| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
Modified Acid Fast Stain, Nocardia and Aerobic Actinomycetes
Test Code14511
CPT 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
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.
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.
Expectorated sputum: 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.
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 capped 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 respiratory specimen • 2 mL body fluid • 1 mL CSF • 20 mL urine
Instructions
Culture recommended in addition to stain
Transport Temperature
Refrigerated (cold packs)
Specimen Stability
Room temperature: Unacceptable
Refrigerated: 5 days
Frozen: Unacceptable
Refrigerated: 5 days
Frozen: Unacceptable
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
24 hour pooled urine • 24 hour pooled sputum • Dry swabs • Specimens received in alcohol, formalin, EDTA, lithium heparin or conventional blood culture bottles • Swabs or raw unpreserved specimen >5 days old • Throat/oral/sputum from non-cystic-fibrosis patients • Stool specimens • Urine specimens in preservative tubes • Red-top (silica-containing) plastic tubes and tubes with additives or clot activator • Prepared slides from client • Specimens received in expired transports
Methodology
Microscopic Examination
Setup Schedule
A.M. Sets up 5 days a week.
Report Available
Reports in 2 to 5 days.
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.
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.
