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Molecular Microbiology – Requisition Form (Bacteria, Fungi, DNA/RNA Viruses, Microscopic Parasites)

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Molecular Microbiology – Requisition Form (Bacteria, Fungi, DNA/RNA Viruses, Microscopic Parasites) KITGEN spol. s r.o. Laboratory for molecular diagnostics V Hůrkách 3 158 00 Prague CZECH REPUBLIC Molecular Microbiology – Requisition Form (bacteria, fungi, DNA/RNA viruses, microscopic parasites) Patient: Referring clinician: Name: Name: Address: ID: ID of the patient: Insurance type: Address: Diagnosis: Stamp and signature: Biological material (please specify): ……………………………………………………… Date and time of sampling: Required tests (tick please): A. MOLECULAR DETECTION OF BACTERIA Detection range of the Real-Time PCR assay Acinetobacter baumannii Acinetobacter baumannii Aggregatibacter actinomycetemcomitans Aggregatibacter actinomycetemcomitans Anaplasma phagocytophilum, Anaplasma platys, Anaplasma spp. Anaplasma ovis, Anaplasma marginale Atopobium vaginae Atopobium vaginae Bacillus anthracis Bacillus anthracis Bartonella spp. Bartonella henselae, Bartonella quintana Bordetella bronchiseptica Bordetella bronchiseptica Bordetella pertussis Bordetella pertussis Borrelia burgdorferi, Borrelia afzelii, Borrelia Borrelia burgdorferi sensu lato garinii Brucella abortus, Brucella mellitensis, Brucella Brucella spp. suis, Brucella canis Burkholderia cepacia, Burkholderia cenocepacia, Burkholderia multivorans, Burkholderia pseudomallei, Burkholderia mallei, Burkholderia amfibaria, Burkholderia Burkholderia spp. vietnamensis, Burkholderia thailadensis Campylobacter spp. Campylobacter jejuni, Campylobacter coli 1/9 KITGEN spol. s r.o. Laboratory for molecular diagnostics V Hůrkách 3 158 00 Prague CZECH REPUBLIC Candidatus neoehrlichia mikurensis Candidatus neoehrlichia mikurensis Citrobacter spp. Citrobacter freundii, Citrobacter koseri Clostridium perfringens, Clostridium tetani, Clostridium botulinum, Clostridium novyi, Clostridium histolyticum, Clostridium difficile, Clostridium spp. Clostridium sordellii Clostridium difficile, toxin A Clostridium difficile, toxin A Clostridium difficile, toxin B Clostridium difficile, toxin B Staphylococcus haemolyticus, Staphylocouccus hominis, Staphylococcus epidermidis, Staphylococcus capitis, Staphylococcus auricularis, Staphylococcus hyicus, Staphylococcus felis, Staphylococcus intermedius, Staphylococcus saprophyticus, Coagulase-negative Staphylococci (more Staphylococcus xylosus, Staphylococcus than 40 species) schleiferi and other less frequent CoNS Corynebacterium diphtheriae, Corynebacterium pseudotuberculosis, Corynebacterium ulcerans, Corynebacterium amycolatum, Corynebacterium striatum, Corynebacterium tuberculostearicum, Corynebacterium pseudogenitalium, Corynebacterium spp. Corynebacterium minutissimum Ehrlichia chaffeensis Ehrlichia chaffeensis Enterobacter cloacae / aerogenes Enterobacter cloacae / aerogenes Enterococcus faecalis Enterococcus faecalis Enterococcus faecium Enterococcus faecium Escherichia coli Escherichia coli Francisella tularensis Francisella tularensis Fusobacterium nucleatum Fusobacterium nucleatum Gardnerella vaginalis Gardnerella vaginalis Haemophilus influenzae Haemophilus influenzae group A-F Helicobacter pylori Helicobacter pylori Chlamydia psitacci, Chlamydophila pneumoniae, Chlamydia trachomatis, Chlamydia caviae, Chlamydia pecorum, Chlamydia abortus, Chlamydia muridarum, Chlamydia avium, Chlamydia (Chlamydophila) spp. Chlamydophila felis Chlamydia trachomatis Chlamydia trachomatis Chlamydophila pneumoniae Chlamydophila pneumoniae Klebsiella oxytoca Klebsiella oxytoca Klebsiella pneumoniae Klebsiella pneumoniae Legionella micdadei Legionella micdadei Legionella pneumophila Legionella pneumophila Leptospira interrogans; Leptospira icterohaemorrhagiae, Leptospira grippotyphosa, Leptospira spp. Leptospira pomona, Leptospira canicola Listeria monocytogenes Listeria monocytogenes Moraxella catarrhalis Moraxella catarrhalis Morganella morganii Morganella morganii 2/9 KITGEN spol. s r.o. Laboratory for molecular diagnostics V Hůrkách 3 158 00 Prague CZECH REPUBLIC Mycobacterium tuberculosis, Mycobacterium ulcerans, Mycobacterium gordonae, Mycobacterium scrofulaceum, Mycobacterium bovis, Mycobacterium malmoense, Mycobacterium xenopi, Mycobacterium kansasii, Mycobacerium intracellulare, Mycobacterium Mycobacterium spp. avium subsp. avium, Mycobacterium fortuitum Mycoplasma genitalium Mycoplasma genitalium Mycoplasma hominis Mycoplasma hominis Mycoplasma pneumoniae Mycoplasma pneumoniae Mycoplasma salivarium, Mycoplasma buccale, Mycoplasma cloacale, Mycoplasma canis, Mycoplasma capricolum, Mycoplasma caviae, Mycoplasma phocae, Mycoplasma heamominutum, Mycoplasma suis, Mycoplasma maculosum, Mycoplasma primatum, Mycoplasma spermatophilum, Mycoplasma equigenitalium, Mycoplasma