Acid-Fast Bacillus (AFB) Testing
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- Also Known As:
- AFB Smear and Culture
- TB Culture and Sensitivity
- Mycobacteria Smear and Culture
- TB NAAT
- Acid-Fast Bacillus Smear and Culture and Sensitivity
- Mycobacterium tuberculosis Nucleic Acid Amplification Test

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At a Glance
Why Get Tested?
To help diagnose tuberculosis (TB) and infections caused by other Mycobacterium species, which are known as acid-fast bacilli (AFB), in people at risk of developing mycobacterial infections; to monitor the effectiveness of treatment
When To Get Tested?
When you have signs and symptoms of a lung infection, such as a chronic cough, weight loss, fever, chills, and weakness, that may be due to TB or a nontuberculous mycobacterial (NTM) infection; when you have a positive IGRA blood test or Tuberculin skin test (TST) and you are in a high-risk group for progressing to active TB; when you have a skin or other body site infection that may be due to mycobacteria; when you are undergoing treatment for TB
Sample Required?
For suspected cases of tuberculosis lung infections, usually three sputum samples are collected early in the morning on different days. If you are unable to produce sputum, a bronchoscope may be used to collect fluid during a procedure called a bronchoscopy. In children, gastric washings/aspirates may be collected. Depending on symptoms, urine, an aspirate from the site of suspected infection, cerebrospinal fluid (CSF), other body fluids, or biopsied tissue samples may be collected for AFB testing.
Test Preparation Needed?
None
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Testing.com is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.
The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.
If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.
Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.
While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”
For more information, please read the article Reference Ranges and What They Mean.
What is being tested?
Most samples that are submitted for acid-fast bacilli (AFB) testing are collected because the health care practitioner suspects that a person has tuberculosis (TB), a lung infection caused by Mycobacterium tuberculosis. Mycobacteria are called acid-fast bacilli because they are a group of rod-shaped bacteria (bacilli) that can be seen under the microscope following a staining procedure where the bacteria retain the color of the stain after an acid wash (acid-fast). AFB laboratory tests detect the bacteria in a person’s sample and help identify an infection caused by AFB.
There are several types of AFB that may be detected with this testing; however, the most common and medically important ones are members of the genus Mycobacterium. Mycobacterium tuberculosis is one of the most prevalent and infectious species of mycobacteria.
Since TB is transmitted through the air when an infected person sneezes, coughs, speaks, or sings, it is a public health risk. It can spread in confined populations, such as in the home and schools, correctional facilities, and nursing homes. Those who are very young, elderly, or have preexisting diseases and conditions, such as AIDS, that compromise their immune systems tend to be especially vulnerable. AFB testing can help diagnose, track, and minimize the spread of TB in these populations and help determine the effectiveness of treatment.
Another group of mycobacteria referred to as nontuberculous mycobacteria (NTM) can also cause infections. However, only a few of the more than 60 species of mycobacteria that have been identified cause infections in humans. Some examples include Mycobacterium avium-intracellulare complex (MAC), which can cause lung infection and disseminated disease in people with weakened immune systems. In addition to TB, AFB testing can help identify infections caused by these nontuberculous mycobacteria.
How is the sample collected for testing?
Sputum is the most commonly tested sample. Sputum is phlegm, thick mucus that is coughed up from the lungs. Preferably, three early morning samples obtained by deep cough are collected on consecutive days in individual sterile cups to increase the likelihood of detecting the bacteria.
If a person is unable to produce sputum, a health practitioner may collect respiratory samples using a procedure called a bronchoscopy. Bronchoscopy allows the health practitioner to look at and collect samples from the bronchi and bronchioles. Once a local anesthetic has been sprayed onto the patient’s upper airway, the practitioner can insert a tube into the bronchi and smaller bronchioles and aspirate fluid samples for testing. Sometimes, the healthcare practitioner will introduce a small amount of saline through the tubing and into the bronchi and then aspirate it to collect a bronchial washing.
Since young children cannot produce a sputum sample, gastric washings/aspirates may be collected. This involves introducing saline into the stomach through a tube, followed by fluid aspiration.
