Important Note: Testing must be ordered by a physician. Results can only be reported to the ordering physician or the referring laboratory. Patients desiring testing and/or test results are advised to consult their physician. We require specimen tubes to be labeled with the patient's name (first and last) and collection date. Unlabeled tubes will not be accepted for testing. We also cannot test grossly hemolyzed samples.
Testing Requirements and Instructions
Many of the tests performed at the Remington Lab require specifics related to sample age, container and shipping conditions. Review these requirements and instructions before shipping a sample to the lab to make sure it’s suitable for testing.
Testing Schedule
Testing is performed at the Remington Lab on weekdays throughout the year. Consult the holiday schedule to find out if the lab is closed on a holiday that falls during the week.
Lab Test Menu
Effective: January 1, 2023
- Reference range: negative < 1:16; positive > 1:16
- Specimen: serum, CSF
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: 86777
- Fee: $180
- Method Reference: Sabin AB, Feldman HA. Dyes as microchemical indicators of a new immunity phenomenon affecting a protozoan parasite (Toxoplasma). Science108:660-663, 1948.
- Reference range: negative < 4, equivocal ≥ 4 to < 8, positive ≥ 8
- Specimen: serum
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: 86777
- Fee: $180
- Method Reference: De Champs C, Pelloux H, Cambon M, Fricker-Hidalgo H, Goullier-Fleuret A, Ambroise-Thomas P. Evaluation of the second generation IMx Toxo IgG antibody assay for detection of antibodies to Toxoplasma gondii in human sera. J Clin Lab Anal. 1997;11(4):214-9. doi: 10.1002/(sici)1098-2825(1997)11:4<214::aid-jcla7>3.0.co;2-8.PMID: 9219063
- Reference range: negative 0.0-1.6, equivocal 1.7-1.9, positive > 2.0 (serum); negative 0.0 - 0.3, positive > 0.4 (CSF)
- Specimen: serum, CSF
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: 86778
- Fee: $185
- Method Reference: Naot Y, Remington J. An enzyme-linked immunosorbent assay for detection of IgM antibodies to Toxoplasma gondii : use for diagnosis of acute acquired toxoplasmosis. J Infect Dis 142:757-766, 1980
- Reference range: negative < 0 .55, equivocal ≥ 0.55 to < 0.65, positive ≥ 0.65
- Specimen: serum
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)CPT code: 86778
- Fee: $185
- Method Reference: De Champs C, Pelloux H, Cambon M, Fricker-Hidalgo H, Goullier-Fleuret A, Ambroise-Thomas P. Evaluation of the second generation IMx Toxo IgG antibody assay for detection of antibodies to Toxoplasma gondii in human sera. J Clin Lab Anal. 1997;11(4):214-9. doi: 10.1002/(sici)1098-2825(1997)11:4<214::aid-jcla7>3.0.co;2-8.PMID: 9219063
- Reference range: reported as positive or negative
- Specimen: serum
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: 86778
- Fee: $185
- Method Reference: Desmonts G, Naot Y, Remington JS. Immunoglobulin M immunosorbent agglutination assay for diagnosis of acute congenital and acquired toxoplasma infections. J Clin Microbiol 14:486-491, 1981
- Reference range:
- Patient > 6 months of age: negative 0.0 - 1.4, equivocal 1.5 - 2.0,
positive > 2.1 - Infants < 6 months of age: negative 0.0 - 0.9, positive > 1.0
- Patient > 6 months of age: negative 0.0 - 1.4, equivocal 1.5 - 2.0,
- Specimen: serum
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
CPT code: 86777-59 - Fee: $180
- Method Reference: Stepick-Biek P, Thulliez P, Araujo F, Remington JS. IgA antibodies for diagnosis of acute congenital and acquired toxoplasmosis. J Infect Dis 162:270-273, 1990
- Reference range: reported as negative, equivocal or positive
- Specimen: serum
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: 86777-59
- Fee: $175
- Method Reference: Wong S, Hadju M, Ramirez R, Thulliez P, McLeod R, Remington JS. Role of specific immunoglobulin E in diagnosis of acute toxoplasma infection and toxoplasmosis. J Clin Microbiol 31:2952-2959, 1993
- Reference range: refer to table
- Specimen: serum
Volume: 0.5 ml - Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: 86406 (2 units)
- Fee: $196
- Method Reference: Danneman B, Vaughn W, Thulliez P, Remington JS. Differential agglutination test for diagnosis of recently acquired infection with Toxoplasma gondii. J Clin Microbiol 28:1928-1933, 1990
- Reference range: high avidity excludes infection within the previous 4 months
- Specimen: serum
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: 86777-59
- Fee: $196 (Includes fee for Remington IgG (Dye test) and Remington IgM ELISA)
Method Reference: Pelloux, H. et al. Determination of anti-Toxoplasma gondii immunoglobulin G avidity: adaption to the Vidas system (bioMérieux). Diagn Microbiol Infect Dis 32: 69-73, 1998
- Reference range: reported as "toxoplasma DNA detected" or "toxoplasma DNA not detected"
- Specimen: (refer to PCR Specimen Requirements table)
- Volume: (refer to PCR Specimen Requirements table)
- Transport temperature: (refer to PCR Specimen Requirements table)
- CPT code: 87798
- Fee: $465-$485 (refer to Fee Schedule)
- Method Reference: Grover C, Thulliez P, Remington J, Boothroyd J. Rapid prenatal diagnosis of congenital Toxoplasma infection by using polymerase chain reaction and amniotic fluid. J Clin Microbiol 28:2297-2301, 1990.
