Authors: Trusov, A.¹; Bumgarner, R.²; Valijev, R.³; Chestnova, R.³; Talevski, S.⁴; Vragoterova, C.⁴; Neeley, E.S.⁵

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 7, July 2009 , pp. 836-841(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

DESIGN: Cross-sectional studies in Russia (n = 502) and Macedonia (n = 205), with fluorochrome-stained sputum examined by 1) the new Lumin™ light emitting diode (LED) fluorescent attachment on a light microscope, and 2) conventional fluorescent microscope (CFM) available in each laboratory, and compared to 3) Ziehl-Neelsen (ZN) restaining/reading of the same smears. Poor readings of ZN-restained smears in Russia stimulated a retrospective laboratory registry analysis for sensitivity and specificity of directly ZN-stained smears (n = 791) from a previous period.

RESULTS: In Macedonia, the sensitivity of the Lumin and CFM were 87.8%, and that of restained ZN smears with conventional light microscope was 78.0%. In Russia, sensitivity was as follows: Lumin 72.8%, CFM 52.5%; re-stained ZN smears 28.5% and directly ZN stained smears 55.6%.

CONCLUSION: Fluorescence microscopy is more sensitive than conventional microscopy. The Lumin attachment to conventional light microscopes provided results equal to or better than the CFMs. Smear restaining for ZN showed a 12% advantage for Lumin and CFM in Macedonia, in line with other meta-analyses. Restaining for ZN gave poor results in Russia for unknown reasons. Retrospective analysis of directly ZN-stained smears showed 55.6% sensitivity compared to the Lumin (72.8%), which is also in line with the superiority of fluorescent microscopy reported in literature.

Keywords: tuberculosis; diagnosis; Ziehl-Neelsen; fluorescence microscopy; LED; Lumin

Document Type: Regular paper

Affiliations: 1: Independent consultant, clinical tuberculosis and program management, Cliffside Park, New Jersey, USA 2: Independent consultant, tuberculosis program design and evaluation, Verona, Virginia, USA 3: The Republic Clinical Tuberculosis Dispensary, Kazan State Medical Academy, Kazan, Russia 4: Institute of Lung Diseases and Tuberculosis, Skopje, Republic of Macedonia 5: Department of Statistics, Brigham Young University, Provo, Utah, USA

Publication date: 2009-07-01

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