Sputum Culture, Mycobacterium

CPT CODE: 87117; 87206
TEST INFORMATION: Test includes culture and acid-fast stain (if specimen volume is adequate). Culture includes decontamination and concentration. If a mycobacterial species is isolated, the organism will be definitely identified. Susceptibility testing will be performed depending upon the isolate identification. Other isolated organisms (i.e. yeast, etc.) may be referred for identification if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
TURNAROUND TIME: Smear results: 24 hours after receipt of the specimen in the laboratory. Preliminary culture reports are available after 1 week or when a mycobacterial isolate is detected. Negative cultures with negative smears will be finalized after 8 weeks. Negative cultures with positive smears will be finalized after 12 weeks. Completion of culture reports may require additional time when mycobacteria are isolated and/or susceptibility testing is performed.
CONTAINER TYPE: Sterile sputum container; sterile Leuken`s tube; sealed, sterile container, no preservative
COLLECTION: The sputum and Leuken`s specimens should be first morning specimens. Nonbacteriostatic saline should be used when irrigation is necessary. The gastric aspirate is to be collected utilizing aseptic technique. The patient should NOT have eaten within the previous 5 hours when obtaining a gastric aspirate.
SPECIMEN REQUIREMENTS: First morning sputum, induced sputum, aspirated sputum, tracheal aspirate, bronchial, Leuken`s, gastric aspirate
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, specimen received in a preservative. Only one specimen per day and three specimens per body site with negative acid-fast smears will be processed. Subsequent specimens will be rejected. Specimens from known positive patients will be accepted only once a week for culture and smear per body site.
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.
REFERENCE RANGE: No acid-fast bacilli observed on smear or isolated in culture
LIMITATIONS OF TEST: A single negative smear does not rule out the presence of mycobacterial infection. Gastric aspirates are frequently diluted with saline.
METHODOLOGY: Acid-fast smear: fluorochrome stain. Culture: inoculation of conventional culture media and a rapid medium for automated continuous analysis.
ADDITIONAL INFORMATION: The recommended screening procedure is three first morning specimens on three consecutive days. DNA probes may be incorporated to aid with more rapid identification of mycobacterial isolates. This will generate an additional charge(s). Susceptibility testing will be performed only on the first Mycobacterium isolate from each specimen type per patient. Additional susceptibilities may be performed after a period of 4 weeks for patients with suspected treatment failure. Susceptibility testing is performed routinely only for M. tuberculosis complex, M. kansasii, M. chelonae complex, and M. fortuitum. Susceptibility testing for other Mycobacterium species is performed by special request only. The battery of drugs routinely tested will vary by isolate and/or physician request. Patients from whom M. tuberculosis is isolated in culture are reported to the City of Chicago Board of Health. This is mandated by law.
TEST SYNONYM(S):Mycobacterium Culture, Sputum; Sputum, AFB Culture; Sputum, TB Culture; TB Culture, Sputum; AFB Culture, Sputum