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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Mobile digital fluorescence microscopy for diagnosis of tuberculosis
Journal of Clinical Microbiology, Volume 51, No. 6, Year 2013
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Description
Access to sputum smear microscopy in high-tuberculosis (TB)-burden regions is limited by a scarcity of microscopes and experienced technicians. We evaluated the accuracy of CellScope, a novel digital fluorescence microscope that may expand access to microscopy. The study utilized smear microscopy slides prepared from sputum specimens submitted by consecutive adults with ≥2 weeks of cough who were admitted to Mulago Hospital (Kampala, Uganda). Conventional light-emitting diode (LED) fluorescence microscopy (FM) and mycobacterial culture were performed by experienced technicians. Two U.S.-based postgraduate researchers without prior microscopy experience restained, imaged, and interpreted the slides using CellScope. We assessed whether sensitivity and specificity of CellScope-based LED FM was noninferior to conventional LED FM by using a preselected margin of inferiority of 15%. Of 525 patients included, 72% were HIV seropositive and 39% had culture-confirmed TB. The proportions of positive results were similar with CellScope and conventional LED FM (34% versus 32%, respectively; P = 0.32), and agreement was substantial. CellScope accuracy was within the noninferiority margin for both sensitivity (63% versus 70%; difference, -7%; 95% confidence interval [CI], -13% to -1%) and specificity (85% versus 92%; difference, -7%; 95% CI, -12% to -3%). A subanalysis of 43 slides evaluated by each CellScope reader found substantial interreader reliability (customweighted kappa, 0.65) and variable intrareader reliability (custom-weighted kappa, 0.11 versus 0.48). CellScope offers promise for expanding microscopy services. Future studies should evaluate the device when operated by health workers in low-resource settings, the feasibility of image transmission and analysis by experienced microscopists, and the accuracy of automated image analysis algorithms. Copyright © 2013, American Society for Microbiology. All Rights Reserved.
Authors & Co-Authors
Tapley, Asa
United States, San Francisco
Ucsf School of Medicine
Switz, Neil
United States, Berkeley
University of California, Berkeley
Reber, Clay
United States, Berkeley
University of California, Berkeley
Davis, J. Lucian
United States, San Francisco
University of California, San Francisco
Uganda, Kampala
Makerere University
Miller, Cecily R.
United States, San Francisco
University of California, San Francisco
Matovu, John Baptist
Uganda, Kampala
Makerere University
Uganda, Kampala
Uganda Ministry of Health
Worodria, William O.
Uganda, Kampala
Makerere University
Uganda, Kampala
Uganda Ministry of Health
Huang, Laurence
United States, San Francisco
University of California, San Francisco
Uganda, Kampala
Makerere University
Fletcher, Daniel A.
United States, Berkeley
University of California, Berkeley
Cattamanchi, Adithya
United States, San Francisco
University of California, San Francisco
Uganda, Kampala
Makerere University
Statistics
Citations: 56
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1128/JCM.03432-12
ISSN:
00951137
e-ISSN:
1098660X
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Uganda