Improved diagnosis of Ziehl-Neelsen smear negative tuberculosis using sodium hypochlorite sedementation method

Githui, W.A.; Matu, S.W.; Muthami, L N; Juma, E

doi:10.4314/eamj.v84i10.9562

Cited by 9 publications

(11 citation statements)

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“…The choice of 3.5% bleach used in this study was because it is the most common formulation of bleach in the Kenyan market and had been successfully used in three recent studies [14,17,18].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, none of these studies used 3.5% bleach with centrifugation after direct smear microscopy to improve on the sensitivity of ZN technique. Two Kenya studies used 3.5% bleach followed by concentration of bacilli using overnight sedimentation before staining [17,18] while another used 3.5% and 5% bleach centrifugation methods respectively with fluorescent microscopy rather than the ZN technique.…”

Section: Improved Ziehl-neelsen Microscopy: Bleach Sputum Smear Negatmentioning

confidence: 99%

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Improved Ziehl-Neelsen Microscopy: Bleach Sputum Smear Negative Specimens after Centrifugation

Matu¹,

Juma²

2013

JLS

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Background: Direct ZN (Ziehl-Neelsen) sputum smear microscopy for diagnosis of TB (tuberculosis) has low sensitivity, especially in TB/HIV co-infected patients. Sputum concentration by bleach (NaOCl) with sedimentation has been used to increase the sensitivity of sputum smear microscopy in many settings but with varying results. Objective: To determine whether bleach plus centrifugation significantly improves the detection of AFB (acid-fast bacilli) in ZN smear-negative sputum specimens. Methods: Three hundred and seventy sputum specimens were collected from new TB suspects attending a Nairobi referral district hospital and processed for direct microscopy using ZN technique and culture on Lowenstein Jensen Media. All smear-negative specimens were treated with 3.5% bleach and left to stand for 30 min before centrifugation. The bleach treated smears were processed and examined using ZN technique. Results: Of the 370 specimens, 200 (54%) were positive culture. The number of sputum samples that were smear-positive by direct ZN was 138 (37.2%), with a sensitivity of 66%. After treatment of direct ZN smear-negative specimens with 3.5% bleach and centrifugation, the total number of AFB smear-positive samples increased to 171 with an increase in sensitivity of 66% to 81.1% (15.1%). Conclusion: In this study, bleach with centrifugation significantly increased the yield of sputum smear microscopy. Further evaluation of these techniques in routine programmes is required especially in settings where the burden of TB/HIV is high.

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Section: Discussionmentioning

confidence: 99%

Section: Improved Ziehl-neelsen Microscopy: Bleach Sputum Smear Negatmentioning

confidence: 99%

Improved Ziehl-Neelsen Microscopy: Bleach Sputum Smear Negative Specimens after Centrifugation

Matu¹,

Juma²

2013

JLS

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“…Adequate training and supervision of the laboratory personnel are also important in optimizing the performance of sputum smear microscopy (10, 12). Recent innovations such as the use of bleach for sputum concentration (27,28) and the use of light emitting diode (LED) fluorescence microscopy (29,30,31) have potential to improve the sensitivity of sputum smear microscopy.…”

Section: Sexmentioning

confidence: 99%

Case-Detection Rate of Direct Sputum Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Abia State, Nigeria

Ekundayo¹,

Abbey²,

O³

2014

Af J Clin Exp Micro

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The accuracy of sputum smear microscopy, the tuberculosis case-finding method in the Abia State TB Control Programme has never been assessed due to lack of culture facilities. To assess the accuracy of sputum smear microscopy in routine control programme conditions in Abia State, sputum samples from patients undergoing investigation for tuberculosis were analyzed using Ziehl-Neelsen staining technique for sputum smear microscopy and culture on Löwenstein-Jensen medium as reference standard. Out of 150 participants tested, 51 were smear-positive for acid fast bacilli (positivity rate, 34.0 %, 51/150) while 79 were culture positive for Mycobacterium tuberculosis complex and 12 for non-tuberculous mycobacteria (NTM). Thirty-seven of the 79 culture positive for M. tuberculosis were smear positive giving a ratio of smear to culture positivity of 46.84%. Forty-two (42.4%) of the 99 smear negative cases were culture positive for M. tuberculosis. The sensitivity of smear microscopy was 50.0% (95%CI=39.0-61.0) and specificity was 92.3% (95% CI=86.4-98.2). The prevalence of HIV/TB coinfection among the study participants was 48% (12/25). Although the case-detection rate of smear microscopy was moderate in this study, the large proportion of TB patients missed by smear microscopy is a cause for concern and requires concerted effort to improve the sensitivity of smear microscopy. Introduction of more sensitive diagnostic methods like culture also need to be considered.

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“…The latest estimates included in this report are that there were almost 9 million new cases in 2011 and 1.4 million TB deaths (990,000 among HIV negative people and 430,000 HIVassociated TB deaths). This is despite the availability of treatment that will cure most cases of TB [2]. Its etiological agent Mycobacterium tuberculosis has accounted for more human deaths than any other pathogen [3].…”

Section: Introductionmentioning

confidence: 99%

“…The bleach method can improve case detection of Pulmonary TB with a maintained specificity [9]- [11]. The bleach method improves detection of AFB in sputum specimen, thereby improving case finding of Pulmonary TB [2] [8] [12]- [16]. As potent disinfectant bleach, unlike other concentration methods, also kills mycobacteria and thus eliminates the risk of laboratory infection.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Increased Sensitivity of Morning Bleach Sample for Detection of Acid Fast Bacilli in Pulmonary Samples

Pingle¹,

Apte²,

Trivedi³

2014

JTR

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Around 85% of the cases of Tuberculosis (TB) are pulmonary in origin and the routine diagnosis usually depends on sputum microscopy. The conventional direct Ziehl-Nelson (ZN) staining technique has been found to have a low sensitivity. The main objective of the study was to verify whether the bleach concentration method increases the sensitivity of sputum smear microscopy for AFB or not and also to see whether the first single morning sample alone is sufficient and better than the three pooled samples after bleach concentration followed by ZN staining. A total of 365 samples were studied from 131 clinically suspected cases of pulmonary TB which included sputum (112), gastric aspirate (5), endotracheal tube washing (2), and bronchial lavage (12). All these samples were processed for conventional ZN staining and Bleach concentration method followed by ZN staining. An increase in positivity was observed in all the cases after using the bleach concentration method and the most significantly useful was that in the case of first morning sputum samples where it increased from 11.6% to 41.96%. Bleach concentration is a simple, cheap and easily available method and also very safe because it kills the Mycobacteria in the process. Its positivity rate is better as compared to direct conventional ZN staining.

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Improved diagnosis of Ziehl-Neelsen smear negative tuberculosis using sodium hypochlorite sedementation method

Cited by 9 publications

References 0 publications

Improved Ziehl-Neelsen Microscopy: Bleach Sputum Smear Negative Specimens after Centrifugation

Improved Ziehl-Neelsen Microscopy: Bleach Sputum Smear Negative Specimens after Centrifugation

Case-Detection Rate of Direct Sputum Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Abia State, Nigeria

Evaluation of Increased Sensitivity of Morning Bleach Sample for Detection of Acid Fast Bacilli in Pulmonary Samples

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