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 Table of Contents  
LETTER TO EDITOR
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 210-211

Performance of light-emitting diode-based fluorescence microscopy to diagnose tuberculosis in a rural hospital of ethiopia


1 Department of Medicine and Laboratory, Gambo Rural General Hospital, Kore, West-Arsi, Gambo, Ethiopia; Division of Infectious Diseases, IIS-Fundación Jiménez Díaz, Madrid, Spain
2 Department of Medicine and Laboratory, Gambo Rural General Hospital, Kore, West-Arsi, Gambo, Ethiopia; Department of Medicine, Universidad Autónoma de Madrid; Department of Internal Medicine, Hospital General Universitario de Alicante, Universidad Miguel Hernandez, Alicante, Spain
3 Department of Medicine and Laboratory, Gambo Rural General Hospital, Kore, West-Arsi, Gambo, Ethiopia; Department of Medicine, Universidad Autónoma de Madrid; Department of Microbiology, Hospital Universitario Principe de Asturias, Alcalá de Henares, Spain
4 Department of Medicine and Laboratory, Gambo Rural General Hospital, Kore, West-Arsi, Gambo, Ethiopia; Division of Infectious Diseases, IIS-Fundación Jiménez Díaz, Madrid; Department of Medicine, Universidad Autónoma de Madrid, Spain

Date of Web Publication19-May-2017

Correspondence Address:
Ramon Perez-Tanoira
Division of Infectious Diseases, Fundación Jiménez Díaz, Av. Reyes Católicos, 2, 28040 Madrid
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_43_17

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How to cite this article:
Perez-Tanoira R, Ramos JM, Prieto-Pérez L, Cuadros J, Górgolas M. Performance of light-emitting diode-based fluorescence microscopy to diagnose tuberculosis in a rural hospital of ethiopia. Int J Mycobacteriol 2017;6:210-1

How to cite this URL:
Perez-Tanoira R, Ramos JM, Prieto-Pérez L, Cuadros J, Górgolas M. Performance of light-emitting diode-based fluorescence microscopy to diagnose tuberculosis in a rural hospital of ethiopia. Int J Mycobacteriol [serial online] 2017 [cited 2021 Jan 18];6:210-1. Available from: https://www.ijmyco.org/text.asp?2017/6/2/210/206607

In resource-limited settings such as Gambo General Hospital (Oromya Region, Ethiopia) that see a high incidence of tuberculosis (TB), diagnosis of pulmonary TB (PTB) is mainly made by sputum examination using microscopy for acid-fast bacilli (AFB).[1],[2] However, the sensitivity of the test is poor, and case detection rates are low. In rural areas of low-income countries, mycobacterial culture or automated methods as GeneXpert MTB/RIF assay are generally not available for the rapid diagnosis of TB.[3] Fluorescence microscopy (FM) using auramine O staining is more sensitive than conventional microscopy using Ziehl–Neelsen (ZN) staining.[1],[2],[3] However, the infrastructure necessary for conventional FM is not possible in most health services due to high cost; short life of the specialized mercury lamp; higher lamp warm-up time, maintenance, and alignment; and need for dark examination rooms.[3],[4] New FMs employing light-emitting diodes (LED-FM) have the combined advantages of light and FM while minimizing their disadvantages; they are inexpensive, easy to maintain and operate and do not require a dark room.[3],[4]

Building on the results of a previous study in the same area from July 2007 to June 2012,[5] we aimed to evaluate the feasibility of using LED-FM (July–December 2013) for increasing the sensitivity and reducing the time needed for analysis compared with ZN (July–December 2012). This study was performed just before the Ethiopian Government decided to promote the use of auramine O staining at a national level. PTB was diagnosed when the National Tuberculosis and Leprosy Control Programme confirmed that at least 2 of 3 smear results were positive for AFB. The Institutional Ethics Review Committee of Gambo General Hospital granted the ethical clearance.

We reviewed a total of 1126 patients attended in the same hospital with suspicion of PTB during July–December 2012 (ZN) and July–December 2013 (LED-FM). In July–December 2012, 532 patients underwent ZN smear testing, of whom 28 were PTB-positive (5.3%), and in July–December 2013, we analyzed 594 patients using LED-FM, of whom 52 (8.8%) were PTB-positive (P = 0.02).

In our study, during July–December 2012, 44 patients (8.3%) were children, of whom 2 (4.5%) were PTB-positive as compared to 6 (15.4%) PTB-positive patients from 39 (6.6%) children who underwent LED-FM smear testing during the same time period of 2013 (P = 0.09, Chi-square test).

Our results are consistent with Bhadade et al.[3] as LED-FM increased the number of diagnoses and reduced the time needed to analyze each sample compared with ZN. This finding, combined with the test's ease of use, supports the introduction of LED-FM for the screening of TB patients at the rural laboratory level in regions with high TB prevalence and low resources. LED-FM has improved diagnostic performance of sputum samples in TB, mainly in adults. However, gastric aspirates are probably necessary to apply LED-FM in children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chandra TJ, Selvaraj R, Sharma YV. Same day sputum smear microscopy for the diagnosis of pulmonary tuberculosis: Ziehl-Neelsen versus fluorescent staining. J Family Med Prim Care 2015;4:525-8.  Back to cited text no. 1
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2.
Davis JL, Cattamanchi A, Cuevas LE, Hopewell PC, Steingart KR. Diagnostic accuracy of same-day microscopy versus standard microscopy for pulmonary tuberculosis: A systematic review and meta-analysis. Lancet Infect Dis 2013;13:147-54.  Back to cited text no. 2
    
3.
Bhadade A, Mehta P, Kanade S, Nataraj G. Utility of light-emitting diode microscopy for the diagnosis of pulmonary tuberculosis in HIV infected patients. Int J Mycobacteriol 2015;4:31-5.  Back to cited text no. 3
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4.
Bhalla M, Sidiq Z, Sharma PP, Singhal R, Myneedu VP, Sarin R. Performance of light-emitting diode fluorescence microscope for diagnosis of tuberculosis. Int J Mycobacteriol 2013;2:174-8.  Back to cited text no. 4
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5.
Ramos JM, Pérez-Butragueño M, Tisiano G, Yohannes T, Reyes F, Górgolas M. Evaluation of Ziehl-Neelsen smear for diagnosis of pulmonary tuberculosis in childhood in a rural hospital in Ethiopia. Int J Mycobacteriol 2013;2:171-3.  Back to cited text no. 5
  [Full text]  




 

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