Before shipment of the specimen, make 
sure there is no leakage from the bottle. 
Amies’ modification of Stuart’s trans- 
port medium may be used. 
(3) A “midstream” specimen of urine is 
collected as cleanly as possible, after 
cleansing the genitalia with soap and 
water and drying the area. Place the 
specimen in a tightly closed container 
for immediate delivery to the labora- 
tory. In typhoid fever, stool cultures 
are more often positive than urine cul- 
tures. 
(4) Specimens of food suspected of con- 
taining Salmonella typhi should be 
placed in ice cream cartons or other 
suitable containers and immediately 
refrigerated. During transport to the 
laboratory, refrigeration must be main- 
tained. 
b. Salmonellosis 
Food poisoning may be caused by many 
members of the Salmonella group. Prelimi- 
nary epidemiological investigation should 
reduce to a minimum the number of sus- 
spected foods likely to be responsible for any 
given outbreak, and indiscriminate collec- 
tion of samples is unwarranted. Such in- 
quiries will indicate the food consumed in 
common by those made ill, and, although 
such evidence is not infallible, it is at least 
presumptive. 
Specimens to be collected for isolation of 
the agent 
( 1 ) If food from sealed containers is sus- 
pect, unopened containers of the same 
production lot should be submitted for 
testing. Also, representative samples of 
the suspected food should be trans- 
ferred to a sterile sample bottle or ice 
cream carton and refrigerated during 
transit to the laboratory. 
(2) Blood specimens for culture from pa- 
tients in food poisoning are of limited 
value. 
Blood cultures may be of value in the 
severe enteric, typhoidal, and septi- 
cemic types of salmonellosis. In such 
cases 10 to 15 ml. of blood may be 
drawn into a tube containing an anti- 
coagulant or into a bottle of blood 
culture medium, as for typhoid fever. 
(3) Fecal specimens, if obtained early dur- 
ing the acute stage of the disease, are 
the specimen of choice and should be 
collected as for typhoid fever. If the 
specimens are to be mailed to the lab- 
oratory, they should be handled in the 
same manner as fecal specimens to be 
examined for S. typhi. 
(4) Serologic studies on the sera of patients 
are not indicated since the results may 
be equivocal and impossible to inter- 
pret. 
c. Shigellosis 
Numerous members of the dysentery group 
of organisms are responsible for enteric dis- 
ease. Their isolation is not difficult, and 
identification is accomplished by biochem- 
ical and serologic studies. 
Specimens to be collected for isolation of 
the agent 
(1) Blood specimens should not be sub- 
mitted for cultural examination in 
suspected cases of shigellosis. 
(2) Fecal specimens should be submitted 
for attempted isolation of the infecting 
organism at any stage of illness, but 
specimens will yield more successful 
isolations if they are obtained in the 
acute phase of the disease. Examina- 
tion of a series of fecal specimens is 
important because the appearance of 
the organism in the stool may be in- 
termittent. The specimen should be 
handled as one for typhoid fever. 
(3) Rectal swab specimens are sometimes 
the most convenient specimens from 
which to attempt recovery of dysentery 
bacilli. This is especially true when ex- 
amining inmates of institutions, hos- 
pitalized patients, or infants and chil- 
dren. Preferably, culture plates should 
be inoculated immediately after the 
specimen is taken, but the plates must 
be hand-carried to the laboratory for 
incubation; otherwise, the specimens 
should be transported to the laboratory 
as promptly as possible by placing the 
swab in Amies’ modification of Stuart's 
transport medium. 
d. Enteropathogenic Escherichia coli 
A variety of agents may cause the diarrheal 
diseases of the newborn and infants. Thus, 
epidemics and sporadic cases of “summer” 
diarrhea, infantile enteritis, or diarrhea of 
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