Microbiology

Culture for tuberculosis is the "gold standard" for diagnosis. 4 Sputum is commonly collected to detect the presence of M. tuberculosis by both culture and smear. In the absence of a satisfactory sputum sample, gastric aspirates, pleural and other body fluids, and tissue samples may be employed for culture and other diagnostic tests. Bronchoscopy may also be used to obtain more direct respiratory samples for both smear and culture. Staining of the specimen for acid fastness (i.e., Ziehl-Neelsen stain) or a fluorochrome procedure is the quickest and least expensive method to provide a presumptive diagnosis of tuberculosis. Approximately 60 percent of culture-positive cases of tuberculosis will have smears where acid-fast bacilli are detected, although this may be lower in individuals with HIV. 13

Newer methods are under development to aid in the speed and sensitivity of diagnosing tuberculosis. Although not widely available, techniques that employ radiometric technology, DNA probes, polymerase chain reaction, reverse transcription, or other technologies may someday provide definitive results in a matter of hours.4

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