Post on 22-Jan-2022
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
Basics on Laboratory Diagnostic Tests for Active TB
LEARNER PACKET
TABLE OF CONTENTS
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Training Overview
Agenda
Learning Objectives
Supplemental Materials
Learner Guide Part 1: Smears and NAATs
Learner Guide Part 2: Culture and DSTs
Classification System For Tuberculosis
Basics on Laboratory Diagnostic Tests for Active TB
Supplemental Material
AGENDA
All times are listed in Pacific Standard Time
12:30-12:35 PM Welcome and Introductions
Presenter: Jennifer Miller, RN, CPH, Communicable Disease Nurse
Consultant with the Montana Department of Public Health and Human
Servives
Presenter: Heidi Behm, RN, MPH, TB Nurse Consultant/TB Controller,
Public Health Division, Oregon Health Authority
Panelist: Drew Francis, M(ASCP)CM, Public Health Scientist III,
Mycobacteriology/Bacteriology Supervisor, Arizona Department of Health
Services, Arizona State Laboratory Services
Moderator: Ann Raftery, Associate Medical Director, Curry TB Center
12:35-12:55 PM What do these lab results mean?
Part 1: Smear Microscopy and Nucleic Acid Amplification (NAA)
12:55-1:20 PM Smear and NAAT Breakout Room
1:20-1:45 PM What do these lab results mean?
Part 2: Culture and Drug-Susceptible Testing (DST)
1:45-2:20 PM Culture and DST Breakout Room
2:20-2:45 PM Panel Q&A and Wrap-Up
LEARNING OBJECTIVES
By the end of this training, participants will be able to:
• describe 4 TB diagnostic tests and list several features unique to each one
• interpret sample laboratory test results, and determine next steps the nurse
case manager should take
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
LEARNER GUIDE PART 1: SMEARS & NAATS
Case Scenario
Friday, April __, 20__
You are the intake Public Health Nurse at the County Health Department and have received a
report from the Public Health Laboratory [see lab result A].
Discuss in small groups here!
1. What does this result mean?
2. What action do I need to take based on this result?
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
Case Scenario (continued)
You reach out to Dr. Habari at the General Hospital to gather additional information about the
patient. Dr. Habari proceeds to give you the following history:
“My patient Mr. K is a 61 y/o Asian American man who presented to our outpatient department
three nights ago with c/o increasing dyspnea and worsening cough. He has a past medical
history of COPD for which he uses inhalers (combination and rescue inhaler) as well as home O2
since 2016. He’s an ex-smoker with a 40-year, ½ pack per day history of cigarette smoking.
Covid-19 has been ruled out.”
“His chest X-ray shows bilateral pulmonary fibrosis with RUL and bilateral lower lobe infiltrates.
He is afebrile. We sent sputum for AFB smear and culture early yesterday and another today to
evaluate for TB.”
Discuss in small groups here!
3. List any additional quaaloestions or actions you will take based on the information
provided.
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
Updated Results
Discuss in small groups here!
4. Updated Results: What does this mean?
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
“Extra Credit” Follow up discussion for groups with extra time: The following is a summary of your patient’s lab results (Two slides. First at December visit.
Second at final results):
First slide:
What does this mean? What are the next steps?
12/18 visit:
results available
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
Second slide:
When was culture conversion?
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
LEARNER GUIDE PART 2: CULTURE AND DSTS
Case Scenario The hospital calls to report that they have a patient whose sputum sample came back with the
following results:
Discuss in small groups here!
1. What does this result mean?
2. What are the next steps?
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
DST RESULTS
DRUG SENSITIVITY
What is the expected turnaround time for final drug susceptibility test (DST) results for the
laboratory services that your health department uses?
Discuss in small groups here!
3. How long will it be until you have DST results?
Here are the DST results:
Discuss in small groups here!
4. What does this result mean?
5. What are the next steps?
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
FINAL RESULTS FROM CDC
Here are the final results:
Discuss in small groups here!
6. What does this result mean?
7. What are the next steps?
Basics on Laboratory Diagnostic Tests for Active TB
Learner Guide
“EXTRA CREDIT” WHAT IF? Follow up discussion for groups with extra time:
What does this result mean? What are the next steps?
