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Submitting Mycobacterium Specimens to DSHS Laboratory

Quick Links:  Specimen Submission Steps | Sputum, Bronchial Washing, and Tracheal Aspirates | Miscellaneous Body Fluids and Tissues | Pure Isolates | AFB Clinical Specimen Preparation and Submission Guidelines | Specimen Labeling Requirements | Required Fields on G-MYCO Submission Forms | G-MYCO Submission Form Tips | Shipping TB and Other Mycobacterial Specimens to the DSHS Laboratory | Shipping Mycobacterial Specimens Safely
 

Specimen Submission Steps

Refer to the DSHS’ LTSM test menu for specific guidance on specimen types, required volumes, and shipping temperatures for each test. Refer to the DSHS’ online Specimen Collection and Submission Guidance and Specimen Shipping and Mailing Guidance content for additional guidance on submitting clinical specimens to the Lab.

The steps to submitting TB specimens are outlined in the 4-step graphic.
 

"Fours stylized arrows summarize the four step DSHS specimen submission process."

1. Request a DSHS Lab Submitter ID Number 

New users and users updating previously submitted information, must fill out every applicable field of a Submitter ID Request Form and email the completed form to labinfo@dshs.texas.gov or fax it to 512-776-7533.

2. Obtain a Specimen Submission Form

Once you have a Submitter ID number, request a master copy of the required G-MYCO specimen submission form from Laboratory Reporting by emailing LabInfo@dshs.tx.gov or calling 512- 776-7578. 
A G-MYCO form is required for each mycobacteriology specimen submission. 

  • Use the most recent version of the G-MYCO form. Using old forms may be missing some required information and cause a specimen to be rejected. Email LabInfo@dshs.tx.gov to order updated forms. 

3. Collect and Label Specimen

High-quality specimens are vital for the laboratory diagnosis of TB. All received specimens must be labeled with at least two unique identifiers, preferably three.

NOTE: Patient identifiers on the specimen label and in the submission form must be identical. 

  • See the section titled Specimen Labeling Requirements for more details on providing matching identifiers on the specimen label and submission form.  
  • Downloadable guidance for correct specimen labeling is available. These flyers are designed to be printable and quick reference. 

Sputum, Bronchial Washing, and Tracheal Aspirates

The Lab accepts sputum, bronchial washings, and tracheal aspirate specimens for smear test, culturing, and Nucleic Acid Amplification Testing (NAAT). 

  • Sputum specimens are preferably collected under the direction of a trained healthcare professional. Additional guidance on sputum collection may be found in the table below. Use sterile, leak-proof 50 mL conical tubes.
  • Minimum volume required for testing is 3mL to 15 mL in each container. Do not overfill.
  • Specimens must be submitted to the DSHS Lab as soon as possible after collection, to be tested within 24 hours of collection. If shipping is delayed, refrigerate the specimen. 

Miscellaneous Body Fluids and Tissues

A variety of body fluid specimens are accepted for mycolic acid detection by direct HPLC and for identification tests. Body fluids are specimens other than plasma, serum, or urine. They include cerebrospinal fluid (CSF), dialysate, postsurgical drain fluid, wound fluid, and other fluids often obtained using ultrasound-guided aspiration (such as pancreatic, pericardial, and pleural fluid). 

  • Use sterile, leak-proof container for specimen collection such as a 50 mL conical tube.
  • CSF volume required ≥ 1mL.
  • Storage and preservation are dependent upon fluid type/origin.
  • Specimens must be submitted as soon as possible after collection.

Pure Isolates 

Pure isolates may be submitted for drug susceptibility testing on solid culture or in liquid media. Specimens must be pure and actively growing. The Laboratory does not supply isolation media. 

  • Solid media must contain visible growth of more than one colony. 
  • Minimal volume of 2 mL for liquid media is required. 
  • Specimen must not be older than 4–5 weeks. 
  • M. tuberculosis isolates MUST be shipped as Category A, UN 2814 Infectious Substance affecting humans. 
  • Unidentified isolates may be shipped as Category B Infectious Substances.

