Microbiology - Enteric Bacteriology
Clinical specimens for the isolation of enteric microorganisms are accepted only from public health care providers. Fecal specimens are examined for the presence of enteric pathogens including Salmonella typhi, other Salmonella serotypes, Shigella, Campylobacter, Yersinia and Escherichia coli (E. coli) 0157:H7 and other Shiga-toxin producing E. coli (STEC). Specimens from contacts of patients culture-positive for communicable enteric pathogens are tested following recommendations in Control of Communicable Diseases in Man. Reference isolates are accepted from public and private health care providers for identification and/or serotyping. The SLPH is the North Carolina serotyping center for Salmonella, Shigella and E. coli 0157:H7 and participates in the national surveillance programs of the CDC.
Please Note: The North Carolina Communicable Disease Control rules (10A NCAC 41A.0209) state that laboratories culturing stool from a person with bloody diarrhea should culture for shiga-toxin producing Escherichia coli or send the specimen to the State Public Health Laboratory for shiga-toxin testing after consultation with the Enterics lab 919-807-8608
Feces and other specimens associated with food-borne illness are screened for disease agents
Consultation and bench training are provided upon request.
Please telephone the Enteric Bacteriology Unit to discuss outbreak-related specimens or to coordinate specimen handling in unusual circumstances.
Specimen Collection
Each specimen must be clearly labeled with the patient´s name and accompanied by DHHS form #3390 (PDF, 345 KB). Unlabeled specimens will not be tested. Specimens should be collected early in the course of enteric disease and before antimicrobial therapy is begun. Please indicate if the patient has bloody diarrhea and if a specific disease agent is suspected. Cary-Blair transport media for collection of feces or rectal swabs is available from the laboratory mailroom on-line at https://slphreporting.ncpublichealth.com/labportal.
Enteric Bacteriology Lab records are computerized and the following data are required: patient name, patient Social Security Number (or assigned number), date of birth, patient Medicaid number (if applicable), submitter Social Security Number or Federal Tax Number (Employer Identification Number), submitter return address, specimen collection date and specimen source. Without these data, specimen records cannot be entered in the computer, nor can a report of results be printed. Other data are helpful for epidemiological follow-up and for statistical purposes.
Note: Specimens received without submitter return address are subject to rejection!
Note: CLIA regulations require the following information on all test requisitions:
- patient name or identifier
- name and address of submitting agency
- test requested
- date specimen collected
- Feces Specimens
- Collect specimen so that feces is free of foreign matter, following instructions in Enteric Culture mailer or equivalent. Do not use the Parasitology mailer: it contains formalin which kills bacteria. Using the scoop, place feces in the vial of transport medium until the level of liquid reaches the fill line marked on the label. Do not overfill vial. Break up any large pieces with the scoop. Stir well, then replace the top tightly on the vial. Label with patient´s name.
- Rectal Swabs (2)
- Collect specimens by inserting two sterile swabs into rectum (best results are obtained if fecal material is observed on swab), avoiding contact with skin of perianal area. Use Enteric Culture mailer or equivalent. Place swabs in the vial of transport medium and break or cut off ends so that swabs fit into vial. Label with patient´s name.
- Blood Cultures
- Following incubation and subculture, isolates may be forwarded for reference identification.
- Reference Cultures
- Reference cultures for further identification should meet the following criteria for inclusion in the family Enterobacteriaceae: gram-negative non-sporeforming rods which grow aerobically and anaerobically, grow on MacConkey agar, ferment glucose, reduce nitrates, are oxidase negative, do not require NaCl and are catalase positive.
- Use the Microbiology Reference mailer or equivalent to ship pure cultures. Agar slant cultures are recommended. Plate cultures should be taped, cushioned with absorbent material and securely sealed in a leak-proof plastic bag. On the form indicate preliminary test results or presumptive identification and patient clinical information.
Note: Reference cultures of nonfermentative organisms as well as fermenters NOT INCLUDED in the family Enterobacteriaceae (ex.:Pasteurella, Aeromonas, Actinobacillus, Vibrio) should be directed to the Atypical Bacteriology Unit and should be accompanied by Special Bacteriology DHHS form 4121.
Specimen Shipment
Mailers for submitting fecal specimens and reference cultures are available from the SLPH Mail Room at (919)733-7656. To submit specimens:
- Write patient´s name on specimen tube. Unlabeled specimens will NOT be tested
- Place completed Enteric Bacteriology DHHS form #3390 (PDF, 345 KB; one form for each specimen) in outer container to avoid contamination in case of breakage or leakage
- Use double-walled or equivalent shipping containers that meet safety requirements. Multiple tubes or specimens should be wrapped individually in absorbent cushioning material and securely packaged in a leak-proof container. Mailers should be clearly labeled "Enteric Bacteriology" on the outside of the container
- Ship clinical specimens as soon as possible after collection. Refrigeration is recommended for Enteric Culture mailers, particularly specimens submitted for isolation of E.coli 0157:H7 and other Shiga-toxin producing E. coli (STEC)
- When shipping by U.S. mail, use first-class postage. Be sure to place return address on outside of container, regardless of shipping method
- Telephone the Enteric Bacteriology Unit before shipping large numbers of specimens or those requiring urgent attention
Relevant Links:
See also:
- About Microbiology
- Botulism
- Bordetella Pertussis
- Enteric Bacteriology
- Foodborne Illness
- Cholera
- Legionella
- Mycobacteriology
- Mycology
- Neisseria Gonorrhoeae
- Norovirus
- Parasitology
- Special & Atypical Bacteriology
