Medical Management of Biological Casualties Handbook

Appendix F: Specimens for Laboratory Diagnosis

U.S. Army Medical Research Institute of Infectious Diseases,Fort Detrick, Frederick, Maryland
Peer Review Status: Internally Peer Reviewed

Face or Acute & Nasal Blood Convalescent

Agent Swab¹ Culture Smear Sera Stool Urine Other

Anthrax + + Pleural and + - - Lesion aspirates

CS fluids

mediastinal

lymph node

spleen

Brucellosis + + - + - - Bone marrow and

spinal fluid

cultures;

tissues, exudates

Cholera - - - + +

Plague + + Sputum + - - Lymph node, buboes, CSF, and

sputum culture

Tularemia + - +² + - -

Q-fever - ⁴ Lesions + Lung, spleen,

lymph cultures

__________________________________________________

¹Within 18-24 hours

²Fluorescent antibody test on infected lymph node smears. Gram stain has little value.

³Virus isolation from blood in appropriate containment.

⁴C. burnetti can persist for days in blood and resists desiccation. EDTA anticoagulated blood

preferred. Culturing should not be done except in BL3 containment.

Face or Acute & Nasal Blood Convalescent

Agent Swab¹ Culture Smear Sera Stool Urine Other

Congo-Crimean - ³ - + - - Liver

Hemorrhagic Fever

VEE - ³ - + - CSF

Clostridial + Wound + + -

Toxins tissues

SEB Toxin + - - + + + Lung

Ricin Toxin + - - + Spleen, lung,

kidney

¹Within 18-24 hours

²Fluorescent antibody test on infected lymph node smears. Gram stain has little value.

³Virus isolation from blood in appropriate containment.

⁴C. burnetti can persist for days in blood and resists desiccation. EDTA anticoagulated blood

preferred. Culturing should not be done except in BL3 containment.

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