Mycobacteriology and Mycotics Division

Mycobacteriology Specimen Requirements

The Mycobacteriology section of the Mycobacteriology and Mycotics (M&M) Division provides diagnostic and reference services to both public and private health care providers. This section isolates and identifies Mycobacterium tuberculosis complex (MTBC) and nontuberculous mycobacteria (NTM).

The Bureau of Clinical Laboratories (BCL) is open Monday through Friday from 7:30 a.m. to 4:00 p.m., except for holidays. All specimens received by 7:30 a.m. will be processed and will have a fluorescent smear result posted that day. Specimens are also processed in the afternoons on Fridays and days before holidays. The Alabama Division of Tuberculosis Control (TB Control) and private health care providers (if applicable) are notified of all smear-positive specimens. Cultures are reported as they become positive, and a copy of all TB-positive smear and culture results is forwarded to TB Control and private providers (if applicable). Negative reports are finalized at 6 weeks.

Drug Susceptibility Testing (DST)

DST is performed routinely on all new MTBC patients and is automatically repeated every 3 months if the patient is still MTBC culture positive. Drugs tested are Streptomycin, Isoniazid, Rifampin, Ethambutol, Pyrazinamide, Levofloxacin, and Moxifloxacin. At the request of TB Control, specimens may be forwarded to the Centers for Disease Control and Prevention (CDC) for further MTBC drug susceptibility testing. NTM susceptibility testing is forwarded to a reference laboratory and is performed by request at the expense of the provider.

Polymerase Chain Reaction (PCR)

PCR for MTBC is performed via Cepheid GeneXpert. PCR is performed on all new smear-positive patients or on smear-negative patients by request. A PCR will be performed on a smear-negative patient up to three times. Specimen sources, except for blood, bone marrow, and gastric specimens, are acceptable for PCR. Excessively bloody or purulent specimens cannot be tested.

Clinical Specimen Collection

The Mycobacteriology section accepts sterile and non-sterile specimen sources. For optimal results, 5-10 mL of sputum and fluid samples are preferred. Greater than 10 mL could result in leaks during transportation and is not recommended.

• All clinical samples, regardless of specimen source, should be sent to the BCL within 24 hours of collection.
• Please notate if a specimen was obtained during an autopsy.
• Sterile and/or difficult-to-obtain specimens received more than 3 days after specimen collection will be accepted but reported with a disclaimer to interpret results with caution, since they were received more than 3 days after collection.
• Gastric washings are very acidic, so they must be buffered before shipping.
• While stool samples are not optimal for the recovery of mycobacteria, they will be accepted; please do not submit more than 5 mL of stool specimen.
• Sputum and urine samples that arrive at the laboratory more than 3 days after the collection date will be considered unsatisfactory and will not be tested.
• Cerebrospinal fluid (CSF) less than 1 mL is reported as quantity not sufficient (QNS) for smear and is only placed in broth culture medium for isolation.
• Blood and bone marrow specimens are not placed in broth culture medium and are cultured only on solid media.

Clinical Specimen Submission

All clinical specimens should be submitted in a conical centrifuge tube supplied by the M&M Division. An official BCL specimen requisition form should be submitted with each specimen. Date of specimen collection, specimen source, patient name, patient date of birth, and the test requested are required for testing. Specimens should be packaged according to the guidance document located on the BCL portion of the Alabama Department of Public Health website and shipped at the appropriate temperature as indicated on the BCL analyte list and per Department of Transportation (DOT) requirements. TB kits containing shipping supplies may be requested through the BCL portion of the ADPH website.

Isolate and Concentrated Specimen Submission

Cultures for identification must be shipped according to DOT requirements for UN2814 Category A Division 6.2 (MTBC) and UN3373 Category B (concentrated specimens, NTM, and actinomycetes). One official BCL requisition form is required per specimen submitted. Isolates may be submitted on a solid media slant or as broth culture; do not submit isolates on agar plates. Date of specimen collection, specimen source, patient name, patient date of birth, and the test requested are required for testing. Concentrated specimens for PCR testing must arrive at the BCL less than 7 days from collection and at 2-8°C.

Contact Information

Phone Number for the Mycobacteriology Section: (334) 290-3089

Physical Address:
Bureau of Clinical Laboratories
204 Legends Court
Prattville, AL 36066

Mycotics Specimen Requirements

The Mycotics section of the Mycobacteriology and Mycotics (M&M) Division provides diagnostic and reference services for health care providers. This section isolates and identifies species of yeast and filamentous fungi.

The Bureau of Clinical Laboratories (BCL) is open Monday through Friday from 7:30 a.m. to 4:00 p.m., except for holidays. All clinical specimens and isolates received by noon will be handled that same day. Clinical specimens are placed onto culture media and are examined weekly for up to 4 weeks. Significant culture growth that appears during that time will be identified and reported. Isolates are subcultured and identified using a combination of microscopic and macroscopic examination and Matrix Assisted Laser Desorption Ionization Time-of-Flight (MALDI-ToF). After 4 weeks, filamentous fungal isolates that exhibit growth but do not sporulate are reported as "Sterile Mycelia". Clinical specimens that do not exhibit culture growth are reported as "No Fungi Isolated".

Specimen Collection

The Mycotics Section only accepts clinical specimens that are collected from sterile site sources including, but not limited to, cerebral spinal fluid, pleural fluid, pericardial fluid, etc. Isolates and inoculated media received for identification are accepted from any source.

All clinical specimens should be submitted in a conical centrifuge tube supplied by the M&M Division. Isolates and inoculated media should be submitted on screw-top culture media slants. Isolates submitted on plates will be rejected. An official BCL specimen requisition form must be submitted with each specimen. The date of specimen collection, specimen source, patient name, patient date of birth, and the test requested are required for testing.

Specimens should be packaged according to the guidance document located on the BCL portion of the Alabama Department of Public Health website and shipped at the appropriate temperature as indicated on the BCL analyte list and per Department of Transportation requirements. Kits containing shipping supplies may be requested through the BCL portion of the ADPH website.

Contact Information

Phone Number for the Mycotics Section: (334) 358-5233

Physical Address:
Bureau of Clinical Laboratories
204 Legends Court
Prattville, AL 36066