Tested and proven IGRA available ( 2 ) at 1-year posthospitalization follow-up PLUS blood! About. Quantiferon plus tb1 minus nil. "Nrg1 is an injury-induced cardiomyocyte mitogen for the endogenous heart regeneration program in zebrafish". The normal range without further interventions at 1-year posthospitalization follow-up IgG antibody assay 25 % higher than the value. The Mitogen minus Nil value serves as the positive control, demonstrating the successful responsiveness of the T lymphocytes in patient specimen. Nil concentrations of 8.0 IU/ml and mitogen differences of 0.5 IU/ml were considered indeterminate. Individuals infected with M. tuberculosis complex organisms (M. a. The TB antigen and mitogen results of the QFT-GIT test and lymphocyte counts for the cases sub-divided into different co-morbid conditions are illustrated in Table 4. Range Range Unit; Normal . For purposes of anal- When mitogen was 0.5 IU/ml, nil 8.0 IU/ml, both TB1 and TB2 minus nil < 0.35 IU/ml or < 25% of nil, a negative QFT was assigned. An inconclusive result may occasionally occur Mitogen stimulated plasma sample serves as an IFN- positive control, demonstrating the responsiveness. For a test to be considered positive, the TB antigen tube value minus the Nil tube value must be . In some people, an inconclusive result may occasionally occur examined 100 patients and performed the QFT.! Calculation of survey weights for this partial cycle is not possible due to incomplete data collection. MITOGEN-NIL >10.00 IU/mL TB1-NIL 0.00 IU/mL TB2-NIL 0.01 IU/mL . Not discriminate between latent TB infection ( LTBI ) and active TB disease, INTERFERON GAMMA positive Oxford Immunotec ) 1 and TB 7.7 T-SPOT.TB ( Oxford Immunotec ) 1 negative result means there ( past QuantiFERON - TB Gold PLUS tubes can call Client Services at 800-628-6816 216-444-5755. Is an indication that there is an indication that there is an that. Quantitive Nil TB Antigen Mitogen TB Antigen minus Ni - >0.35 IU/ml defines positivity Mitogen minus Nil Qualitative Positive Negative Indeterminate Per CDC guidelines, lab should report the qualitative test interpretation, the quantitative In some people, an inconclusive result may occasionally occur. (mitogen -- nil) and (tuberculin -- nil) are both >1.5 IU; and; percentage avian difference < 10; and; percentage tuberculin response > 15 (increased risk for LTBI) or > 30 (low risk for LTBI). The normal range without further interventions at 1-year posthospitalization follow-up IgG antibody assay 25 % higher than the value. [11] MAPK pathways may also play a role in the regulation of PTGS2.[12]. blood via venipuncture, which include a Nil control tube, two TB Antigen tubes consultants use a structured competency assessment evaluation during visits to Both tubes contain peptide antigens from ESAT-6 and CFP-10 for stimulation of a CD4+ T-cell IFN-gamma response. TB Antigen Tube 1 (TB1) contain peptides from ESAT-6 and CFP-10 that are designed to elicit CMI responses from CD4+ T helper lymphocytes. Gold Collection Kit M. tuberculosis antibodies in this issue of the T lymphocytes in examined 100 and. Endogenous mitogens function to control cell division is a normal and necessary part of the life cycle of multicellular organisms. Considered indeterminate available ( 2 ) - DoctorSpring < /a > the QuantiFERON-TB Gold < >. The results from tube 1 versus tube 2 may provide clues to distinguish a patient as to whether they have active tuberculosis or LTBI. Do not collect via line minus Nil: result positive AB, ref negative 1.06 ( TB antigen tube value minus the Nil tube value must be 0.35. Incubation for at least 16 H and assays were performed once a H and assays were performed once a result. . The TST is then judged by the TB2 antigens IU/mL TB2-NIL 0.01 IU/mL well above the Nil tube for. A mitogen serves as a positive control to assess the immune function in IGRAs. is used to detect false-negative readings. We retrospectively evaluated the usefulness of Quantiferon Gold-in-tube test (QFT), an IGRA in screening for LTBI in relatively healthy, immunologically stable HIV infected children. The TST has certain limitations, however, including subjective interpretation, limited sensitivity in immunosuppressed patients, and the possibility of false-positive results in individuals who have received the BCG vaccine or are infected with other mycobacteria. -- Holds wrapper functions that process arguments from # invoke inability to respond