Basics on Laboratory Diagnostic Tests for Active TB
Supplemental Material
TUBERCULOSIS (TB) ACRONYMS AND ABBREVIATIONS
AFB acid-fast bacilli
ALT alanine aminotransferase
ARPE Aggregate Reports for Tuberculosis Program Evaluation
AR auramine-rhodamine – smear method using fluorescent microscope
ART antiretroviral therapy
AST aspartate aminotransferase
AK amikacin
ATS American Thoracic Society
BCG Bacille Calmette-Guérin
BDQ bedaquiline
CBC complete blood count
CDC Centers for Disease Control and Prevention
cDST culture-based drug susceptibility test
CI contact investigation
CFZ clofazimine
CNS central nervous system
CM capreomycin
CS cycloserine
CXR chest x-ray
DTBE Division of Tuberculosis Elimination
DOT directly observed therapy
DR drug-resistance
DST drug susceptibility test(ing)
EMB (E) ethambutol
EPTB extra-pulmonary tuberculosis
ESRD end-stage renal disease
ETA ethionamide
FQN (fQ) fluoroquinolone
IGRA interferon gamma release assay
INH Isoniazid
inhA a specific mutation in the M.tb genome that confers resistance to INH & ethionamide
Basics on Laboratory Diagnostic Tests for Active TB
Supplemental Material
HIV human immunodeficiency virus
IGRA interferon gamma release assay
INH (I) Isoniazid
IP infectious period
IVDU intravenous drug use
KAN (KM) kanamycin (injectable drug not readily available in the US)
katG specific mutation in the M.tb genome that confers INH resistance
LFT liver function test
LJ Lowenstein-Jensen (type of TB culture medium)
LZD (Lz) linezolid
LTBI latent tuberculosis infection
M. tb Mycobacterium tuberculosis; MTBC= Mycobacterium tuberculosis complex
MAC Mycobacterium avium complex
MDDR molecular detection of drug resistance
MDR-TB multidrug-resistant tuberculosis
mDST molecular-based drug susceptibility test
MFX moxifloxacin
MGIT mycobacteria growth indicator tube (TB culture method)
MIRU mycobacterial interspersed repetitive units (genotype method)
MMWR Morbidity and Mortality Weekly Report
NAAT nucleic acid amplification test
NALC N-acetyl L-cysteine – used to liquefy thick sputum
NaOH sodium hydroxide – used to decontaminate sputum specimen
NSAIDs non-steroidal anti-inflammatory drugs
NTCA National Tuberculosis Controllers Association
NTIP National Tuberculosis Indicators Project
NTM nontuberculous mycobacteria
NTNC National Tuberculosis Nurse Coalition
PCR polymerase chain reaction
PPD purified protein derivative
pncA specific mutation in the M.tb genome that confers PZA resistance
PSQ pyrosequencing
PTB pulmonary tuberculosis
Basics on Laboratory Diagnostic Tests for Active TB
Supplemental Material
PZA (P) pyrazinamide
QFT QuantiFERON blood test (commercial product to test for LTBI)
RFB (RBT) rifabutin
RIPE rifampin, isoniazid, pyrazinamide and ethambutol
RPT rifapentine
RIF (R) rifampin
RIF-R rifampin resistance
rpoB specific loci in the M.tb genome where mutation may occur conferring RIF-R
RVCT Report of Verified Case of Tuberculosis
SAT self-administered therapy
SIRE streptomycin, isoniazid, rifampin, ethionamide
SPC specimen control
SM (S) streptomycin
SQ sequence – referenced in relation to molecular beacon
TAT turnaround time
TDM therapeutic drug monitoring
TNF-α tumor necrosis factor-alpha
TST tuberculin skin test
ULN upper limit of normal
VDOT video-based directly observed therapy
VNTR variable number of tandem repeats (genotype method)
WGS whole genome sequencing
XDR-TB extensively drug-resistant tuberculosis
ZN Ziehl-Neelson (AFB staining method)