Acid-fast (Mycobacteria) Smear and Culture With Reflex to Identification

CPT: 87116; 87206
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Test Details

Synonyms

  • Blood Mycobacteria Culture
  • Culture, Acid-Fast (Sputum, Tissue, Urine, and Gastric Contents)
  • Culture, Blood, Mycobacteria
  • Mycobacteria Culture (Sputum, Tissue, Urine, and Gastric Contents)

Test Includes

Specimen processing (ie, N-acetyl-L-cystine-sodium hydroxide treatment or equivalent, concentration, grinding, both or neither), mycobacterial culture, and smear when appropriate (smears are not performed on blood or when there is less than 2 mL of fluid). Identification by DNA probes or sequencing will be performed at an additional charge. This culture will often detect Nocardia species and other aerobic actinomyces, and identification appropriate for these organisms will be included.

Use

Isolate and identify mycobacteria

Limitations

Biopsy or body fluid: Transbronchial biopsy cultures may be of assistance in diagnosing tuberculosis in sputum smear-negative cases; however, sputum and bronchial washing cultures have a higher yield.1,2 In one study, only 2 out of 12 (16%) transbronchial biopsies were positive, and in those cases the biopsy was not the only source of culture-positive material.1

Mycobacterium marinum may cause a localized cutaneous lesion that may be nodular, verrucous, ulcerative, or sporotrichoid and which may rarely involve deeper structures. If it is suspected, the laboratory must be notified so that the culture may be incubated at an appropriate temperature (30°C).3Mycobacterium marinum infection occurs in patients who have been exposed to the organism following cutaneous abrasion or penetrating injury while cleaning aquariums, clearing barnacles, and with other aquatic exposures.

Likewise, there are two additional mycobacterial pathogens requiring special conditions for laboratory culture. Mycobacterium haemophilum, which causes a cutaneous, joint, or pulmonary infection in immunocompromised patients and lymphadenitis in children, requires special growth media and incubation temperature. Mycobacterium genavense has been recovered from disseminated infections in AIDS patients. It requires special acidulated media and extended incubation conditions. If either of these mycobacteria is suspected, the laboratory must be notified so that appropriate cultivation conditions can be initiated.

Sputum: Bronchial washings are frequently diluted with topical anesthetics and irrigating fluids, but bronchoscopy still provides a high yield of positive specimens. Postbronchoscopy expectorated specimens may provide a better yield of organisms than those obtained during the procedure. The yield of prebronchoscopy sputum was 75%, bronchial washings 66%, and postbronchoscopy sputum 58%. Bronchoscopy can, however, be an important adjunct to serial sputum collection in the definitive diagnosis of pulmonary infection due to mycobacteria.4,5 Gastric aspirates yield organisms in <50% of cases of M tuberculosis infection in children. Acid-fast stain of gastric aspirate has a sensitivity of 30% and provides a useful clinical diagnosis if positive.6

Urine: Positive acid-fast stained smears with low numbers of organisms are not diagnostic, because of the presence of Mycobacterium smegmatis in genital secretions of normal patients.

Stool: M avium complex is commonly isolated from the stool of patients with AIDS and may contribute to diarrheal disease, but other agents must also be ruled out. Stool is rarely the specimen of choice for the primary diagnosis of mycobacterial infection.

Methodology

Concentrated smears are stained with auramine/rhodamine and read by fluorescence microscopy. Broth-based and/or agar-based culture. Culture is held for six weeks before negative is reported. Organisms are identified by use of DNA probes and/or nucleic acid sequencing.

Additional Information

This test is set up in the LabCorp computer as a sequential series of tests to comply with customer needs and bill for testing that is performed. Smear, when appropriate, is a separate test along with appropriate specimen processing needed to perform the smear and culture. The culture portion of the test is also separate, and, once growth of acid-fast organisms (or other aerobic actinomycetales) is detected, the culture portion is reported and identification testing begins with DNA probes. The results of DNA probes will be reported whether positive or negative. If all DNA probes are negative, identification will proceed by DNA sequencing.

