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

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No Fasting Required

Details

PCR detection of TB vs NTM in pleural fluid.

₹2,664₹3,806

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

  • Why is it done?
    • Diagnosis of pleural tuberculosis: This test detects the presence of Mycobacterium tuberculosis (M.Tb) in pleural fluid, which is the fluid surrounding the lungs
    • Differentiation between M.Tb and Non-Tuberculous Mycobacteria (NTM): CBNAAT can distinguish between tuberculosis and other mycobacterial infections that may present similarly
    • Detection of rifampicin resistance: The test simultaneously identifies resistance to rifampicin, an essential first-line TB drug, aiding in treatment planning
    • Evaluation of pleural effusion: Performed when patients present with pleural effusion of unknown etiology, particularly in high TB prevalence areas
    • Rapid diagnostic confirmation: This test is ordered when tuberculosis pleuritis is clinically suspected and rapid microbiological confirmation is needed
    • Clinical circumstances: Patients presenting with chest pain, persistent cough, fever, night sweats, and imaging findings suggestive of pleural involvement
  • Normal Range
    • Negative Result: No M.Tb detected and no rifampicin resistance detected (MTB NOT DETECTED / RIF SUSCEPTIBLE or NOT DETECTED)
    • Positive Result (M.Tb Detected): M.Tb is present in the pleural fluid (MTB DETECTED)
    • Rifampicin Resistance: Rifampicin-resistant M.Tb is detected (MTB DETECTED / RIF RESISTANT)
    • Indeterminate Result: Test unable to produce a valid result; may need to be repeated or alternative testing considered (INVALID / NO RESULT)
    • Units of Measurement: Qualitative (present/absent or positive/negative); may include semi-quantitative grades (MINIMAL, MODERATE, HIGH) based on cycle threshold values
    • Interpretation: Negative = TB pleuritis ruled out (with high probability); Positive = TB pleuritis confirmed and rifampicin susceptibility status determined for treatment guidance
  • Interpretation
    • MTB NOT DETECTED (Negative): No tuberculosis organism found in pleural fluid. This does not completely rule out TB pleuritis but makes it less likely. Consider alternative diagnoses or additional confirmatory tests (mycobacterial culture, histopathology, immunological markers)
    • MTB DETECTED / RIF SUSCEPTIBLE (Positive Drug-Susceptible): M.Tb is present and sensitive to rifampicin. Standard first-line anti-TB therapy (isoniazid, rifampicin, pyrazinamide, ethambutol) should be initiated. Prognosis is generally favorable with appropriate treatment
    • MTB DETECTED / RIF RESISTANT (Positive Drug-Resistant): M.Tb is present and resistant to rifampicin, indicating multidrug-resistant TB (MDR-TB). Requires modified second-line drug regimens including fluoroquinolones and injectable agents. Requires specialist TB management and closer monitoring
    • Factors Affecting Results: Sample quality and volume, timing of specimen collection relative to treatment initiation, contamination, presence of inhibitory substances, and proper handling of specimen
    • Semi-Quantitative Grades: MINIMAL (HIGH Ct, >35): Very low bacterial load, may indicate early infection or low organism count; MODERATE (MEDIUM Ct, 25-35): Moderate bacterial load; HIGH (LOW Ct, <25): High bacterial load, indicates significant infection
    • Clinical Significance: CBNAAT is highly sensitive and specific (>95% sensitivity, >98% specificity for M.Tb detection); rapid turnaround time (2 hours) enables prompt diagnosis and early initiation of appropriate therapy; detection of rifampicin resistance has major implications for treatment regimen selection
  • Associated Organs
    • Primary Organ Systems: Respiratory system (lungs, pleural membranes); lymphatic system; mediastinal structures
    • Medical Conditions Associated with Abnormal Results: Tuberculosis pleuritis/pleural TB, disseminated tuberculosis, TB lymphadenitis with pleural involvement, tuberculous empyema
    • Diseases Diagnosed or Monitored: Pulmonary tuberculosis with pleural involvement, drug-susceptible TB (DS-TB), multidrug-resistant TB (MDR-TB), extensively drug-resistant TB (XDR-TB) when rifampicin resistance is detected
