Michigan department of community health tbmycology lab manager objectives overview of laboratory role in tb diagnosis and control techniques for diagnosing tb additional lab results critical to effective case management relevance of lab results to clinical and. Laboratory diagnosis of tuberculosis tb moderator dr. Laboratory diagnosis of mycobacterium tuberculosis infection and. Laboratory diagnosis of tuberculosis by sputum microscopy. Laboratory diagnosis and experimental methods in tuberculosis. Laboratory diagnosis of pulmonary tuberculosis the bmj. Tuberculosis or tb short for tubercle bacillus is a common and often deadly infectious disease caused by mycobacterium usually mycobacterium tuberculosis genus mycobacteria is divided in to 1. Describe three laboratory methods used in the diagnosis and control of tb resulting in a better understanding of laboratory results and improved communication between the clinician, the laboratory, and the patient index of materials pages 1. Recent advances in the laboratory diagnosis of tuberculosis the conventional diagnostic methods but provide preliminary information and improve patient management. Because a qualified sputum specimen is difficult to obtain in children, this study evaluated the diagnostic value of ultra in childhood tuberculosis using bronchoalveolar lavage fluid. It most commonly involves the lungs and is communicable in this form, but may affect almost any organ system including the lymph nodes, cns, liver, bones, genitourinary tract, and gastrointestinal tract. Laboratory diagnosis of pulmonary tuberculosis in tb and hiv. Laboratory diagnosis of tuberculosis gs linkedin slideshare.
An early and accurate diagnosis of pulmonary tb should be established using chest xray, sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Tuberculosis is an acute or chronic infection caused by mycobacterium tuberculosis. Pulmonary tuberculosis is an infectious disease caused by mycobacterium tuberculosis. Whoendorsed rapid tb diagnostics and drug susceptibility testing dst should be available to all persons with signs and.
Laboratory diagnosis of tuberculosis latest diagnostic tools. However, adolescents with pulmonary disease often have the hallmarks of adulttype disease cavitary. Introduction tuberculosis tb is one of the leading infectious diseases in the world and is responsible for more than 2 million deaths and 8 million new cases annually. More than 8 million new cases of tuberculosis occur annually leading to 2 million deaths. Pulmonary tuberculosis tb remains a major cause of morbidity and mortality worldwide, with about onethird of the worlds population infected. Early diagnosis of tuberculosis and drug resistance improves survival and by identifying infectious cases promotes contact tracing, implementation of institutional crossinfection procedures, and other publichealth actions. Goals of tuberculosis tb treatment include eradication of mycobacterium tuberculosis infection, preventing transmission, preventing relapse of disease, and preventing development of drug resistance management consists of a patientcentered approach in which the patient, provider, public health, and laboratory enter into a relationship that assures that the goals of. Tb diagnostics and laboratory strengthening who policy. Megaloblastic anemia macrocytes in blood in cases of abdominal tb with malabsorption. Tuberculosis tb ranks as the second leading cause of death from an infectious disease worldwide. Tuberculosis tb is an infectious disease usually caused by mycobacterium tuberculosis mtb bacteria. Modern laboratory diagnosis of tuberculosis the lancet. A definitive diagnosis of tuberculosis can only be made by culturing mycobacterium tuberculosis organisms from a specimen taken from the patient most often sputum, but may also include pus, csf, biopsied tissue, etc.
Mortality is particularly high in those coinfected with hiv and where the bacteria are multipledrugresistant strainsie, strains resistant to at. Evaluation of genexpert mtbrif system performances in the. Laboratory diagnosis of mycobacterium tuberculosis. There have been many advances in methodology for tuberculosis diagnosis. Clinical presentation and diagnosis of tuberculosis 10 diagnostic process the first step. A test for more accurate diagnosis of pulmonary tuberculosis. In nsw all mycobacteria recovered from clinical samples are forwarded to the nsw mycobacterium reference laboratory mrl at. Xpert mycobacterium tuberculosis and rifampicin mtbrif ultra assay has increasingly been used in adult tuberculosis diagnosis, but data relating to its diagnostic accuracy in children are lacking.