Biopsy or body fluid: Occult infections with nontuberculous mycobacteria, particularly Mycobacterium avium and Mycobacterium intracellulare, occur in patients with acquired immune deficiency syndrome (AIDS).7 In some institutions, the incidence of isolation of non-Mycobacterium tuberculosis species, specifically M avium complex, may exceed the rate of isolation of M tuberculosis. Mycobacteria have been recovered from culture of Kaposi sarcoma and bone marrow specimens in which the characteristic granulomatous reaction has been absent.8,9 Optimal isolation of mycobacteria from tissue is accomplished by processing as much tissue as possible for culture. Swabs should not be submitted.

Tuberculous spondylitis represents 50% to 60% of all cases of skeletal tuberculosis. It is seen in children in developing countries and adults older than 50 years of age in the United States and Europe. Frequently, several vertebrae are involved and adjacent psoas muscle abscesses or paravertebral abscesses are not uncommon ("cold abscesses"). Colony counts obtained from bone biopsies are low; however, >90% are culture positive. The diagnosis of vertebral tuberculosis should be considered in all cases of unexplained spondylitis.

Cases of sternal wound infection, early prosthetic valve endocarditis, infections complicating mammary augmentation surgery, and other cutaneous/subcutaneous infections have been attributed to rapidly growing mycobacteria.10,11M fortuitum is the most commonly implicated Mycobacterium in these infections, which are thought to be caused by local environmental strains rather than contaminated commercial surgical materials or devices. Rapidly growing mycobacteria often grow on routine bacterial culture media within the time allotted to incubating routine bacterial cultures. Such organisms may be misidentified as "diphtheroids" and disregarded as contaminants.

Pleural effusions frequently yield positive cultures in cases of pulmonary tuberculosis. The diagnosis of peritoneal tuberculosis is difficult and is usually made at laparotomy or after a considerable delay. Tuberculosis should be considered in any patient with ascitic fluid and chronic abdominal pain.12 Peritoneal tuberculosis accounted for 11% of a series of cases of extrapulmonary tuberculosis reported by Alvarez and McCabe.13

Pericardial tuberculosis accounts for <5% of extrapulmonary tuberculosis and frequently requires biopsy for diagnosis. See table.

Predisposing Clinical Conditions and Site of Involvement of Non-M tuberculosis Mycobacterial Infections

Site

Predisposing Clinical Conditions

Species

Disseminated

Immunodeficiency/malignancy

M avium complex

M kansasii

Gastrointestinal tract/disseminated

Acquired immunodeficiency syndrome

M avium complex

Lung

Chronic pulmonary disease

M avium complex

M kansasii

Lymph nodes

Pediatric age group

M avium complex

M scrofulaceum

Peritonitis

Chronic ambulatory peritoneal dialysis

M fortuitum

M chelonae

Skeleton

Immunodeficiency/malignancy

M avium complex

M kansasii

Skin and soft tissue

Percutaneous trauma/abrasion

M fortuitum

M chelonae

Immunodeficiency/malignancy

M haemophilum

Sputum: Tuberculosis decreased in incidence in the United States in the 1970s and 1980s, but the incidence of tuberculosis in the United States increased from 1986-1994. High-incidence populations exist in depressed inner city areas, some rural areas, amongst new immigrants, in prison inmates, and in HIV-positive patients. The emergence of M tuberculosis and M avium complex infections complicating the acquired immunodeficiency syndrome was striking. When tuberculosis occurs as a first or case-defining opportunistic infection, 75% to 100% of patients of HIV-positive patients have pulmonary disease. After the diagnosis of AIDS has been made, 25% to 70% of HIV-associated tuberculosis patients have an extrapulmonary site of infection.14

