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AFB-M.Tb detection (M.Tb/NTM Detection) by CBNAAT BAL

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No Fasting Required

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Detects TB vs NTM in bronchoalveolar lavage fluid.

₹2,664₹3,806

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AFB-M.Tb Detection (M.Tb/NTM Detection) by CBNAAT BAL

  • Why is it done?
    • Detects Mycobacterium tuberculosis (M.Tb) and Non-Tuberculous Mycobacteria (NTM) in bronchoalveolar lavage (BAL) samples using CBNAAT (Cartridge Based Nucleic Acid Amplification Test) technology
    • Primary indication: Diagnosis of pulmonary and suspected pulmonary tuberculosis when sputum samples cannot be obtained or are inconclusive
    • Used in patients with persistent cough, fever, hemoptysis, and radiological findings suggestive of TB despite negative sputum smears
    • Identifies drug-resistant tuberculosis (MDR-TB) by detecting rifampicin resistance simultaneously
    • Differentiates between M.Tb and NTM infections to guide appropriate treatment decisions
    • Performed in immunocompromised patients (HIV/AIDS, immunosuppressive therapy) who may have atypical presentations
    • Used when rapid diagnosis is clinically necessary, especially in diagnostic uncertainty or acute respiratory conditions
  • Normal Range
    • Result Interpretation:
    • Negative (MTB NOT DETECTED): No M.Tb or NTM organisms detected in the BAL sample; normal/expected result indicating absence of TB infection
    • Positive (MTB DETECTED): M.Tb identified; indicates active tuberculosis infection requiring treatment initiation
    • Positive with Rifampicin Resistance Detected: Indicates MDR-TB or mono-resistant TB; requires second-line anti-TB drugs
    • Positive (NTM DETECTED): Non-tuberculous mycobacteria identified; may indicate NTM lung disease rather than TB
    • Invalid Result: Test failure due to technical issues; specimen may need to be recollected
    • Units: Qualitative results (Positive/Negative/Invalid) Sensitivity: 95-100% for M.Tb detection in BAL samples Specificity: 98-100% Rapidity: Results typically available within 2-2.5 hours
  • Interpretation
    • Positive Result (M.Tb Detected):
    • Confirms active pulmonary TB; patient has M.Tb in lower respiratory tract; initiate anti-TB therapy immediately
    • Rifampicin Susceptible: Start standard 4-drug TB regimen (HRZE: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol)
    • Rifampicin Resistant: Initiate MDR-TB treatment with second-line drugs (Fluoroquinolones, Bedaquiline, Linezolid, etc.); requires drug susceptibility testing confirmation
    • Negative Result (M.Tb Not Detected):
    • TB unlikely but not completely excluded (negative predictive value ~99%); consider alternative diagnoses
    • In high clinical suspicion cases, may repeat BAL or perform culture and other investigations
    • Positive Result (NTM Detected):
    • Suggests NTM lung disease; further species identification required to guide treatment; may represent contamination or colonization
    • Factors Affecting Results:
    • Sample quality: Adequate specimen with sufficient material from lower respiratory tract essential for accuracy
    • Specimen handling: Improper storage, contamination, or delayed processing may affect sensitivity
    • Immunosuppression: May reduce bacterial load; lower sensitivity in severely immunocompromised patients
    • Timing: Early disease or endobronchial TB may have lower bacillary load
    • Prior TB treatment: Prior anti-TB therapy may reduce bacterial detection
  • Associated Organs
    • Primary Organ Systems:
    • Respiratory System: Lungs, bronchi, broncchioles, alveoli; lower respiratory tract directly assessed
    • Diseases Diagnosed/Monitored:
    • Pulmonary Tuberculosis (drug-sensitive and drug-resistant): Primary indication for this test
    • Multi-Drug Resistant TB (MDR-TB): Detected by simultaneous rifampicin resistance identification
    • Non-Tuberculous Mycobacterial (NTM) Lung Disease: MAC (Mycobacterium avium complex), M. kansasii, M. marinum
    • TB in Immunocompromised Patients: HIV/AIDS with low CD4 count, patients on TNF-α inhibitors, organ transplant recipients
    • Endobronchial TB: TB involving bronchial mucosa; difficult to detect via sputum microscopy
    • Sputum-Smear Negative TB: Patients unable to produce sputum or with low bacillary burden
    • Associated Complications:
    • Delayed diagnosis of active TB leading to disease progression and transmission
    • Development of MDR-TB if drug-resistant strains treated with inappropriate therapy
    • Pulmonary fibrosis and chronic lung damage from untreated TB
    • Extrapulmonary TB dissemination if pulmonary disease not diagnosed early
    • Respiratory failure in severe pulmonary TB with extensive lung involvement
    • Bronchiectasis and chronic airway disease as sequelae
  • Follow-up Tests
    • If CBNAAT Positive (M.Tb Detected):
    • Drug Susceptibility Testing (DST): Confirm susceptibility to first-line and second-line drugs; essential for treatment selection
    • Mycobacterial Culture: Gold standard for confirmation; allows species identification and DST; takes 2-8 weeks
    • Line Probe Assay (LPA) or GenoType MTBDRplus: Rapid detection of MDR-TB mutations; results in 2 days
    • Chest X-ray or CT Thorax: Evaluate extent of pulmonary disease; assess for cavitary disease, bronchiectasis
    • HIV Testing: Essential in TB patients; CD4 count and viral load if HIV positive
    • Baseline Liver and Kidney Function Tests: Before initiating TB therapy; baseline sputum AFB for treatment monitoring
    • Baseline Hearing Assessment: If aminoglycosides (streptomycin/amikacin) planned for MDR-TB
    • If CBNAAT Negative (M.Tb Not Detected):
    • Repeat BAL with AFB Culture: If high clinical suspicion and diagnostic uncertainty persist
    • Sputum Induction: Attempt to collect sputum sample; obtain AFB smear, culture, and CBNAAT
    • Mycobacterial Culture of BAL: Establish definitive diagnosis; may detect slow-growing species
    • Additional Investigations: Bronchial biopsy if endobronchial TB suspected; fungal and bacterial cultures if alternative diagnoses likely
    • During TB Treatment Monitoring:
    • Repeat Sputum AFB Smear: At 2 weeks and 8 weeks of therapy; indicates treatment response (should become negative)
    • Clinical Assessment: Monthly evaluation for symptom resolution, weight gain, radiological improvement
    • Liver Function Tests: Monthly if on hepatotoxic drugs (INH, RIF, PZA); baseline and 4-6 weeks in HIV-TB coinfection
    • Repeat CXR: At end of intensive phase (2 months) and after completion of therapy for documentation of cure
  • Fasting Required?
    • No fasting required for CBNAAT BAL testing
    • Patient Preparation:
    • NPO (Nothing by Mouth) for 6-8 hours before bronchoscopy procedure to obtain BAL sample; prevents aspiration risk
    • Informed consent and procedural explanation; patient counseling on bronchoscopy risks and benefits
    • Pre-medication may be given: Anticholinergics (atropine) to reduce secretions; sedatives per protocol
    • Discontinue certain medications: Blood thinners (warfarin, aspirin, NSAIDs) 3-5 days before procedure; continue regular medications unless instructed otherwise
    • Local anesthetic and topical spray: Applied to throat during procedure; patient may feel numbness and temporary difficulty swallowing
    • Avoid smoking: Ideally 24 hours before procedure to reduce cough reflex and improve visualization
    • Loose comfortable clothing: Facilitates easy access and patient comfort during procedure
    • Post-procedure: Remain NPO for 1-2 hours after bronchoscopy until throat anesthesia wears off; no hot beverages immediately after

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