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HIV-related incremental yield of bleach sputum concentration and fluorescence technique for the microscopic detection of tuberculosis

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Abstract

Bleach sputum concentration and fluorescence microscopy (FM) are reportedly more sensitive than direct Ziehl-Neelsen (ZN) sputum smears for tuberculosis detection, and might be particularly valuable for human immunodeficiency virus (HIV)-positive patients excreting fewer bacilli. This study, implemented in Yaoundé, Cameroon, determined the yield from both direct and bleach-concentrated FM and ZN duplicate smears against culture on Löwenstein-Jensen medium, with HIV testing from the sputa. From 418 HIV-positive and 518 HIV-negative tuberculosis suspects, 185 (44.3%) and 243 (46.9%) cultures, respectively, grew Mycobacterium tuberculosis. Direct ZN was positive for, respectively, 87 (47.0%) and 202 (83.1%) of the culture-positive cases. Proportional incremental yield over direct ZN from ZN and FM bleach smears was 14.9% (P < 10–3) and 17.2% (P < 10–4) for HIV-positive versus 4.9% (P < 10–2) and 2.0% (non-significant) for HIV-negative cases. There was no gain from direct FM. Bleach FM showed 2% excess false positives. The bleach concentration, therefore, increases the yield of ZN and FM, particularly from HIV-positive patients, but with a higher risk for false positives with bleach FM. With excellent baseline direct ZN, the gain remains modest. Field studies under real-life conditions are needed to determine whether it is worth the risks and operational challenges in HIV high-prevalence populations. FM was not more sensitive than ZN in this study, probably because of sub-optimal objective power and background staining. Culture on solid media with sparing laurylsulfate decontamination was clearly superior for HIV-positives, but it remains to be seen if culture also leads to more cases started on treatment routinely.

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Acknowledgement

This publication was made possible through support provided by the United States Agency for International Development under the terms of award no. GHS-A-00-03-00045-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development.

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Authors and Affiliations

  1. Laboratoire des Mycobactéries, Laboratoire de Référence pour le PNLT, Centre Pasteur du Cameroun, BP 1274, Yaoundé, Cameroon

    S. I. Eyangoh, Y. Kamdem & F. F. Piam

  2. Mycobacteriology Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium

    G. Torrea & A. Van Deun

  3. Laboratoire d’Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, BP 1274, Yaoundé, Cameroon

    M. C. Tejiokem

  4. German Technical Cooperation (GTZ), BP 4400, Douala, Cameroon

    J. Noeske

  5. International Union against Tuberculosis and Lung Disease, 68 Boulevard St. Michel, 75006, Paris, France

    A. Van Deun

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  1. S. I. Eyangoh
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  2. G. Torrea
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  3. M. C. Tejiokem
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  4. Y. Kamdem
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  7. A. Van Deun
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Correspondence to A. Van Deun.

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Eyangoh, S.I., Torrea, G., Tejiokem, M.C. et al. HIV-related incremental yield of bleach sputum concentration and fluorescence technique for the microscopic detection of tuberculosis. Eur J Clin Microbiol Infect Dis 27, 849–855 (2008). https://doi.org/10.1007/s10096-008-0516-4

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  • DOI: https://doi.org/10.1007/s10096-008-0516-4

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