Lab Dept:

Microbiology/Virology

Test Name:

CHLAMYDIA TRACHOMATIS CULTURE

General Information

Lab Order Codes:

CHLC

Synonyms:

Chlamydia culture

CPT Codes:

87110 – Culture, Chlamydia, any source

Test Includes:

Tissue culture with detection by fluorescent monoclonal antibody.

Logistics

Lab Testing Sections:

Virology

Phone Numbers:

Minneapolis:

Saint Paul:

612-813-5806

651-220-6555

Test Availability:

Daily, 24 hours

Turnaround Time:

2 - 5 days

Special Instructions:

● Do Not use calcium alginate swabs or swabs with wooden shafts as both are toxic to chlamydia.

● Do Not use ProbeTec swabs.

● Requisition must state specific site of specimen and date/time of collection.

● If both gonorrhea and chlamydia testing are requested, collect 2 separate specimens. The gonorrhea specimen should be collected prior to the chlamydia specimen.

● This organism infects the columnar epithelial cells and will not be found in the inflammatory cells.

● Chlamydia specimens not in transport media must be received in lab within 1 hour of collection.

Specimen

Specimen Type:

Bronch, tissue, swab of conjuctiva, cervix ,oropharynx, posterior nasopharynx, rectum, or urethra

Container:

Chlamydia transport media (M4 VTM) (available in Microbiology)

Swab transport system

Volume:

1 swab

Aspirate or sputum: 0.5 mL

Collection:

Cervical:

1. Remove exudate prior to collection of specimen.

2. Gently insert separate large swab or cytobrush into endocervical canal past squamocolumnar junction. Rotate cytobrush one full turn. If using a swab, rotate for 5 - 10 seconds.

3. To avoid contamination, withdraw swab while avoiding touching any vaginal surfaces.

4. Place swab in transport media.

Conjunctival:

1. Using a sterile cotton ball or gauze, clear eye of any mucus or discharge.

2. Moisten swab with sterile saline. Vigorously swab across conjunctiva, sampling the less affected conjunctiva first to reduce potential for further contamination of that eye. For suspected trachoma, the specimen should be taken from the upper fornix of the conjunctiva. In inclusion conjunctivitis, the specimen should be taken from the lower conjunctiva.

3. Place swab in transport media.

4. Scrapings: Instill one or two drops of topical anesthetic and scrape the lower tarsal conjunctiva. Place in transport media.

Nasopharyngeal:

1. Obtain 2 specimens using 2 NP swabs (i.e. MiniTip™Culturette).

2. Gently insert swab through nose into posterior nasopharynx.

3. Gently rotate swab slowly for 5 seconds to absorb secretions.

4. Collect a second specimen in the same manner.

5. Place swabs in transport medium.

Oropharyngeal:

1. Depress tongue with tongue depressor.

2. Sample the posterior pharnyx, tonsils, and inflamed areas with a sterile swab.

3. Place swab in transport media.

Bronchoscopy:

1. Specimen obtained by physician through the biopsy channel of the bronchoscope.

2. Transfer specimen into a luki tube.

3. Transport to the Microbiology Laboratory immediately.

Tissue:

1. Submit specimen in a screw-capped, sterile container.

2. Maintain sterility and forward promptly.

3. If there is a delay in transport of 1 hour or more, place specimen in transport media and refrigerate.

Rectal:

1. Insert swab approximately 1 inch into anal canal.

2. Gently move the swab from side to side to sample the anal crypts.

3. If fecal contamination occurs, discard swab and use another to obtain specimen.

4. Place swab in transport media.

Urethral (Males Only):

1. Instruct the patient not to urinate for 1 hour prior to sampling.

2. Remove excess mucus/pus with a cotton ball or swab. Discard cotton ball or swab.

3. Insert a separate swab 4-6 cm into the urethra. Gently rotate swab, using sufficient pressure to obtain an adequate number of epithelial cells.

4. Place swab in transport media.

Special Processing:

Specimens must be placed in transport media withing one hour of collection. Do not remove swabs from transport media.

Transport/Storage:

Transport to the Microbiology Laboratory immediately. Refrigerate specimen in transport media if there is a delay in transport of <24 hours. If there is a delay in transport of >24 hours, send specimen in transport media frozen at –70° C on dry ice.

Sample Rejection:

Specimen not in transport media with a transit time exceeding 1 hour; not submitted in appropriate transport container; improperly labeled specimen; insufficient volume; external contamination. If an unacceptable specimen is received, the physician or nursing station will be notified and another specimen will be requested before the specimen is discarded.

Interpretive

Reference Range:

No Chlamydia trachomatis isolated.

Limitations:

● A single negative culture may not rule out the presence of chlamydial infection. Chlamydia is an obligate intracellular parasite and does not survive well outside the host system. The sensitivity of culture probably is only 70% to 90% because Chlamydia trachomatis does not always survive transit to the laboratory and because of often inadequate sample with multiple swabs.

● This test will not detect Chlamydia psittaci or Chlamydia pneumoniae.

Methodology:

Tissue culture and immunofluorescence

References:

Cook, JH, and M Pezzlo (1992). Specimen receipt and accessioning. Section 1. Aerobic bacteriology, 1.2.1-4. In HD Isenberg (ed) Clinical Microbiology Procedures Handbook. American Society for Microbiology, Washington DC

Miller, J Michael (1999) A Guide To Specimen Management in Clinical Microbiology, American Society for Microbiology, Washington DC

Miller, J Michael, and HT Holmes (1999) Specimen Collection, Transport, and Storage In PR Murray et al, (ed), Manual of Clinical Microbiology, 7^th edition, American Society for Microbiology, Washington DC, pg 33-104

Updates:

11/20/2007: Added information about transport swabs and processing of specimens not sent in transport media.
11/23/2010: Update to special processing.