Table 7.
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 culturea 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 culturea 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.