Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates
CPT4 code
Name of the Procedure:
Culture, tubercle or other acid-fast bacilli (e.g., TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates.
Summary
This procedure involves collecting a sample from the patient and testing it to detect the presence of Mycobacterium tuberculosis or other acid-fast bacilli (AFB), which cause diseases such as tuberculosis (TB). The process involves culturing the sample, isolating any bacteria present, and working towards a preliminary identification.
Purpose
The purpose of this procedure is to diagnose infections caused by tubercle bacilli or other types of mycobacteria. The main goal is to identify the presence of these bacteria in the body to guide appropriate treatment and prevent the spread of infectious diseases like tuberculosis.
Indications
- Persistent cough lasting more than three weeks
- Coughing up blood
- Unexplained weight loss
- Night sweats and fever
- History of exposure to TB
- Immunocompromised patients exhibiting signs of infection
Preparation
- Patients may need to provide sputum samples, which often requires fasting or collecting in the morning.
- For other sample types (e.g., urine, tissue biopsies), specific instructions will be provided.
- No extensive preparation is generally needed, but patients should inform healthcare providers about any medications they are taking.
Procedure Description
- Sample Collection: Depending on the suspected infection site, samples such as sputum, urine, blood, or tissue biopsies are collected.
- Lab Processing: The samples are sent to a laboratory where they are cultured in special media that support the growth of AFB.
- Isolation: Over a period of days to weeks, lab technicians isolate any bacterial colonies that grow.
- Presumptive Identification: Using techniques like staining (e.g., Ziehl-Neelsen stain) and molecular tests, the isolated bacteria are presumptively identified as Mycobacterium tuberculosis or other mycobacteria.
Duration
The procedure itself (sample collection) takes a few minutes, but the culturing and identification process can take anywhere from a few days to several weeks.
Setting
The sample collection can occur in various healthcare settings, including hospitals, outpatient clinics, and doctor’s offices. The laboratory analysis is performed in specialized microbiology labs.
Personnel
- Primary care physician or specialist (e.g., infectious disease specialist)
- Nurses or phlebotomists for sample collection
- Lab technicians and microbiologists for sample processing and analysis
Risks and Complications
- Minimal risks associated with sample collection, such as minor discomfort or risk of bleeding if a biopsy is performed.
- Rare risk of contamination leading to false results.
Benefits
- Accurate diagnosis of TB and other mycobacterial infections
- Timely and appropriate treatment initiation
- Prevention of disease spread
Recovery
- No significant recovery period needed for most sample collections.
- Patients may resume normal activities immediately unless otherwise directed by healthcare providers.
- Follow-up appointments may be scheduled to discuss results and treatment plans.
Alternatives
- Tuberculin skin test (TST) for TB infection screening
- Interferon-gamma release assays (IGRAs) for TB infection detection
- These alternatives are less invasive but may not provide the same level of detail for active infections, particularly for mycobacteria other than TB.
Patient Experience
- Minimal discomfort during sample collection, particularly for blood draws or sputum collection.
- Patients may experience anxiety while awaiting results, which healthcare providers can help manage with clear communication.
- Pain management is usually not necessary, but comfort measures and reassurance from healthcare providers help ease any discomfort.