In an ambulatory inner city population, two specimens processed for acid-fast stain and culture identified all cases of active tuberculosis within the time required for culture. The most infectious cases were identified immediately by the acid-fast stain. Tuberculin tests and chest x-rays were also performed but did not significantly increase the number of cases identified in this population.15

M kansasii is uncommon as an environmental contaminant. Implication of M avium complex as a pathogen usually requires at least one of the following criteria:

• Clinical evidence of a disease process that can be explained by nontuberculous mycobacterial infection

• Repeated isolation of the same mycobacterial species from sputum over a period of weeks to months

• Exclusion of other possible etiologies

• Biopsy demonstrating acid-fast bacilli or diagnostic histopathologic changes16

Endobronchial tuberculosis has been increasingly recognized because of its incidence in association with the acquired immunodeficiency syndrome and because it may mimic carcinoma.17,18

Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis has been noted to occur from patient to patient and from patient to health care worker. Acid-fast bacilli isolation precautions and adherence to appropriate infection control procedures are recommended until at least three smears from specimens collected on different days are negative.19,20

While M tuberculosis is contagious and is usually transmitted from person to person, most of the other disease-causing mycobacteria are not characterized by person-to-person spread, are found in the environment, and are considered opportunistic pathogens. They may be called potentially pathogenic environmental (PPE) mycobacteria. They include M avium, M intracellulare, M asiaticum, M flavescens M fortuitum complex, M haemophilum, M kansasii, M malmoense, M marinum, M scrofulaceum, M simiae, M genavense, and M xenopi. They are correlated with HIV.16,21

Urine: Although it has been thought that tuberculosis of the urinary tract should be suspected when hematuria and pyuria (sterile pyuria) occur without recovery by routine culture of usual urinary tract pathogens, concomitant infections with ordinary pathogens are not rare. Mycobacteria cultures of the urine are approximately 90% sensitive. The kidney is the most frequent site of infection; prostate, salpinx, and endometrial involvement also occurs. Continuing tuberculous bacilluria may cause cystitis with frequency. Genitourinary infections with PPE mycobacteria, particularly M kansasii and M avium complex, occur.16 Recovery of M bovis BCG from the urine of patients undergoing BCG treatment for bladder cancer can be expected.

Stool: The increasing recognition of mycobacterial infections in patients with the acquired immunodeficiency syndrome (AIDS) has resulted in increased awareness of the potential to recover clinically significant mycobacteria from stool. Seven of 132 AIDS patients studied for intestinal infection were found to harbor M avium complex.22 Isolation of mycobacteria from stool indicates disseminated disease, and cultures from blood, bone marrow, and lymph nodes are usually also positive for the same mycobacterial isolate.23

Specimen Requirements

Specimen

First morning sputum (not saliva) (three separate specimens from three separate days are recommended), fasting gastric aspirate, induced sputum, whole blood, tissue, biopsy, bronchial aspirate, urine, skin, cerebrospinal fluid (CSF), bone marrow, body fluid, stool. Swabs of exudate from skin sources are acceptable, otherwise swab specimens should not be submitted. Collect aspirate using sterile, nonbacteriostatic saline or other noninhibitory medium. Do not send syringe; it will be rejected.

Volume

5 mL sputum or respiratory aspirate, 10 mL whole blood, 2 cm³ tissue, 5 mL CSF, 5 cc bone marrow (or as much as possible), 50 mL body fluid (eg, gastric aspirate/lavage, urine, pleural, pericardial, chronic peritoneal dialysate), 10 mL stool, biopsy of skin

Container

Sterile container with tight screw-cap seal or green-top (sodium heparin) tube or Isolator™

Storage Instructions

Refrigerate. If sample is to be split for other tests, specimen should be divided at the time of collection so that each portion is transported at the appropriate temperature.

