Kurth A, Achenbach J, Miller L, Mackay IM, Pauli G, Nitsche A (2007): Orthopoxvirus detection in environmental specimens during suspected bioterror attacks: Inhibitory influences of common household products
Appl. Environ. Microbiol.: Epub Oct 26, doi:10.1128/AEM.01501-07.

After terrorists attacked the United States in 2001 the appearance of letters and other objects containing powdery substances with an unknown potential for biological threat focused attention on the speed, sensitivity and reliability of diagnostic methods. This study summarizes the abilities and limitations of real-time PCR, electron microscopy (EM) and virus isolation when used to detect potential bioweapons. In particular, we investigated the inhibitory influence of different common household products present in environmental specimens on PCR yield, EM detection and virus isolation. We used Vaccinia virus as a model for orthopoxviruses by spiking it into specimens. In the second part of the study we described modifications of diagnostic methods to overcome inhibitory effects. A variety of PCR amplification enhancers, DNA extraction protocols and the application of internal controls were evaluated to improve diagnostic simplicity, speed, and reliability. As a result, we strongly recommend using at least two different front-line techniques in parallel, e.g. EM and PCR. A positive result obtained by any one of these techniques should be followed by a biological method to confirm the putative diagnosis. Confirmatory methods include virus isolation followed by an agent-specific immunofluorescence assay (IFA) to confirm the presence of replication-competent particles.