Physician Office Specimen Requirements

Serum

Container/Tube:  5-mL plain, sterile red-top (gel) tube(s)

Specimen:  Full tube

Transport Temperature:  Refrigerate

Collection Instructions:  Blood or serum specimen is used for antibody testing and should be drawn at onset or acute phase of  illness. A second or convalescent phase blood specimen should be taken 3 weeks to 4 weeks after initial or acute specimen. If 1 of these specimens is not available, a single specimen may be accepted for testing. Single specimens should be drawn 10 days after onset of symptoms. Criteria for suspect cases of West Nile Virus are as follows:

1. An adult or pediatric patient with viral encephalitis with or without associated muscle weakness.

a. Fever > 38° C or 100° F and

b. Altered mental status (altered level of consciousness, agitation, lethargy) and/or other evidence of cortical involvement (e.g., focal neurologic findings, seizures), and

c. CSF pleocytosis with predominant lymphocytes and/or elevated protein and a negative gram stain and culture, with or without

d. Muscle weakness (especially flaccid paralysis) confirmed by neurologic exam or by electromyography (EMG).

2. An adult or pediatric (≥2 years of age) patient with presumptive aseptic meningitis as follows:

Fever, headache, stiff neck and/or other meningeal signs, with CSF pleocytosis with predominant lymphocytes and moderately elevated protein, and a negative gram stain and culture.

Note:  1. Indicate serum on request form.

2. Label specimen appropriately (serum).

Spinal Fluid

Container/Tube:  Screw-capped, sterile vial

Specimen:  1 mL spinal fluid

Transport Temperature:  Refrigerate

Collection Instructions:  Criteria for suspect cases of West Nile Virus are as follows:

1. An adult or pediatric patient with viral encephalitis with or without associated muscle weakness.

a. Fever > 38° C or 100° F and

b. Altered mental status (altered level of consciousness, agitation, lethargy) and/or other evidence of cortical involvement (e.g., focal neurologic findings, seizures), and

c. CSF pleocytosis with predominant lymphocytes and/or elevated protein and a negative gram stain and culture, with or without

d. Muscle weakness (especially flaccid paralysis) confirmed by neurologic exam or by electromyography (EMG).

2. An adult or pediatric (≥2 years of age) patient with presumptive aseptic meningitis such as:

Fever, headache, stiff neck and/or other meningeal signs, with CSF pleocytosis with predominant lymphocytes and moderately elevated protein, and a negative gram stain and culture.

Note:  1. Indicate spinal fluid on request form.

2. Label specimen appropriately (serum).

3. This specimen may be used for virus isolation as well as for serological detection.