Causes for Rejection

Inadequate quantity of specimen, including swab specimen without visible evidence of tissue present; specimen received in expired transport media or inappropriate transport device; specimen received after prolonged delay (usually >72 hours); specimen received after leaking out of transport container into the specimen bag (trach-suction devices will often leak if the cap with tubing is not removed and replaced by a solid cap); syringe with attached needle; unlabeled specimen or name discrepancy between specimen and request label; lithium heparin tube

Clinical Information

Footnotes

1. Stenson W, Aranda C, Bevelaqua FA. Transbronchial biopsy culture in pulmonary tuberculosis. Chest. 1983 Jun; 83(6):883-884. 6406164
2. Jett JR, Cortese DA, Dines DE. The value of bronchoscopy in the diagnosis of mycobacterial disease. A five-year experience. Chest. 1981 Nov; 80(5):575-578. 6794991
3. Brown JW 3rd, Sanders CV. Mycobacterium marinum infections. A problem of recognition, not therapy? Arch Intern Med. 1987 May; 147(5):817-818. 3579434
4. Stager CE, Libonati JP, Siddigi SH, et al. Role of solid media when used in conjunction with the BACTEC system for mycobacterial isolation and identification. J Clin Microbiol. 1991 Jan; 29(1):154-157. 1899678
5. Kolk AH, Schuitema AR, Kuijper S, et al. Detection of Mycobacterium tuberculosis in clinical samples by using polymerase chain reaction and a nonradioactive detection system. J Clin Microbiol. 1992 Oct; 30(10):2567-2575. 1400955
6. Klotz SA, Penn RL. Acid-fast staining of urine and gastric contents is an excellent indicator of mycobacterial disease. Am Rev Respir Dis. 1987 Nov; 136(5):1197-1198. 2445232
7. Hawkins CC, Gold JW, Whimbey E, et al. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1986 Aug; 105(2):184-188. 3729201
8. Cohen RJ, Samoszuk MK, Busch D, Lagios M. Occult infections with M intracellulare in bone-marrow biopsy specimens from patients with AIDS. N Engl J Med. 1983 Jun 16; 308(24):1475-1476. 6190082
9. Croxson TS, Ebanks D, Mildvan D. Atypical mycobacteria and Kaposi's sarcoma in the same biopsy specimens. N Engl J Med. 1983 Jun 16; 308(24):1476. 6855818
10. Wallace RJ, Musser JM, Hull SI, et al. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery. J Infect Dis. 1989 Apr; 159(4):708-716. 2926161
11. Wallace RJ Jr, Steele LC, Labidi A, Silcox VA. Heterogeneity among isolates of rapidly growing mycobacteria responsible for infections following augmentation mammaplasty despite case clustering in Texas and other southern coastal states. J Infect Dis. 1989 Aug; 160(2):281-288. 2760484
12. Martin RE, Bradsher RW. Elusive diagnosis of tuberculosis peritonitis. South Med J. 1986 Sep; 79(9):1076-1079. 3092366
13. Alvarez S, McCabe WR. Extrapulmonary tuberculosis revisited: A review of experience at Boston City and other hospitals. Medicine (Baltimore). 1984 Jan; 63(1):25-55 (review). 6419006
14. Chaisson RE, Slutkin G. Tuberculosis and human immunodeficiency virus infection. J Infect Dis. 1989 Jan; 159(1):96-100. 2642524
15. Tenover FC, Crawford JT, Huebner RE, Geiter LJ, Horsburgh CR Jr, Good RC. The resurgence of tuberculosis: Is your laboratory ready? J Clin Microbiol. 1993 Apr; 31(4):767-770. 8463384
16. Wayne LG, Sramek HA. Agents of newly recognized or infrequently encountered mycobacterial diseases. Clin Microbiol Rev. 1992 Jan; 5(1):1-25. 1735092
17. Smith LS, Schillaci RF, Sarlin RF. Endobronchial tuberculosis. Serial fiberoptic bronchoscopy and natural history. Chest. 1987 May; 91(5):644-647. 3105965
18. Maguire GP, Delorenzo LJ, Brown RB, Davidian MM. Endobronchial tuberculosis simulating bronchogenic carcinoma in a patient with the acquired immunodeficiency syndrome. Am J Med Sci. 1987 Jul; 294(1):42-44. 3605189
19. Pearson ML, Jereb JA, Frieden TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers. Ann Intern Med. 1992; 117(3):191-196. 1352093
20. Iseman MD. A leap of faith. What can we do to curtail intrainstitutional transmission of tuberculosis? Ann Intern Med. 1992 Aug 1; 117(3):251-253. 1616220
21. Böttger EC, Teske A, Kirschner P, et al. Disseminated "Mycobacterium genavense" infection in patients with AIDS.Lancet. 1992 Jul 11; 340(8811):76-80. 1352014
22. René E, Marche C, Regnier B, et al. Intestinal infections in patients with acquired immunodeficiency syndrome. A prospective study in 132 patients. Dig Dis Sci. 1989 May; 34(5):773-780. 2714152
23. Wolinsky E. Mycobacterial diseases other than tuberculosis. Clin Infect Dis. 1992 Jul; 15(1):1-10. 1617048