If the health care practitioners suspect TB is present outside of the lungs (extrapulmonary), they may test the body fluids and tissues most likely affected. For instance, one or more urine samples may be collected if the practitioner suspects TB has infected the kidneys. A needle may be used to collect fluid from joints or from other body cavities, such as the pericardium or abdomen. Occasionally, the practitioner may collect a sample of cerebrospinal fluid (CSF) or perform a minor surgical procedure to obtain a tissue biopsy.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed, except to rinse the mouth with water before collecting the sputum sample.
Common Questions
Health Professionals – LOINC
LOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a common language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research. Learn More.
Listed in the table below are the LOINC with links to the LOINC detail pages. Please note when you click on the hyperlinked code, you are leaving Testing.com and accessing Loinc.org.
LOINC | LOINC Display Name |
---|---|
20893-4 | M. avium ss paratuberculosis Org specific cx Ql (Stl) |
20892-6 | M. avium ss paratuberculosis Org specific cx Ql (Tiss) |
24427-7 | M. avium ss paratuberculosis Org specific cx Ql (Unsp spec) |
90433-4 | Mycobacterium preliminary growth Org specific cx Ql (Sput) |
90438-3 | Mycobacterium preliminary growth Org specific cx Ql (Tiss) |
44851-4 | Mycobacterium sp identified # 2 Org specific cx Nom (Unsp spec) |
44852-2 | Mycobacterium sp identified # 3 Org specific cx Nom (Unsp spec) |
44854-8 | Mycobacterium sp identified # 4 Org specific cx Nom (Unsp spec) |
44855-5 | Mycobacterium sp identified # 5 Org specific cx Nom (Unsp spec) |
532-2 | Mycobacterium sp identified Org specific cx Nom (Asp) |
76687-3 | Mycobacterium sp identified Org specific cx Nom (BAL) |
90284-1 | Mycobacterium sp identified Org specific cx Nom (Bile) |
533-0 | Mycobacterium sp identified Org specific cx Nom (Bld) |
9823-6 | Mycobacterium sp identified Org specific cx Nom (Bronch spec) |
88167-2 | Mycobacterium sp identified Org specific cx Nom (Corn/Cnjt) |
534-8 | Mycobacterium sp identified Org specific cx Nom (CSF) |
30045-9 | Mycobacterium sp identified Org specific cx Nom (Dial fld) |
535-5 | Mycobacterium sp identified Org specific cx Nom (Body fld) |
9824-4 | Mycobacterium sp identified Org specific cx Nom (Gast fld) |
89637-3 | Mycobacterium sp identified Org specific cx Nom (Implanted device) |
9825-1 | Mycobacterium sp identified Nom (Isol) |
536-3 | Mycobacterium sp identified Org specific cx Nom (BM) |
88168-0 | Mycobacterium sp identified Org specific cx Nom (Ocular fluid) |
53909-8 | Mycobacterium sp identified Org specific cx Nom (Pleur fld) |
537-1 | Mycobacterium sp identified Org specific cx Nom (Periton fld) |
89636-5 | Mycobacterium sp identified Org specific cx Nom (Lower resp) |
538-9 | Mycobacterium sp identified Org specific cx Nom (Syn fld) |
539-7 | Mycobacterium sp identified Org specific cx Nom (Sput) |
540-5 | Mycobacterium sp identified Org specific cx Nom (Tiss) |
541-3 | Mycobacterium sp identified Org specific cx Nom (U) |
542-1 | Mycobacterium sp identified Org specific cx Nom (Wound) |
543-9 | Mycobacterium sp identified Org specific cx Nom (Unsp spec) |
64412-0 | Mycobacterium sp Org specific cx Ql (Bld) |
50941-4 | Mycobacterium sp Org specific cx Ql (Unsp spec) |
79375-2 | Microscopic observation spec 2 Acid fast stain.Ziehl-Neelsen Nom (Sput) |
79376-0 | Microscopic observation spec 3 Acid fast stain.Ziehl-Neelsen Nom (Sput) |
