TB Test Price in Pakistan: From Rs 385 at Marham Lab

Tuberculosis is caused by bacteria called Mycobacterium tuberculosis, which usually attack the lungs though they can attack any part of the body. CDC explains that TB germs can live in your body for years without making you feel sick, a state it calls inactive TB. At Marham Lab a sputum AFB stain costs Rs 385, which makes it the cheapest way to start.

If You Have a BCG Scar, Read This First

This is the single most important thing on this page for anyone in Pakistan, where BCG vaccination is routine and almost everyone carries the scar on their upper arm.

CDC states that TB blood tests are the preferred test for people who have received the TB vaccine, and explains why: unlike the TB skin test, TB blood tests are not affected by BCG vaccination.

The skin test, known here as the Mantoux or PPD test, can react to the vaccine rather than to a real infection. That is how a healthy vaccinated person ends up with a positive skin test and months of worry. The blood test, which CDC calls an interferon gamma release assay or IGRA, measures how your immune system reacts when a small amount of your blood is mixed with TB proteins, and the vaccine does not interfere.

If you were vaccinated, tell your doctor before any TB test is chosen.

The Two Questions TB Testing Answers

These are different questions and they use different tests. Getting them mixed up is the usual reason people pay for the wrong thing.

CDC describes two types of test for TB infection, the blood test and the skin test, and says a positive result means you have TB germs in your body. It then states that your provider will do other tests to determine whether you have inactive TB or active TB disease, and that these may include a chest x-ray and a test of the sputum you cough up.

So a screening test tells you whether the germs are there. A sputum test tells you whether you are currently ill and infectious.

Prices and Turnaround

Two things to notice. The culture is the slowest test in our entire catalogue at 3 to 7 weeks, because the bacteria genuinely take that long to grow. And Gene Xpert also reports rifampicin resistance, which is why doctors increasingly ask for it rather than a plain smear.

Follow the prescription. If your doctor wrote Gene Xpert, a cheaper smear is not a substitute.

How the Skin Test Works

CDC describes it simply. A health care provider uses a small needle to put some testing material under the skin, and you will need to return in two to three days to see whether there is a reaction.

That second visit is not optional and it is not flexible. A skin test that is never read is money wasted, and this is the commonest failure with the Mantoux here.

Who Should Be Tested

CDC says you may need a TB test if you have symptoms of TB disease, have spent time with someone who has active TB, have risk factors, or need testing for employment, school, travel or immigration screening. It adds that you may need a test even if you do not feel sick.

CDC lists a higher risk of exposure for people who were born in or frequently travel to countries where TB is common, including some countries in Asia, Africa and Latin America. Pakistan is among the countries carrying the heaviest TB burden in the world, which puts most of the population in this group by CDC's own criterion.

Other exposure risks CDC names: living or having lived in large group settings such as shelters or prisons, recently spending time with someone who has active TB, and working in hospitals, shelters, correctional facilities or nursing homes.

CDC separately lists a higher risk of developing disease once infected.

• A weaker immune system from certain medicines or conditions such as diabetes, cancer or HIV
• Infection with TB germs in the last two years
• Being a baby or young child, especially under five years of age
• Injecting illegal drugs
• Other diseases that weaken the immune system
• Being elderly
• Not having been treated correctly for TB in the past

Diabetes is worth naming twice given how common it is here. CDC also notes that TB tests are generally not needed for people with a low risk of infection.

Reading Your Result

CDC is clear about both directions.

A positive result for TB infection means you have TB germs in your body, and your provider will do other tests, which may include a chest x-ray and a sputum test, to determine whether the TB is inactive or active.

A negative result means inactive or active TB is unlikely, though CDC notes your provider may still do more tests, especially if you have symptoms of active TB disease such as coughing, chest pain, fever, weight loss or tiredness, if you have HIV, or if you were recently exposed to TB germs.

CDC adds a practical point that saves a lot of trouble later. Once you have a positive TB blood test or skin test result, you may still test positive on future tests, including after you finish all your TB medicine. It advises asking your provider for a written record of the positive result, which will help if you are asked to be tested again.

Keep that paper. In Pakistan it is commonly requested again for jobs, visas and college admission.

How to Prepare

No fasting is needed for the blood tests.