References

Addison NV. Abdominal tuberculosis—A disease revived. Ann R Coll Surg Engl. 1983 Mar; 65(2):105-111. 6338801
Alvarez SZ, Carpio R. Hepatobiliary tuberculosis. Dig Dis Sci. 1983 Mar; 28(3):193-200. 6825541
Beck-Sagué C, Dooley SW, Hutton MD, et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA. 1992 Sep 9; 268(10):1280-1286. 1507374
Claydon EJ, Coker RJ, Harris JRW. Mycobacterium malmoense infection in HIV positive patients. J Infect. 1991 Sep; 23(2):191-194. 1753120
Des Prez RM, Heim CR. Mycobacterium tuberculosis. In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases. 3rd ed. New York, NY: Churchill Livingstone;1990:chap 229, 1877-1906.
Gradon JD, Timpone JG, Schnittman SM. Emergence of unusual opportunistic pathogens in AIDS: A review. Clin Infect Dis. 1992 Jul; 15(1):134-157. 1617054
Griffith DE. Environmental mycobacteria. An increasing problem. Hosp Pract (Off Ed). 1988 May 15; 23(5):125-130,132,137. 3131352
Mehta JB, Morris F. Impact of HIV infection on mycobacterial disease. Am Fam Physician. 1992 May; 45(5):2203-2211. 1575115
Musial CE, Roberts GD. Rapid detection and identification procedures for acid-fast organisms. Clin Microbiol Newslet. 1987 Jun 15; 9(12):89-96.
Pitchenik AE. Tuberculosis control and AIDS epidemic in developing countries. Ann Intern Med. 1990 Jul 15; 113(2):89-91. 2360757
Woods GL, Washington JA 2nd. Mycobacteria other than Mycobacterium tuberculosis: Review of microbiologic and clinical aspects. Rev Infect Dis. 1987 Mar-Apr; 9(2):275-294. 3296098
Yajko DM, Nassos PS, Sanders CA, et al. Comparison of four decontamination methods for recovery of Mycobacterium avium complex from stools. J Clin Microbiol. 1993 Feb; 31(2):302-306. 8432816

