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Modified Acid Fast Stain, Nocardia and Aerobic Actinomycetes [14511X]
Test CodeCPT Codes
87206
Preferred Specimen
5-10 mL respiratory specimens including expectorated sputum, aerosol-induced sputum, bronchial washing, bronchial brushing, transtracheal aspirate, bronchoalveolar lavage fluid collected in a sterile, leak-proof container
As much as possible of biopsy, aspirate or granules from lung, sinus tract, subcutaneous tissue, central nervous system collected in a sterile, leak-proof container or other systemic sites collected in a culture swab in Amies liquid transport swab, Amies gel transport swab, Amies liquid elution swab (ESwab) or equivalent
5 mL body fluid collected in a sterile, leak-proof container
2 mL CSF collected in a sterile, leak-proof container
40 mL entire first morning voided urine collected in a sterile, leak-proof container
Patient Preparation
Expectorated Sputum: Instruct the patient to rinse his/her mouth and gargle with water prior to collection. Tell the patient not to expectorate saliva or postnasal discharge into the container. 3 separate samples should be collected over an 8-24 hour interval of time. Include at least one first morning specimen. For follow-up patients on therapy, collect at weekly intervals beginning 3 weeks after initiation of therapy.
Induced Sputum: Use a wet toothbrush and brush the buccal mucosa, tongue, and gums of the patient prior to collection. Rinse the patient?s mouth thoroughly with water.
Invasive procedures such as transtracheal aspirate, bronchial biopsy and fine needle aspirate yield the highest percentage of positive results.
Aerosol-induced Sputum: Using an ultrasonic nebulizer, have patient inhale approximately 20-30 mL of sterile hypertonic saline. Avoid sputum contamination with nebulizer reservoir water.
Bronchial washings and bronchoalveolar lavage fluids: Generally obtained before brushings or biopsy to avoid excess blood in the specimen. Aspirate or lavage specimens that are collected in traps should be transferred to a sterile, screw-cap conical tube to avoid leakage during transport.
Tissue and Biopsy Material: Obtain a sample as large as possible in a small amount of sterile, non-bacteriostatic saline.
Urine: Appropriate cleaning of the genitalia must precede collection. Collect entire first morning specimen (>40 mL) on 3 consecutive days. Organisms may accumulate in the bladder overnight, so first morning void provides the best yield.
Minimum Volume
2 mL body fluid
1 mL CSF
20 mL urine
Instructions
Transport Temperature
Specimen Stability
Refrigerated: 5 days
Frozen: Unacceptable
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Methodology
Microscopic Examination
Setup Schedule
Clinical Significance
The clinical manifestations, severity, and prognosis of nocardiosis are extremely variable. In immunocompetent hosts, localized subcutaneous infections are the most common infections. N. brasiliensis is the predominant causative agent of primary cutaneous infections. In immunocompromised patients, the most common clinical presentations are invasive pulmonary infections and disseminated disease. These infections are produced by several species including Nocardia farcinica and Nocardia nova.
Clinical symptoms of Nocardiosis may resemble tuberculosis or actinomycosis. Nocardia disease, especially in immunocompromised patients may begin as a pulmonary infection and then disseminate to the central nervous system, kidneys, and other organs. On rare occasions, the eye has been infected.
