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Tuberculosis

Material:

Bacteriology: Req. specimen (according to DIN) An essential prerequisite for a succesful detection of mycobacteria is the way and the frequency with which specimen are collected. Generally as much sample as possible from different days should be collected for examination. Sample quantity and specimen type: sputum At least 3 samples from different days should be examined. Send 2-6 ml. The best specimen is sputum from the morning (collected during less than 1 hr). Bronchial secretion and BAL 2-5 ml bronchial secretion obtained with or without lavage from the deeper respiratory tract. The best specimen is broncho-alveolar lavage. The sputum produced after bronchoscopy can als be used. Pleural aspirate 10-30 ml Gastric juice At least 20-30 ml. Gastric juice is collected under fasting conditions with a lavage of sterile physiological saline solution. Saturated trisodium phosphate solution (1 ml) or 100 mg of natrium carbonate are used to neutralize the secretion. These substances are available from the laboratory. Morning urine Starting in the evening the intake of fluid is restricted.The next morning urine is collected in a sterile container avoiding bacterial contamination. If an urogenital tuberculosis is suspected 3 urine samples each with a volume of at least 30 ml are required. The samples should be produced on three different days. Remark: Because of the risk of bacterial contamination a 24 h urine collection is less suitable than a morning urine sample. Menstrual blood After collection in a sterile container the blood is diluted with an identical volume of sterile water. Semen Punctate The volume should possibly be 20 ml or more. cerebrospinal fluid At least 5 ml Blood 6 -10 ml heparin blood (for culture), EDTA blood (for PCR testing). A mycobacterial culture from blood is only useful if there is an immundeficiency (HIV) or if a disseminated infection is suspected. Biopsy specimen If possible several samples should be sent in. Formaldehyde should not be used. To avoid the drying out of the sample, it should be put in a small amount of sterile physiological saline solution. Swab Swabs are not very suitable. They should be sent in transport medium. More adequate are punctates or biopsy specimens Pus Faeces DNA-test sputum, bronchial secretion, 1-2 ml cerebrospinal fluid, 3 ml urine. Because of the risk of contamination the tube with a specimen for PCR testing should remain unopened. Aliquots for other analyses should not be taken. Transport Between sampling and processing at the laboratory there should be no more than 24 hrs. If samples cannot be processed without delay, they should be stored at 4 °C.

Description

Mycobacterium tuberculosis complex (MTB complex):

M. tuberculosis (with variants such as M. africanum)

M. bovis and related BCG strains

M. microti

atypical mycobacteria

(MOTT: mycobacteria other than tuberculosis or NTM: non tuberculosis

mycobacteria)