Value of bronchoalveolar lavage and gastric lavage in the diagnosis of pulmonary tuberculosis in children. From robbins 9th edition secondary pulmonary tb miliary tuberculosis 12. Clinical presentation and diagnosis of tuberculosis. Isoniazid inh rifampin rif pyrazinamide pza ethambutol emb the current world health organization recommendations are that all new patients with tuberculosis, irrespective of site or severity of disease, and in the absence of evidence of drug resistance, should receive a 6month course of therapy, consisting. Diagnosis of pulmonary tuberculosis in adults uptodate. Jain inspite of the discovery of the causative agent more than a century back, the bacteriological diagnosis of tuberculosis has been a major hurdle in the treatment and control of the disease. The remaining patients will have latent tb, which can advance to active infection in times of immunosuppression. Laboratory diagnosis of pulmonary tuberculosis br med j 1954. The purpose of this section is to outline the main methods of laboratory tuberculosis tb confirmation available to clinicians in new south wales nsw.
Multidrugresistant tb is of particular concern to both clinicians and national tb programmes. Get a printable copy pdf file of the complete article 474k, or click on a page image below to browse page by page. Tuberculosis generally affects the lungs, but can also affect other parts of the body. The laboratory diagnosis of pulmonary tuberculosis. Pdf clinical and laboratory diagnosis of the patients. The division of tuberculosis elimination dtbe laboratory branch lb provides services for the following tests on mycobacterial cultures. Diagnosis of tuberculosis in children is challenging. Recent advances in the laboratory diagnosis of tuberculosis. Tuberculosis, pulmonary diagnosis tuberculosis, multidrugresistant diagnosis clinical laboratory techniques diagnostic techniques and procedures europe isbn 978 92 890 5237 5 address requests about publications of the who regional office for europe to. Clinical pathology laboratory diagnosis of pulmonary tuberculosis. Pdf rapid laboratory diagnosis of pulmonary tuberculosis. Who recommends the number of specimens to be examined for screening of tb cases can be reduced from three to two, in places where a wellfunctioning external quality assurance eqa system exists, where the workload is very high and human resources are limited.
List at least five symptoms of pulmonary tb disease explain the. Full text full text is available as a scanned copy of the original print version. For pulmonary tb, sputum is the most critical sample for laboratory testing. Anemia may be there due to the chronic debiliting natureof the disease. Challenges in the laboratory diagnosis of tb in highincidence countries, tb control relies on passive case finding among individuals selfpresenting to health care facilities, followed by either diagnosis based on clinical symptoms or laboratory diagnosis using sputum smear microscopy. This study aims to evaluate the performance of genexpert mtbrif cepheid sunnyvale, ca, united states in diagnosis of extrapulmonary. Application of a circulating antigen detection immunoassay for laboratory diagnosis of extrapulmonary and pulmonary tuberculosis. Direct sputum smear microscopy is the most widely used method for. Tb laboratory techniques for diagnosing tuberculosis dale e. Routine laboratory tests are rarely helpful for making the diagnosis of tuberculosis. Both pulmonary and extrapulmonary tb disease symptoms. Molecular diagnostic techniques are crucial in the world health organizations new tuberculosis control strategy. People living in crowded and poorly ventilated conditions and who are immunocompromised are most likely to become infected. Classification of mycobacteria mycobacterium tuberculosis complex refers to a genetically related groups of mycobacterium species that can cause tuberculosis tb in humans.
Laboratory diagnosis of mycobacterium tuberculosis infection and disease in children. The document presents comprehensive algorithms for diagnosis and treatmentmonitoring of pulmonary tb and mdrtb using rapid molecular techniques recommended by who. Laboratory diagnosis of pulmonary tuberculosis in tb and hiv endemic. Laboratory diagnosis of tuberculosis by sputum microscopy in many countries, sputum smear microscopy remains the primary tool for the laboratory diagnosis of tuberculosis. The diagnosis of pulmonary tuberculosis ptb is still difficult, and the prominent challenge for diagnosis is the lack of a highly sensitive and specific method. The laboratory is essential laboratory is a critical partner in the diagnosis of tb rapid, reliable results are essential for early detection of mtbc to prevent ongoing transmission drug susceptibility test results identify drug resistance and help guide the clinician in providing appropriate treatment. Seminar regarding tb pathogenesis and lab diagnosis with advancements. The symptoms and signs of both primary and reactivation tuberculosis are described. Sah medical microbiology lecture cmlt, 2 nd year tuberculosis or tb short for tubercle bacillus. Dozens of commercial serological tests for tuberculosis. At the present time the health department has two school nurses, two tuberculosis nurses, and. Standard guidelines and recent advances for diagnosing pulmonary tb are summarized in this article. Haematology complete blood count is usually normal.
