Careful patients may notice that your sputum test doctor issued a sputum smear looking for antacid bacilli, not sputum looking for tuberculosis bacilli. The report also says that no acid-fast bacilli or how many + signs of acid-fast bacilli were found, not that no TB bacilli or how many + signs of TB bacilli were found. Why is this? This is because the smear method can only determine if it is an acid-fast bacillus, not if it is a tuberculosis bacillus! Mycobacterium tuberculosis should be called Mycobacterium tuberculosis to be precise, and is a member of the family of acid-resistant bacilli, in addition to non-tuberculous mycobacteria, etc. However, because it is mainly Mycobacterium tuberculosis that causes our disease, a positive sputum smear for acid-fast bacilli is used clinically as a criterion for the diagnosis of tuberculosis. If you are careful, you must have noticed the problem again: So, a positive sputum smear sometimes does not necessarily mean TB? Yes, it can also be non-tuberculous mycobacteriosis! Therefore, a positive sputum smear still has some limitations and cannot be the “gold standard” for TB diagnosis! Is there a so-called gold standard? The 8th edition of Internal Medicine, page 65, states: Mycobacterium tuberculosis culture provides accurate and reliable results for sputum Mycobacterium tuberculosis examination, and is more sensitive than the smear method, and is often used as the “gold standard” for the diagnosis of tuberculosis. This is one of the implications of having a sputum culture to further confirm the diagnosis of TB! Of course, there is more to it than that. More importantly, a drug sensitivity test can be done at the same time to determine if there is drug resistance. Is there single drug resistance? Multi-drug resistant? Or is it multi-drug resistant? (With the drug sensitivity results, we can get rid of the embarrassing situation that TB treatment is one-size-fits-all, and we can eliminate those ineffective drugs and add more sensitive drugs to form a sharper combination, so that the treatment can be individualized and the program can be more targeted and the treatment effect can be more guaranteed. Therefore, with sputum smear and then sputum culture, by no means let patients and friends spend more money, but to provide more powerful evidence and help for our diagnosis and treatment. The money will definitely not be spent in vain!