| dc.contributor |
Epicentre, Paris, France; Médecins Sans Frontières, Paris, France; Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya |
|
| dc.creator |
Bonnet, M |
|
| dc.creator |
Ramsay, A |
|
| dc.creator |
Githui, W |
|
| dc.creator |
Gagnidze, L |
|
| dc.creator |
Varaine, F |
|
| dc.creator |
Guerin, P J |
|
| dc.date |
2008-06-01 |
|
| dc.date.accessioned |
2017-01-31T07:11:42Z |
|
| dc.date.available |
2017-01-31T07:11:42Z |
|
| dc.identifier |
Clin Infect Dis 2008;46(11):1710-6 |
|
| dc.identifier |
1537-6591 |
|
| dc.identifier |
18444789 |
|
| dc.identifier |
10.1086/587891 |
|
| dc.identifier |
http://hdl.handle.net/10144/31935 |
|
| dc.identifier |
http://fieldresearch.msf.org/msf/handle/10144/31935 |
|
| dc.identifier |
Clinical Infectious Diseases |
|
| dc.identifier.uri |
http://dspace.mediu.edu.my:8181/xmlui/handle/10144/31935 |
|
| dc.description |
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 < .001) and 1 AFB/100 HPF (P < .001) cutoffs, respectively. Regardless of the case definition used, bleach sedimentation microscopy detected significantly more positive cases than did direct smear microscopy: 26.7% (172 of 644) versus 21.7% (140 of 644), respectively, with the case definition of 1 positive smear and the 1 AFB/100 HPF cutoff (P < .001), and 21.4% (138 of 644) versus 18.6% (120 of 644), respectively, with the case definition of 1 positive smear and the 10 AFB/100 HPF cutoff (P < .001). Inter- and intrareader reproducibility were favorable, with kappa coefficients of 0.83 and 0.91, respectively. Bleach sedimentation was relatively inexpensive and was not time consuming. CONCLUSIONS: Bleach sedimentation microscopy is an effective, simple method to improve the yield of smear microscopy in a setting of high prevalence of HIV. Further evaluation of this method, under operational conditions, is urgently needed to determine its potential as a tool for tuberculosis control. |
|
| dc.language |
en |
|
| dc.publisher |
Infectious Diseases Society of America |
|
| dc.relation |
http://www.journals.uchicago.edu/CID/ |
|
| dc.rights |
Archived on this site with permission and copyright 2008 by the Infectious Diseases Society of America |
|
| dc.title |
Bleach sedimentation: an opportunity to optimize smear microscopy for tuberculosis diagnosis in settings of high prevalence of HIV |
|
| dc.type |
Article |
|