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Chickenpox is usually acquired by the inhalation of airborne respiratory droplets from an infected host. After initial inhalation of contaminated respiratory droplets, the virus infects the conjunctivae or the mucosae of the upper respiratory tract. A person with chickenpox can spread the disease from 1 to 2 days before they get the rash until all their chickenpox blisters have formed scabs. It takes from 10 to 21 days after exposure to a person with chickenpox or shingles for someone to develop chickenpox. If a person vaccinated for chickenpox gets the disease, they can still spread it to others. Nosocomial transmission of varicella-zoster virus (VZV) is well-recognized and can be life threatening to certain groups of patients. Patients, health care providers, and visitors with varicella or herpes zoster can spread VZV to susceptible patients and health care providers in hospitals, long-term-care facilities, and other healthcare settings.
Whenever possible, collect all culture specimens prior to administration of any antimicrobial agents.
Specimens may be hand delivered to the laboratory or transported via the runners from Technical Services if the specimens are not indicated as deliver immediately. Specimens should be in tightly sealed, leak proof containers and transported in sealable, leak-proof plastic bags.
Further questions may be referred to the Microbiology laboratory (356-2591) or pathology resident (pager 4903 weekdays; pager 3404 evenings and weekends). A sterile container (37777) may be used for tissue if transported to the microbiology lab immediately (add drops of sterile saline to keep small pieces of tissue moist).
Copan Liquid Amies Elution Swab (ESwab) (74541) a€“ swab specimens are suboptimal, but will be accepted if no other sample can be obtained. Anaerobic flora is prevalent on mucosal surfaces of the oral cavity, upper respiratory, gastrointestinal, and genital tracts; specimens collected from these sites should not ordinarily be cultured for anaerobic bacteria. Holding the applicator sponge downward, pinch wings on applicator to break ampule and release the antiseptic. Use a side-to-side motion to scrub the site with the friction pad for a full 30 sec; allow site to dry completely (at least 30 sec) before venipuncture.
Remove overcaps from bottles (1 aerobic 924171 and 1 anaerobic 924172) and cleanse each rubber septum with separate 70% alcohol swabs. For adults with a suspected bloodstream infection (BSI), collect two initial sets of blood cultures sequentially from separate phlebotomy procedures followed by a third and a fourth set at 4-6 hour intervals (will detect >99% of BSIs). If patient is allergic to chlorhexidine, prep site with a povidone iodine swab stick (907172) applied in concentric circles (start at center). Pediatric – Apart from NICU patients, the minimum volume drawn should be 1 mL per year of age per blood culture set. Cerebrospinal Fluid (CSF) – Aseptically collect CSF from a lumbar puncture into sterile tubes (907131). Inner ear – Tympanocentesis should be reserved for complicated, recurrent, or chronic persistent otitis media.
Conjunctiva – Sample each eye with separate swabs (premoistened with sterile saline) by rolling over conjunctiva.
Genital –Cultures for Neisseria gonorrhoeae should be collected using an Copan Liquid Amies Elution Swab (ESwab). If Nocardia is suspected, culture for Nocardia should be requested as an add-on test as standard culture is inadequate for its recovery. Transport fluid to laboratory in sterile, leak-proof container (BD Vacutainer, no additive, yellow top, 924044) or anaerobic transport vial (Vial, 59546). Amniotic and culdocentesis fluids should always be transported in an anaerobic transport vial (59546). One aerobic blood culture bottle (924171) inoculated at bedside (up to 10 mL) is highly recommended provided adequate sample is available.
Surveillance cultures may be ordered on Bone Marrow transplant and other immunocompromised patients to detect overgrowth of normal flora by Staph aureus, yeast or a gram negative bacillus. Gray top C&S urine containers are not acceptable for urinalysis and urine chemistries because the preservative interferes with testing. Midstream clean catch method: Patients should be instructed to wash hands prior to collection and offered exam gloves. Female patients should be instructed to sit on toilet with legs apart and spread labia with one hand.

