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AFB-detection by smear examination ZN Stain Body fluids

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AFB Detection by Smear Examination using Ziehl-Neelsen (ZN) Stain – Body Fluids, commonly used to diagnose tuberculosis (TB) from various extrapulmonary sites

₹119₹500

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AFB-Detection by Smear Examination ZN Stain Body Fluids - Comprehensive Medical Guide

  • 1. Why is it done?
    • Test Purpose: This test detects acid-fast bacilli (AFB), primarily Mycobacterium tuberculosis and other mycobacterial species, in body fluid specimens using Ziehl-Neelsen (ZN) staining technique. It is a rapid preliminary screening method for tuberculosis diagnosis.
    • Primary Indications: Suspected tuberculosis infection in body fluids (cerebrospinal fluid, pleural fluid, peritoneal fluid, pericardial fluid, synovial fluid); extrapulmonary TB assessment; immunocompromised patients with TB symptoms; monitoring treatment response
    • Clinical Circumstances: Fever of unknown origin; meningitis symptoms; pleural effusion evaluation; abdominal tuberculosis investigation; pericarditis assessment; joint TB suspicion; routine TB screening in high-risk populations; baseline investigation before anti-TB therapy initiation
  • 2. Normal Range
    • Normal Result: AFB Not Seen / Negative
    • Result Grading System: WHO/IUATLD standardized grading: • Negative: No AFB seen in 100 oil immersion fields • 1+: 1-9 AFB in 100 oil immersion fields • 2+: 10-99 AFB in 100 oil immersion fields • 3+: 1-10 AFB per oil immersion field • 4+: >10 AFB per oil immersion field
    • Interpretation Guide: Negative = Absence of acid-fast bacilli; Positive (any grade) = Presence of AFB consistent with mycobacterial infection, predominantly TB in endemic regions
    • Units of Measurement: Qualitative assessment; graded on numeric scale (1+ to 4+); number of organisms per microscopic field
    • Normal vs Abnormal: Normal = Negative result indicates absence of mycobacterial infection; Abnormal = Any positive finding warrants further investigation, culture confirmation, and clinical correlation
  • 3. Interpretation
    • Negative Result (AFB Not Seen): Suggests absence of TB in examined specimen; however, does not completely rule out disease (10-20% of extrapulmonary TB cases may be smear-negative); further culture testing or additional clinical investigation may be necessary, especially in symptomatic patients
    • 1+ Result (1-9 AFB per 100 fields): Low bacterial load; positive for mycobacteria; requires culture confirmation; patient is potentially infectious but lower transmission risk; commence anti-TB therapy based on clinical judgment
    • 2+ Result (10-99 AFB per 100 fields): Moderate bacterial burden; highly suggestive of TB; confirmation by culture strongly recommended; patient is infectious; initiate isolationist precautions and anti-TB therapy immediately
    • 3+ Result (1-10 AFB per field): High bacterial load; definite TB infection; patient is highly infectious; isolation and immediate anti-TB therapy essential; culture confirmation confirmatory
    • 4+ Result (>10 AFB per field): Very high bacterial load; extensive mycobacterial infection; severe TB with rapid progression; maximum infectivity; strict isolation and urgent anti-TB treatment initiation required
    • Factors Affecting Results: Specimen quality and volume; collection method; transport conditions; staining technique standardization; observer experience; HIV co-infection (lower AFB in disseminated disease); previous TB treatment; specimen type (CSF has lower sensitivity than pleural fluid)
    • Clinical Significance Patterns: Positive results + clinical symptoms = likely active TB; Negative results + high clinical suspicion = repeat testing, culture, or molecular methods recommended; Semi-quantitative grading guides treatment response monitoring; Serial specimens with decreasing grades indicate treatment efficacy
  • 4. Associated Organs
    • Primary Organ Systems Involved: Central nervous system (meningitis); respiratory system (pulmonary TB dissemination); pleural cavity (pleural TB); peritoneal cavity (abdominal TB); pericardium (pericardial TB); synovial membranes (tuberculous arthritis); lymphatic system (disseminated TB)