elephantis, Mycoplasma phocicerebrale, Mycoplasma phocirhinis, Mycoplasma phocidae, Mycoplasma arginini, Mycoplasma pulmonis, Mycoplasma Mycoplasma spp. orale, Mycoplasma flocculare Neisseria gonorrhoeae Neisseria gonorrhoeae Neisseria meningitidis Neisseria meningitidis Nocardia nova, Nocardia asteroides, Nocardia Nocardia spp. aobensis, Nocardia brasiliensis Porphyromonas endodontalis Porphyromonas endodontalis Porphyromonas gingivalis Porphyromonas gingivalis Prevotella intermedia Prevotella intermedia Proteus mirabilis Proteus mirabilis Pseudomonas aeruginosa / putida Pseudomonas aeruginosa / putida Rickettsia rickettsii, Rickettsia helvetica, Rickettsia parkeri, Rickettsia massiliae, Rickettsia peacockii, Rickettsia sibirica, Rickettsia spp. Rickettsia raoultii Salmonella enteric subsp. enterica type Enteritidis, Typhimurium, Newport, Anatum, Salmonella enterica subsp. enterica Montevideo, Paratyphi A, Infantum Serratia marcescens Serratia marcescens Shigella sonnei, Shigella flexneri, Shigella Shigella spp. dysenteriae Staphylococcus aureus Staphylococcus aureus Stenotrophomonas maltophilia Stenotrophomonas maltophilia Streptococcus pneumoniae Streptococcus pneumoniae Streptococcus anginosus, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus parasanguinis, Streptococcus oralis, avium, Streptococcus constellatus, Streptococcus equi, Streptococcus equisimillis, Streptococcus haemolyticus, Streptococcus milleri, Streptococcus mutans, Streptococcus porcinus, Streptococcus salivarius, Streptococcus suis, Streptococcus spp. (more than 70 Streptococcus zooepidemicus, Streptococcus species) canis and other less frequent species 3/9 KITGEN spol. s r.o. Laboratory for molecular diagnostics V Hůrkách 3 158 00 Prague CZECH REPUBLIC Tannerella forsythia Tannerella forsythia Treponema denticola Treponema denticola Treponema pallidum Treponema pallidum Tropheryma whipplei Tropheryma whipplei Ureaplasma urealyticum, Ureaplasma diversum, Ureaplasma gallorale, Ureaplasma felinum, Ureaplasma cati, Ureaplasma canigenitalium, Ureaplasma spp. Ureaplasma parvum Yersinia pestis, Yersinia pseudotuberculosis, Yersinia spp. Yersinia enterocolitica subsp. enterocolitica G(-): Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Serratia marcescens, Enterobacter cloacae/aerogenes, Proteus mirabilis, Pseudomonas aeruginosa/putida, Acinetobacter baumannii, Stenotrophomonas maltophilia G(+): Staphylococcus aureus, Coaguláza-negativní staphylokoky (Staphylococcus epidermidis, S. haemolyticus, S. hominis, S. intermedius, S. xylosus), Streptococcus pneumoniae, Streptococcus spp. (Streptococcus agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. infantarius, S. intermedius, S. minor, S. mitis, S. mutans, S. oligofermentans, S. oralis, S. parasanguinis, S. peroris, S. pseudopneumoniae, S. pyogenes, S. salivarius, S. sanguinis, S. thermophilus, S. viridans), Enterococcus faecium, Enterococcus Bacteria-Multiplex faecalis Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter cloacae, Streptococcus Bacteria-Multiplex A pneumoniae, Klebsiella oxytoca Coagulase-negative staphylococci (over 40 species), Serratia marcescens, Enterococcus faecium, Proteus mirabilis, Acinetobacter Bacteria-Multiplex B baumannii Streptococcus spp. (over 70 species), Pseudomonas aeruginosa / putida, Escherichia coli, Stenotrophomonas maltophilia, Bacteria-Multiplex C Enterococcus faecalis Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Listeria MeningitisPlexB1 monocytogenes, Staphylococcus aureus Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Staphylococcus haemolyticus, Staphylocouccus hominis, Staphylococcus epidermidis, Staphylococcus capitis, Staphylococcus auricularis, Staphylococcus hyicus, Staphylococcus felis, Staphylococcus intermedius, Staphylococcus saprophyticus, Staphylococcus xylosus, Staphylococcus schleiferi, Streptococcus anginosus, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus parasanguinis, Streptococcus oralis, avium, Streptococcus constellatus, MeningitisPlexB2 Streptococcus equi, Streptococcus equisimillis, 4/9 KITGEN spol. s r.o. Laboratory for molecular diagnostics V Hůrkách 3 158 00 Prague CZECH REPUBLIC Streptococcus haemolyticus, Streptococcus milleri, Streptococcus mutans, Streptococcus porcinus, Streptococcus salivarius, Streptococcus suis, Streptococcus zooepidemicus, Streptococcus canis, Borrelia burgdorferi, Borrelia afzelii, Borrelia garinii Leptospira interrogans; Leptospira icterohaemorrhagiae, Leptospira grippotyphosa, Leptospira pomona, Leptospira canicola, Bartonella henselae, Bartonella quintana, Brucella abortus, Brucella mellitensis, Brucella suis, Brucella canis, Rickettsia rickettsii, Rickettsia helvetica, Rickettsia parkeri, Rickettsia massiliae, Rickettsia peacockii, Rickettsia sibirica, Rickettsia raoultii, Mycobacterium tuberculosis, Mycobacterium ulcerans,
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