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  • Culture: Laboratory Specimens for Suspected Bioterrorism Agents Disease

Laboratory Specimens for Suspected Bioterrorism Agents Disease

McLendon Clinical Laboratories
Clinical Microbiology/Immunology Laboratory
984-974-1805

CDC Public Health Emergency Preparedness & Response Web Site (http://www.bt.cdc.gov/).

NOTE:

According to the Centers for Disease Control and Prevention and the North Carolina Division of Public Health, screening of asymptomatic patients for possible exposure to agents of bioterrorism is appropriate ONLY as part of an epidemiological survey conducted under properly controlled conditions. Such screening is not indicated on individual patients, and will NOT be performed by the McLendon Clinical Laboratories. Similarly, nasopharyngeal swabs have no known diagnostic value in symptomatic patients, and will not be performed by the Laboratories. See Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy, October 2001, Morbidity and Mortality Weekly Report, CDC, October 26, 2001
 
Call the Clinical Microbiology Laboratory (984-974-1805) or the Director on-call BEFORE submitting samples.
ANTHRAX - Bacillus anthracis
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Syndrome or Known Infectious DiseaseBlood Cultures (x2)SputumSerum (Gold-Top Tube)LesionCSF (If meningeal signs present)StoolAnterior Nares SwabID Consult RecommendedNote on Requisition
Possible Anthrax Exposure Only; Asymptomatic patient. No No No No No No No No N/A
Anthrax - Inhalation

Yes, 2-8 days post-exposure

No:
Pleural Fluid may be useful if clinically indicated.

Yes No Yes No No Yes R/O Anthrax
Anthrax - Cutaneous - Vesicular stage Yes No Yes Soak 2 Stuart's Transport Swabs in previously unopened vesicle fluid. No No No

Yes

Anthrax - cutaneous - eschar stage Yes No Yes Rotate 2 Stuart's Transport Swabs beneath edge of eschar without removing eschar. No No No Yes
Anthrax - GI

Yes, 2-3 days post-exposure

No

Yes

No No

Yes

No

Yes

PLAGUE - Yersinia pestis
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Syndrome or Known Infectious DiseaseBlood Cultures (x2)Lower RespiratorySerum (Gold-Top Tube)Bubo AspirateBiopsyAnterior Nares SwabID Consult RecommendedNote on Requisition
Possible Plague Exposure Only; Asymptomatic patient. No No No No No No No N/A
Plague - pneumonic or bubonic

Yes

Yes
Bronchial Wash or BAL Recommended; Sputum is of lower value.
Yes Yes
Aspirate may yield little material: sterile saline flush may yield a more adequate sample.
Yes
Liver, Spleen, Bone Marrow, and/or Lung may be useful
Yes Yes R/O Plague
BOTULISM - Clostridium botulinum
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Syndrome or Known Infectious DiseaseStool (not in transport medium)CSF (If meningeal signs present)Serum (Gold-Top Tube)Gastric Aspirate/VomitusID Consult RecommendedNote on Requisition
Possible Botulism Exposure Only; Asymptomatic patient. No No No No No N/A
Botulism - Symptomatic Yes >25g stool Not recommended. Will be normal in cases of botulism; may help R/O other causes Yes, 3 tubes (10 cc blood each tube) Yes Yes R/O Botulism
TULAREMIA - Francisella tularensis
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Syndrome or Known Infectious DiseaseBlood Cultures (x2)SputumCSF (If meningeal signs present)Serum (Gold-Top Tube)Lymph Node Biopsy or Aspirate (NO NEEDLES)Swab of LesionID Consult RecommendedNote on Requisition
Possible Tularemia Exposure Only; Asymptomatic patient. No No No No No No No N/A
Tularemia Yes Yes Yes Yes Yes Yes,
Swab of advancing edge of lesion; aspirate/biopsy preferred
Yes R/O Tularemia
Smallpox - Smallpox (Variola) virus
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Syndrome or Known Infectious DiseaseSkin Scraping of Lesions.
- Use blunt edge of scalpel to open previously unopened vesicular lesion
- harvest fluid with a cotton swab - scabs can be removed with forceps
ID Consult RecommendedNote on Requisition
Possible Smallpox Exposure Only; Asymptomatic patient. No No N/A
Smallpox Yes
Swabs and scabs should be placed in a sterile tube, sealed with tape. Double-bag in Biohazard bag. HAND CARRY to Microbiology Lab -- DO NOT send via pneumatic tube system!
Yes R/O Smallpox
See CDC Specimen Collection and Transport Guidelines for Smallpox PRIOR to ordering or collecting specimens!

Reviewed by gloria_crawford on February 18, 2016

Note: Reference ranges provided on this web site are for guidance only, and may not reflect the most recent changes. Refer to laboratory reports for current reference data.

UNC Hospitals
McLendon Clinical Laboratories
101 Manning Drive
Chapel Hill, NC 27514

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