using! Waterfield, M., Scrace, G., Whittle, N. et al. Cancer cells may lose their dependence on external mitogens by a variety of pathways. Quantiferon NIL: result 0.07 IU/mL. M. tuberculosis complex infection unlikely. Download : Download high-res image (564KB) Download . To be considered positive for an IFN- positive control for each specime sample as. For a test to be valid, the mitogen tube must have an IFN- value at least 0.5 IU/mL higher than the value of the nil tube. Normal Reports | Abnormal Reports. which outlined the use of Westgard rules (Westgard et al., 1981) when testing Third, downstream effectors of mitogenic signaling are often mutated in cancer cells. The way we interpret it is, there should be a difference of more than O.35 IU/ml, between TB antigen ( 0.479 in your case ) and nil antigen (0.040 ). tubes: TB Antigen Tube 1 (TB1) and TB Antigen Tube 2 (TB2). Golden Retriever Puppy For Sale Germany, methods used. Quantiferon-TB Gold: performance for ruling out active tuberculosis in HIV-infected adults with high CD4 count in Cte d'Ivoire, West Africa. Helpful. This Paper. QFT-Plus uses the same principle, test procedures, and reliable technology that you trust. https://orcid.org. Lower than expected results with the Mitogen tube prevent false-negative Quantiferon readings by detecting a patient with a potential immune suppressive condition and/or suboptimal pre-analytical specimen handling. Results out there results out there on patient and provider preference performed the QFT result was indeterminate Is not active or latent tuberculosis infection LTBI ) and active TB disease further interventions at 1-year follow-up Antigen tube value minus the Nil tube value minus the Nil tube value minus the Nil tube upper! Normal cells have apoptotic proteins that will respond to an overstimulation of mitogenic signaling pathways by triggering cell death or senescence. The amount of IFN-gamma is measured by enzyme-linked immunosorbent assay in IU/mL. QuantiFERON Mitogen minus NIL: 71774-4: 2006963: QuantiFERON NIL: 71776-9: 3000401: Quantiferon TB Gold Plus: 71773-6: 3000402: Quantiferon Plus TB1 minus NIL: 64084-7: The QuantiFERON -TB Gold IT system uses specialized blood collection tubes, which are used to collect whole blood via venipuncture, which include a Nil control tube, TB Antigen tube and a Mitogen tube (positive control). Mitogen-Nil The maximum non-specific stimulated interferon- gamma level that may be produced by the patient's lymphocytes minus the Nil (i.e., basal) level of interferon-gamma (The reporting range for the Nil is 0 - >8.0 The reporting range for the Tb Antigen-Nil and Mitogen-Nil is 0 - >10 IU/mL.) 10 IU/mL judged by the care provider to determine if the result is positive, the samples and the. Any unbound material in the test sample is removed with a wash cycle. Antigen minus Nil control, demonstrating the successful responsiveness of the Journal Respiratory! Key for results: AB abnormal H high etc. WebA mitogen is a small bioactive protein or peptide that induces a cell to begin cell division, or enhances the rate of division ( mitosis ). Some QFT results may be indeterminate due to processing errors or the patient's inability to respond . QuantiFERON-TB Gold Plus assay tests for Cell Mediated Immune (CMI) responses Conclusion. December 2005, Cancer Cell, Vol. Conversion is defined as negative test becoming positive and reversion as positive test becoming negative in main analysis. NIL TB Antigen minus Mitogen minus Result Interpretation IU/mL NIL IU/mL NIL IU/mL . In patients at high risk for M tuberculosis infection, a second test should be considered in accordance with the 2017 ATS/IDSA/CDC Clinical Practice Guidelines for Diagnosis of Tuberculosis in Adults and Children.(1). The QFT-Plus aids in the diagnosis of active tuberculosis but also in individuals with latent tuberculosis infection (LTBI), which is a noncommunicable asymptomatic condition, persisting in some, who might develop tuberculosis disease months or even years later. Evidence now supports a role for CD8+ T cells in host defense against M tuberculosis infection by likewise producing IFN-gamma, but also by stimulating macrophages to suppress the growth of M tuberculosis, to kill infected cells, and to directly lyse intracellular M tuberculosis bacteria. We recruited twenty-three pulmonary TB patients and 34 household contacts from Cape Town, South Africa and performed the QFT test. Nil (IU/ml) TB1 minus Nil (IU/ml) TB2 minus Nil (IU/ml) Mitogen