    • Associated Medical Conditions: Tuberculosis meningitis (TBM); tuberculous pleurisy; tuberculous peritonitis; tuberculous pericarditis; Poncet's disease (tuberculous arthritis); spinal TB (Pott's disease); lymphadenitis; disseminated TB; miliary TB; AIDS-related TB (ART-naïve patients); drug-resistant TB (MDR-TB/XDR-TB)
    • Diagnostic Value: Helps diagnose extrapulmonary TB; aids in rapid identification of infectious patients; provides initial evidence for treatment decisions; useful in monitoring disease progression; essential for public health surveillance and contact tracing
    • Potential Complications of Abnormal Results: Delayed diagnosis leading to disease progression; severe meningeal inflammation causing neurological sequelae; organ damage (renal, hepatic, cardiac); miliary dissemination; drug resistance development with suboptimal treatment; immunosuppression in HIV co-infected patients; potential for nosocomial transmission; mortality if untreated
  • 5. Follow-up Tests
    • Confirmatory and Complementary Tests: Mycobacterial culture (gold standard; 2-8 weeks turnaround time); Gene Xpert MTB/RIF (rapid molecular test; detects TB and rifampicin resistance within 2 hours); TB-LAMP (loop-mediated isothermal amplification); Auramine-rhodamine fluorescence microscopy (alternative to ZN stain)
    • Recommended Follow-up Investigations: AFB culture on Lowenstein-Jensen (LJ) or MGIT media; drug susceptibility testing (DST); HIV testing (in all TB patients); CD4 count assessment; chest radiography (for pulmonary involvement assessment); CT imaging (for CNS or abdominal TB); tuberculin skin test (TST) or interferon-gamma release assay (IGRA)
    • Treatment Monitoring Protocol: Repeat AFB smear examination at 2 weeks, 4 weeks, 8 weeks of therapy; smear conversion to negative at 8 weeks indicates treatment response; repeat culture and DST if resistance suspected; monthly sputum/fluid AFB if available during intensive phase; clinical assessment concurrent with laboratory findings
    • Monitoring Frequency for Ongoing Conditions: During initial phase (2 months): Monthly or as clinically indicated; Continuation phase (4 months): Bi-monthly or upon clinical deterioration; Post-treatment completion: As per surveillance protocol (12-18 months); For MDR-TB: More frequent monitoring (every 2 weeks during intensive phase)
    • Related Complementary Tests: Body fluid analysis (chemistry, cytology, glucose, protein); AFB culture from other body sites; AFB testing in sputum specimens; TB antigen detection tests; serology for TB antibodies (limited utility); immunological markers (TNF-alpha, IL-6) in body fluids
  • 6. Fasting Required?
    • Fasting Requirement: NO
    • Special Preparation Instructions: No fasting required; no specific dietary restrictions; patient can eat and drink normally before specimen collection; meals do not affect test results
    • Collection-Specific Preparation: Cerebrospinal fluid (CSF): Obtained via lumbar puncture under sterile conditions; patient positioned appropriately; local anesthesia applied; Pleural fluid: Thoracentesis performed with antiseptic technique; Peritoneal fluid: Paracentesis under sterile conditions; Pericardial fluid: Pericardiocentesis under ECG/ultrasound guidance
    • Medications to Avoid: No medications need to be stopped specifically for this test; if patient is on anticoagulation therapy, consult physician regarding continuation prior to invasive collection procedures; anti-TB medications can continue; inform laboratory of all current medications
    • Pre-Procedure Patient Instructions: Informed consent obtained; procedure risks and benefits explained; patient positioned comfortably; vital signs monitored; void before procedure if possible; aseptic technique maintained throughout; sterile specimen containers used; prompt transport to laboratory (within 2 hours for CSF, room temperature or refrigerated per protocol)
    • Post-Collection Requirements: Specimen label verification; proper storage conditions; rapid processing (within 4 hours optimal); patient monitoring post-procedure for complications; site care as per protocol; observation period in healthcare facility as needed; follow-up clinical assessment

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