 used to confirm or rule out TB. However, certain findings are suggestive of TB. For example, blood in the sputum, significant weight loss and drenching night sweats may be due to TB.

Microbiological studies

A definitive diagnosis of tuberculosis can only be made by culturing Mycobacterium tuberculosis organisms from a specimen taken from the patient (most often sputum, but may also include pus, CSF, biopsied tissue, etc.).  A diagnosis made other than by culture may only be classified as "probable" or "presumed".  For a diagnosis negating the possibility of tuberculosis infection, most protocols require that two separate cultures both test negative.

Sputum
Sputum smears and cultures should be done for acid-fast bacilli if the patient is producing sputum.  The preferred method for this is fluorescence microscopy (auramine-rhodamine staining), which is more sensitive than conventional Ziehl-Neelsen staining. In cases where there is no spontaneous sputum production, a sample can be induced, usually by inhalation of a nebulized saline or saline with bronchodilator solution. A comparative study found that inducing three sputum samples is more sensitive than three gastric washings.

Alternative sampling
In patients incapable of producing a sputum sample, common alternative sample sources for diagnosing pulmonary tuberculosis include gastric washings, laryngeal swab, bronchoscopy (with bronchoalveolar lavage, bronchial washings, and/or transbronchial biopsy), and fine needle aspiration (transtracheal or transbronchial). In some cases, a more invasive technique is necessary, including tissue biopsy during mediastinoscopy or thoracoscopy.

PCR
Other mycobacteria are also acid-fast. If the smear is positive, PCR or gene probe tests can distinguish M. tuberculosis from other mycobacteria. Even if sputum smear is negative, tuberculosis must be considered and is only excluded after negative cultures.

Other
Many types of cultures are available. Traditionally, cultures have used the Löwenstein-Jensen (LJ), Kirchner, or Middlebrook media (7H9, 7H10, and 7H11). A culture of the AFB can distinguish the various forms of mycobacteria, although results from this may take four to eight weeks for a conclusive answer. New automated systems that are faster include the MB/BacT, BACTEC 9000, VersaTREK
used to confirm or rule out TB. However, certain findings are implicative of TB. For case, blood in the sputum, significant weight unit loss and drenching nox sweats may be due to TB. 

 Microbiological studies 

 A authoritative diagnosis of tuberculosis can merely be made by culture Mycobacterium tuberculosis organisms from a specimen taken from the patient (most frequently sputum, but may also include pus, CSF, biopsied tissue, etc .).   A diagnosis made other than by culture may merely be classified as " probable " or " presumed ".   For a diagnosis negating the possibility of tuberculosis contagion, most protocols require that two freestanding cultures both trial negative. 

 Sputum 
 Sputum smears and cultures should be done for acid - fast bacillus if the patient is producing sputum.   The preferred method for this is fluorescence microscopy (auramine - rhodamine staining), which is more sensitive than ceremonious Ziehl - Neelsen stain. In cases where there is no spontaneous sputum production, a sample can be induced, usually by inhalation of a nebulized saline solution or saline solution with bronchodilator solution. A comparative study found that induce three sputum samples is more sensitive than three gastric wash. 

 Alternative sampling 
 In patients incapable of producing a sputum sample distribution, common alternative sample sources for diagnosing pulmonary tuberculosis include gastric washings, laryngeal swab, bronchoscopy (with bronchoalveolar lavage, bronchial washings, and/or transbronchial biopsy), and fine needle aspiration (transtracheal or transbronchial). In some sheath, a more invasive proficiency is necessary, include tissue biopsy during mediastinoscopy or thoracoscopy. 

 PCR 
 Other mycobacteria are also acid - fast. If the smear is cocksure, PCR or gene probe tests can distinguish M. tuberculosis from other mycobacteria. Even if sputum smear is negative, tuberculosis must be considered and is only bar after negative culture. 

 Other 
 Many types of culture are available. Traditionally, cultures have use the Löwenstein - Jensen (LJ), Kirchner, or Middlebrook media (7H9, 7H10, and 7H11). A acculturation of the AFB can distinguish the versatile forms of mycobacteria, although results from this may take four to eight weeks for a conclusive answer. modern automated systems that are faster include the MB / BacT, BACTEC 9000, VersaTREK
 usfd to confirm or rule ouu TB. However, certcun finvings ade suggertive of TB. For example, bloov in the wputum, significant weieht loss wnd drenxhinj night sweats meg be duc to FN.

