. 2013 Jul 4;29(3):717–756. doi: 10.1016/j.ccc.2013.03.015

Table 7.

Clinical specimens and tests for diagnosing potential agents of bioterrorism

Agent	Clinical Specimen	Diagnostic Tests	Characteristic Laboratory Features	Biosafety Level
Bacillus anthracis	Nasal swab Feces Lesion exudate A and C sera	Culture (nonhemolytic on 5% sheep blood agar, 35°C, 18–24 h) FA Gammaphage anti-PA ELISA PCR and RT-PCR Capsule demonstration Immunochromatography	Gram-positive bacilli Spore-forming Nonhemolytic	2
Yersinia pestis	Nasal swab Sputum Bubo aspirate Blood A and C sera	Culture (5% sheep blood agar, chocolate agar, Casman blood agar, cystine heart blood agar, or MacConkey agar. 35°C, 24–48 h) FA PCR RAD	Gram-negative coccobacilli Bipolar staining Nonlactose fermenter	2
Brucella sp	Whole blood Bone marrow A and C sera	Culture (tryptose agar with 5% bovine sera, Thayer-Martin, chocolate agar with VCNT, 35°C, 5%–10% CO₂, 10 d) FA PCR	Gram-negative coccobacilli Aerobic Nonmotile Nonfermenter	2
Burkholderia sp	Whole blood A and C sera Lesion exudate	Culture (5% sheep blood agar, MacConkey agar. 35°C, 24–48 h) PCR	Gram-negative bacilli Motile (except Burkholderia mallei)	2
Francisella tularensis	Nasal swab A and C sera	Culture (glucose cystine heart blood agar, thioglycolate, 35°C, 48–72 h) FA PCR	Gram-negative Obligate aerobe	2
Botulinum toxin	Nasal swab A and C sera	Immunoassay Mouse neutralization	150 kDa protein neurotoxin	2
Ricin	Nasal swab A and C sera	Immunoassays for antigen Serology	66 kDa protein toxin	2
SEB	Nasal swab Urine A and C sera	Immunoassays for antigen Serology	23–29 kDa protein Superantigens	2
Variola virus	Nasal swab Throat swab Lesion exudate A and C sera	Viral culture^a Electron microscopy PCR	Brick morphology	4
VEE virus	Nasal swab Throat swab A and C sera	Viral culture Virus neutralization RT-PCR	Enveloped RNA virus	2
VHF viruses	Nasal swab A and C sera	Viral culture^a RT-PCR	Enveloped RNA viruses	4

Abbreviations: A and C sera, acute and convalescent sera; ELISA, enzyme-linked immunosorbent assay; FA, fluorescent antibody; PA, protective antigen; PCR, polymerase chain reaction; RAD, rapid antigen detection kit; RT-PCR, real-time PCR; VCNT, vancomycin, colistin sulfate, nystatin, and trimethoprim; VEE, Venezuelan equine encephalitis.

Not recommended except by qualified laboratory with appropriate biosafety equipment.

Adapted from Pavlin JA, Gilchrist MJ, Osweiler GD, et al. Diagnostic analyses of biologic agent-caused syndromes: laboratory and technical assistance. Emerg Med Clin North Am 2002;20(2):331–50; with permission.