Yersinia pestis (Please notify laboratory if suspected)
| Serologic detection or molecular detection of Yersinia pestis (plague) | |
| Microbiology | |
| Bacteriology | |
| Systemic ○ Whole blood (serology and PCR) ○ Serum (serology) ○ Biopsy tissue* ○ CSF* ○ Blood cultures * Specimens only applicable to molecular testing at NML Pneumonic ○ BAL ○ Bronchial washings |
○ Whole blood or serum: Vacutainer serum separator tube
○ Biopsy tissue: sterile container with small amount of saline
○ CSF, BAL, bronchial washings: sterile container
○ Blood cultures: BD BACT/ALERT® FA Plus Aerobic , BD BACT/ALERT® FN Plus Anaerobic , BD BACT/ALERT® PediFAN (pediatric)
○ Biopsy tissue: sterile container with small amount of saline
○ CSF, BAL, bronchial washings: sterile container
○ Blood cultures: BD BACT/ALERT® FA Plus Aerobic , BD BACT/ALERT® FN Plus Anaerobic , BD BACT/ALERT® PediFAN (pediatric)
Whole blood or serum:
○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine. Collect at least 5 mL of blood if multiple tests will be ordered
Biopsy tissue (e.g. spleen, liver):
○ Collect 5-10 mm3 tissue aseptically using surgical technique/punch biopsy. Place in a clean, sterile container with a small amount of sterile saline. Do not wrap in gauze. Select caseous portion if available.
○ If submitting tissue from lymph nodes, place a small amount of sterile saline in the container and do not freeze
CSF:
○ Decontaminate skin, collect at least 0.5 mL of CSF by lumbar puncture
BAL
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). Instill a large volume of 0.85% sterile saline (nonbacteriostatic) into the airway lumen. Discard the initial fluid recovered (likely contaminated). Collect remaining fluid in a clean, sterile container via suction.
Bronchial washing
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). For washings, inject aliquots of approximately 20 to 30 mL of 0.85% sterile saline (nonbacteriostatic) for adults, or 5 mL for children. Suction washings into a sterile container.
Blood cultures
See: Bacterial culture and sensitivities – Blood culture
○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine. Collect at least 5 mL of blood if multiple tests will be ordered
Biopsy tissue (e.g. spleen, liver):
○ Collect 5-10 mm3 tissue aseptically using surgical technique/punch biopsy. Place in a clean, sterile container with a small amount of sterile saline. Do not wrap in gauze. Select caseous portion if available.
○ If submitting tissue from lymph nodes, place a small amount of sterile saline in the container and do not freeze
CSF:
○ Decontaminate skin, collect at least 0.5 mL of CSF by lumbar puncture
BAL
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). Instill a large volume of 0.85% sterile saline (nonbacteriostatic) into the airway lumen. Discard the initial fluid recovered (likely contaminated). Collect remaining fluid in a clean, sterile container via suction.
Bronchial washing
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). For washings, inject aliquots of approximately 20 to 30 mL of 0.85% sterile saline (nonbacteriostatic) for adults, or 5 mL for children. Suction washings into a sterile container.
Blood cultures
See: Bacterial culture and sensitivities – Blood culture
Refer to section Sample Processing / Delivery
PHOL
○ Up to 7 days for culture
○ Up to 21 days from receipt by PHO laboratory. Samples are forwarded to the Centers for Disease Control and Prevention in Colorado for testing.
○ Up to 14 days from receipt by NML
○ Up to 21 days from receipt by PHO laboratory. Samples are forwarded to the Centers for Disease Control and Prevention in Colorado for testing.
○ Up to 14 days from receipt by NML
416-586-4800 extension 4432
YES; notify laboratory if this agent is suspected prior to collecting specimens
○ Label specimen container. Place specimens in biohazard bag and seal.
○ Transport specimens to UHN/SH Microbiology Laboratory at refrigeration temperature (2-8˚C) ASAP and notify the laboratory prior to collecting specimens, except for blood cultures.
○ The specimen will be referred to the Public Health Ontario Laboratory or National Microbiology Laboratory depending on the clinical scenario.
○ Transport specimens to UHN/SH Microbiology Laboratory at refrigeration temperature (2-8˚C) ASAP and notify the laboratory prior to collecting specimens, except for blood cultures.
○ The specimen will be referred to the Public Health Ontario Laboratory or National Microbiology Laboratory depending on the clinical scenario.