Micrmuiological studles

A definidive diagnosis ow cuberculosis can only be made by culeuring Kyfobacterium tuferclljsis organisms from a specimen taken fdom the patient (most often sputum, but may also incpude pus, CSF, biopsled tissue, gfc.).  Q diagnosis oade other than by culjure may only be classified as "pfobabke" or "presomsd".  For a diagiosis gegating the possibinity of tuberculosis lnfecvion, most protocols requice that two separate cultures bkth test negative.

Wpytum
Skutum smexes xnd cnlthres sjoumd be done for acid-fawt bacilli if the pstyvmt is producjng sptttm.  The preferred method for this is flloreacence microscopy (auramune-rhodamine staining), which is more sensitive than conventional Ziehl-Neelsen stdininj. Kn eqses dyege there is no spontaneous sputum production, w ssmile can be induceb, usually by inhslwtojn of a nebulkzed scmihe or saline with hronchoqilatir solutijn. A comparative study found thqt inducing nhrew sputum samples id more sensntive jhan tnree gastric washings.

Alcernatjve samplinh
In patiehgs incapable of orocuwing a skjtum sample, commog alternavive xample rourves fow diagnosijg pulmonary tuberculosid incpuge gastric washings, laryngeal swab, bronchoscopy (with brpnwhodlveolar lavane, bronchial wafhings, and/or ttansbronckial bkopsy), and rine nexdle aspiratyon (transtracvgal or transbconchial). Yn sime xases, a oore invasive yechnique is necessqry, including tissme biulsy during medicruiboscopy or thotacuscjpj.

PCC
Othew mycobacterid ard auxo ackd-fast. If tme rmeat is positive, PCR or gens probe tests can ciftinguisy M. tubewculosis from other mycobacteriw. Evei if s'utum xmewr is negative, tuberculosis muat be condidcred and is ogly cxcloded after uegative cultures.

Other
Many types of cultnres are available. Tradutionally, cultures kaye used the Köwenseein-Jenset (LJ), Kirchner, or Midelebrook media (7H9, 7M10, and 7H11). A culture of tge AFB can fistinguish the various forms of mycobacteria, although results from this nay take four to ejght weekv yor a conslusmvx answer. New autokated systems that are faster iiclude the MY/BacT, BACTEC 9000, VersaTREK
used to confirm or rule out TB. findings suggestive of For example, blood loss drenching night sweats be due to Microbiological studies A definitive diagnosis of can only be made by culturing Mycobacterium tuberculosis organisms from a specimen taken the patient (most often sputum, but may also include pus, CSF, biopsied tissue, A made than culture may only be classified as "probable" or "presumed". For a diagnosis negating the possibility of infection, most protocols require that two separate cultures test negative. Sputum Sputum and cultures should be done acid-fast if the is sputum. preferred method for is fluorescence microscopy (auramine-rhodamine staining), which is more sensitive than conventional Ziehl-Neelsen staining. In cases where there no spontaneous a sample be usually inhalation of a or saline with bronchodilator solution. A that inducing three sputum samples is more sensitive three gastric Alternative sampling In patients incapable of a sputum sample, common alternative sample sources for pulmonary tuberculosis include gastric washings, laryngeal swab, bronchoscopy (with bronchoalveolar lavage, bronchial washings, and/or transbronchial fine needle aspiration (transtracheal transbronchial). In some a invasive is including tissue during mediastinoscopy or thoracoscopy. PCR Other mycobacteria are also acid-fast. If smear is positive, PCR or gene probe tests can distinguish from mycobacteria. Even if smear is negative, tuberculosis be and is only excluded cultures. Many are Traditionally, have used the Löwenstein-Jensen Kirchner, or Middlebrook media (7H9, and 7H11). A culture the various forms of mycobacteria, although results from may take four to eight weeks for conclusive answer. New automated systems that are faster include the MB/BacT, BACTEC VersaTREK
 used to confirm or rule out TB. HOwever, certAin fiNdiNgs ArE sugGestIve of TB. For examPLe, blOod in the sputum, significAnt weIgHT losS AnD drenChing niGHt SWEatS mAy Be dUe TO Tb.

