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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Performance of LED-based fluorescence microscopy to diagnose tuberculosis in a peripheral health centre in Nairobi
PLoS ONE, Volume 6, No. 2, Article e17214, Year 2011
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Description
Background: Sputum microscopy is the only tuberculosis (TB) diagnostic available at peripheral levels of care in resource limited countries. Its sensitivity is low, particularly in high HIV prevalence settings. Fluorescence microscopy (FM) can improve performance of microscopy and with the new light emitting diode (LED) technologies could be appropriate for peripheral settings. The study aimed to compare the performance of LED-FM versus Ziehl-Neelsen (ZN) microscopy and to assess feasibility of LED-FM at a low level of care in a high HIV prevalence country. Methods: A prospective study was conducted in an urban health clinic in Nairobi, Kenya. Three sputum specimens were collected over 2 days from suspected TB patients. Each sample was processed with Auramine O and ZN methods and a 4th specimen was collected for TB culture reference standard. Auramine smears were read using the same microscope, equipped with the FluoLED™ fluorescence illuminator. Inter-reader agreement, reading time and technicians' acceptability assessed feasibility. Results: 497 patients were included and 1394 specimens were collected. The detection yields of LED-FM and ZN microscopy were 20.3% and 20.6% (p = 0.64), respectively. Sensitivity was 73.2% for LED-FM and 72% for ZN microscopy, p = 0.32. It was 96.7% and 95.9% for specificity, p = 0.53. Inter-reader agreement was high (kappa = 0.9). Mean reading time was three times faster than ZN microscopy with very good acceptance by technicians. Conclusions: Although it did not increase sensitivity, the faster reading time combined with very good acceptance and ease of use supports the introduction of LED-FM at the peripheral laboratory level of high TB and HIV burden countries. © 2011 Bonnet et al.
Authors & Co-Authors
Bonnet, Maryline M.B.
France, Paris
Epicentre
Gagnidze, Laramie
France, Paris
Epicentre
Githui, Willie Abela
Kenya, Nairobi
Kenya Medical Research Institute
Guérin, Philippe Jean Jean
France, Paris
Epicentre
Bonte, Laurence
Switzerland, Geneva
Medecins Sans Frontieres
Varaine, Francis F.V.
Switzerland, Geneva
Medecins Sans Frontieres
Ramsay, Andrew R.C.
Switzerland, Geneva
Organisation Mondiale de la Santé
Statistics
Citations: 48
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0017214
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Kenya