88156-5 | Microscopic observation Acid fast stain Nom (Amn fld) |
88159-9 | Microscopic observation Acid fast stain Nom (Asp) |
88231-6 | Microscopic observation Acid fast stain Nom (Bile) |
32699-1 | Microscopic observation Acid fast stain Nom (Bld) |
24002-8 | Microscopic observation Acid fast stain Nom (Bronch spec) |
58943-2 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (CSF) |
32188-5 | Microscopic observation Acid fast stain Nom (CSF) |
89582-1 | Microscopic observation Acid fast stain Nom (Cvx) |
58944-0 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Body fld) |
32189-3 | Microscopic observation Acid fast stain Nom (Body fld) |
641-1 | Microscopic observation Acid fast stain.Kinyoun modified Nom (Gast fld) |
642-9 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Gast fld) |
11476-9 | Microscopic observation Acid fast stain Nom (Gast fld) |
88148-2 | Microscopic observation Acid fast stain Nom (Genital specimen) |
89660-5 | Microscopic observation Acid fast stain Nom (Implanted device) |
88153-2 | Microscopic observation Acid fast stain Nom (BM) |
90269-2 | Microscopic observation Acid fast stain Nom (Milk) |
88155-7 | Microscopic observation Acid fast stain Nom (Ocular fluid) |
88145-8 | Microscopic observation Acid fast stain Nom (Pericard fld) |
14353-7 | Microscopic observation Acid fast stain.Kinyoun modified Nom (Pleur fld) |
58942-4 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Pleur fld) |
58945-7 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Periton fld) |
88144-1 | Microscopic observation Acid fast stain Nom (Periton fld) |
89662-1 | Microscopic observation Acid fast stain Nom (Lower resp) |
89661-3 | Microscopic observation Acid fast stain Nom (Upper resp) |
88154-0 | Microscopic observation Acid fast stain Nom (Sinus) |
88157-3 | Microscopic observation Acid fast stain Nom (Sem) |
63433-7 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Syn fld) |
646-0 | Microscopic observation Acid fast stain.Kinyoun modified Nom (Sput) |
647-8 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Sput) |
11477-7 | Microscopic observation Acid fast stain Nom (Sput) |
11478-5 | Microscopic observation Acid fast stain Nom (Stl) |
6656-3 | Microscopic observation Acid fast stain.Kinyoun modified Nom (Tiss) |
6657-1 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Tiss) |
11479-3 | Microscopic observation Acid fast stain Nom (Tiss) |
651-0 | Microscopic observation Acid fast stain.Kinyoun modified Nom (U) |
652-8 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (U) |
11480-1 | Microscopic observation Acid fast stain Nom (U) |
14354-5 | Microscopic observation Acid fast stain.Kinyoun modified Nom (Wound) |
88151-6 | Microscopic observation Acid fast stain Nom (Wound) |
655-1 | Microscopic observation Acid fast stain.Kinyoun modified Nom (Unsp spec) |
656-9 | Microscopic observation Acid fast stain.Ziehl-Neelsen Nom (Unsp spec) |
11545-1 | Microscopic observation Acid fast stain Nom (Unsp spec) |
76083-5 | Microscopic observation Acid fast stain.Ziehl-Neelsen Ql (BAL) |
88171-4 | Microscopic observation Acid fast stain Ql (Corn/Cnjt) |
88172-2 | Microscopic observation Acid fast stain Ql (Isol) |
88173-0 | Microscopic observation Acid fast stain Ql (Pleur fld) |
88234-0 | Microscopic observation Acid fast stain Ql (Syn fld) |
88366-0 | Microscopic observation Acid fast stain Ql (Vomitus) |
72357-7 | Microscopic observation Acid fast stain Ql (Unsp spec) |
23243-9 | M. avium ss paratuberculosis Acid fast stain.Ziehl-Neelsen Ql (Stl) |
