Table 9 Definitive Diagnostics
Pathogen Diagnostic test
Category A pathogens
Anthrax (B. anthracis) Culture of blood, sputum, pleural fluid, cerebrospinal fluid, or
skin lesions. PCR may be used to speciate.
Botulism (C. botulinumtoxin) Mouse bioassay (may be negative in wound and infant
botulism). Confirmatory testing (bioassay and stool
cultures) for toxin may be time consuming. Optical
immunoassay for toxins A, B, E, and F is rapid. Other
assays: a vertical-flow strip immunochromatography and
a small disposable immunoaffinity column for type A
toxin.
Plague (Y. pestis) Culture of sputum or blood or other tissue. Real time PCR of
sputum can rapidly detect organism in the experimental
setting. Direct fluorescent antibody testing of tissue or
fluids.
Smallpox (V. major) Viral culture from skin lesions with real-time PCR to
differentiate from other poxviridae (monkeypox)—only
performed by the CDC or WHO.
Tularemia (F. tularensis) Difficult to grow on laboratory media. Serology (enzyme-
linked immunosorbent assay) or histologic examination of
involved tissue may be needed. PCR is of value in
examining samples from primary lesions. Culture and
lymphocyte stimulation have also been used.
Viral hemorrhagic fevers [filoviruses
(e.g., Ebola, Marburg)] and arenaviruses
(e.g., Lassa, Machupo)]
Antigen testing by enzyme-linked immunoabsorbent assay
or viral culture—only performed by the CDC.Rabies Nuchal biopsy specimen and saliva sample will reveal the
presence of viral antigen and viral RNA by DFA test and
RT-PCR, respectively.
Category B pathogens
Brucellosis (Brucellaspecies) Culture (confirmatory), blood culture immunofluorescence,
agglutination titers, ELISA, other serologies, and real-
time PCR.
Epsilon toxin ofC. perfringens Detection of anti-epsilon toxin serum antibodies and real-
time PCR for detection and toxin-typing organisms.
Food safety threats (e.g.,Salmonellaspp.,
E. coliO157:H7,Shigella, Vibriospp.,
L. monocytogenes, C. jejuni,
Y. enterocolitica)
Culture.Glanders (Bk. mallei) Culture from sputum, blood, urine, pus, or swabs of skin
lesions: PCR used to identify organisms; various
serologic tests (polysaccharide microarray serology;
ELISA, agglutination, and complement fixation).
Melioidosis (Bk. pseudomallei) Culture: PCR used to identify organisms; polysaccharide
microarray serology; IHA titer.
Psittacosis (C. psittaci) Culture: isolation in cell culture, identifying by
immunofluorescence staining, PCR identification in
clinical samples; serology (ELISA, MIF, nested PCR-EIA.
Q fever (C. burnetii) Serology gold standard for diagnosis but antibodies take
2–3 wk to detect. Cell culture sensitivity maybe low.
Real-time PCR rapidly detects organism.
Ricin toxin fromR. communis(castor beans) Serum antigen detection by ELISA, assay configurations
use monoclonal capture antibody coupled with either a
polyclonal or monoclonal detector antibody for detection
of toxin in foods.
Staphylococcal enterotoxin B Capture ELISA serum assay; mass spectrometry
(availability limited), PCR, latex agglutination assay,
LAMP assay targeting the toxin genes, measurement of
toxin-neutralizing antibodies (may be absent in immune-
compromised patients).
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