抗酸杆菌涂片和培养

抗酸杆菌为杆状的细菌，涂片抗酸染色后可在显微镜下观察和计数。分枝杆菌属为最常见的抗酸杆菌。

        结核分枝杆菌是分枝杆菌属中最常见也是最常导致感染的种。大部分送检做抗酸杆菌涂片或培养的标本，是因为医生怀疑该病人可能患肺结核。分枝杆菌属中有60多个种，其中只有少部分会导致人类感染，包括：

• 非洲分枝杆菌，在某些地方引起类似于肺结核的疾病。
• 鸟分枝杆菌-无色分枝杆菌复合群（MAC），可引起免疫低下病人（如老年人和获得性免疫缺陷病患者）肺部感染，这种感染不传染但是不易治疗，因其易于对多种抗生素高度耐药。
• 其他分枝杆菌属的细菌，如海分枝杆菌，生长在水中（如鱼缸），可导致皮肤感染。其他一些快生长分枝杆菌会导致伤口感染。
• 很少分枝杆菌属的细菌，如牛分枝杆菌，有时可由动物传染给人。

        因为细菌的数量每天都可能变化，没必要对来自不同标本的涂片都进行抗酸杆菌计数。任意一张涂片中查到抗酸杆菌，即说明可能存在分枝杆菌感染，而结核分枝杆菌为最常见的引起呼吸道感染的分枝杆菌，所以可以做出疑似肺结核病的诊断，再进行后续试验来鉴定该抗酸杆菌为结核分枝杆菌还是其他分枝杆菌。

        患者标本在涂片查抗酸杆菌的同时作抗酸杆菌培养，即在实验室中让抗酸杆菌生长。体液或组织标本需要先去除正常呼吸道菌群的污染，消化使粘液乳化，浓缩集菌，再转移到有营养的环境中孵育。因分枝杆菌生长缓慢，阳性培养结果（包括种属鉴定）可能需要数天到数周时间，阴性培养结果（即无分枝杆菌生长）需要6到8周时间。

因结核分枝杆菌和牛分枝杆菌常引起肺部感染，故常采取痰液标本，要求从肺部咳出粘液样或浓稠粘液样的痰。通常连续几天分别采取3到5次晨痰标本于单独的无菌痰杯中。

        若无法咳出痰，医生可用支气管镜检查采集呼吸道标本。医生可以通过支气管镜看到支气管及细支气管，并从中采集标本。这些分支的管子可以通过喉咙到达肺部，提供一条由外界至肺部的通道。当局麻药物喷入气管后，医生即可将管子插入气管、细支气管，并抽吸其中的液体作为标本。有时，医生会通过该管道注入少量的生理盐水，冲洗支气管后再抽吸出来作为标本。

        因小儿难于留取痰标本，可采集胃灌洗液，即通过管道将生理盐水注入胃里，冲洗后再抽吸出来。

        若医生怀疑为肺部以外的结核病（常见于AIDS患者），可采取可疑感染部位的体液或组织作为标本。例如，若怀疑肾结核，可采取一次或多次尿液检查;也可用针采取关节或其他体腔中的液体，如心包积液或腹水。医生偶尔会采取脑脊液或进行一个小的外科手术采取活体组织标本。

疾病: 结核, 非结核性分枝杆菌

CDC National Center for HIV, STD and TB Prevention: Division of Tuberculosis Elimination
American Lung Association
World Health Organization

S1
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

S2
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

S3
Heimerdinger, M. (2000). Tuberculosis [21 paragraphs]. ACP-ASIM [On-line session report]. Available FTP: http://www.acponline.org/vas2000/sessions/tb.htm

S4
Kirchner, J. (2000 February 1). Do Sputum Smears Positive for AFB Signify Treatment Failure? [6 paragraphs]. American Family Physician [On-line journal]. Available FTP: http://www.aafp.org/afp/20000201/tips/25.html

S5
Jerant, A. et.al. (2000 May 1). Identification and Management of Tuberculosis [60 paragraphs]. American Family Physician [On-line journal]. Available FTP: http://www.aafp.org/afp/20000501/2667.html

S6
Sadovsky, R. (2001 May 15). Making the Diagnosis of Tuberculosis in Children [5 paragraphs]. American Family Physician [On-line journal]. Available FTP: http://www.aafp.org/afp/20010515/tips/9.html

S7
Centers for Disease Control and Prevention (CDC) (2002 August 13, Reviewed). Frequently Asked Questions, Questions and Answers about TB [65 paragraphs]. National Center for HIV, STD and TB Prevention Division of Tuberculosis Elimination [On-line information]. Available FTP: http://www.cdc.gov/nchstp/tb/faqs/qa.htm

S8
Tuberculosis [45 paragraphs]. The Merck Manual of Medical Information--Home Edition [On-line information]. Available FTP: http://www.merck.com/pubs/mmanual_home/sec17/181.htm

S9
Tan, L.J. (2000 June 28, Updated). ATS/CDC Statement Revises Treatment and Testing for Latent TB Infection [7 paragraphs]. American Medical Association [On-line information]. Available FTP: http://www.ama-assn.org/ama/pub/article/1865-2125.html

