Basics on Laboratory Diagnostic Tests for Active TB

Basics on Laboratory Diagnostic Tests for Active TB

Learner Guide


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


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


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?


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.”


3. List any additional quaaloestions or actions you will take based on the information

provided.


Learner Guide

Updated Results


4. Updated Results: What does this mean?


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


Learner Guide

Second slide:

When was culture conversion?


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:



2. What are the next steps?


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?


3. How long will it be until you have DST results?

Here are the DST results:





Learner Guide

FINAL RESULTS FROM CDC

Here are the final results:





Learner Guide

“EXTRA CREDIT” WHAT IF? Follow up discussion for groups with extra time:

What does this result mean? What are the next steps?



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



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



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)

Basics on Laboratory Diagnostic Tests for Active TB

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