Skin: Using a scalpel blade, scrape the periphery of the lesion border and transport in a sterile container.
Swabs are suboptimal for recovery of mycobacteria due to limited material and the hydrophobicity of the mycobacterial cell envelope (often compromises a transfer from swabs onto media). Nasopharyngeal swab: Collect specimen using the flexible minitip flocked swab (Hospital Stores #33595). With sterile gloved hand, insert suction catheter into the patient's nose to the depth of the nasopharyngeal area (beyond the turbinates). With the non-sterile gloved hand, instill approximately 1-2 mL normal saline outside the catheter. Specimens transported by tube system must be transferred from trap to a leak-proof sterile container (be sure the lid is tightly secured). PCR Assays are available for the following viruses: HSV1&2, VZV, enterovirus (CSF), EBV (Blood and CSF) and CMV (blood, CSF, or BAL). HIV Viral Load by PCR, Hepatitis C Virus RNA by PCR and Hepatitis B Virus DNA by PCR: For each test collect at least 6 mL whole bold in one pink (EDTA) top tube. Neisseria gonorrhoeae & Chlamydia trachomatis Detection by PCR: Amplified DNA (PCR) testing is recommended for urine, endocervical, urethral, oral or pharyngeal and rectal swab. Endocervical, urethral, oral or pharyngeal, rectal swab: Use multicollect specimen kit available from hospital stores (46161). Urine: The patient should not have urinated for at least one hour prior to sample collection. Ova and parasite exam: Within 1 hour of collection, transfer a few grams of stool to each vial of SHL collection kit (Hospital Stores 923450). Parasite exam: For direct examination of parasites (worms), arthropods (insects, spiders), and suspect material passed in stool. Scabies exam: Sterile mineral oil is available from Pharmacy (item 991565, 10 mL container). Wet Prep for Trichomonas, Yeast or Gardnerella: Collect vaginal specimen in Affirm VPIII Collection and Transport System. The highly contagious nature of VZV explains the epidemics of chickenpox that spread through schools as one child who is infected quickly spreads the virus to many classmates. Viral proliferation occurs in regional lymph nodes of the upper respiratory tract 2-4 days after initial infection and is followed by primary viremia on postinfection days 4-6.
Cell-mediated immune responses are also important in limiting the scope and the duration of primary varicella infection. The virus spreads easily from people with chickenpox to others who have never had the disease or received the chickenpox vaccine.
However, for a few people, they can get chickenpox more than once, although this is not common. Reports of nosocomial transmission are relatively uncommon in the United States since introduction of varicella vaccine.
These transmissions have been attributed to delays in the diagnosis or reporting of varicella and zoster and failures to implement control measures promptly. The following is a list of specimens that are likely to be contaminated with anaerobic normal flora and are NOT routinely accepted for anaerobic culture. For intact eardrum, clean ear canal with soap solution and collect fluid via syringe aspiration. If blood culture bottle is inoculated, submit separate aliquot in anaerobic transport vial (59546) or sterile container (37777) for preparation of cytocentrifuged Gram stain and inoculation of solid media (allows quantitation, aids in culture interpretation). Specimens for mycobacteria should be double bagged and sent sealed in leak-proof containers. Measure the distance from the patienta€™s nostril to the nasopharynx (half the distance from nostril to base of the ear) and hold the swab at that location.
With specimen trap still in-line, rinse catheter with remaining saline to clear secretions. PCR testing requires a dedicated collection tube and cannot be added onto a previously opened vacutainer tube. Submit vesicle fluid, surface swab, or BAL (sputum and tracheal aspirates are unacceptable) in UTM media.
Touch the perianal folds with clear scotch tape, then attach the tape to a clean glass slide and transport to the laboratory sealed in a ziplock bag.
High viral titers are found in the characteristic vesicles of chickenpox; thus, viral transmission may also occur through direct contact with these vesicles, although the risk is lower.

A second round of viral replication occurs in the body's internal organs, most notably the liver and the spleen, followed by a secondary viremia 14-16 days postinfection. After primary infection, VZV is hypothesized to spread from mucosal and epidermal lesions to local sensory nerves. A person with shingles can spread the virus to others who have never had chickenpox or received the chickenpox vaccine. Use needle and syringe to aseptically collect 4 mL freshly voided urine though catheter port. Use needle and syringe to aseptically collectA  A 20 mL freshly voided urine though catheter port. Using sterile technique, insert a double catheter into the cleansed stoma, to a depth beyond the fascial level, and collect the urine into a sterile container.
The lab only accepts Copan Liquid Amies Elution Swab (ESwab) for AFB culture when the ordering physician confirms that the swab is the only possible way to obtain the specimen.
Each test requires a dedicated collection tube and cannot be added onto a previously opened vacutainer tube. After collection, specimens may be stored and transported at 2 to 30 A?C for up to 14 days. This secondary viremia is characterized by diffuse viral invasion of capillary endothelial cells and the epidermis. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters. Gently insert the swab along the base of one nostril (straight back, not upwards) and continue along the floor of the nasal passage until reaching the nasopharynx. Preliminary slide results will be available within 90 minutes if specimen received between 0700-1900 or by 0930 if after 1900. VZV infection of cells of the malpighian layer produces both intercellular and intracellular edema, resulting in the characteristic vesicle. Reactivation of VZV results in the clinically distinct syndrome of herpes zoster (shingles).
Onset of diarrhea in patients hospitalized for >3 days is usually not attributed to a parasitic infection. If clinical suspicion for malaria remains after one set of negative smears, additional specimens should be submitted at 12 hour intervals for the subsequent 36 hour period.
AfolayanI, * IBotany Programme Unit, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa IIDepartment of Medical Virology, University of Pretoria, P.O.
Box 2034, Pretoria 0001, South Africa IIIDepartment of Medical Virology, University of Pretoria, and National Health Laboratory Service, P.O. Our results indicate that the use of these two plant species for the treatment of STIs could have a scientific rationale. Aloe emodin is a new type of anticancer agent with selective activity against neuroectodermal tumors.
Withania somnifera Dunal (Ashwagandha): Potential plant source of a promising drug for cancer chemotherapy and radiosensitization. The riminophenazine agents clofazimine and B669 reverse acquired multidrug resistance in a human lung cancer cell line. Bioactive compounds isolated from Aloe ferox: A plant traditionally used for the treatment of sexually transmitted infections in the Eastern Cape, South Africa.
Stimulation of the immunological reactivity of cancer patients by Eleutherococcus extract.
Maintenance medium was the same as the propagation medium, except that the former contained only 2% FCS. The virus was diluted in serum-free MEM and used at a final concentration of 100 TCID50 per microtitre tray well. Cells were examined daily for seven days, by light microscopy, for the appearance of any cytopathic effect (CPE).
The absence of CPE at a specific concentration of the extracts or aloin was considered to be indicative of antiviral activity. Anti-viral effects of aqueous extracts of Aloe ferox and Withania somnifera on herpes simplex virus type 1 in cell culture.

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