Rapid diagnostic tests should be conducted for rifampicin resistance Infection control measures and treatment for MDR TB should be started as outlined by NICE Rapid diagnostic tests for M. tuberculosis complex identification should be conducted on biopsy material only if: all the samples has been inappropriately placed in formalin acid-fast bacilli are visible on microscopy All NAATs should be carried out in accordance with manufacturer’s instructions. Suitable clinical samples should also ideally be sent for conventional AFB microscopy and culture investigations as outlined above. 4.5.5 Culture media, conditions and organisms Clinical Specimen Standard Incubation Cultures Target details/ read organism(s) ‡ Temp Atmos Time conditions oC Automated liquid 35 37 Air 8 weeks Weekly Mycobacterium – systems* extending to 12 species Bone and All bone marrow weeks if joint, aspirates required 45 including and spinal Wound swab tuberculosis Pus or Pus LJ + pyruvate swabs** 35 37 Air 8 weeks Weekly Mycobacterium – CSF extending to 12 species Tuberculous Automated liquid Ascites weeks if meningitis systems* fluid required 45 Pleural fluid and LJ + pyruvate*** 42 Air 8 weeks Weekly M. xenopi extending to 12 Sputum weeks if Pulmonary Brochoalveolar required 45 tuberculosis lavage/bronchial washings Gastric washings Urine Automated liquid 35 37 Air 8 weeks Weekly Mycobacterium – systems* extending to 12 species weeks if and required 45 tuberculosis LJ + pyruvate Consider for Automated liquid 28 - 30 Air 8 weeks Weekly Non-tuberculous bone and joint systems* extending to 12 mycobacteria fluids eg from weeks if and extremities required 45 and/or direct LJ + pyruvate smear positive
Rapid diagnostic tests should be conducted for rifampicin resistance Infection control measures and treatment for MDR TB should be started as outlined by NICE Rapid diagnostic tests for M. tuberculosis complex identification should be conducted on biopsy material only if: all the samples has been inappropriately placed in formalin acid-fast bacilli are visible on microscopy All NAATs should be carried out in accordance with manufacturer’s instructions. Suitable clinical samples should also ideally be sent for conventional AFB microscopy and culture investigations as outlined above. 4.5.5 Culture media, conditions and organisms Clinical details/ conditions Specimen Standard Incubation Cultures read Target organism(s) ‡ Temp oC Atmos Time Bone and joint, including spinal tuberculosis All bone marrow aspirates Wound swab Pus or Pus swabs** Automated liquid systems* and LJ + pyruvate 35 – 37 Air 8 weeks extending to 12 weeks if required 45 Weekly Mycobacterium species Tuberculous meningitis CSF Ascites fluid Pleural fluid Automated liquid systems* and LJ + pyruvate*** 35 – 37 Air 8 weeks extending to 12 weeks if required 45 Weekly Mycobacterium species Pulmonary tuberculosis Sputum Brochoalveolar lavage/bronchial washings Gastric washings 42 Air 8 weeks extending to 12 weeks if required 45 Weekly M. xenopi tuberculosis Urine Automated liquid systems* and LJ + pyruvate 35 – 37 Air 8 weeks extending to 12 weeks if required 45 Weekly Mycobacterium species Consider for bone and joint fluids eg from extremities and/or direct smear positive Automated liquid systems* and LJ + pyruvate 28 - 30 Air 8 weeks extending to 12 weeks if required 45 Weekly Non-tuberculous mycobacteria
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