āTest(s) requested
| - āMultiple tests can be requested.
- If MGIT DST is requested on a subsequent culture of the same patient, the collection dates of the two cultures should be at least three months apart.
- If clinical conditions warrant repeat DST in less than 3 months, please provide the reasons in the āCommentā section.
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āFirst-line DST
| āFirst-line drugs are INH, RIF, EMB and PZA. Streptomycin is NOT a first-line drug and is not routinely tested at MDL, because it is rarely used to treat TB patient in the US.
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āSecond-line DST
| āSecond-line drugs are moxifloxacin (MFX), amikacin, capreomycin and ethionamide.- The quinolone routinely tested at MDL is MFX. It is tested at 0.25 Āµg/ml. If an isolate is susceptible to MFX at 0.25 Āµg/ml, it predicts Levofloxacin (LEV) susceptibility. If resistant to MFX at 0.25 Āµg/ml, it predicts LEV resistance. When LEV is requested, MFX will be tested instead.
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āPyrosequencing (PSQ)
| - āPlease check the boxes for reason(s) why PSQ is requested.
- If the specimen type is āsedimentā, please make sure the volume is at least 0.5 ml. Please submit more volume especially when the smear is of low positivity.
- PSQ performs well when smear result is ā„ 1+ or ā„ āfew AFBā. If multiple specimens are available, please submit the one with highest smear positivity and volume. If smear is ārareā, it can be accepted but the test sensitivity is reduced.
- Do not send smear-negative specimen unless approved.
- If PSQ is requested on a subsequent sample, the collection dates must be at least 2 months apart. If less than 2 months, do not send without approval.
- Please only check the box for PSQ 2nd line panel as needed. PSQ 2nd line panel is provided when the patient shows resistance or intolerance to first line drugs or has other clinical reasons for using 2nd line drugs.
- Please specify the reason(s) for PSQ MTBC ID. PSQ can differentiate M. bovis from MTBC not M. bovis, but cannot differentiate M. bovis with M. bovis BCG.
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āOther tests
| āIf tests requested are not listed above, please email or call us before sending.- Genotyping. Isolates for genotyping should be sent by county laboratories. MDL may accept the request in rare occasions, for example, the county does not have the isolate, but MDL has. Genotyping can be performed on isolates only, not on sediments.
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āSample type submitted
| āPlease
select the type of specimen you are submitting. Check one from Culture,
Sediment or Miscellaneous.
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āCulture
| āāPlease
select the medium being sent on, such as LJ, 7H10, MGIT, MP,
VT, etc.
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āSediment
| A sediment sample resulting from processing a raw specimen can be sent for PSQ, not for DST or genotyping. MDL does not perform DST on a sediment sample. Please select the AFB smear result. PSQ has low sensitivity for testing smear- negative sediments. When Xpert detects MTBC and the Ct values are ā¤ 28, PSQ may work. It requires approval before submitting smear-negative sediments.
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āMiscalleneous
| āāOn
rare occasions, a sample other than a culture or sediment may be submitted.
Check one from āDNAā, āRaw Specimenā or āOtherā. Do not send without approval.
Please contact the TB laboratory prior to submission.
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āSubmitting Laboratoryās Findings
| Enter your laboratoryās findings in this section. If the XpertĀ®MTB/RIF test is performed, please provide the results and include the printout from the Xpert instrument containing Ct values in the specimen package.
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āComments
| āEnter comments that are relevant to the requested test(s), such as a brief treatment history, suspicion of M. bovis or drug resistance, etc.
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