For a sputum test, the sample needs to come from deep in the chest rather than from the mouth. The best sample is usually the first one coughed up in the morning. Rinse your mouth with water first, breathe deeply a few times, then cough hard into the container. Saliva is not a sputum sample and will give a useless result.

Tell your doctor if you have had BCG vaccination, if you have been treated for TB before, and about every medicine you take, particularly steroids or anything that affects the immune system.

What Happens During the Test

For the blood tests, a trained phlebotomist takes a small blood sample from a vein in your arm using a small needle. It takes under five minutes and a brief sting or slight bruising afterwards is normal. In Lahore the sample can be collected at your home at no extra cost.

For a sputum test you provide the sample in a container, which can also be collected from your home. For the Mantoux test you must attend in person, both for the injection and for the reading two to three days later.

اردو میں

ٹی بی ایک جراثیم سے ہونے والی بیماری ہے جو عام طور پر پھیپھڑوں کو متاثر کرتی ہے، اگرچہ یہ جسم کے کسی بھی حصے میں ہو سکتی ہے۔ ایک اہم بات یہ ہے کہ ٹی بی کے جراثیم جسم میں برسوں تک موجود رہ سکتے ہیں اور کوئی علامت ظاہر نہیں ہوتی۔

سب سے ضروری بات ان لوگوں کے لیے جن کے بازو پر بی سی جی کا نشان ہے، یعنی پاکستان میں تقریباً سب کے لیے۔ عالمی ادارہ صحت کے امریکی ادارے سی ڈی سی کے مطابق جن لوگوں کو بی سی جی ویکسین لگی ہو ان کے لیے خون کا ٹیسٹ زیادہ موزوں ہے، کیونکہ جلد کے ٹیسٹ یعنی منٹو ٹیسٹ پر ویکسین کا اثر پڑتا ہے جبکہ خون کے ٹیسٹ پر نہیں۔ اسی لیے ویکسین لگی ہوئی صحت مند شخص کا منٹو ٹیسٹ بھی پازیٹو آ سکتا ہے۔ ڈاکٹر کو ویکسین کے بارے میں ضرور بتائیں۔

دوسری اہم بات۔ ٹی بی کے ٹیسٹ دو مختلف سوالوں کا جواب دیتے ہیں۔ خون یا جلد کا ٹیسٹ بتاتا ہے کہ جراثیم جسم میں موجود ہیں یا نہیں۔ بلغم کا ٹیسٹ اور ایکسرے بتاتے ہیں کہ بیماری اس وقت فعال ہے یا نہیں۔ رپورٹ پازیٹو آنے کا مطلب یہ نہیں کہ آپ بیمار ہیں، اس کے بعد مزید ٹیسٹ ہوتے ہیں۔

بلغم کا نمونہ دینے کا صحیح طریقہ یہ ہے کہ صبح اٹھ کر منہ پانی سے صاف کریں، چند گہرے سانس لیں، پھر زور سے کھانس کر سینے سے بلغم نکالیں۔ منہ کا تھوک بلغم نہیں ہوتا اور اس سے رپورٹ بے کار ہو جاتی ہے۔

ایک اور ضروری بات۔ ایک بار رپورٹ پازیٹو آ جائے تو آئندہ ٹیسٹوں میں بھی پازیٹو آ سکتی ہے، علاج مکمل ہونے کے بعد بھی۔ اس لیے ڈاکٹر سے رپورٹ کا تحریری ریکارڈ ضرور لیں، کیونکہ نوکری، ویزے یا داخلے کے وقت یہ دوبارہ مانگا جاتا ہے۔

مرہم لیب میں بلغم کے اے ایف بی ٹیسٹ کی قیمت صرف تین سو پچاسی روپے ہے اور لاہور میں گھر سے نمونہ لینے کی سہولت مفت ہے۔

Final Thoughts

TB testing in Pakistan goes wrong in three predictable ways. A BCG vaccinated person is given a skin test and panics over a positive result that reflects the vaccine. A Mantoux is injected and never read two days later. And a saliva sample is sent in place of sputum, producing a clean report on a sick patient. Tell your doctor about your BCG scar, follow the prescription rather than the price, give a proper deep cough sample, and keep a written record of any positive result for the next time somebody asks.