Pure Isolates for CDC Referral 

Isolates for CDC referral must first be submitted to the DSHS Austin Laboratory. Providers must not submit mycobacteria directly to CDC. 
Questions about CDC referrals? Call the Mycobacteriology Team at 512- 776-7342, or email Mycobacteriology@dshs.texas.gov.

For more information on specimen collection and storage requirements, review the test description of your requested test at the DSHS Lab Testing Service Manual. Acid fast bacilli (AFB) specimen collection and submission guidance is also provided in the table Acid Fast Bacilli Clinical Specimen Collection and Submission Guidelines. 

"A UN2814 Infectious Substance Category A Label flanked on both sides by a red biohazard symbol"


Acid Fast Bacilli Clinical Specimen Preparation and Submission Guidelines 

Specimen Type

Required Vol. and Specimen Preparation

Storage and Shipping

Replica Limits

Abscess: General

2 –3 ml of tissue in sterile saline. Minimum of 1g of tissue.
Aspirates are preferred over swab specimens.  

Collect in sterile leak-proof container such as a 50 mL conical tube.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze or preserve.
Swabs submitted in transport medium or culturette tubes are unacceptable.

 

1/day/source

Abscess: Open

2 – 3 ml of tissue in sterile saline. Minimum of 1g of tissue. 
Aspirates are preferred over swab specimens.

Collect in sterile leak-proof container. Do not use culture swabs or transport media.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze or preserve.
Swabs submitted in transport medium or culturette tubes are unacceptable.

1/day/source

Body Fluids: abdominal, amniotic, ascites, bile, joint, paracentesis, pericardial, peritoneal, pleural, synovial, thoracentesis

2 – 3 ml minimum
Always submit as much fluid as possible.
Never submit a swab dipped in fluid. 

Collect in sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen, but do not freeze. 

None

Cellulitis, aspirates

2 – 3 ml minimum
Collect aspirate in sterile leak-proof container such as a sterile 50 mL conical tube. E.g., 50 mL Falcon tube.  

Submit in sterile leak-proof container such as a 50 ml conical tube.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen, but do not freeze.

1/day

Cerebrospinal Fluid (CSF) Analysis

2– 3 ml minimum

Submit in a sterile leak-proof container.
Ship to Lab overnight at ambient temperature, ASAP after collection. Do not freeze 
Keep specimen at room temperature; do not refrigerate or freeze.

None

Endometrial Tissue

Minimum 1 g of tissue
Collect tissue aseptically during endometrial biopsy procedure.

Submit in a sterile leak-proof container; if dry, add up to 5 ml sterile saline for transport.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze or preserve.

1/day

Eye: Corneal Scrapings 

n/a

 
Specimen should be collected by an ophthalmologist.


Inoculate ulcer or lesion scrapings directly onto medium.

Isolate on BHI with 10% sheep blood agar plate (BAP) or chocolate agar plates (CHOC). 
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.

None

Eye Exudate

Minimum 1 mL preferred
Aspirates are preferred, if possible.

Submit in a sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.

None

Feces/Stool

1 g minimum, preferably more

Pass specimen directly into a sterile leak-proof container.
Do not use holding medium or transport medium. 

Rectal swabs are not acceptable for mycobacterial culture.

Submit in a sterile leak-proof container.
Ship raw specimen to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.
Do not preserve specimen.

1/day

Gastric Wash or lavage for mycobacteria

5 – 10mL minimum
15 ml maximum

Neutralize wash within 1 h of collection with 100 mg sodium carbonate since mycobacteria die rapidly in gastric washings.

Submit in a sterile leak-proof container.
Ship to Lab overnight at ambient temps, ASAP after collection.

1/day on three consecutive days

Respiratory: lower bronchoalveolar lavage, brush or wash, endotracheal aspirate, transtracheal aspirate

3 mL minimum
Collect washing or aspirate in a sputum trap.
Place brush in sterile leak-proof container with up to 5 ml of saline. 

Submit in a sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.

1/day

Skin Lesion

Tissue: 
in 2–3mL sterile saline
Swabs: in 2–3mL sterile saline
Place transudate in sterile leak-proof container.  

If tissue is collected, place tissue in sterile leak-proof container and add 2 ̶̶– 3 mL sterile saline for transport.

