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Free Content The bleach microscopy method and case detection for tuberculosis control [Unresolved Issues]

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The World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) recommend direct sputum smear microscopy for tuberculosis (TB) case finding in resource-poor settings. This method is associated with poor sensitivity. Digestion of sputum with bleach prior to smear preparation has been reported to increase sensitivity. Some workers, having reviewed the relevant literature, have called for the WHO and The Union to advocate for a shift to this methodology for TB case finding. This article highlights deficiencies in the scope and detail of available evidence, and cautions against the premature, and possibly counter-productive, adoption of so-called ‘bleach microscopy’. Further well-guided research is required to answer policy-relevant gaps in our knowledge about this promising technology.
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Keywords: bleach; diagnosis; hypochlorite; microscopy; sputum; tuberculosis

Document Type: Miscellaneous

Affiliations: 1: UNICEF/United Nations Development Programme/World Bank/World Health Organization Special Programme on Research and Training for Tropical Diseases (TDR), Geneva, Switzerland 2: EQUI-TB Knowledge Programme, Liverpool School of Tropical Medicine, Liverpool, United Kingdom 3: Nuffield Centre for International Health & Development, University of Leeds, Leeds, United Kingdom 4: Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland

Publication date: 2006-03-01

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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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