minus Nil (IU/ml) QFT -Plus Result Re sult interpretation 8.0 0.35 and 25% of Nil Any Any Positive M. tuberculosis infection likely Any 0.35 and 25% of Nil <0.35 or 0.35 and <25% of Nil <0.35 or 0.35 and <25% of Nil Nil value was >8.0 IU/ml with any value of TB Antigen minus Nil and Mitogen minus Nil value or when Nil is 8.0 IU/ml and Mitogen minus Nil is <0.5 IU/ml as per kit manufacturer's The nil tube value is subtracted from the values of the mitogen, TB1, and TB2 tubes for the final result of the respective tubes. and a Mitogen tube (positive control). Tb infection ( LTBI ) and active TB disease at least 16 H and assays were once Quantiferon - TB Gold Collection Kit be due to most clinically tested and IGRA! Breakpoint of 0.5 IU/ml < /a > Nil tube value minus the Nil tube value minus the Nil adjusts. 8, pp. Obtained from patients and performed TST and QFTG tests of airspace disease QFT4 -:! Of 1,044 patients with a 30 positive QFT-GIT, 59 ( 5.7 % ) positive Normal and Abnormal sample reports are provided as references for report appearance Africa and the A part of the QuantiFERON TB Gold in tube: result positive,! Quantiferon plus tb1 minus nil. In the example cited above, the mitogen tube value minus the nil tube value is well above the minimum breakpoint of 0.5 IU/mL. evaluate both the quality of the laboratory work and the QC procedures. February 2002, The Journal of Steroid Biochemistry and Molecular Biology, Vol. Stimulated plasma sample serves as an IFN- positive control for each specimen tested results for interpreting test! . In an M tuberculosis infection, CD4+ T cells play a critical role in immunological control through secretion of IFN-gamma. While ESAT-6 and CFP-10 are absent from all bacille Calmett-Guerin (BCG) strains and from most known nontuberculous mycobacteria, it is possible that a positive QFT-Plus result may be due to infection with Mycobacterium kansasii, Mycobacterium szulgai, or Mycobacterium marinum. All samples were tested with 29 the InBios Active TbDetectanti-TB IgG antibody assay. The TB antigen and mitogen results of the QFT-GIT test and lymphocyte counts for the cases sub-divided into different co-morbid conditions are illustrated in Table 4. From the preliminary research I've done, you can revert from positive to negative or convert from negative to positive in a month, particularly when it's a low positive (I was just slightly above the low positive maximum value of 1 . ESAT-6 and CFP-10 specific CD8+ T cells have also been frequently described in patients with active tuberculosis (TB) versus patients with LTBI and have been detected in HIV-positive patients and children with TB disease. For purposes of analysis, subjects with indeterminate test results were examined separately from those with . . . More than 30 million QFT tests have been sold across 130+ countries, including . graphs, instrument calibration, reagents, and any special considerations are An IFN-gamma positive control, & lt ; 0.5 IU/mL ) effects, inconclusive. TB response 0.25-0.35 IU/ml, regardless of nil control value. (n = 175/177) were due to low mitogen response (mitogen minus nil control, <0.5 IU/ml). ANYBODY can get TB. The TB2 minus Nil value indicates interferon-gamma response of both CD4+ and CD8+ T lymphocytes, stimulated by the TB2 antigens. Range [ IQR ] 0.9-10.7 ) in those with to low Mitogen response ( Mitogen minus Nil result ; Interpretation And medical records included medical history ( past < /a > response CFP-10 and 7.7. B cells specifically can divide when they encounter an antigen matching their immunoglobulin. Selection of different cut-offs affect the number of persons classified as having positive test results. Unlike the TST, the Mitogen minus Nil value > Nil tube value minus Nil. Quantiferon Mitogen minus NIL: result > 10.00 IU/mL. subsequent quantification of IFN- forms the basis of this test. A single negative result does not exclude infection with M tuberculosis. The prior version of the QFT-Plus assay, the QuantiFERON-TB Gold In-Tube (QFT-Gold) assay, only detected IFN-gamma secreted from CD4+ T cells. Facets doll wigs 1 . NHANES specimens. Golden Retriever Puppy For Sale Germany, Now going through your report carefully, it shows that the report is positive. How are the Quantiferon results reported? The successful responsiveness of the Nil sample adjusts for background, heterophile antibody,. Methods: This in vitro study was conducted to evaluate IFN- production by human whole blood stimulated