Swabs are discouraged unless it is the only specimen available.

Submit in a sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.

Swabs submitted in transport medium or culturette tubes are unacceptable.

1/day

Sputum: Natural

3 mL minimum
Collect in a sterile, leak proof container such as a 50 mL Falcon tube.

Submit in a sterile leak-proof container such as a 50 ml conical tube.
Submit in a sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.

At least three consecutive specimens needed, collected at 8-to-24-hour intervals, with at least one collected in the early morning.

Sputum: Induced 

3 mL minimum

Collect in a sterile, leak proof container such as a 50 mL Falcon tube.

Submit in a sterile leak-proof container such as a 50 ml conical tube.
Submit in a sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.

At least three consecutive specimens needed, collected at 8-to-24-hour intervals, with at least one collected in the early morning.

Tissue / Lymph Node Biopsy

As much tissue as possible. 
Aseptically collected during surgery or cutaneous biopsy procedure.

Submit in a sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.
Add 2 – 3mL of saline to tissue specimen for transport to Lab.

1/day

Vaginal Secretions

[no volume provided for secretions]
Swabs: in 2–3mL sterile saline.

Swabs are discouraged unless it is the only specimen available.

Submit secretions in a sterile leak-proof container.
Ship to Lab overnight on cold packs, ASAP after collection.
If shipping is delayed, refrigerate specimen; do not freeze.
Add 2 – 3mL of saline to specimen for transport.

Swabs submitted in transport medium or culturette tubes are unacceptable.

1/day

 

Specimen Labeling Requirements

  • Every specimen must have at least two unique patient identifiers affixed to it. Three identifiers are preferred. 
  • Every specimen must be submitted with a submission form. 
  • Patient-specific identifiers on the specimen and the submission form must match exactly. 
  • All required fields in the submission form must be completed.

Specimens not meeting these requirements will be rejected (unsat) by the Laboratory. Potential delays in patient treatment can be avoided with correct specimen labeling and completion of submission forms.

Acceptable specimen identifiers include, but are not limited to: 

  1. Patient’s Name 
  2. Patient’s Date of Birth 
  3. Patient’s Medical Record Number 
  4. Specimen ID Number 
  5. CDC Number 
  6. Unique Random Number
  7. Medicaid Number
  8. Date of Collection

Note: Location-based identifiers such as hospital room number or street address are NOT acceptable.
"A green arrow points to the patient identifiers on a specimen label. Label reads: "Three identifiers on this label: 1. Name, 2. Date of Birth, 3. Medical Record Number""

Sample label showing acceptable identifiers 
Patient identifiers on label are fictitious. Any similarity to a real person is coincidental. 

 

Required Fields on G-MYCO Specimen Submission Forms 

  • All required fields in the G-MYCO form are marked with double asterisks (**) and MUST be completed.
  • A G-MYCO specimen submission form is required for every mycobacteriology specimen submission.
  • If filling out the form by hand, use BLOCK lettering. To improve legibility and reduce transcription errors avoid using cursive script.
  • A submission form is required with every specimen.
  • Do not bundle a submission form with two or more specimens.
  • Do not place labels or stickers over any required fields. 

Required Fields on G-MYCO Submission Form, Explained

Submitter’s Texas Provider Identifier (TPI) Number
SECTION 1
 
The TPI number is a unique number the DSHS Laboratory assigns to each of our submitters. To obtain a Texas Provider Identifier (TPI) number, contact Texas Medicaid and Healthcare Partnership (TMHP) at 1-800-925-9126. To request a DSHS submitter number, a master form, or to update submitter information, call (888) 963-7111 ext. 7578 or 512- 776-7578, or fax 512- 776-7533. Alternatively, visit DSHS Forms and Laboratory Fee Schedule
Submitter’s National Provider Identification (NPI) Number
SECTION 1
 
All health care providers must include their NPI number. To obtain an NPI number, contact the National Plan and Provider Enumeration System (NPPES) toll free at (800) 465-3203 or via their website at https://nppes.cms.hhs.gov/NPPES/Welcome.do
Submitting Facility’s Name and Address
SECTION 1
 