S10
Mazurek, G. & Villarino, M. (2002 December 18 Updated). Guidelines for Using the QuantiFERON®-TB Test for Diagnosing Latent Mycobacterium tuberculosis Infection [31 paragraphs]. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report [On-line report]. Available FTP: http://www.cdc.gov/mmwr/preview/mmwrhtml/di51cha1.htm

S11
Centers for Disease Control and Prevention (2002 March 23, Reviewed). TB and HIV Coinfection [29 paragraphs]. National Center for HIV, STD and TB Prevention, Division of Tuberculosis Elimination [On-line information]. Available FTP: http://www.cdc.gov/nchstp/tb/pubs/TB_HIVcoinfection/default.htm

S12
Tuberculosis: Ancient Enemy Present Threat, "I must die": Tuberculosis in History [12 paragraphs]. NAIAD [On-line information]. Available FTP: http://www.niaid.nih.gov/newsroom/focuson/tb02/story.htm

S13
Tuberculosis (TB) [51 paragraphs]. American Lung Association [On-line information]. Available FTP: http://www.lungusa.org/diseases/lungtb.html

S14
(2002 January). American Lung Association® Fact Sheet: Tuberculosis [25 paragraphs]. ALA [On-line information]. Available FTP: http://www.lungusa.org/diseases/tbfac.html

S15
(2002 January). American Lung Association® Fact Sheet: Tuberculosis Skin Test [10 paragraphs]. ALA [On-line information]. Available FTP: http://www.lungusa.org/diseases/tbskinfac.html

S16
(2002 January). American Lung Association® Fact Sheet: Pediatric Tuberculosis [8 paragraphs]. ALA [On-line information]. Available FTP: http://www.lungusa.org/diseases/pedtbfac.html

S17
NIAID (1999 December 1, Updated). The Global Burden of Tuberculosis [8 paragraphs]. National Institute of Allergy and Infectious Diseases, National Institutes of Health [On-line publication]. Available FTP: http://www.niaid.nih.gov/publications/blueprint/page2.htm

S18
Tuberculin skin test [17 paragraphs]. Hendrick Health System AccessMed [On-line information]. Available FTP: http://www.hendrickhealth.org/healthy/00069330.html

S19
Tuberculosis [33 paragraphs]. Hendrick Health System AccessMed [On-line information]. Available FTP: http://www.hendrickhealth.org/healthy/00069340.html

S20
Mycobacteriology, Introduction to the Genus Mycobacteria [4 paragraphs]. Microbiology Public Health for Northern Alberta, Bugs on the Web [On-line information]. Available FTP: http://www2.provlab.ab.ca/bugs/mycob/mbintro.htm

S21
Mycobacteriology, Acid-Fast Staining Procedures for Mycobacteria [15 paragraphs]. Microbiology Public Health for Northern Alberta, Bugs on the Web [On-line information]. Available FTP: http://www2.provlab.ab.ca/bugs/mycob/afb_stain/afb_tutorial.htm

S22
Hall, G. (2001). Practical Microbiology, Update on Broth Media for the Isolation of Mycobacterium Species [12 paragraphs]. Medscape from Infect Med 18(1):28-30, 2001 [On-line journal]. Available FTP: http://www.medscape.com/viewarticle/410131

S23
Tuberculin Purified Protein Derivative (Mantoux) Tubersol [58 paragraphs]. Aventis Pasteur Inc. (Swiftwater, PA) [Package Insert].

S24
(1996 October 28, Rev L). AccuProbe, Mycobacterium Tuberculosis Complex Culture Identification Test [63 paragraphs]. Gen-Probe [Package Insert]. Available FTP: http://www.gen-probe.com/mtd.html

S25
(2006 November 3). Notice to Readers: Revised Definition of Extensively Drug-Resistant Tuberculosis [3 paragraphs]. Accessed December 10, 2006. CDC MMWR 55(43);1176 [On-line information]. Available FTP: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5543a4.htm

S26
(2006 April). Tuberculosis: General Information [12 paragraphs]. Accessed December 10, 2006. National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination Fact Sheet [On-line information]. Available FTP: http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250010.htm

S27
(2006 March, Revised). Tuberculosis [18 paragraphs]. Accessed December 10, 2006. World Health Organization [On-line information]. Available FTP: http://www.who.int/mediacentre/factsheets/fs104/en/index.html

S28
(2006 March). Tuberculosis [33 paragraphs]. Accessed December 10, 2006. NIAID Fact Sheet [On-line information]. Available FTP: http://www.niaid.nih.gov/factsheets/tb.htm

S29
(2006 April). Diagnosis of Tuberculosis Disease [7 paragraphs]. Accessed December 10, 2006. National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination Fact Sheet [On-line information]. Available FTP: http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250102.htm

S30
Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby’s Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 955-957.

S31
Moore, DAJ et al. Microscopic-Observation Drug-Susceptibility Assay for the Diagnosis of TB. New England Journal of Medicine 2006;355:1539-1550.