Flowchart of Specimen Processing to Isolate Mycobacteria

• answer #1: sterile

  
• answer #2: nonsterile

  
• answer #3: centrifuge and use sediment

  
• answer #4: liquefaction (N-acetyl-L-Cysteine)

  
• answer #5: Decontamination (NaOH)

  
• answer #6: Neutralization (buffer or H2O)

  
• answer #7: Centrifugation (>3000x g)

  
• answer #8: Liquid medium

  
• answer #9: Solid media

  
• answer #10:

  Lowenstein-Jensen (L-J)

  L-J with RNA

  L-J with pyruvic acid

  Middlebrook 7H10

  
• answer #11:

  Incubate at 37°C ≥ 8 wk

  
• answer #12: If growth occurs, confirm by AFB smear

  
• answer #13: Mycobacteria growth indicator tube (drug resistant strains)

  
• answer #14: Incubate at 37°C ≥ 6 wk

  
• ANSWER #15: IF FLUORESCENCE IS DETECTED

  
• ANSWER #16: BACTEC MEDIUM

  
• answer #17: Incubate at 37°C ≥ 6 wk

  
• answer #18: IF GROWTH INDEX ≥ 10

  
• ANSWER #19: septi-check

  
• answer #20: Incubate, inverting regularly, at 37°C ≥ 8 wk

  
• answer #21: If colonies or turbidity observed

  
• answer #22: Continuous monitoring systems

  
• answer #23: Incubate at 37°C ≥ 6 wk

  
• answer #24: If growth is detected

  
• answer #25: Confirm by AFB smear

  
• answer #26: Reinoculate solid media