The diagnosis of tuberculosis in developing countries still relies on direct sputum examination by light microscopy, a method that is easy to perform and that is widely applied. However, because of its poor sensitivity and requirement for significant labor and training, light microscopy examination detects the bacilli in only 45 to 60% of all people whose specimens are culture positive for Mycobacterium tuberculosis. Therefore, new diagnostic methods that would enable the detection of the undiagnosed infected population and allow the early commencement of antituberculosis treatment are needed. In this work, the potential use of mycobacterial cyan autofluorescence for the detection of Mycobacterium tuberculosis was explored. The tubercle bacilli were easily visualized as brilliant fluorescent bacilli by microscopy and were easily tracked ex vivo during macrophage infection. Assays with seeded sputum and a 96-well microplate reader fluorimeter indicated that <10 6 bacilli ml ؊1 of sputum could be detected. Moreover, the use of microplates allowed the examination of only 200 l of sputum per sample without a loss of sensitivity. Treatment with heat or decontaminating chemical agents did not interfere with the autofluorescence assay; on the contrary, they improved the level of bacterial detection. Autofluorescence for the detection of bacilli is rapid and easy to perform compared to other methodologies and can be performed with minimal training, making this method suitable for implementation in developing countries.The diagnosis of tuberculosis (TB) in low-and middle-income countries, where more than 90% of TB cases occur, is mainly performed by microscopy examination of stained sputum smears for acid-fast bacilli (25). The International Standards for Tuberculosis Care considers the microscopic analysis of two or three specimens per patient to be a cornerstone for the diagnosis of TB (13). Although light microscopy is inexpensive, easy to perform, and highly specific in areas where there is a high prevalence of TB, it is relatively insensitive, requiring Ն10 4 bacilli ml Ϫ1 of sputum to achieve a positive result (15,35). In addition, the procedure requires the observation of from 100 to 300 fields in order to obtain accurate results (31).The sensitivity of microscopy is influenced by numerous factors, such as the prevalence and severity of disease, the quality of specimen collection, the type of specimen, the method of processing (direct or concentrated, centrifugation, liquefaction), staining, and finally, the quality of the examination (20,23,26,29). In well-trained hands, the test detects tubercle bacilli in 75% of all people who have active pulmonary TB, but the sensitivity may fall to 45 to 60%, depending on the training, eye, and motivation of the laboratory technician (1). The basis of conventional light microscopy was developed more than 100 years ago, and, at present, conventional light microscopy uses carbolfuchsin Ziehl-Neelsen or Kinyoun acid-fast stains. Fluorescence microscopy with fluorochrome dyes suc...