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This is Charles prober and I'm Morgan theis and we're going to be talking about the diagnosis of tuberculosis and the reason that we're talking about the diagnosis of tuberculosis is that it's as we said before a very important infection it's estimated that there are about 9 million new cases of tuberculosis recognized recognized each year around the world but it's also estimated there's another three million or so cases about a third additional that are not diagnosed so our goal is to increase our diagnostic abilities around TB now the picture the x-ray that's shown is from the Centers for Disease Control and this was a patient who had pulmonary TB you can see the arrows pointing in the lung to a round lesion which appears like a cystic lesion and this is actually a cavity so this is cavity TD so how would you how would you start suspecting somebody might have a pulmonary infection with t v-- well first of all they would typically present to the physician with symptoms respiratory symptoms coughing for example shortness of breath inability to do the exercise the way they used to do it before when they're coughing they might be coughing up sputum which is of an odd color maybe yellow or green or oftentimes the sputum has blood in it so called hemoptysis so you would see such a patient you would think they have a pulmonary process you do a chest x-ray and this is what you see on chest x-ray and then you the astute clinician would say this might be TB so the first thing you then would do is a tuberculin skin test which is shown in the picture of the skin also from the CDC and the arrows indicate the arrows pointing at the ruler indicate that the area of swelling in the area of induration with this TB skin test is about 10 Melanie and that's a positive reaction there's also surrounding redness but that doesn't count in terms of measuring the size of the reaction so we now have a person who's got a positive chest x-ray consistent with tuberculosis and a positive TB skin test and that suggests that gee this really might be TD but the diagnosis is not made at that point one needs to then try to isolate to find the organism in the lung of the patient and what's done as a first step to that is to obtain a sample of the patient's peuta so to induce them to cough up some of their sputum and then to send that sputum to the laboratory and in the laboratory the first thing that they will do after you've told them you're suspecting TB is they will do a TB specific stain looking for AFB acid-fast bacilli there are several TV specific stains one for example is called the zeal Nielsen stain which is abbreviated the Zn stain and these are good staining techniques but they're.