MODULE B
As soon as this is received at the Treatment Center, write “Mtb” for the February 7 and 8, 2007 specimens after putting a slash to separate this from the DSSM result. See how this is done on page 81, column 16 of the TB Symptomatics Masterlist.
5.4 Decide on the appropriate action in response to the culture results If a patient has at least one positive sputum culture for M. tuberculosis, this means that the MDR-TB suspect has confirmed pulmonary TB. •
If the culture is positive (10 or more colonies), the Culture Center will send the culture isolate to the DST center.
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If one sputum culture yields a count of < 10 colonies, the second sputum culture must also have a growth of at least < 10 colonies for the culture to be interpreted as positive. Between these two isolates with both < 10 colonies each, send the isolate with more colonies or more luxuriant growth to the DST Center while keeping the other one at the Culture Center.
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If one sputum culture has <10 colonies and the second culture has negative growth, DST will still be performed on the isolate with < 10 colonies as this is a diagnostic specimen. This is not done for follow-up specimens.
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If both culture results are negative or have no growth, no further test will be done.
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If culture result is negative and smear result is positive, refer to the consilium for further discussion and decision on management.
For screening and baseline specimens, the isolates are sent to the DST Center for DST. However, for follow-up specimens, the isolates are simply kept at the Culture Center unless otherwise requested for DST by the Treatment Center. When the patient with a positive culture calls the Treatment Center for the results, he should be informed that the culture was positive and that the result of the final stage of diagnostic testing will be available in the following weeks. The patient is advised to make a follow-up call 1-2 months after to find out the results of the DST and asked to come in for further examination. The Culture Center will send the isolates to the DST Center along with the other isolates for DST. All isolates are listed one by one on the Laboratory Receiving Form for Specimens. Tick the “Isolates” box; write down the names of the patients with positive culture results, indicate the laboratory numbers of the isolates. All isolates will be packed in a biobottle and prepared according to guidelines on proper packing and transportation of infectious materials. The person receiving the box signs the form and brings the box to the DST Center. The DST Center staff will carefully unpack the package in a safety hood and check the isolates against the Laboratory Receiving Form for Specimens. If there is no discrepancy, he affixes his initials and date on the form and files it. However, if there is a discrepancy, the DST Center will call the Culture Center and document their agreement on the form. He then files the form at the DST Center.
78 Detect Cases of MDR-TB
