests: Trypanosomiasis to Typhus