It aims to describe the more important methods of the laboratory diagnosis of tuberculosis and to consider some of the more significant procedures and principles involved in the experimental study of the infection. Chest xray of patient with active pulmonary tuberculosis 22. Rapid diagnosis and targeted treatment are essential to. Tuberculosis is a public health problem worldwide, including in the united statesparticularly among immunocompromised patients and other highrisk groups. Usually moderate normochromic or slightly hypochromic anemia. Due to its global prevalence, the methods available for. Laboratory diagnosis of tuberculosis in resourcepoor. The first page of the pdf of this article appears above. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. Tb laboratory techniques for diagnosing tuberculosis. As a result, the diagnosis of tb disease may be delayed or even overlooked, and the. Pulmonary tuberculosis symptoms, diagnosis and treatment. In many cases, m tuberculosis becomes dormant before it progresses to active tb. Any local health department, licensed physicians office, licensed laboratory or licensed health care facility may submit cultures for testing but they must be routed through either their state health department or other authorized facility.
Tuberculosis tb is a global health concern for both developing and developed countries and has recently become more complex due to persistence in aging populations and the rise of drugresistant strains, even in korea1,2. Laboratory diagnosis, treatment and prevention of tuberculosis. People with the germ have a 10 percent lifetime risk of getting sick with tb. The specimens should be examined and cultured in a laboratory that. Serial sputum specimens are required one taken on the spot and the second brought in the following.
In clinical practice, rapid tb diagnosis can be difficult, and early pulmonary tb detection continues to be challenging for clinicians. The first line of anti tb agents that form the core of treatment regimens are. Summary background tuberculosis tb in africa is increasing because of the. Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis. It requires simple laboratory facilities, and when performed correctly, has a role in rapidly identifying infectious cases. Tb diagnostics and laboratory strengthening who policy reduction of number of smears for the diagnosis of pulmonary tb, 2007. Both pulmonary and extrapulmonary tb disease symptoms can be caused by other diseases. The typical symptoms of pulmonary tb include fever, night sweats. Tb disease should be suspected in persons who have the following symptoms. Most infections show no symptoms, in which case it is known as latent tuberculosis. Tuberculosis tb is not as common as it was many years ago in the united states. Clinical diagnosis lacks standardization, and traditional and molecular microbiologic methods lack sensitivity, particularly in children. Onethird of the global population is believed to be infected with bacteria of the mycobacterium tuberculosis complex, the causative agent of tuberculosis.
Tb is characterized by pulmonary infiltrates, formation of granulomas with caseation, fibrosis, and cavitation. Handbook on tb laboratory diagnostic methods in the. Diagnosis of tuberculosis disease centers for disease. Pulmonary tuberculosis tb is a contagious, infectious disease that attacks your lungs. Pdf application of a circulating antigen detection. Despite extensive investigation over the years, there is still a great deal to learn about the. Laboratory diagnosis of tuberculosis linkedin slideshare. An antibody detectionbased diagnostic test in a suitable format could potentially replace microscopy and extend tuberculosis diagnosis to lower levels of health services. Tb diagnostics and laboratory strengthening who policy reduction of number of smears for the diagnosis of pulmonary tb, 2007 who recommends the number of specimens to be examined for screening of tb cases can be reduced from three to two, in places where a wellfunctioning external quality assurance eqa system exists, where the workload is very high and human resources are limited. Clinical and laboratory diagnosis of the patients with sputum smearnegative pulmonary tuberculosis article pdf available in archives of iranian medicine 151. Currently marketed rapid serologic tb tests vary widely in performance but generally perform poorly compared to a combined reference standard using wellcharacterized.
59 722 354 598 98 493 865 981 155 1348 1305 866 46 1388 114 667 1627 1180 832 452 165 512 71 1013 1084 551 245 1153 489 1208