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Free Content Performance of variations of carbolfuchsin staining of sputum smears for AFB under field conditions

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SETTING: A field project in Bangladesh.

OBJECTIVE: To compare the effectiveness of commonly used carbolfuchsin staining variations.

DESIGN: Routine hot Ziehl-Neelsen (ZN) 1% basic fuchsin staining for 15 min in 75 field clinics. Blind reading of duplicate smears stained by ZN 1% vs. 0.3% basic fuchsin applied for 5 min, or by ZN 1% 5 min vs. Kinyoun cold staining. Rechecking of discordant series.

RESULTS: For comparable numbers of false positives, sensitivity was significantly lower with Kinyoun than with ZN 1% 5 min (85.6% vs. 93.0%, P < 0.001). Sensitivity with ZN 1% 5 min was not significantly higher than with 0.3% 5 min staining (89.9% vs. 86.5%). Routine examination using 1% 15 min ZN identified more positives than any of the study techniques.

CONCLUSIONS: Kinyoun cold staining sensitivity was unsatisfactory in field clinics. The sensitivity of the WHO/IUATLD recommended 0.3% fuchsin for 5 min was not significantly different from the original 1% ZN for 5 min, but 1% 15 min hot staining might be superior. A reduced fuchsin concentration together with a short staining time may leave too narrow a margin for error. TB programmes using hot ZN with a concentrated stain or longer staining time should not be urged to change.
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Keywords: Ziehl-Neelsen; carbolfuchsin; microscopy; staining

Document Type: Regular Paper

Affiliations: 1: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerpen, Belgium; and International Union against Tuberculosis and Lung Disease, Paris, France 2: Damien Foundation Bangladesh, Dhaka, Bangladesh 3: Damien Foundation Belgium, Brussels, Belgium

Publication date: 2005-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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