Last Revised: 2003-03-21 13:00 CST

Health Santé

Canada Canada

For physicians, public health, hospitals and FYI to Labs

Recommended Laboratory Investigation of

Severe Acute Respiratory Syndrome

In addition to clinically indicated laboratory testing conducted at the local level, the following specimens should be collected for all patients meeting the probable case definition or for all suspect cases with close contacts* to probable cases:

Acute and convalescent blood for serology with at least 2 weeks between acute and convalescent samples.

         I.      Red tube (10mL, minimum)

       II.      Lavender tube - (7 mL minimum) for amplification tests

      III.      Throat swab in viral transport media

   IV.      Nasopharyngeal swab or aspirate in viral transport medium (2mL)

     V.      Stool for virology - fresh or in viral transport media (if diarrhea is present). Not in preservative.

AND WHERE POSSIBLE

   VI.      Bronchial alveolar lavage or tracheal aspirate in a sterile container.

  VII.      IF a probable or suspect case had additional symptoms of meningitis**

- CSF for virology - fresh specimen in CSF tube.

IX. All tissues from biopsy or autopsy - fresh and fixed: lung, liver, spleen, brain, etc.

Laboratories should follow normal testing procedures and refer specimens where necessary, to the appropriate reference laboratories.

IMPORTANT Transportation notes!!

1. Please indicate “SARS SPECIAL INVESTIGATION” on laboratory requisition form.
2. Please indicate date of onset of illness
3. Please indicate ' travel history' and/or 'contact of known case'
4. Please distinguish specimens as either ‘suspect’ or ‘probable’ SARS.
5. Address and contact information for shipment to Winnipeg should be appended to the document.
6. It should be made clear in the requisition/cover letter that the specimens are from one of: a case, or probable SARS case (fits case definition of March 17) or possible SARS case (fits most case criteria).
7. PLEASE communicate with local provincial laboratories FIRST before sending samples to the provincial labs or to the NML).

THEY WILL BE REFINED AS NEW INFORMATION BECOMES AVAILABLE…

* Close contact means having cared for, lived with or had face-to-face (within 1metre) contact with or having had direct contact with respiratory secretions and/or body fluids of a person with SARS.

** Meningitis has not been reported in SARS cases reported to date.

Please that additional lab testing, not included as part of the SARS protocol MUST be requested separately on the laboratory requisition. All SARS investigation samples received by the Toronto Public Health Lab are forwarded to the National Microbiology Laboratory in Winnipeg.