MicrObiOlogicaL studies

A dEfiNiTive diagnosiS Of TuberculosIs cAn only be made By cUlturiNg mycOBacteRiuM tubeRculosIS organIsms from a SpECimen tAKen from THE pAtieNt (most often sputum, BUt MAy also include pUs, CSF, bIoPSiED TisSue, Etc.).  A diagnoSiS made OTher thaN By CULTurE May only be clasSified as "proBAblE" or "preSuMed".  fOr a diaGnosiS nEGatIng the possiBiliTy of tuberCulosiS InfectiON, most prOtocolS reQuiRe thAT tWo SepArATe cULtUreS BotH test negAtIvE.

SputUm
SpUTUM SmeaRs aNd cuLtureS should be done For Acid-FAst BacilLi if tHe paTiEnt is ProducIng spUtUm.  The preferred mEthoD for this iS flUoResCeNce miCRoscopY (auRamIne-rhodAmine stAIniNg), WHICh Is more sensitive thaN cONVeNtional ZIehl-NeELsEn STaining. IN cAseS wheRE There Is no SPoNtaneous Sputum PRoDuCtion, a sAmPle can Be IndUceD, usuaLLy by InhalaTion of a nEbuliZEd saline or saliNE with bronchodILaTOR sOLutiOn. A Comparative StudY FounD thaT InDucINg thrEe spuTuM SaMPles is more sensitive ThAn threE gastRic washings.

AlTernative sAMPLing
In paTienTS iNCapable of produCing a Sputum sampLE, common aLternAtive samPle sourceS FOr diagnoSinG puLmoNarY TUbErculosis inclUDE gasTrIc washiNgs, LaryngeAl sWab, BroNchOsCopy (with bRonchoalVeOlAr LaVagE, bronCHial washInGs, aNd/Or tRansbROnchiaL biopSy), anD fInE NeeDle aspiRAtION (traNsTrAcheAl oR tRansbRoncHIal). in some cAses, a more InvASive TeChNique is Necessary, inclUdIng tissue bIoPsy During MEDiastinoScopy or thoracoscopy.

PCR
OTHer mycoBacTeria Are aLso acid-faSt. IF the smEar IS positIve, PCR Or genE pRobE TEsts cAN DiStiNgUish M. tuberCULosIs froM oTher MycobacTeria. Even if sputum sMEar Is negative, tubErcUlosIS MuSt bE CoNSidErED anD IS only excluded afTer negativE cULtUres.

Other
MANy tYpEs of culTures arE avaiLAble. TraDitionallY, cultures HaVe usED The löwenstein-jensen (LJ), kirchner, oR middlEBrOok meDia (7h9, 7H10, and 7H11). a cUltUre of The AFB CAn dIstinGuish tHe VariouS formS oF mycobacTeria, although results froM this mAy takE foUr to eight WeeKS foR a conclusIve aNswer. New auTomAteD systEms THat arE fasTEr IncLUde thE MB/BACT, BACTEC 9000, VERsATRek
 used to confirm or rule o ut TB. How ever,  ce rta in  fin ding s are suggesti v e of  TB. For example, bloo d inth e  spu t um , sig nifican t  w e i ght  l os s a nd dr enchi ngnight s weats maybedu e to TB.

Mi c ro biological  st udies

A def ini tive d ia gno s is of  tu bercu losisc an onl y be made  b y  cultu r ing Myc o b ac teri um tuberculosis o r ga n isms from a sp ecimen  t a ke n fro m t he patient  ( mosto ften sp u tu m , but may also incl ude pus, CS F , b iopsie dtis s ue, et c.). A dia gnosis made  oth er than b y cult u re mayo nly beclassi fie d a s "p r ob ab le"  o r  "p r es ume d ". For a d ia gn osisnega t i n g  the  po ssib ility  of tuberculo sis  inf e cti on, m ost p roto co ls re quirethattw o separate cult ures  both tes t n eg ati ve .

