PARACLINICALS FOR TB

1) Radiographic procedure
Chest xray
Initial suspicion of PTB is often based on abnormal chest radiograph
Classic pic.: upper lobe disease with infiltrate and cavities
CT scan
Helps in interpreting questionable findings on CXR
Extrapulmonary TB

2) Tuberculin test / TST

Diagnostic skin test which identifies Tuberculous infection, recent or past, with or
without disease
Basis: person infected with tubercle bacilli develop hypersensitivity to the protein of
organism
Types of reagent
a) Old tuberculin
Original test reagent
From boiled 6-week-old broth culture from which the organisms were
filtered and concentrated by steaming
Active compenent: heat stable protein
b) PPD
Partially purified preparation of OT prepared by ammonium sulphate
fractionation

Administration
Standard dose: 0.1 mL of PPD or 5 TU
Mantoux test intradermal with tuberculin syringe
Reading
Induration palpable, raised, hardened area or swelling, not the erythema (CDC)
48 to 72h after injection
>72h still positive (Nelson)
< 24h negative (Nelson)

An induration of 5 or more An induration of 10 or more An induration of 15 or

millimeters is considered positive in
-HIV-infected persons
-A recent contact of a person with TB
disease
-Persons with fibrotic changes on
chest radiograph consistent with
prior TB
-Patients with organ transplants
-Persons who are immunosuppressed
for other reasons (e.g., taking the
equivalent of >15 mg/day of
prednisone for 1 month or longer,
taking TNF-a antagonists)
millimeters is considered positive more millimetersis
in considered positive in any
-Recent immigrants (< 5 years) person, including persons
from high-prevalence countries with no known risk factors
-Injection drug users for TB. However, targeted
-Residents and employees of skin testing programs
high-risk congregate settings should only be conducted
-Mycobacteriology laboratory among high-risk groups.
personnel
-Persons with clinical conditions
that place them at high risk
-Children < 4 years of age
- Infants, children, and
adolescents exposed to adults in
high-risk categories

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 > 10mm - infection
>5 mm & <10mm doubtful
<5mm or erythema only- negative
Tuberculin sensitivity develop 3 weeks after to 3 months after inhalation of organism
False negative: immunocompromised, vaccination with live vaccine, 10% immunocompetent
False positive : NTM, BCG

2) AFB microscopy
Decontaminate and concentrate
N-acetyl-cysteine (mucolytic agent), 4% NaOH (decontaminant)
Stain (acid fast stain)
Principle: acid-fast organisms are very hard to stain but once stained they are hard
to decolorize; due to mycolic acid; mycobacteria has the longest chain of mycolic
acid
Ziehl-Neelsen method
- Carbolfuchsin
- Steam (5min)
- Acid alcohol
- Methylene blue (10-30sec)
Red in blue background
Kinyoun method
- Kinyouns carbolfuchsin
- Acid alcohol
- Malachite green
Red against green background

3) AFB culture
Lowenstein-Jensen agar
4) interferon- gamma release assay
5) Nucleic acid amplification
PCR- uses DNA sequence as markers for microorganism
Negative PCR result never eliminates the diagnosis of tuberculosis and the diagnosis is not
confirmed by positive PCR result
Sensitivity : 25-83%
Specificity: 80-100%
Gene Xpert MTB/RIF
Also detects rifamin resistance
Rifampin used as proxy for MDR tuberculosis
2 hours
Sensitivity: 72-77%, 99% smear (-)
Specificity: 98-99%, smear (+)

6) extrapulmonary TB
Testing of specimen from involved site
CSF meningitis
Pleural fluid and biopsy pleural dss
Biopsy and culture of bone marrow and liver tissue disseminated TB

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