Parmley S, Goebel F, Remington JS. Detection of Toxoplasma gondii in cerebro-spinal fluid from AIDS patients by polymerase chain reaction. J Clin Microbiol 30:3000-3002, 1992
- Reference range: reported as positive or negative
Specimen: whole blood (EDTA or Citrate preferred), amniotic fluid, placenta and other tissues
NOTE: Specimens must not be frozen or placed in formalin or other fixative. Inoculations are recommended within 48 hours of specimen collection date. Results available in six weeks.
- Volume: 3 ml (fluids); 1 g (solid tissues)
- Transport temperature: 2 – 8° C.
- CPT code: 87003
- Fee: $677
- Method Reference: Remington J.S., McLeod R., Thulliez P., Desmonts G. Toxoplasmosis.
In Remington J.S., Wilson C.B., Baker C.J. and Klein, J.O. (eds.) Infectious Diseases of the Fetus and Newborn Infant, Sixth Edition. Philadelphia: Elsevier Saunders Company, 2006, pp 1009-1010.
- Reference range: reported as negative or positive
- Specimen: serum
- Volume: 0.5 ml
- Transport temperature: 2 – 8° C (preferred); ambient (acceptable)
- CPT code: 86318
- Fee: $140
- Method Reference: Montoya JG, Adams AE, Bonetti V, Deng S, Link NA, Pertsch S, Olson K, Li M, Dillon EC, Frosch DL. 2021. Differences in IgG antibody responses following BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines. Microbiol Spectr 9:e01162-21.
Renard N, Daniel S, Cayet N, Pecquet M, Raymond F, Pons S, Lupo J, Tourneur C, Pretis C, Gerez G, Blasco P, Combe M, Canova I, Lesenechal M, Berthier F. 2021. Performance characteristics of the Vidas SARS-CoV-2 IgM and IgG serological assays. J Clin Microbiol 59:e02292-20.
- Reference range: reported as negative or positive
- Specimen: nasal swab, nasopharyngeal swab, oropharyngeal swab
- Volume: swab in transport media (viral transport media preferred)
- Transport temperature: ambient; 2 – 8° C
- CPT code: 87635
- Fee: $155
Method Reference: TaqPath™ COVID-19 Combo Kit INSTRUCTIONS FOR USE, Catalog Number A47814 Publication Number MAN0019181 Revision G.0
Panels
IgG (Dye Test), Remington IgM ELISA, Alternative IgG, Alternative IgM
- Specimen: serum
- Volume: 0.5 to 1.0 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: Refer to individual tests above
- Fee: $350
IgG (Dye Test), Remington IgM ELISA, Avidity
- Specimen: serum
- Volume: 0.5 to 1.0 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: Refer to individual tests above
- Fee: $546
IgG (Dye Test), Remington IgM ELISA, AC/HS, Avidity
- Specimen: serum
- Volume: 0.5 to 1.0 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: Refer to individual tests above
- Fee: $742
- Specimen: serum
- Volume: 1.0 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: Refer to individual tests above
- Fee: $515
IgG (Dye Test), Remington IgM ELISA, Remington IgA ELISA, Remington IgE ELISA, AC/HS
- Specimen: serum
- Volume: 2.0 ml
- Transport temperature: 2 – 8° C. (preferred); ambient or frozen (acceptable)
- CPT code: Refer to individual tests above
- Fee: $876
| Specimen Type | Specimen Age | Container | Shipping Conditions | Recommended Volume |
|---|---|---|---|---|
| Serum (Toxoplasma and Covid) | Up to one week when stored refrigerated; Indefinite when stored frozen | Serum-Separator tube or red-top tube (Centrifuge specimen and if possible, send serum only) | Cold pack or frozen preferred 20-25oC acceptable; Overnight delivery | 3 ml |
| CSF (Toxoplasma) | Up to one week when stored refrigerated; Indefinite when stored frozen | Sterile tube | Cold pack or frozen preferred 20-25oC acceptable; Overnight delivery | 1 ml |
- Our specimen requirement for serologic testing is 3 ml of serum from a serum-separator tube or a red-top tube (minimum 0.5 ml, but this quantity may be insufficient for repeat testing). Please centrifuge the specimen, and if possible, send serum only. Grossly hemolyzed, icteric, lipemic, and bacterially contaminated specimens cannot be tested. Serum specimens can be sent at ambient temperature.