    • Potential Complications Associated with Positive Results: Progressive pleural infection, development of tuberculous empyema, pleural thickening and fibrosis, bronchial obstruction, respiratory compromise, systemic dissemination if untreated, organ damage from prolonged disease
    • Risk Factors for Positive Results: Immunosuppression (HIV/AIDS, immunosuppressive therapy), close contact with TB patients, high TB prevalence areas, malnutrition, alcoholism, diabetes mellitus, previous TB history
  • Follow-up Tests
    • If CBNAAT is Positive: Mycobacterial culture and drug sensitivity testing (DST) for confirmation and additional drug resistance patterns; line probe assay (LPA) for detection of other resistance markers; chest X-ray or CT thorax for assessment of lung involvement; sputum AFB microscopy and culture if pulmonary TB is suspected
    • If CBNAAT is Negative: Mycobacterial culture (gold standard but slower); pleural fluid adenosine deaminase (ADA) level; pleural biopsy with histopathology for caseating granulomas; sputum AFB microscopy and culture; molecular testing on sputum if available; tuberculin skin test (TST) or interferon-gamma release assay (IGRA) for TB exposure assessment
    • If MDR-TB is Detected (RIF Resistant): Extended drug sensitivity testing (DST) for isoniazid, fluoroquinolones, injectable drugs; line probe assay to determine XDR status; molecular testing for additional resistance markers (fluoroquinolone, bedaquiline, linezolid resistance); consultation with TB specialist
    • Complementary Diagnostic Tests: Pleural fluid analysis (protein, LDH, glucose, cell count and differential); pleural fluid adenosine deaminase (ADA) - highly suggestive of TB if >10 IU/L; imaging studies (chest X-ray, ultrasound, CT scan); immunological tests (IGRA testing); HIV testing in suspected cases
    • Monitoring During Treatment: Monthly clinical assessment and AFB microscopy/culture of sputum (if pulmonary involvement) to document conversion; repeat imaging at 2-3 months to assess treatment response; chest imaging at end of intensive phase; sputum examination at 5-6 months to confirm cure; mycobacterial culture conversion is main measure of treatment success
    • Monitoring Frequency: Monthly during first 6 months of treatment; then at completion of intensive phase (2 months); then at 3-month intervals until treatment completion; more frequent monitoring required for MDR-TB cases (every 4-8 weeks) due to prolonged and complex treatment regimens
  • Fasting Required?
    • Fasting Requirement: NO - Fasting is not required for this test
    • Special Preparation: This test requires pleural fluid sample obtained via thoracentesis (pleural aspiration); typically performed in hospital/clinic setting under aseptic conditions; no prior fasting or dietary restrictions needed
    • Pre-Procedure Instructions: Patient should empty bladder before procedure; can eat and drink normally before thoracentesis; inform physician of any medications, especially anticoagulants or antiplatelet agents; wear loose, easily removable clothing; arrive with recent chest X-ray if available
    • Medications to Avoid: Anticoagulants (warfarin, dabigatran) should be managed according to institutional protocols; antiplatelet drugs (aspirin, clopidogrel) may need to be held 3-5 days before procedure; discuss with physician; continue all other regular medications unless specifically instructed otherwise
    • Sample Collection Requirements: Minimum 5-10 mL of pleural fluid is required; sterile container without preservatives for CBNAAT; proper labeling with patient identification, collection date/time; sample processed immediately or refrigerated at 2-8°C if delay is unavoidable (not to exceed 24 hours)
    • Post-Procedure Care: Rest for a few hours after thoracentesis; keep puncture site clean and dry; can resume normal activities the next day if no complications; monitor for signs of pneumothorax, hemorrhage, or infection; seek medical attention if chest pain, shortness of breath, fever, or bleeding occurs

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