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Liquid culture and DST systems are more complex and sensitive than solid culture and DST media. Increased bacterial contamination and an increased frequency of nontuberculous mycobacterial (NTM) isolation must be addressed. A rapid method to differentiate the Mycobacterium tuberculosis complex from other mycobacterial species is essential. Several manufacturers have recently marketed tools that can automatically detect M. tuberculosis growth in the laboratory, such as the Bactec ""Mycobacterial Growth Indicator Tube 960"" (MGIT 960; Becton-Dickinson, Sparks, MD, USA) and the MB/Bact Alert 10 3D (Biom��rieux, Durham, NC, USA). Unfortunately, these automatized incubators are expensive, they do not give rapid mycobacterial species' identification, and they do not identify contaminated or mixed cultures. Conversely, cultures on solid media Oxymatrine provide all of this information with a simple observation of colonies. The current guideline recommends that all specimens cultured on liquid media also be inoculated on solid media to ensure purity and sufficient strengthen for the diagnosis9,11. 3. Molecular methods 1) Nucleic acid amplification testing Nucleic acid amplification (NAA) tests are a reliable way to increase the specificity of diagnosis, but the sensitivity is too poor to rule out disease, especially in smear-negative (paucibacillary) disease where clinical diagnosis is equivocal and where the clinical need is greatest23,24. Compared with AFB smear microscopy, the added value of NAA selleck kinase inhibitor testing lies in (1) its greater positive predictive value (PPV) (>95%) with AFB smear-positive specimens in settings in which NTMs are common and (2) its ability to rapidly confirm the presence of M. tuberculosis in 50%-80% of AFB smear-negative, culture-positive specimens. Compared with culture, NAA tests can detect the presence of M. tuberculosis bacteria in a specimen weeks before culture for 80%-90% of patients suspected to have pulmonary TB whose TB is ultimately confirmed by culture23,24,25. Although NAA testing is recommended to perform the initial diagnosis of persons suspected to have TB, the currently available NAA tests should selleck products not be ordered routinely when the clinical suspicion of TB is low because the PPV of the NAA test is