Inhalation Anthrax: Recommended Specimens for Microbiology and Pathology for Diagnosis
Specimens should be collected from any patient being evaluated for inhalation Bacillus anthracis infection. This includes cases of known exposure or high risk of exposure (including bioterrorism events where agent is unconfirmed), or cases with a clear epidemiologic link to exposure with presence of inhalation anthrax symptoms, or cases where there is evidence of symptoms compatible with anthrax, but with no diagnosis.
We recommend that all of the following specimens be collected for inhalation anthrax testing, as allowable.
- Blood (for culture, Gram stain and PCR)
- For gram stain and culture, collect appropriate blood volume and number of sets per local hospital laboratory protocol.
- For Polymerase Chain Reaction (PCR) collect 10 ml blood in EDTA (for pediatric cases collect volumes allowable).
- Pleural Fluid (intended for culture, Gram stain and PCR)
- Collect >1 ml of a pleural fluid into a sterile container. Store at 4°C for no more that 24h.
- Collect >1 ml of a pleural fluid into a sterile container. Store at 4°C for no more that 24h.
- Cerebrospinal Fluid (CSF) (intended for culture, Gram stain and PCR)
- If meningeal signs are present or meningitis is suspected: Collect > 1 ml into a sterile container
Blood and CSF specimens intended for culture and PCR should be transported directly to the laboratory at room temperature. Pleural fluid specimens intended for culture and/or PCR should be shipped using cold packs and stored at 2 to 8°C.
- Serum (process using BSL2 practices)
- Acute serum specimens should ALWAYS be collected within the first 7 days of symptom onset or as soon as possible after known exposure.
- Even if diagnosis of anthrax is confirmed by isolation of B. anthracis from clinical specimens, collect a convalescent serum sample, 14-35 days after symptom onset.
- Both acute and convalescent serum specimens should be obtained from a minimum of 8 ml blood, yielding ~ 4 ml of sera (laboratories may be testing for multiple potential etiologies).
- Separate serum from clot; sera should frozen immediately following separation and stored frozen at -20°C or colder, and should be shipped frozen on dry ice to CDC, in appropriately labeled plastic screw cap vials.
- Do NOT send blood culture bottles or whole blood.
- Appropriate use of the commercially available Immunetics QuickELISA™ Anthrax-PA Kit:
- The Immunetics Kit should be considered a primary screening serology test
- This test generates a positive /negative result; therefore any paired sera producing either a
- -/+ reaction (acute/convalescent) or
- +/+ reaction
should be sent to CDC for confirmation and quantitative ELISA measurements.
- -/- reaction (acute/convalescent) or
- +/- reaction
do not need confirmation.
- Biopsy (can be evaluated if available)
- A bronchial or pleural biopsy may be obtained from patients with signs and symptoms of inhalation anthrax.
- Fresh tissue samples (not formalin fixed) should be stored and shipped frozen to CDC at -70°C; formalin fixed samples should be shipped at room temperature.
- Page last updated February 22, 2006
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