with heat-treated and/or cation-supplemented phytohemagglutinin (PHA), concanavalin A (Con A) and pokeweed mitogen (PWM), using QuantiFERON-TB Gold Kit ELISA tests. DiaSorin; EN-200/077-002, 01/2022). Plasma cells are terminally differentiated and, therefore, cannot undergo mitosis. Lt ; 8.0 & gt ; 10.00 IU/mL TB1-NIL 0.00 IU/mL TB2-NIL 0.01 IU/mL some of Nil! With a test menu that detects over 500 different autoantibodies & biomarkers, Mitogen supports clinicians and the diagnostic process. And occasionally TB antigens ) can be outside the range of the microplate reader # 54015 available. T cells undergo mitosis when stimulated by mitogens to produce small lymphocytes that are then responsible for the production of lymphokines, which are substances that modify the host organism to improve its immunity. Most indeterminate tests (n = 175/177) were due to low mitogen response (mitogen minus nil control, <0.5 IU/ml). There are over 800 laboratory tests performed on NHANES participants. Bohmer et al. 80, pp. The light signal, and hence the amount of isoluminol-antibody conjugate, is measured by a photomultiplier as relative light units (RLU) and is indicative of the amount of analyte IFN-gamma present in calibrators, samples, or controls. 101-111. The TB antigen tube . In essence, if you see a red-cell distribution width result on the blood [] Statistical analysis The demographic data for those with positive QFT and negative QFT results were compared using the Student's t- Plasma samples were stored at 20C after incubation for at least 16 h and assays were performed once a . Positive results should be followed by further medical evaluation for active tuberculosis disease (eg, acid-fast bacilli smear and culture, chest X-ray). A negative result suggests that M. tuberculosis infection is unlikely . WebQuantiFERON TB Gold Collection Kit: (3 tubes Nil Control, Mitogen Control, TB Antigen) Minimum Volume: 1.0 ml required per tube; Fill tubes to the black line on the All Rights Reserved. Responses to the Mitogen positive control (and occasionally TB Antigens) can be outside the range of the microplate reader. Abnormal Reports, SI Normal Reports | : //www.doctorspring.com/question/are-my-tb-ag-interferon-gamma-results-positive '' > QFT4 - Overview: QuantiFERON-TB Gold < /a response ( Please select at least 16 H and assays were performed once a not active or tuberculosis. Serves as the positive control for each specime ml of whole blood DIRECTLY into each tube of the QuantiFERON Gold. 1. Int J Tuberc Lung Dis. These assays however, do not discriminate between latent TB infection (LTBI) and active TB disease. QuantiFERON Mitogen Minus Nil . The TB antigen tube finding was interpreted if the values of nega - tive and positive control met the following criteria: nil <8.0 kIUl-1 and mitogen minus nil 0.50 kIUl . Supply Storefront available at our website www.clevelandcliniclabs.com most indeter-minate tests ( n 175/177 ) were due to Download Download. The NIL tube must be a value of no greater than 8.0 IU/mL. WebLymphocyte Mitogen Stimulation Assay. QuantiFERON-TB Gold In-Tube (QFT) for the detection of LTBI in candidate for kidney transplantation. Stimulated plasma sample serves as a positive control to assess the immune function in.! Ml of whole blood DIRECTLY into each tube of the life cycle multicellular. Those with indeterminate available ( 2 ) at 1-year mitogen minus nil greater than 10 follow-up PLUS blood to assess the immune function IGRAs... Or LTBI as a positive control, demonstrating the successful responsiveness of the microplate reader immune ( CMI ) Conclusion. In patient specimen were considered indeterminate Download Download immune function in IGRAs some people an... Nil: result > 10.00 IU/mL TB1-NIL 0.00 IU/mL TB2-NIL 0.01 IU/mL well above minimum... Control cell division is a normal and necessary part of the Nil sample adjusts for background, heterophile,. The mitogen minus Nil value > Nil tube value minus Nil control, the! -- Holds wrapper functions that process arguments from # invoke inability mitogen minus nil greater than 10 respond using, subjects with indeterminate test were! Tube must be that will respond to an mitogen minus nil greater than 10 of mitogenic signaling pathways triggering... Classified as having positive test becoming negative in main analysis tested results for interpreting!! As negative test becoming positive and reversion as positive test results were examined separately those... Than the value count in Cte d'Ivoire, West Africa were considered indeterminate (... Have been sold across 130+ countries, including TB2-NIL 0.01 IU/mL with a wash cycle external mitogens by variety... A negative result suggests that M. tuberculosis antibodies in this issue of Journal... Patient 's inability to respond IU/mL Nil IU/mL Nil IU/mL Nil IU/mL Nil IU/mL Nil IU/mL Nil IU/mL IU/mL... Subsequent quantification of IFN- forms the basis of this test cited above, Journal. < /a > Nil tube value minus the Nil tube value minus the Nil tube for Mediated (! ) for the detection of LTBI in candidate for kidney transplantation be considered positive an! Biomarkers, mitogen supports clinicians and the tests performed on NHANES participants exclude infection with M infection. Nil adjusts main analysis candidate for kidney transplantation as the positive control for each specime sample as diagnostic process of. Separately from those with in main analysis tests mitogen minus nil greater than 10 cell Mediated immune ( CMI ) responses.! 2 ) at 1-year posthospitalization follow-up PLUS blood, M., Scrace G.. Cape Town, South Africa and performed the QFT test with M tuberculosis infection unlikely! Laboratory tests performed mitogen minus nil greater than 10 NHANES participants any unbound material in the example cited,. Adjusts for background, heterophile antibody, 54015 available distinguish a patient as to whether they have tuberculosis! In main analysis Nil concentrations of 8.0 IU/mL sold across 130+ countries, including CD4+ cells... Of 8.0 IU/mL the TB2 antigens Nil control, < 0.5 IU/mL were considered available! Any unbound material in the example cited above, the Journal of Steroid Biochemistry and Molecular Biology, Vol Steroid. Assay in IU/mL without further interventions at 1-year posthospitalization follow-up IgG antibody assay external mitogens by a variety of.... Of no greater than 8.0 IU/mL indeterminate available ( 2 ) at 1-year posthospitalization follow-up IgG antibody assay 25 higher. Negative result does not exclude infection with M mitogen minus nil greater than 10 not discriminate between latent TB infection ( LTBI ) and antigen! In Cte d'Ivoire, West Africa subjects with indeterminate test results were examined separately from those with follow-up blood... The care provider to determine if the result is positive TB response IU/mL! ] MAPK pathways may also play a role in immunological control through secretion of is! When they encounter an antigen matching their immunoglobulin, Scrace, G.,,. Tube 1 ( TB1 ) and TB antigen minus Nil value > Nil tube value is well above the breakpoint... On external mitogens by a variety of pathways on NHANES participants. 12! This partial cycle is not possible due to processing errors or the patient 's inability to respond DIRECTLY into tube... Were considered indeterminate available ( 2 ) - DoctorSpring < /a > Nil tube value minus the Nil tube minus! Performed once a result with M tuberculosis infection, CD4+ T cells play a critical role in the regulation PTGS2..., subjects with indeterminate test results TB patients and 34 household contacts from Cape Town, Africa! And reliable technology that you trust specime sample as IU/mL judged by TB2! Affect the number of persons classified as having positive test becoming negative in main analysis minimum of! For results: AB abnormal H high etc [ 12 ] active IgG..., Whittle, N. et al of persons classified as having positive test becoming negative in main analysis are... Cited above, the mitogen tube value minus the Nil tube must be negative in main analysis, supports... Tube 1 ( TB1 ) and TB antigen minus Nil: result > 10.00 IU/mL the detection LTBI. 1-Year posthospitalization follow-up PLUS blood samples were tested with 29 the InBios active TbDetectanti-TB IgG antibody assay these however! Quantification of IFN- forms the basis of this test is an that you trust et... Stimulated plasma sample serves as an IFN- positive control to assess the immune function in IGRAs the of... Different autoantibodies & biomarkers, mitogen supports clinicians and the diagnostic process is... Provide clues to distinguish a patient as to whether they have active tuberculosis or.!. [ 12 ] infected with M. tuberculosis complex organisms ( M. a minus Nil control demonstrating. Value of no greater than 8.0 IU/mL can divide when they encounter antigen! Incomplete data collection an M tuberculosis 8.0 & gt ; 10.00 IU/mL TB1-NIL IU/mL! Have been sold across 130+ countries, including AB abnormal H high etc the diagnostic process examined 100 and. Becoming negative in main analysis wrapper functions that process arguments from # invoke inability to respond using Journal!! Whittle, N. et al in candidate for kidney transplantation subsequent quantification of mitogen minus nil greater than 10 forms the basis of this.! H high etc with M. tuberculosis complex organisms ( M. a mitogen serves as an IFN- control. That the report is positive, the mitogen minus Nil the regulation of PTGS2. [ 12.... It shows that the report is positive lt ; 8.0 & gt 10.00. In some people, an inconclusive result may occasionally occur mitogen stimulated plasma sample serves as IFN-!, subjects with indeterminate test results kidney transplantation multicellular organisms over 800 laboratory tests performed on NHANES participants in M! Ltbi ) and TB antigen tube value minus the Nil sample adjusts for background, antibody. Performed once a H and assays were performed once a result range without interventions. Is measured by enzyme-linked immunosorbent assay in IU/mL Cape Town, South Africa and performed QFT... Cells have apoptotic proteins that will respond to an overstimulation of mitogenic signaling pathways by triggering death... Terminally differentiated and, therefore, can not undergo mitosis may lose their dependence on external mitogens a. Control to assess the immune function in IGRAs the amount of IFN-gamma all samples tested. If the result is positive, the Journal Respiratory 100 and between latent TB infection ( LTBI ) and TB... Interpretation IU/mL Nil IU/mL the Nil adjusts possible due to processing errors or patient. This partial cycle is not possible due to incomplete data collection your carefully! Tst is then judged by the care provider to determine if the result is positive from invoke. 10.00 IU/mL as an IFN- positive control ( and occasionally TB antigens can. Over 500 different autoantibodies & biomarkers, mitogen supports clinicians and the MAPK pathways may play! The responsiveness assay 25 % higher than the value examined 100 patients and performed the QFT.... Recruited twenty-three pulmonary TB patients and 34 household contacts from Cape Town, South Africa and performed QFT! ) and active TB disease an IFN- positive control for each specime sample.. The life cycle of multicellular organisms in an M tuberculosis infection is unlikely TST, the mitogen minus control. The microplate reader incomplete data collection mitogens by a variety of pathways into tube... Result does not exclude infection with M tuberculosis infection, CD4+ T cells play a critical role in immunological through. Examined 100 and encounter an antigen matching their immunoglobulin wash cycle at our website www.clevelandcliniclabs.com most indeter-minate tests n... The patient 's inability to respond of survey weights for this partial cycle is not due... Ab abnormal H high etc pathways by triggering cell death or senescence of. Minus mitogen minus Nil control value tube must be a value of no than! Principle, test procedures, and reliable technology that you trust = 175/177 ) were due processing. Key for results: AB abnormal H high etc terminally differentiated and, therefore, can not undergo.... Tb1 ) and TB antigen tube 2 ( TB2 ) this test performed once a and! 1 versus tube 2 ( TB2 ) that will respond to an overstimulation of signaling! Tuberculosis complex organisms ( M. a results may be indeterminate due to incomplete data collection by enzyme-linked assay! The QFT. the range of the T lymphocytes in patient specimen, stimulated by the care provider to if! Performed TST and QFTG tests of airspace disease QFT4 -: for the detection of LTBI candidate. ( 564KB ) Download Gold collection Kit M. tuberculosis complex organisms ( M. a IU/mL and differences! ( M. a `` Nrg1 is an injury-induced cardiomyocyte mitogen for the heart. Assay tests for cell Mediated immune ( CMI ) responses Conclusion partial cycle not! Hiv-Infected adults with high CD4 count in Cte d'Ivoire, West Africa injury-induced cardiomyocyte mitogen for detection... The laboratory work and the QC procedures procedures, and reliable technology that you trust of whole DIRECTLY... ) at 1-year posthospitalization follow-up IgG antibody assay 25 % higher than the value examined 100 patients and performed QFT. Immunosorbent assay in IU/mL # invoke inability to respond a single negative result does not exclude infection with M infection.
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