Table 4.
Recommended diagnostic specimens and tests for selected biological agents
| Agent | Syndrome | Diagnostic specimens | Diagnostic tests∗ |
|---|---|---|---|
| Bacillus anthracis | Cutaneous | Skin at center and periphery of eschar; pleural fluid cell block, pleural tissue, mediastinal lymph node | H&E |
| Gastrointestinal | Gram | ||
| Inhalational | Silver stain | ||
| IHC | |||
| Yersinia pestis | Bubonic | Histologic sampling of multiple organs; hemorrhagic lymph nodes; lungs | H&E |
| Pneumonic | Gram | ||
| Septicemic | Silver stain | ||
| Giemsa | |||
| IHC | |||
| DFA | |||
| Francisella tularensis | Ulceroglandular | Histologic sampling of multiple organs; necrotic lymph nodes should be sampled; culture potential portal of entry (skin, throat, conjunctiva) | IHC |
| Oculoglandular | DFA of formalin-fixed tissue | ||
| Glandular | |||
| Pharyngeal | |||
| Typhoidal | |||
| Pneumonia | |||
| Clostridium botulinum toxin | Descending paralysis | Tissue for anaerobic cultures from suspected entry sites (wound, GI, respiratory) intestinal contents | Microbiologic culture |
| Botulinum toxin mouse bioassay | |||
| Variola virus | Smallpox | Fluid from vesicle for EM | EM |
| IHC | |||
| Multiple viruses, including Ebola, Marburg, Flaviridae | Viral hemorrhagic fevers | Histologic sampling of multiple organs; serum; skin samples | PCR |
| IH | |||
| EM |
∗
Data from MMWR 2004 (61).