Type of test

 Various (e.g., blood, urine, stool, tissue culture, sputum, lymph node biopsy, skin)

 Normal findings

Negative for evidence of infectious agent

Test explanation and related physiology

There are many infectious agents used in bioterrorism, and it would be difficult to discuss each possible agent. In this test, those agents to which humans are most likely to be exposed, either in war or in a civilian terrorist attack, are discussed. Refer to Table 1 for specific information on each agent. All documented cases must be reported to the Department of Public Health.

Botulism infection

 The botulinum toxin produced by Clostridium botulinum causes this disease. The gastrointestinal tract usually absorbs this organism after eating undercooked meat or sauces exposed to room temperature for prolonged periods. The organism also can be inhaled by handling these items or by open wound contamination of soil that contains C. botulinum.

Anthrax

Anthrax is caused by Bacillus anthracis, which is a spore-forming gram-positive rod. Gastrointestinal anthrax is contracted by eating undercooked meat. Pulmonary anthrax results from inhalation of spores or tissues from infected animals. Once inhaled, it is always fatal without treatment. Cutaneous anthrax occurs after contact with contaminated meat, wool, hides, or leather from infected animals.

Treatment for this disease is early institution of antibiotics and supportive care.

 Hemorrhagic fever (yellow fever)

This disease complex has many causative viruses, including arenavirus, bunyavirus (including hantavirus), filovirus (including Ebola), and flavivirus. The diagnosis is determined by clinical evaluation. However, viral cultures, serology, and immunohistochemistry of tissue specimens are possible. There is no specific treatment other than supportive medical therapy.

 Plague

 This disease is caused by Yersinia pestis and has three forms:

 bubonic (enlarged lymph nodes), septicemic (blood-borne), and pneumonic (aerosol). Pneumonic is by far the deadliest form of the infection. This disease complex can be treated with antibiotics when started early in the course of the disease.

 Brucellosis

 This disease is caused by Brucella abortus, suis, melitensis, or canis. It is contracted by ingestion of contaminated milk products, direct puncture of the skin (in butchers and farmers), or by inhalation.

Smallpox

 Smallpox is a serious, contagious, and sometimes fatal infectious disease caused by the variola virus (a DNA virus). There is no specific treatment for smallpox disease, and the only prevention is vaccination. It is very easily spread and is therefore considered a potential bioterrorism weapon.

 Viral culture, serology, immunohistochemistry, or electron microscopy can make the diagnosis. There is no treatment for the disease.

 Tularemia

This disease is caused by a bacterium called Francisella tularensis. It is contracted by drinking contaminated water or eating vegetation contaminated by infected animals.

Procedure and patient care

 Before

 • Maintain strict adherence to all procedures to avoid violations in isolation or contamination.

During

 • If an enema is used to obtain a botulinum stool specimen, use sterile water. Saline can negate results.

 • Send enough blood for adequate testing. Usually two red-top tubes are adequate. It is best to send it on ice.

• Send food for testing in its original container.

• For anthrax or smallpox testing of a cutaneous lesion, soak one or two culture swabs with fluid from an unopened lesion.

 After

• Identify all potential sources of contamination.

 • Isolate individuals suspected of having a contagious disease.

 Abnormal findings

 See Table 1.

Table 1. Bioterrorism infectious agents testing