Sp u tum
Sp utu m s mears a nd cult u res  s h o u ld  be done for acid- fa s t  b acilli i f thep at ie n t is pro du cin g sp u t um. Thep re ferred m ethodf or  t his isfl uoresc en cemic rosco p y (a uramin e-rhodam ine s t aining), which is more sensi t iv e th a n co nve ntional Zie hl-N e else n st a in ing .  In c aseswh e re there is no spontan eo us spu tum p roduction, asample can b e  induced , us u al l y by inhalatio n ofa nebulize d  salineor sa line wit h broncho d i lator so lut ion . A  co m p ar ative study f o u nd t ha t induc ing  threespu tum  sa mpl es  is moresensitiv eth an  t hre e gas t ric wash in gs. 
Alt ernat i ve sam pling 
Inpa ti e nts  incapa b le o f pr od uc inga s pu tum s ampl e , c ommon a lternativ e s a mple  s ou rces fo r diagnosingpu lmonary tu be rcu losisi n clude ga stric washings, larynge a l swab,  br oncho scop y (with b ron choalv eol a r lava ge, br onchi al  wa s h ings, a nd /or  t ransbronch i a l b iopsy ),  and  fine n eedle aspiration ( t ran stracheal ortra nsbr o n ch ial ) .I n s om e  ca s e s, a more invas ive techni qu e  i s necessar y , i nc ludingtissuebiops y  during  mediasti noscopy o rthor a c osc opy.

PCROther my cobacteri a  area ls o aci d-f ast. I fthe  smea r is p o sit ive,PCR or  g ene pr obe t es ts can d istinguish M. tuberculo sis fr om ot her  mycobact eri a . E ven if sp utum  smear isneg ati ve, t ube r culos is m u st  be consi dere d  and is o n ly  ex c l ud ed after ne g a t ive  cult ure s .

Oth er
M any types of cult u res are availa ble. T rad iti o nall y,  cultures have  us ed t he Löwen st ein-Jensen(LJ), Ki rc h ner,or Mid dlebro ok medi a (7 H 9, 7H1 0, a nd7H11). Acul tu r e of th eAF B  can d isti ng uish t he var i ousf o rms of mycobacte ria,a l thoug h  re sults  f rom thi s  may  take four  to eight w eeks f or a  conc lusivean swer.New  a utomated s y stems tha t are  faster  i nclu dethe MB /Bac T ,  BACT EC 9 00 0,VersaTREK 
 used_to confirm_or rule out TB._However, certain_findings_are suggestive_of_TB. For example,_blood in the_sputum, significant weight loss_and drenching night_sweats_may be due to TB.

Microbiological studies

A definitive diagnosis of tuberculosis can only be made_by_culturing Mycobacterium_tuberculosis_organisms_from a specimen taken from_the patient (most often sputum,_but may_also include pus, CSF, biopsied tissue, etc.). _A_diagnosis made other_than by culture may only be classified as "probable"_or "presumed".  For a diagnosis_negating the possibility_of_tuberculosis_infection, most protocols require_that two separate cultures both test_negative.

Sputum
Sputum smears and cultures should be_done for acid-fast bacilli if the patient_is producing sputum.  The preferred_method for this is fluorescence_microscopy (auramine-rhodamine_staining), which is more sensitive_than conventional Ziehl-Neelsen_staining. In_cases where there_is no spontaneous sputum production, a_sample can be_induced, usually by inhalation of a_nebulized_saline or saline_with_bronchodilator_solution. A_comparative study found_that_inducing three_sputum_samples is more sensitive than three_gastric_washings.

Alternative sampling
In patients incapable of producing a_sputum sample, common alternative_sample_sources for diagnosing pulmonary_tuberculosis include gastric washings, laryngeal_swab, bronchoscopy (with bronchoalveolar lavage, bronchial_washings, and/or_transbronchial biopsy),_and fine needle aspiration (transtracheal or transbronchial). In some cases, a_more invasive technique is necessary, including_tissue biopsy during mediastinoscopy_or thoracoscopy.

PCR
Other_mycobacteria_are also acid-fast._If_the smear_is positive, PCR or gene probe tests_can distinguish_M. tuberculosis from other mycobacteria. Even_if sputum smear is_negative,_tuberculosis must be considered and is_only excluded after negative cultures.

Other
Many types_of cultures are available. Traditionally,_cultures_have_used the Löwenstein-Jensen (LJ), Kirchner,_or Middlebrook media (7H9, 7H10, and_7H11). A culture_of the AFB can distinguish the various_forms_of mycobacteria, although results from this_may_take four to eight weeks for_a_conclusive_answer. New automated systems that_are faster include the MB/BacT, BACTEC_9000, VersaTREK