Provide the submitter’s name, address, City, State, and zip code. Clearly print, use a pre-printed label, or use a legible photocopy of a master form provided by DSHS Laboratory.
Submitting Facility’s Point of Contact Information  Provide the name, telephone number, and fax number of the point of contact (POC) at the submitting facility in case the laboratory needs additional information about the specimen or isolate.
SECTION 1  
Clinic Code
SECTION 1
 
Provide only when applicable. The clinic code identifies the satellite office that submitted the specimen to the submitter. It helps the submitter identify where the lab report belongs in situations when the submitter has a primary mailing address with satellite offices. 
Patient Information
SECTION 2 
 
Complete ALL required fields in this section. The patient’s first and last name provided on the specimen MUST match the patient’s name on this form. All specimens MUST be labeled with at least two patient-specific identifiers; both a primary and a secondary identifier. The identifiers used MUST appear on both the specimen container and its submission form. Specimens that do not meet these identifier requirements will be classified as unsatisfactory for testing and will not be tested.
Specimen Source or Type
SECTION 3
 
Indicate the type of material or the source of the specimen or isolate being submitted. For specimens not described in the list, check the “Other” option, provide specific details, and initial next to them.
Clinical Specimens: Test Requested 
SECTION 4 
 
Identify the test requested for the clinical specimen being submitted. Tests are groups by specimen type: Raw Unprocessed, Processed Sediments, and AFB Positive Smears. Note: Prior authorization is required for submission of AFB positive smears.  
To cancel a test marked in error, place a single line through the test name and write “error”. 
Provide information about any previous laboratory testing of this specimen to assist DSHS with the identification process.
 
Referred Pure Cultures: Test Requested 
SECTION 5 
 
Identify the test requested for the isolate being submitted.
To cancel a test marked in error, place a single line through the test name and write “error”. 
Provide information about any previous laboratory testing of this specimen to assist DSHS with the identification process.
 
Ordering Physician’s Information
SECTION 6
 
Provide the name of the physician who ordered the test and the physician’s NPI number. 
Payor Source
SECTION 7
 
Select TB Elimination (1619) as the Payor. 
Susceptibility Testing
SECTION 8
 
Check “Yes” or “No” to indicate whether the specimen is of suspected Multiple Drug Resistant M. tuberculosis
Indicate which Drug Susceptibility Panel is being requested, for either M. tuberculosis (MTB), or M. kansasii.
 
  • All required information on a submission forms is marked with double asterisks (**).
  • A submission form is required with every specimen.
  • Do not bundle a submission form with two or more specimens.
  • Do not place labels or stickers over any required fields. 

Submission Form Questions? Contact the Laboratory Reporting Group at 1-888-963-7111 ext. 7578 or email: LabInfo@dshs.texas.gov.

G-MYCO Submission Form Tips

Several TB specimens received at the Laboratory require follow up calls to submitters because they are missing required information or identifiers. The following are tips to avoid the most common submission form issues.

Specimen Label and Submission Forms Must Agree

  • Patient identifiers provided on label and in Sections 2 and 3 of submission form must match exactly.
  • The patient identifiers on specimen labels must also be put in the submission form. Abbreviating or obscuring patient name(s) on specimen labels is discouraged.
  • The Date of Collection (DOC), MUST be provided. 

"A screenshot of an excerpt from Sections 2 and 3 of a G-MYCO specimen submission form.  Two specimen labels are above the excerpt. Labels and Submission form sections have patient identifiers printed on them."

Section 3: Specimen Source Must be Identified 

Identify only one specimen source.

  • Indicate the specimen source by checking only one option in Section 3.
  • Avoid accidentally checking two boxes.

"A screenshot of an excerpt from a G-MYCO specimen submission form that lists specimen sources or types. "Sputum: Natural" is marked with a check mark"

Sections 4 and 5: Request a Test 

  • Identify the type of test requested by checking only one option in Section 4. DSHS Laboratory.
  • Only one test should be selected.
  • Ensure the test requested is appropriate for the specimen.
  • Specimens cannot be processed without a test being selected.

"A close-up of Sections 4 and 5 of a G-MYCO specimen submission form. AFB Smear and Culture is selected with a check mark."

