What are acid-fast bacillus (AFB) tests?

Acid-fast bacillus (AFB) is a type of bacteria that causes tuberculosis and certain other infections. Tuberculosis, commonly known as TB, is a serious bacterial infection that mainly affects the lungs. It can also affect other parts of the body, including the brain, spine, and kidneys. TB is spread from person to person through coughing or sneezing.

TB can be latent or active. If you have latent TB, you'll have TB bacteria in your body but won't feel sick and can't spread the disease to others. If you have active TB, you'll have symptoms of the disease and could spread the infection to others.

AFB tests are usually ordered for people with symptoms of active TB. The tests look for the presence of AFB bacteria in your sputum. Sputum is a thick mucus that is coughed up from the lungs. It is different from spit or saliva.

There are two main types of AFB tests:

• AFB smear. In this test, your sample is "smeared" on a glass slide and looked at under a microscope. It can provide results in 1–2 days. These results can show a possible or likely infection, but can't provide a definite diagnosis.
• AFB culture. In this test, your sample is taken to a lab and put in a special environment to encourage the growth of bacteria. An AFB culture can positively confirm a diagnosis of TB or other infection. But it takes 6–8 weeks to grow enough bacteria to detect an infection.

Other names: AFB smear and culture, TB culture and sensitivity, mycobacterial smear and culture

What are they used for?

AFB tests are most often used to diagnose active tuberculosis (TB) infection. They may also be used to help diagnose other types of AFB infections. These include:

• Leprosy, a once feared, but now a rare and easily treatable disease that affects the nerves, eyes, and skin. The skin often becomes red and flaky, with loss of feeling.
• An infection is similar to TB mostly affects people with HIV/AIDS and others with weakened immune systems.

AFB tests may also be used for people who have already been diagnosed with TB. The tests can show if the treatment is working and whether the infection can still be spread to others.

Why do I need an AFB test?

You may need an AFB test if you have symptoms of active TB. These include:

• Cough that lasts for three weeks or more
• Coughing up blood and/or sputum
• Chest pain
• Fever
• Fatigue
• Night sweats
• Unexplained weight loss

Active TB can cause symptoms in other parts of the body besides the lungs. Symptoms vary depending on which part of the body is affected. So you may need testing if you have:

• Back pain
• Blood in your urine
• Headache
• Joint pain
• Weakness

You may also need testing if you have certain risk factors. You may be at higher risk of getting TB if you:

• Have been in close contact with someone who has been diagnosed with TB
• Have HIV or another disease that weakens your immune system
• Live or work in a place with a high rate of TB infection. These include homeless shelters, nursing homes, and prisons.

What happens during AFB testing?

Your health care provider will need a sample of your sputum for both an AFB smear and an AFB culture. The two tests are usually done at the same time. To get sputum samples:

• You will be asked to cough deeply and spit into a sterile container. You will need to do this for two or three days in a row. This helps make sure your sample has enough bacteria for testing.
• If you have trouble coughing up enough sputum, your provider may ask you to breathe in a sterile saline (salt) mist that can help you cough more deeply.
• If you still can't cough up enough sputum, your provider may perform a procedure called a bronchoscopy. In this procedure, you will first get medicine so you won't feel any pain. Then, a thin, lighted tube will be put through your mouth or nose and into your airways. The sample may be collected by suction or with a small brush.

Will I need to do anything to prepare for the test?

You don't any special preparations for an AFB smear or culture.

Are there any risks to the test?

There is no risk to providing a sputum sample by coughing into a container. If you have a bronchoscopy, your throat may feel sore after the procedure. There is also a small risk of infection and bleeding at the site where the sample is taken.