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
183753 Acid Fast Smear+Culture 008619 AFB Specimen Processing 8100-0
183753 Acid Fast Smear+Culture 008620 Acid Fast Smear 11545-1
183753 Acid Fast Smear+Culture 182405 Acid Fast Culture 50941-4
Reflex Table for AFB Specimen Processing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183153 Straight Inoculation, No Smear 183153 Straight Inoculation, No Smear N/A
Reflex Table for AFB Specimen Processing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183155 Tissue Grinding 183155 Tissue Grinding N/A
Reflex Table for AFB Specimen Processing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183156 Concentration 183156 Concentration N/A
Reflex Table for AFB Specimen Processing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183157 Tissue Grind/Digestion/Decon 183157 Tissue Grind/Digestion/Decon N/A
Reflex Table for Acid Fast Smear
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 008692 Internal QC AFB Smear Pos 008692 Internal QC AFB Smear Pos N/A
Reflex Table for Acid Fast Smear
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 008692 Internal QC AFB Smear Pos 008692 Internal QC AFB Smear Pos N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 008695 AFB Organism ID by DNA Probe N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183712 M tuberculosis complex 17296-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183713 M avium complex 5022-9
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183716 M kansasii 5026-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183715 M gordonae 5024-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182866 000000 38347-1 008392
Reflex 3 000000 008393 000000 38347-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 182834 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 182831 000000 40699-1 RSLT05
Reflex 4 000000 RSLT05 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998535 000000 12-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998536 000000 185-9
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998528 000000 189-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998529 000000 241-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998530 000000 29254-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998531 000000 31037-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998532 000000 428-3
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 998533 000000 460-6
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 182833 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182835
Reflex 3 000000 183734 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 182861 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 182858 000000 N/A RSLT05
Reflex 4 000000 RSLT05 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998537 000000 12-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998538 000000 20-8
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998539 000000 141-2
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998540 000000 185-9
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998541 000000 189-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998543 000000 279-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998544 000000 29254-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998545 000000 335-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998547 000000 508-2
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 998546 000000 516-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 182860 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182859
Reflex 3 000000 183735 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182578 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182575 000000 9825-1 RSLT05
Reflex 4 000000 RSLT05 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 998513 000000 48177-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 998514 000000 25217-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 998515 000000 25202-3
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 998516 000000 25194-2
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 998517 000000 25229-6
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182577 000000 N/A 182691
Reflex 4 000000 182692 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182577 000000 N/A 182691
Reflex 4 000000 998522 000000 25205-6
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182577 000000 N/A 182691
Reflex 4 000000 998523 000000 25206-4
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182577 000000 N/A 182691
Reflex 4 000000 998519 000000 25218-9
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182577 000000 N/A 182691
Reflex 4 000000 998521 000000 25219-7
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182577 000000 N/A 182691
Reflex 4 000000 998525 000000 25202-3
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 182577 000000 N/A 182691
Reflex 4 000000 998636 000000 25194-2
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182579
Reflex 3 000000 183733 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 182841 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 182839 000000 N/A RSLT05
Reflex 4 000000 RSLT05 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 998549 000000 12-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 998550 000000 189-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 998551 000000 241-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 998552 000000 335-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 998553 000000 428-3
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 998554 000000 516-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 182860 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182842
Reflex 3 000000 183736 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 182918 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 182916 000000 40699-1 RSLT05
Reflex 4 000000 RSLT05 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998565 000000 12-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998558 000000 116-4
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998566 000000 185-9
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998560 000000 189-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998211 000000 225-3
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998561 000000 279-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998562 000000 29254-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998212 000000 335-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998210 000000 31037-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998213 000000 42355-8
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998564 000000 508-2
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 998563 000000 516-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 182862 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182917
Reflex 3 000000 183639 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 182926 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 182924 000000 40699-1 RSLT05
Reflex 4 000000 RSLT05 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998568 000000 12-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998569 000000 185-9
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998570 000000 189-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998571 000000 241-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998572 000000 29254-0
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998573 000000 31037-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998574 000000 428-3
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998576 000000 460-6
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 998577 000000 516-5
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 182833 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182867 000000 N/A 182925
Reflex 3 000000 183659 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 183724 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 182866 000000 38347-1 008392
Reflex 3 000000 008393 000000 38347-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183714 Other: 43854-9
Reflex 2 000000 183724 000000 N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183755 AFB ID by DNA Probe 183722 DNA Probe ID Tracking N/A
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183757 Organism ID by Sequencing 182866 Organism ID by Sequencing 38347-1
Reflex 2 000000 008393 000000 38347-1
Reflex Table for Acid Fast Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 183757 Organism ID by Sequencing 183724 Sequencing ID Tracking N/A

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf