Bleach Sedimentation: An Opportunity to Optimize Smear Microscopy for Tuberculosis Diagnosis in Settings of High Prevalence of HIV

Background. The purpose of the study was to evaluate the performance and feasibility of tuberculosis diagnosis by sputum microscopy after bleach sedimentation, compared with by conventional direct smear microscopy, in a setting of high prevalence of HIV. Methods. In a community-based study in Kenya...

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Bibliographic Details
Published in:Clinical infectious diseases 2008-06, Vol.46 (11), p.1710-1716
Main Authors: Bonnet, Maryline, Ramsay, Andrew, Githui, Willie, Gagnidze, Laramie, Varaine, Francis, Guerin, Philippe J.
Format: Article
Language:English
Subjects:
Articles and Commentaries
Bacterial diseases
Bacteriological Techniques
Biological and medical sciences
Bonnets
Centrifugation
Chlorine
Comparative analysis
Diagnostic tests
HIV
HIV Infections - complications
HIV Infections - epidemiology
Human bacterial diseases
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious diseases
Lungs
Medical sciences
Microscope slides
Microscopy
Mycobacterium
Mycobacterium tuberculosis
Performance evaluation
Prevalence
Pulmonary tuberculosis
Sodium Hypochlorite
Specimen Handling - methods
Sputum
Sputum - microbiology
Studies
Tuberculosis
Tuberculosis and atypical mycobacterial infections
Tuberculosis control
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - microbiology
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:Background. The purpose of the study was to evaluate the performance and feasibility of tuberculosis diagnosis by sputum microscopy after bleach sedimentation, compared with by conventional direct smear microscopy, in a setting of high prevalence of HIV. Methods. In a community-based study in Kenya (a population in which 50% of individuals with tuberculosis are infected with HIV), individuals with suspected pulmonary tuberculosis submitted 3 sputum specimens during 2 consecutive days, which were examined by blind evaluation. Ziehl-Neelsen—stained smears were made of fresh specimens and of specimens that were processed with 3.5% household bleach followed by overnight sedimentation. Two different cutoffs for acid-fast bacilli (AFB) per 100 high-power fields (HPF) were used to define a positive smear: >10 AFB/100 HPF and 1 AFB/100 HPF. Four smear-positive case definitions, based on 1 or 2 positive smears with the 1 AFB or 10 AFB cutoff, were used. Results. Of 1879 specimens from 644 patients, 363 (19.3%) and 460 (24.5%) were positive by bleach sedimentation microscopy, compared with 301 (16.0%) and 374 (19.9%) by direct smear microscopy, with use of the 10 AFB/100 HPF (P
ISSN:1058-4838
1537-6591
DOI:10.1086/587891