Locally Grown: Bioterrorism Lab Capability at Risk
(continued from Coalition Connection newsletter)
One of our many responsibilities as an LRN lab is to train labs that do bacterial culture
identification, known as sentinel laboratories, to recognize suspected select agents of
bioterrorism and when to refer them to the LRN. That process continues to be put to the test.
One such incident occurred when patient from Oregon was hospitalized and a blood culture was
taken. Not having a lab in the hospital, the culture was sent to a commercial sentinel laboratory
in Seattle. The blood culture grew a gram negative rod and was identified as an Acinetobacter
lwoffi. Meanwhile, the patient was transferred to another hospital in Oregon. Another blood
culture was drawn and the organism that grew was identified by that hospital sentinel lab as
Pseudomonas luteloa. Concerned with the discrepant results, the physician requested repeat
testing. This time the organism was identified as Yersinia pseudotuberculosis. Unfortunately, the
Oregon labs did not suspect a select agent as this time. The organism then referred to a
commercial sentinel laboratory in Spokane, WA requesting identification of a gram negative rod.
A second identification of Yersinia pseudotuberculosis was made. The technologist’s skills and
training allowed her to realize this identification did not fit the clinical picture and repeated the
I.D. with a different test method. This time the result was Yersinia pestis, the causative agent of
plague. The isolate was referred to the SRHD LRN lab for confirmation. A presumptive
identification was made within hours. Twenty four hours after receiving the specimen, SRHD
confirmed the identification of Yersinia pestis. Because the isolate was not immediately
recognized by the sentinel labs as being a select agent, it was processed on the open bench
potentially exposing all those that worked with it. Therefore, all the individuals that worked with
the isolate were either put on a fever watch or given antibiotics. It took 25 days and travel
between two states before the organism was correctly identified. Luckily, no other individuals
acquired disease from this incident.
The next test came when another isolate was suspected as being Yersinia pestis. The Spokane
sentinel commercial reference lab knew just what to do. As soon as it was suspected that
isolate could not be ruled out as a Yersinia pestis, all testing procedures on that isolate stopped.
All manipulations were conducted in a biological safety cabinet to prevent any laboratory
acquired exposure and the isolate was immediately referred to SRHD for confirmation. SRHD
received the specimen and was able to rule out Yersinia pestis within hours. The sentinel
reference lab was able to resume testing according to their standard operating procedures.
Because of their training and excellent work, the local sentinel lab was able to avoid any
potential exposure to themselves and patient contacts. Without being able to test locally, the
specimen would have been packaged and shipped to WASPHL where the turnaround time
would be shifted from hours to days. Because of the potential for person to person exposure
with plague and the need for antibiotic treatment as soon as possible, within 24 hours of
exposure, it is possible that the patient would be put into isolation and potentially exposed
individuals prophylaxed while awaiting the final test results.
These examples clearly illustrate the positive impact of local training and local testing. We
cannot afford a potential 25 day turnaround time by outsourcing our Bioterrorism Lab