- THE PATIENT'S NAME AND COLLECTION DATE MUST APPEAR ON SPECIMEN LABEL. Unlabelled specimens will not be tested.
- Please contact our laboratory at 650-853-4828 for specimens that do not meet these requirements. For specimens not meeting our requirements, testing can still be performed when authorized by the client.
- Please contact our laboratory at 650-853-4828 for specimens that are less than the recommended volume. Specimens received with less than recommended volumes may be insufficient for repeat testing.
PCR Validated Specimens
The following samples have been validated for Toxoplasma testing in our laboratory:
- Amniotic fluid
- Bronchoalveolar lavage (BAL)
- Cerebrospinal fluid (CSF)
- Ocular fluids
- Serum
- Solid tissues
- Urine
- Whole blood
PCR Reports
Toxoplasma PCR results will be reported as follows:
- "Toxoplasma gondii DNA not detected."
- "Toxoplasma gondii DNA detected."
Preferred Conditions for Processing, Storing, and Shipping Specimens for Toxoplasma PCR Testing1
| Specimen Type | Specimen Age | Shipping Conditions | Minimum Volume1 | Recommended Volume1 |
|---|---|---|---|---|
| Amniotic fluid (collected at ≥18 weeks gestation) | Up to one month when stored refrigerated; indefinite when stored frozen | 2 – 8° C on ice or cold packs preferred; frozen acceptable; overnight delivery | 3 ml | 10 ml |
| BAL | Up to one month when stored refrigerated; indefinite when stored frozen | 2 – 8° C on ice or cold packs; frozen acceptable; overnight delivery | 3 ml | 10 ml |
| CSF | Up to one month when stored refrigerated; indefinite when stored frozen | Frozen preferred; 2 – 8° C on ice or cold packs acceptable; overnight delivery | 0.4 ml | 1 ml |
| Ocular fluids (vitreous and aqueous) | Up to one month when stored refrigerated; indefinite when stored frozen | Frozen preferred; 2 – 8° C on ice or cold packs acceptable; overnight delivery | 0.1 ml | 0.5 ml |
| Serum | Up to one month when stored refrigerated; indefinite when stored frozen | Frozen preferred; 2 – 8° C on ice or cold packs acceptable; overnight delivery | 1 ml | 5 ml |
| Whole blood Bone marrow | Up to 2 days (DO NOT FREEZE) | EDTA or citrate tube; 20 – 25° C preferred; overnight delivery | 1 ml | 5 ml |
| Urine | Up to one week when stored refrigerated; indefinite when stored frozen | 2 – 8° C on ice or cold packs preferred; frozen acceptable; overnight delivery | 6 ml | 10 ml |
| Solid tissues | Up to 24 hours when stored refrigerated; indefinite when stored frozen; NO preservatives | Frozen preferred; 2 – 8° C on ice or cold packs acceptable; overnight delivery | 25 mg | 50 mg |
Covid PCR results will be reported as follows:
- "Positive"
- "Negative"
Preferred Conditions for Processing, Storing, and Shipping Specimens for Covid PCR Testing1
| Specimen Type | Specimen Age | Shipping Conditions | Volume1 |
|---|---|---|---|
| Nasopharyngeal Swab | Up to five days when stored ambient or refrigerated | Ambient; 2 – 8° C on ice or cold packs; overnight delivery | Swab in transport media (viral transport media preferred) |
| Oropharyngeal Swab | Up to five days when stored ambient or refrigerated | Ambient; 2 – 8° C on ice or cold packs; overnight delivery | Swab in transport media (viral transport media preferred) |
| Nasal Swab | Up to five days when stored ambient or refrigerated | Ambient; 2 – 8° C on ice or cold packs; overnight delivery | Swab in transport media (viral transport media preferred) |
1The Remington Laboratory will test specimens that deviate from these conditions. However, sensitivity might be compromised. Please contact our laboratory at 650-853-4828 for any questions about testing specimens that do not conform to these conditions.
