Presentation on theme: "MDCH STATE LABORATORY TUBERCULOSIS TESTING Specimens/Tests/Reports"— Presentation transcript:
1 MDCH STATE LABORATORY TUBERCULOSIS TESTING Specimens/Tests/Reports Dale E. Berry, B.S.TB Lab Manager(517)Title slide
2 MDCH STATE LABORATORY LANSING, MICHIGAN Picture of lab.
3 TYPES OF SPECIMENS SPUTUM PULMONARY ASPIRATES GASTRIC ASPIRATES BODY FLUIDSTISSUESBLOODFECESOTHER
4 SPECIMEN QUALITY Three specimens on three successive days Early morning specimens (First thing out!)Adequate specimen volume (>7 ml)Sputum not saliva (epithelial cells?)Condition of specimen (pH, etc.)Appropriate specimen containerComplete and accurate informationProper packaging (i.e. US Postal Service)“Prompt” delivery to MDCH
6 AFB Slide Examination Least Sensitive AFB Test Requires 100,000 AFB/ml Requires an adequate specimenNegative smear – Does not rule out AFBPositive smear – AFB present (viability?)AFB Positive = Mycobacterium spp., etc.Help support TB diagnosisQuantitation: Positive/Positive Few/ Negative
7 MTD – Direct Amplified Probe Rapid Test & SensitiveSpecific – M.tuberculosis complexNot a test of viability or curePulmonary Specimens onlySpecimen MDCH onlyReduces subsequent test sensitivityDelays culture & susceptibility results97%/100% Sensitive/Specific
8 AFB Culture and Isolation More sensitive than slideRequires only 10 AFB/ ml of specimenAFB Growth in 1-2 weeks (Bactec)Genetic Probes and HPLC Rapid IDFewer AFB/ml – Delayed growth“AFB Growth” required for other testsMixed cultures require subcultures
9 Preliminary AFB Identification Genetic Probe/HPLCOne day after culture positiveProbe for M.tuberculosis complexHPLC for MOTTHelps confirm antibiotic therapy
10 Preliminary TB Susceptibility Approximately 1 week after pre-IDTests “Primary” anti-Tuberculosis drugsDirect and Indirect testingBactec methodologyConfirmed by“Proportion Plate Method”
11 Final AFB Identification Required to differentiate M.tb complexRequired to confirm HPLC ID’sRequired to clarify unresolved ID’sRequires additional time (3-4 weeks)Final Report ASAP
12 TB Susceptibility - Additional Proportion Plate MethodRequires additional 3 weeksTo increases choices for therapyPerformed for drug resistant TB casesTests 2nd and 3rd line antibioticsConfirms results of “Broth Method”
13 MOTT Susceptibility Testing Test according to latest NCCLS GuidelinesM.avium complex - ClarithromycinM.kansasii/M.marinum - Rifampin/EthambutolM.fortuitum/M.chelonae – Refer to CDCAdditional antibiotics not offered by MDCH Refer to National Jewish Hospital in Denver, Colorado
14 RFLP – DNA Fingerprinting For TB outbreak investigationsCheck for “reactivation vs re-infectionCheck for lab cross-contaminationPerformed on approved requests only
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