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AFB Rapid Culture by MGIT - Urine

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Culture for TB bacilli in urine samples.

₹1,169₹1,670

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AFB Rapid Culture by MGIT - Urine

  • Why is it done?
    • Detects and identifies Mycobacterium tuberculosis (MTB) and other acid-fast bacilli (AFB) in urine specimens using liquid culture media (MGIT - Mycobacterium Growth Indicator Tube)
    • Diagnoses urogenital tuberculosis (TB of kidneys, bladder, and urinary tract), which is an extrapulmonary form of tuberculosis
    • Confirms active TB infection when symptoms suggest urinary involvement (dysuria, hematuria, frequency, pyuria without bacterial growth)
    • Provides rapid detection (typically 2-3 weeks) compared to conventional solid culture methods (4-8 weeks)
    • Ordered when patients present with symptoms of TB such as fever, constitutional symptoms, or when pulmonary TB diagnosis has already been established and extrapulmonary involvement is suspected
    • Used for surveillance, monitoring, and drug susceptibility testing in confirmed TB cases
  • Normal Range
    • Result: NEGATIVE (No growth detected)
    • Normal Value: Absence of Mycobacterium tuberculosis and other pathogenic acid-fast bacilli in urine culture
    • Interpretation of Negative Result: Indicates either absence of TB infection in the urinary tract or successful anti-tuberculous treatment response; rules out active urogenital tuberculosis
    • Result: POSITIVE (Growth detected)
    • Abnormal Value: Presence of MTB or other clinically significant acid-fast bacilli in urine specimen
    • Interpretation of Positive Result: Confirms active urogenital tuberculosis; indicates TB infection in kidneys, bladder, or other urinary tract structures; requires immediate initiation or continuation of anti-tuberculous therapy
    • Units: Colony-forming units (CFU) may be reported when quantification is performed; typically reported as Negative or Positive with species identification
    • Specimen Status: May be reported as Contaminated or Insufficient if collection or processing was inadequate
  • Interpretation
    • Negative Result Interpretation:
    • No growth of MTB or AFB detected in the urine culture; may indicate: (1) Absence of urogenital TB; (2) Early stage infection before organisms appear in urine; (3) Adequate response to anti-tuberculous therapy; (4) Non-TB causes of urinary symptoms
    • Positive Result Interpretation:
    • Confirms active TB infection in urinary system; organism identification (usually Mycobacterium tuberculosis) is diagnostic for urogenital tuberculosis; indicates need for complete anti-tuberculous therapy regimen; patient is potentially infectious and should be isolated appropriately
    • Time to Positivity (TTP):
    • MGIT reports the number of days to detection (typically 2-3 weeks); earlier detection suggests higher bacterial load; May have prognostic implications and help guide severity assessment
    • Contamination/Insufficient Result:
    • Specimen must be recollected using proper clean-catch or straight catheterization technique; inadequate volume or improper collection method requires repeat testing
    • Factors Affecting Results:
    • Specimen quality and volume (minimum 40-50 mL urine recommended); Improper collection technique or contamination; Prior anti-tuberculous therapy may reduce organism detection; Number of early morning voided samples (typically 5-6 consecutive samples increase diagnostic yield); Stage of disease progression
    • Clinical Significance:
    • Single positive culture is sufficient to diagnose TB; Additional drug susceptibility testing is performed on positive cultures to guide therapy selection; Repeat cultures may be obtained to monitor treatment response (negative conversion indicates therapeutic efficacy); Species identification (M. tuberculosis vs. non-tuberculous mycobacteria) is clinically critical
  • Associated Organs
    • Primary Organ Systems Involved:
    • Kidneys (renal tuberculosis - most common site); Bladder (vesical TB); Ureters; Urethra; Prostate gland (male); Genital tract (female) including fallopian tubes and endometrium
    • Medical Conditions Associated with Abnormal Results:
    • Urogenital Tuberculosis (primary diagnosis); Renal TB with progressive parenchymal destruction; Ureteric strictures and obstruction; Bladder fibrosis and contracture; Sterile pyuria (pyuria without bacterial growth on routine culture); Hematuria with negative bacterial cultures; Chronic urinary tract infections resistant to standard antibiotics
    • Associated Extrapulmonary TB Manifestations:
    • Disseminated tuberculosis; TB meningitis; Abdominal TB; Spinal TB; TB lymphadenitis
    • Potential Complications from Positive Results:
    • Progressive renal failure and chronic kidney disease if untreated; Ureteric strictures leading to hydronephrosis and obstruction; Bladder contracture with reduced capacity; Infertility from involvement of reproductive organs; Secondary bacterial superinfection; Sepsis and systemic complications; Drug-resistant TB requiring prolonged and more complex therapy; Renal scarring with permanent loss of function
    • Risk Factors for Urogenital TB:
    • Previous pulmonary TB; Immunocompromised states (HIV/AIDS); Diabetes mellitus; Chronic kidney disease; Malnutrition; Alcoholism; Prolonged corticosteroid use; Living in endemic TB areas
  • Follow-up Tests
    • If Culture is Positive:
    • Drug Susceptibility Testing (DST): Phenotypic DST or Genotypic DST (GeneXpert MTB/RIF) to determine resistance pattern to first-line drugs (isoniazid, rifampicin) and second-line drugs; Essential for guiding appropriate anti-tuberculous therapy
    • Imaging Studies: High-resolution CT or MRI of abdomen/pelvis to assess renal parenchymal damage, ureteric involvement, bladder fibrosis, and extent of disease; Plain pelvic radiography or urography to evaluate structural changes
    • Renal Function Tests: Serum creatinine, BUN, and eGFR to assess baseline renal function and monitor for progression of renal damage
    • Urinalysis: Repeat urinalysis to assess pyuria, hematuria, and bacteriuria changes during treatment
    • Chest X-ray: To rule out concurrent pulmonary TB or assess extent of systemic disease
    • AFB Smear Microscopy: Routine AFB smear from urine specimens for immediate detection confirmation while awaiting culture results
    • If Culture is Negative (with high clinical suspicion):
    • Repeat AFB Culture: Multiple sequential early morning urine cultures (typically 5-6 samples over 2 weeks) increase diagnostic yield; single negative culture does not exclude TB
    • GeneXpert MTB/RIF (Xpert MTB/RIF): Rapid molecular test on urine for MTB detection and rifampicin resistance; higher sensitivity than culture in early disease
    • TB Interferon-Gamma Release Assays (IGRAs): QuantiFERON-Gold or T-SPOT to assess TB infection status if diagnosis remains uncertain
    • Treatment Monitoring:
    • Follow-up Urine Cultures: At 2-4 weeks after initiating therapy to document negative conversion; typically repeated monthly or at specific intervals to confirm treatment efficacy
    • Clinical and Laboratory Monitoring: Monthly assessment for drug side effects; periodic renal function tests (creatinine, eGFR); Liver function tests (for hepatotoxic anti-TB drugs)
    • Follow-up Imaging: Repeat imaging at 3-6 months to assess response and document resolution of structural abnormalities
    • Complementary Tests:
    • Sputum AFB Culture and Smear: If pulmonary TB coexistence is suspected; HIV testing for patients with TB; Histopathology from cystoscopy/biopsy if bladder involvement is suspected and diagnosis remains unclear
  • Fasting Required?
    • Fasting Required: NO
    • Specimen Collection Requirements:
    • Early morning first-void urine (early morning midstream clean-catch specimen) is preferred; Minimum volume of 40-50 mL urine required per specimen
    • Collection Method (Clean-Catch Technique):
    • Wash hands thoroughly with soap and water; Cleanse genital area with sterile gauze or wipes from front to back (females) or retract foreskin and cleanse glans (males); Void initial portion of urine into toilet; Collect midstream portion into sterile, wide-mouthed, screw-capped container; Cap container securely
    • Alternative Collection Methods:
    • Straight catheterization (aseptic technique): May be required if clean-catch is not feasible; Catheterized specimen avoids urethral contamination and improves diagnostic accuracy
    • Specimen Handling and Storage:
    • Transport to laboratory promptly (within 2-4 hours if possible); If transport is delayed, refrigerate at 2-8°C but do not freeze; Label specimen clearly with patient name, date, time, and specimen type
    • Medications and Preparations:
    • No medications need to be withheld; Patients should not use vaginal douches, urinary antiseptics, or antimicrobial agents 24 hours prior to collection; Avoid routine antiseptic urinal/toilet cleaners on collection day if possible
    • Number of Samples:
    • For optimal diagnostic yield, 5-6 consecutive early morning urine samples collected over 2 weeks are recommended; Single specimen may miss diagnosis; Multiple samples increase sensitivity to 90-95%
    • Patient Instructions:
    • No fasting or dietary restrictions are necessary; Maintain normal daily fluid intake; Collect specimen immediately upon waking and before any micturition; Ensure adequate personal hygiene prior to collection; Follow written collection instructions provided with collection kit

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