General Instructions
Specimen Types and Requirements
PCR Specimen Requirement Table
Shipment
Send specimens for PCR testing to this address:
Dr. Jack S. Remington Laboratory for Specialty Diagnostics
Palo Alto, CA 94301
Ship samples for PCR testing separately from other samples. All samples received for PCR testing will be prepared for testing, and will not be suitable for return.
A serum specimen for Toxoplasma serologic testing must accompany Toxoplasma PCR test requests for any patient not recently tested in our laboratory. The minimum request for Toxoplasma serologic testing must include IgG and IgM. There is an additional charge for testing this serum.
Amniotic Fluid
It is recommended that amniocentesis for toxoplasmosis PCR be performed at a minimum of 18 weeks gestation. A serum sample from the mother must accompany the amniotic fluid, unless she has been previously tested in our laboratory.
Specimen
DNA for our PCR procedure is obtained from pelleted amniotic fluid.
Volume
10 ml
Shipment
Ship amniotic fluid on wet ice or cold packs sufficient to maintain temperature of 2 - 8° C. during shipment; frozen acceptable. Include enough dry ice to keep specimen frozen during shipment.
Cerebrospinal, Vitreous or Aqueous Fluid
Specimen
A serum sample from the patient must accompany the fluid, unless serum has been recently tested in our laboratory.
Volume
1 ml
Shipment
Freeze sample immediately after collection. Ship sample on dry ice by overnight courier. Include enough dry ice to keep specimen frozen during shipment.
Covid PCR
Specimen
Nasal swab, oropharyngeal swab, or nasopharyngeal swab
Volume
Swab in transport media (viral transport media preferred)
Shipment
Ship nasal swab, oropharyngeal swab, and nasopharyngeal swab ambient or with cold packs sufficient to maintain temperature of 2 – 8°C during shipment.
General Instructions
Specimen Types and Requirements
Whole blood (EDTA or Citrate preferred), amniotic fluid, CSF and other body fluids, placenta and other tissues
Shipment
Send specimens for Isolation testing to this address:
Dr. Jack S. Remington Laboratory for Specialty Diagnostics
Attention: Isolation
795 El Camino Real, Ames Building
Palo Alto, CA 94301
Ship each sample for Isolation testing in a separate sealed bag from other samples. All samples received for Isolation testing will be prepared for testing, and will not be suitable for return. Note: Isolation is a costly and labor intensive procedure. Once started, it may not be cancelled.
NOTE: Specimens must NOT be frozen or placed in formalin or other fixative. Inoculation for isolation is recommended within 48 hours of specimen collection date. Results available in six weeks.
Preferred Conditions for Processing, Storing, and Shipping Specimens for Isolation Testing
| SAMPLE TYPE | STORAGE | SHIPPING CONDITIONS | MINIMUM VOLUME1 | RECOMMENDED VOLUME1 |
|---|---|---|---|---|
| Amniotic Fluid, CSF and other body fluids | Store sterilely, keep cool (NOT FROZEN) with ice bag or frozen cold packs. | 2 – 8° C on ice or cold packs preferred; overnight delivery; DO NOT FREEZE | 1 ml | 3 ml |
| Whole Blood (EDTA, citrate, ACD tubes preferred; clot tubes (red top) accepted) | Keep cool (NOT FROZEN) with ice bag or frozen cold packs. | 2 – 8° C on ice or cold packs preferred; overnight delivery; DO NOT FREEZE | 1 ml | 3 ml |
| Placenta | Store sterilely in sterile saline (NO FORMALIN OR OTHER PRESERVATIVE, DO NOT FREEZE). Penicillin (100 units per ml) and Streptomycin (100μgm/ml) or gentamicin (10- 40 mg/ml) should be added. Keep cool (NOT FROZEN) with ice bag or frozen cold packs. | 2 – 8° C on ice or cold packs preferred; overnight delivery; DO NOT FREEZE | 1g* | 5g |
| Other Tissues | Store sterilely in sterile saline (NO FORMALIN OR OTHER PRESERVATIVE, DO NOT FREEZE). Keep cool (NOT FROZEN) with ice bag or frozen cold packs. | 2 – 8° C on ice or cold packs preferred; overnight delivery; DO NOT FREEZE | 1g* | 5g |
1The Remington Laboratory may test specimens that deviate from these conditions with client authorization. However, sensitivity might be compromised. Please contact our laboratory at 650-853-4828 for any questions about testing specimens that do not conform to these conditions.
*Please note: smaller amounts of some tissues are accepted due to accessibility and difficulty of collection.