Tuberculosis Case Management Manual

Missouri State Public Health Laboratory TB Section

The Tuberculosis (TB) Section provides mycobacteriology diagnostic laboratory services to all Missouri healthcare providers and public health agencies.

Our mission is to provide accurate and timely detection, identification, drug susceptibility testing and genotyping of Mycobacterium tuberculosis complex (MTBC):

• In support of the State TB Elimination Program.
• To all public health agencies and Missouri healthcare providers.

The TB Section also provides limited identification of clinically significant nontuberculous mycobacteria (NTM) utilizing Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and genetic probe technology.

• Information on sputum collection and submission (See the Missouri State Public Health Laboratory).

Procedure for Sputum Collection:

Instructions for the patient/applicant:

• Sputum should be collected in the morning, before the patient has eaten.
• Have the person rinse his or her mouth with water before starting to collect the specimen to remove contamination such as food particles and bacteria. Patients with postnasal discharge should clear these passages before beginning sputum collection.

Instruct the patient as follows:

• Cough deeply. The lungs are like a sponge, containing moisture as well as air. Try to squeeze some of this moisture out of the lungs by coughing. Saliva from the mouth or mucous from the nasal or throat areas are not acceptable.
• Take a deep breath, hold your breath for a few seconds, and expel the air slowly. Do this twice. The third time, inhale deeply, hold your breath, and then forcefully blow the air out through your mouth. The fourth time, inhale deeply and cough.
• Hold the sputum container to your lower lip and gently release the specimen from your mouth into the container. After coughing, clear your throat to avoid swallowing the specimen.