Laboratory Specimens for Suspected Bioterrorism Agents Disease

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

ANTHRAX - Bacillus anthracis Back
Syndrome or Known Infectious Disease	Blood Cultures (x2)	Sputum	Serum (Gold-Top Tube)	Lesion	CSF (If meningeal signs present)	Stool	Anterior Nares Swab	ID Consult Recommended	Note 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 Back
Syndrome or Known Infectious Disease	Blood Cultures (x2)	Lower Respiratory	Serum (Gold-Top Tube)	Bubo Aspirate	Biopsy	Anterior Nares Swab	ID Consult Recommended	Note 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 Back
Syndrome or Known Infectious Disease		Stool (not in transport medium)		CSF (If meningeal signs present)	Serum (Gold-Top Tube)	Gastric Aspirate/Vomitus	ID Consult Recommended	Note 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 Back
Syndrome or Known Infectious Disease		Blood Cultures (x2)	Sputum	CSF (If meningeal signs present)	Serum (Gold-Top Tube)	Lymph Node Biopsy or Aspirate (NO NEEDLES)	Swab of Lesion	ID Consult Recommended	Note 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 Back
Syndrome or Known Infectious Disease		Skin 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 Recommended	Note 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!