Coxiella burnetii
Clinical Specimen Submission Guidance
Submit all specimens to 50 Orms St, Providence RI 02904. Open Monday to Friday 8:30 AM to 4:30 PM
Special Pathogens & Biothreats Laboratory 401-222-5586
Coxiella burnetii
Q-Fever
Clinical Specimens: Real-time PCR
Serology: Indirect Immunofluorescence antibody (IFA)
PREAUTHORIZATION is required prior to sending specimens or isolates.
LABORATORIES MUST NOTIFY RIDOH Center for Acute Infectious Disease Epidemiology at (401) 222-2577 and the RISHL Special Pathogens & Biothreats Laboratory at (401) 222-5586 IMMEDIATELY when test is ordered or specimen/isolate is suspicious for a potential agent of Bioterrorism (e.g. Q Fever).
Molecular detection methods have decreasing sensitivity after febrile (acute) stage illness. Hemolysis of whole blood can interfere with results. Samples in saline buffer have decreased sensitivity and are subject to rejection. Other shipping media is not recommended and will be subject to rejection. Multiple freeze-thaw cycles and sample storage above refrigerated temperatures can interfere with nucleic acid extraction.
Refer to the current version of the ASM Sentinel Guidance for appropriate specimen selection and testing. This protocol is available in your microbiology laboratory and can also be accessed via the internet at: https://www.asm.org/Articles/Policy/Laboratory-Response-Network-LRN-Sentinel-Level-C or consult with the RISHL Special Pathogens & Biothreats Laboratory for appropriate specimen collection.
Consult with the RISHL Special Pathogens & Biothreats Laboratory (401) 222-5586 for appropriate specimen selection. Submit original specimen as soon as possible after collection.
Clinical Specimens (PCR): If, based on clinical history, there is a high index of suspicion for Q Fever, specimens are accepted for PCR testing. Collect 1.0 mL acute whole blood (taken within 14 days after illness onset or while symptomatic): EDTA-treated, or ACD A treated. Specimens must be collected prior to or shortly after the initiation of antimicrobial therapy. Securely seal with parafilm or other appropriate barrier film.
Serology Specimens: Collect 1.0 mL acute-phase serum (taken within 14 days of illness onset or while symptomatic) paired with convalescent-phase serum (taken 2-10 weeks after initial sample); or single acute-phase or convalescent serum. Securely seal with parafilm or other appropriate barrier film.
Keep specimen at 2° to 8°C up to 7 days after draw. If storing over 7 days, freeze at -20°C or lower up to 2 months (35 days for tissue), or -70°C or lower up to 1 year (for serum, blood, tissue).
Other specimens, e.g. tissues, may be tested in consultation with the RI State Health Laboratories and CDC.
Tissue stored at 2° to 8°C should be placed in a sterile specimen cup with a gauze pad slightly moistened with sterile saline. To freeze tissue, place specimen in cryogenic container at -20°C or lower. Do Not immerse tissue in saline.
For swab specimen, place in sterile container without any medium
CLIA regulations require specimens be labeled with at least two patient identifiers. Examples of identifiers are first and last name, date of birth, chart/medical record number. The specimen container must be labeled to match the test requisition or the electronic order.
Rhode Island State Health Laboratories (RISHL) test requisition form https://health.ri.gov/forms/LabRequisitionForm.pdf
CDC 50.34 form is required
PCR (whole blood only): CDC Send-out
Write "Coxiella whole blood" under Comments/Other Test Requests
Serology: CDC Send-out
Write "Coxiella serology" under Comments/Other Test Requests
Specimens must be packaged & transported in accordance with current federal shipping regulations.
Submit original specimen as soon as possible after collection.
Refrigerated Clinical Specimens: Transport and deliver to the laboratory within 24 hours of collection at 2-8°C in a cooler able to maintain specimen temperature. A plug-in electric cooler is recommended, however, a cooler packed with excess frozen gel packs is acceptable as long as the transport temperature is maintained at 2-8°C.
Frozen: If specimen previously frozen, it must be transported on frozen gel packs in insulated shipper.
Shipments that meet the definition for 'Category A' infectious substances as defined by federal regulation require additional packaging/labeling.
PCR: Molecular detection methods have decreasing sensitivity after febrile (acute) stage illness. Hemolysis of whole blood can interfere with results. Multiple freeze-thaw cycles and sample storage above refrigerated temperatures can interfere with nucleic acid extraction.
Serology: Multiple freeze thaw cycles may interfere with antigen binding. An antibody response may not be detected in the acute phase of illness; therefore, acute and convalescent serum samples are needed for diagnosis.
The following rejection criteria will be used to ensure accurate specimen information and specimen condition for testing:
- Specimen received outside acceptable transport range
- Demographics different of specimen
- Two identifiers required on specimen / Unable to read identifiers on specimen
- Expired/ incorrect collection kit
- Insufficient quantity
- Urine cup received
- No specimen received
- Specimen leaked in transit
- Test not evaluated in adolescents < 14
- No swab received
- Specimen too old
Negative for Coxiella burnetii
Providers must report patient information on Q-Fever immediately using the RIDOH reportable disease form.
CDC PCR result: 6 weeks
CDC Serology result: 6 weeks
Containers specifically labeled for transport of specimens and isolates to the RISHL Special Pathogens & Biothreats Laboratory are available in all Microbiology Laboratories and Laboratory Sendout Departments.