Section 7: Identify the TB Elimination Program as the Payor 

  • Select “TB Elimination”.
  • If Section 7 is left blank, the submitter is automatically charged.

 

 

4. Shipping TB and Other Mycobacterial Specimens to the DSHS Laboratory 

Mycobacterial specimen submissions are classified as infectious substances and must be packed and shipped accordingly. Submitters have legal responsibilities for the safe handling, labeling, and shipping of mycobacterial specimens.

Specimen Type Infectious Substances Classification
Clinical Specimens Category B Infectious Substance, UN3373
Unidentified Isolates Category B Infectious Substance, UN3373
M. tuberculosis and Suspected M. tuberculosis Isolates Category A, UN2814 Infectious Substance Affecting Humans

 Before shipping your specimens, make sure you

  • labeled the specimen with the required patient identifiers (two minimum, three preferred),
  • secured the lid of specimen container to prevent leaks,
  • completed a G-MYCO specimen submission form for each specimen,
  • provided the date of collection on the submission form,
  • selected the requested test on the form, 
  • attached copies of any previous lab results,
  • triple packed the specimen according to its classification,
  • secured specimen inside shipping container to prevent breaks, 
  • affixed all required shipping labels to the outer mailer, and 
  • packed with frozen gel packs, not dry ice with chilled specimens.

Also refer to the shipping directions in the LTSM test pages found in the LTSM Test Menu for test-specific details. 
 

Temperature Requirements for AFB and TB Specimens

Specimen Type Shipping/Storage Temperature Other Requirements
Sputum, Bronchial Washing, and Tracheal Aspirate Cold (2–8°C)
  • Ensure the primary container for patient self-collect sputum specimens has a specimen in it. 
  • Specimen must be tested within 24 hours of collection. 
  • Ship to Lab ASAP on frozen cooler packs. 
  • Ensure the specimen source is identified.
  • Close lid of specimen tube tightly, making sure the cap is threaded properly. 
  • Seal lid with wrap (such as Parafilm) to ensure the sample will not leak.
Miscellaneous Bodily Fluids Cold (2–8°C)
  • Ship to the DSHS Laboratory ASAP.
  • Pack with frozen cooler packs if shipping is delayed by more than 1 hour after collection.
  • Ensure the specimen source is identified on submission form.
Isolates Ambient
  • M. tuberculosis isolates must be shipped as Category A Biological Substances. Undetermined isolates may be shipped as Category B.
  • Personnel who handle and ship isolates MUST be properly trained on shipping Category A infectious substances.    

 

 

Shipping Mycobacterial Specimens Safely

"Warning symbol with solid fill"

 

Submitters are legally responsible for the safe handling, labeling, and shipping of infectious substances to the DSHS Laboratory. 

 

Without exception, anyone handling or shipping Category A or Category B specimens is required to complete the appropriate training on handling and shipping of hazardous materials and to maintain their certification(s) for review. See 49 CFR § 172.700, 49 CFR § 172.702, and 49 CFR § 172.704.

Failure to be trained and to properly pack and ship infectious substances materials is a violation of federal law and each person who knowingly violates a requirement of the law is liable for a civil penalty (fines).

NOTE: The DSHS Laboratory does not provide, nor is it responsible for ensuring submitters complete the required training. The shipping information presented here is not a substitute for completing shipping hazardous materials training required to comply with Federal Hazardous Materials Transportation law.  

Mycobacterial Specimen Type Classification Outer Mailer Labeling Requirements
Clinical (e.g., swabs, stool, urine, sputum, gastric lavage, biopsy tissue)  Category B Infectious Substances, UN3373 "UN3373"
Pure Isolate (liquid or solid media) Category A Infectious Substances, UN2814 Infectious Substance affecting humans "UN2814/Infectious Substance"

 

Wrap Primary Containers Individually Multiple fragile primary containers must be individually wrapped in absorbent material or separated to prevent contact between them.

  • Ideally, each primary container should be sealed in its own secondary container with enough absorbent material to soak up all of specimen should it spill. 

Triple Packing Required for Shipping Infectious Substances
"A blackline drawing diagram of a cut-out shipping package for a Category B biological substance and a package for shipping a Category A "