Mpox — Orthopoxvirus Testing — Clinical Pathway: Emergency Department, Outpatient Specialty Care and Primary Care

Mpox (Monkeypox) Clinical Pathway — Emergency Department, Outpatient Specialty Care and Primary Care

Orthopoxvirus Testing

Preparation and Collection of Specimens for Mpox Testing

If clade I disease is possible, please discuss immediately with IPC on call (via 5-SAFE) the indications for sending specimen directly to the PA State Lab (BOL), which requires a dry swab specimen. This page below describes lab preparation for send outs to ARUP/Labcorp/Quest.

CHOP Lab Mpox Testing

  • Place Mpox PCR order for Orthopoxvirus PCR, ARUP test code 99999.080
    • For uninsured patients, prior authorization by the health department is required to place an order for this testing.
  • See the Online Test Menu for a sample screenshot
Lab test Epic screenshot
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Specimen Collection Guidance for PCR Testing

  • Select 2-4 different lesions to swab
  • Early lesions may have higher viral loads than older lesions
  • It is not necessary to unroof the lesion before swabbing
  • Consider collection of scabs if no newer lesions are present
  • Use sterile dry polyester, rayon, or Dacron® swab (no calcium alginate or wood)
  • Place in viral transport medium (VTM), one swab per container
  • If sampling multiple anatomic sites, one swab for each site per container

Specimen collection swab

Item Mfr # Description UOM Conv
191185 GL4692 Viral Transport Media EA 1EA/50BX
191307 SW0302 Swab Nares Skin Speci Collect EA 1EA/100CS
178256 DYND30261 BG Specimen Biohazard 6x9-178256 PK 1PK/10CA

Specimen Transport Conditions

Main Campus Lab

  • Submit to central lab within 24 hours of collection (room temperature)
  • Specimens can be sent through pneumatic tube system

Ambulatory

  • Follow current workflow for specimen send out.
  • Labcorp/Quest — specimens will need to go out on ice. Note “refrigerate” on the specimen bag. Put ice pack on sample within the collection box.
  • ARUP — specimens may be at room temperature.

Additional Laboratory Testing for Consideration

Consider also testing for other infections such as syphilis (RPR assay), site specific gonorrhea/chlamydia testing (urethral/urine, pharyngeal, and/or rectal), HIV antibody/antigen, and HSV PCR based off symptoms and presentation due to remarkably high rates of STI coinfections.

If < 13 years old or not sexually active, consider testing for VZV, enterovirus.

If concern for bacterial superinfection, collect red-top culture tube for culture and sensitivities.