Background: The bacteriological diagnosis of tuberculosis (TB) is largely dependent on the Ziehl-Neelsen (ZN) microscopy. This method has a low sensitivity, which can be improved by the concentration of the specimen with sodium hypochlorite (NaoCl), followed by centrifugation before doing acid fast staining (AFB). Aim:To study the improvement in the sensitivity of the sputum smear by the bleach method. On spot, morning and second on spot samples were collected from each patient. Direct smears were prepared and they were stained with the hot ZN technique and the remaining samples were concentrated by using 5% NaoCl, followed by centrifugation and staining with ZN stain. The improvement in the sensitivity following the bleach method was studied. Setting and StudyStatistical Analysis: The Fisher's exact test was used.Results: A total of two hundred and fifty five specimens from eighty five patients were included in this study; each patient produced three specimens. AFB was detected in twenty five direct smears and in eighty four bleach smears. A statistically significant (p < 0.001) increase in the positivity with the use of the bleach method was detected as compared to that with the use of the direct method. The ZN sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) were 29%, 99%, 96% and 74% respectively with a 95% confidence interval, with the use of the 5% NaoCl method. Conclusion:The bleach method has advantages over the direct ZN method, as it is simple and as it does not require any additional expertise beyond that which is required for the conventional direct smear microscopy. The materials and the reagents are also affordable and they are available locally.

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Tuberculosis presenting as breast lump is a rare disease. This condition usually occurs in females who are in the reproductive age group. Diagnosis is quite difficult unless prompt investigations are meticulously done. They are often mistaken for malignancy. We report a 19-year-old girl with tubercular breast abscess. The abscess was incised and drained based on fine-needle aspiration cytology and ultrasonography revealed it as pyogenic abscess. Ziehl–Neelsen stain (ZN stain) of the pus sample showed acid-fast bacilli. Now, she has been started on antitubercular treatment.

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