23244-7 | M. avium ss paratuberculosis Acid fast stain.Ziehl-Neelsen Ql (Tiss) |
85581-7 | M. avium and M. intracellulare DNA NAA+probe Nom (Sput/Bronchial) |
71719-9 | M. avium complex DNA NAA+probe Ql (Unsp spec) |
20463-6 | M. avium complex rRNA NAA+probe Ql (Unsp spec) |
23246-2 | M. avium ss paratuberculosis DNA NAA+probe Ql (Stl) |
23245-4 | M. avium ss paratuberculosis DNA NAA+probe Ql (Unsp spec) |
45116-1 | M. gordonae rRNA NAA+probe Ql (Unsp spec) |
45117-9 | M. kansasii rRNA NAA+probe Ql (Unsp spec) |
21405-6 | Mycobacterium sp DNA NAA+probe Ql (Bronch spec) |
14972-4 | Mycobacterium sp DNA NAA+probe Ql (CSF) |
14973-2 | Mycobacterium sp DNA NAA+probe Ql (Sput) |
23247-0 | Mycobacterium sp DNA NAA+probe Ql (Tiss) |
30523-5 | Mycobacterium sp DNA NAA+probe Ql (U) |
14974-0 | Mycobacterium sp DNA NAA+probe Ql (Unsp spec) |
42716-1 | Mycobacterium sp rRNA NAA+probe Nar (Isol) |
85362-2 | M. tuberculosis complex DNA NAA+probe Ql (Sput/Bronchial) |
38379-4 | M. tuberculosis complex DNA NAA+probe Ql (Unsp spec) |
48174-7 | M. tuberculosis complex rRNA NAA+probe Ql (Unsp spec) |
46244-0 | M. tuberculosis DNA rpoB NAA+probe Nom (Isol) |
53257-2 | M. tuberculosis DNA NAA+probe (Unsp spec) [#/Vol] |
78357-1 | M. tuberculosis DNA NAA+probe Ql (BAL) |
90283-3 | M. tuberculosis DNA NAA+probe Ql (Bile) |
16278-4 | M. tuberculosis DNA NAA+probe Ql (Bld) |
14557-3 | M. tuberculosis DNA NAA+probe Ql (Bronch spec) |
88165-6 | M. tuberculosis DNA NAA+probe Ql (Corn/Cnjt) |
14561-5 | M. tuberculosis DNA NAA+probe Ql (CSF) |
58931-7 | M. tuberculosis DNA NAA+probe Ql (Body fld) |
14558-1 | M. tuberculosis DNA NAA+probe Ql (Gast fld) |
89635-7 | M. tuberculosis DNA NAA+probe Ql (Implanted device) |
88166-4 | M. tuberculosis DNA NAA+probe Ql (Ocular fluid) |
14559-9 | M. tuberculosis DNA NAA+probe Ql (Pleur fld) |
14562-3 | M. tuberculosis DNA NAA+probe Ql (Sem) |
14556-5 | M. tuberculosis DNA NAA+probe Ql (Sput) |
14560-7 | M. tuberculosis DNA NAA+probe Ql (U) |
13956-8 | M. tuberculosis DNA NAA+probe Ql (Unsp spec) |
33634-7 | M. tuberculosis rifampin resistance gene NAA+probe Nom (Sput) |
View Sources
Sources Used in Current Review
Lewinsohn, D, et. al. (2017 January 03). Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clinical Infectious Diseases, Volume 64, Issue 2, 15 January 2017, Pages 111–115. Available online at https://academic.oup.com/cid/article/64/2/111/2811357. Accessed on 8/05/18.
Vyas, J. et. al. (2016 November 14, Updated). Sputum stain for mycobacteria. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/003724.htm. Accessed on 8/05/18.
Koirala, J. (2017 November 14, Updated). Mycobacterium Avium Complex (MAC) (Mycobacterium Avium-Intracellulare [MAI]). Medscape Infectious Diseases. Available online at https://emedicine.medscape.com/article/222664-overview. Accessed on 8/05/18.
Herchline, T. and Amorosa, J. (2017 November 9, Updated). Tuberculosis (TB). Medscape Infectious Diseases. Available online at https://emedicine.medscape.com/article/230802-overview. Accessed on 8/05/18.
Batra, V. and Ang, J. (2018 April 26, Updated). Pediatric Tuberculosis. Medscape Pediatrics: General Medicine. Available online at https://emedicine.medscape.com/article/969401-overview. Accessed on 8/05/18.
Barker, A. (2018 July, Updated). Mycobacterium tuberculosis – Tuberculosis. ARUP Consult. Available online at https://arupconsult.com/content/mycobacterium-tuberculosis. Accessed on 8/05/18.
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