Monday - Friday

Smear: Within 24 hours of receipt except for Friday afternoon and weekend deliveries

Culture: 6-8 Weeks for a negative culture. If specimen is contaminated with non-mycobacteria and needs re-decontamination, culture may take up to 12 weeks

Smear: Presumptive diagnosis of mycobacterial disease; rapid identification of most infectious TB cases, e.g. those that are smear positive; to follow progress of TB patients on chemotherapy; one of the criteria to determine if a patient may be discharged from hospital or isolation. 

Culture: Determine presence of mycobacteria and identify the species or complex. If a fastidious Mycobacterium species (M. haemophilum, M. genavense, etc.) is suspected, notify WSLH either prior to or at time of specimen submission so that appropriate culture conditions can be set up. 

No

M. tuberculosis complex (MTBC) PCR (MM00256) and M. avium complex (MAC) PCR (MM00260) is automatically performed on the first smear-positive specimen from all Wisconsin residents not previously diagnosed with tuberculosis or NTM disease (fee-exempt). Fee-for-service real-time PCR is available on smear-positive specimens that do not qualify for fee-exempt testing (i.e. previously positive), contact customer service. M. tuberculosis (MTBC) Susceptibility First Line drugs (MM00204) is automatically performed on all initial M. tuberculosis complex isolates (additional fee), testing for additional drugs is available upon request. The first M. tuberculosis complex isolate per patient is automatically genotyped as part of the CDC universal genotyping program (fee-exempt). Cepheid GeneXpert MTB/RIF (MM00261) is automatically performed on all MTBC positive specimens for rapid detection of Rifampin resistance (fee-exempt). 

Collect specimens prior to chemotherapy. Sterile preparation of site if applicable. Early morning sputum is preferred. 

Sputum: Volume no less than 3ml, optimal volume 5-10 ml in sterile container. Collect three consecutive specimens, each collected in 8-24 hour intervals with at least one being an early morning specimen (CDC MMWR 2005: 54, RR-17) 

Other respiratory specimens (BAL, bronch wash, etc.): 5-10ml in sterile container

Gastric Lavage: 5-10 ml, must use WSLH Kit #13 (contains buffer for neutralization), collected in a series of 3 specimens over 3-5 days. 

Stool: 1 gram in sterile container

Tissue Biopsy: 1 gram in sterile container; ≥3 or more specimens from the same collection site will be automatically pooled into a single specimen for smear and culture. 

Urine: 40 ml, first-morning, clean catch in sterile container (24-hour pooled specimens are unacceptable)

Body Fluids (pleural, pericardial etc.): 5-10ml in sterile container

Whole Blood: 10 ml in SPS blood collection tube or Heparin tube (do not use EDTA)

Bone Marrow: As much as available in sterile container or SPS tube

CSF: As much as available in sterile container (minimum of 1 ml required)

Skin Lesions: scrapings or exudates

Specimens collected via surgical methods that do not meet the above minimum volume criteria may be tested at the discretion of WSLH CDD Directors with interpretation comments added to all reports. 

AFB smears are not performed on blood specimens.

Special Instructions for Sputum: Collect three specimens, each collected in 8-24 hour intervals with at least one being an early morning specimen (CDC MMWR 2005: 54, RR-17). Optimally 5mL of sputum, minimum 3mL. Sputum specimens collected less than 8 hours apart will be pooled into a single smear and culture. 

Special Instructions for Gastric Lavage: Collect fasting specimen soon after patient awakens in order to obtain sputum swallowed during sleep; place in neutralizing buffer (100 mg sodium carbonate powder; provided in WSLH Kit #13) immediately.

13 Mycobacteria (AFB,TB) Gastric Specimens    

8 TB /Legionella Respiratory Specimens

CDD Requisition Form A

Laboratory regulations require the following minimum information to be provided on the requisition form for a specimen to be accepted for testing: Patient name or unique identifier, date and time of collection, patient date of birth and sex, specimen type/site of collection, test request(s), clinician name and UPIN, and address for reporting results. Please be certain that name/identifier on the form matches that on the specimen label which is required to have a minimum of two identifiers.

Blood collected in EDTA tube; gastric lavage specimens that have not been neutralized (buffered); 24-hour pooled specimens; sputum specimens <3 ml; dry swab specimens; specimens received more than 7 days after collection; frozen specimens; specimens with visible food; saliva. Surgical specimens wrapped in gauze may be rejected if sufficient material is not recoverable.

For all specimens except for blood and bone marrow: Store at 2-8°C, ship with frozen cold packs. Do not freeze specimen. Do not wrap surgically collected specimens (tissue, body fluids, etc.) in sterile gauze.

For blood and bone marrow: Store and ship at ambient temperature and ship as soon as possible (within 48 hours). 

Category B Shipping

Use pressure-resistant bags as inner packaging. 

Specimens submitted for surveillance or at the request of a public health department are eligible for fee-exempt courier. Contact Purple Mountain Dispatch at 800-990-9668 for specimen pickup.

Monday-Friday 6:00 AM - 4:30 PM, Saturday 6:30 AM - 12:30 PM

Smear: Negative, positive (with semi-quantification), questionable. 

Culture: Negative for Mycobacteria; Species identification when mycobacterial growth is detected; Culture overgrown with non-acid-fast organisms

Negative results obtained from specimens submitted on swabs are not reliable. Negative results from specimens that do not meet minimum volume criteria may not be reliable. A negative test result does not rule out infection with mycobacteria. Improper specimen collection and handling may compromise assay performance. AFB Smears are not performed on blood because of very low bacterial concentration.

For direct detection of mycobacteria from clinical specimens, see M. tuberculosis complex (MTBC) PCR (MM00256) and M. avium complex (MAC) PCR (MM00260).

For susceptibility testing of clinically significant mycobacteria isolates, see M. tuberculosis (MTBC) Susceptibility First Line drugs (MM00204), and M. avium complex (MAC) Susceptibility (MM00202).

Acid fast smear: Auramine O stain

Culture: BACTEC MGIT 960 System, broth and solid media cultures. Mycobacteria identification may include one or more of the following analyses: MALDI-TOF, real-time PCR, 16S/rpoB gene sequencing, and growth characteristics.

Acid Fast Smear and Culture

Yes, with DHS pre-approval

1-800-862-1065 arbill@slh.wisc.edu