Bleach Sedimentation: An Opportunity to Optimize Smear Microscopy for Tuberculosis Diagnosis in Settings of High Prevalence of HIV

Bonnet, Maryline; Ramsay, Andrew; Githui, Willie; Gagnidze, Laramie; Varaine, Francis; Guerin, Philippe J.
June 2008
Clinical Infectious Diseases;6/1/2008, Vol. 46 Issue 11, p1710
Academic Journal
Background. The purpose of the study was to evaluate the performance and feasibility of tuberculosis diagnosis by sputum microscopy after bleach sedimentation, compared with by conventional direct smear microscopy, in a setting of high prevalence of HIV. Methods. In a community-based study in Kenya (a population in which 50% of individuals with tuberculosis are infected with HIV), individuals with suspected pulmonary tuberculosis submitted 3 sputum specimens during 2 consecutive days, which were examined by blind evaluation. Ziehl-Neelsen-stained smears were made of fresh specimens and of specimens that were processed with 3.5% household bleach followed by overnight sedimentation. Two different cutoffs for acid-fast bacilli (AFB) per 100 high-power fields (HPF) were used to define a positive smear: >10 AFB/100 HPF and 1 AFB/100 HPF. Four smear-positive case definitions, based on 1 or 2 positive smears with the 1 AFB or 10 AFB cutoff, were used. Results. Of 1879 specimens from 644 patients, 363 (19.3%) and 460 (24.5%) were positive by bleach sedimentation microscopy, compared with 301 (16.0%) and 374 (19.9%) by direct smear microscopy, with use of the 10 AFB/100 HPF (P<.001) and 1 AFB/100 HPF (P<.001) cutoffs, respectively. Regardless of the case definition used, bleach sedimentation microscopy detected significantly more positive cases than did direct smear microscopy: 26.7% (172 of 644) versus 21.7% (140 of 644), respectively, with the case definition of 1 positive smear and the 1 AFB/100 HPF cutoff (P<.001), and 21.4% (138 of 644) versus 18.6% (120 of 644), respectively, with the case definition of 1 positive smear and the 10 AFB/100 HPF cutoff (P<.001). Inter- and intrareader reproducibility were favorable, with κ coefficients of 0.83 and 0.91, respectively. Bleach sedimentation was relatively inexpensive and was not time consuming. Conclusions. Bleach sedimentation microscopy is an effective, simple method to improve the yield of smear microscopy in a setting of high prevalence of HIV. Further evaluation of this method, under operational conditions, is urgently needed to determine its potential as a tool for tuberculosis control.


Related Articles

  • HIV-related incremental yield of bleach sputum concentration and fluorescence technique for the microscopic detection of tuberculosis. Eyangoh, S.; Torrea, G.; Tejiokem, M.; Kamdem, Y.; Piam, F.; Noeske, J.; Van Deun, A. // European Journal of Clinical Microbiology & Infectious Diseases;Sep2008, Vol. 27 Issue 9, p849 

    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,...

  • Sensitivity of direct versus concentrated sputum smear microscopy in HIV-infected patients suspected of having pulmonary tuberculosis. Cattamanchi, Adithya; Dowdy, David W.; Davis, J. Lucian; Worodria, William; Yoo, Samuel; Joloba, Moses; Matovu, John; Hopewell, Philip C.; Huang, Laurence // BMC Infectious Diseases;2009, Vol. 9 Issue 1, Special section p1 

    Background: Sputum concentration increases the sensitivity of smear microscopy for the diagnosis of tuberculosis (TB), but few studies have investigated this method in human immunodeficiency virus (HIV)-infected individuals. Methods: We performed a prospective, blinded evaluation of direct and...

  • Clinical and radiological deterioration in a patient with AIDS. De Backer, A. I.; Mortelé, K. J.; Bomans, P.; De Keulenaer, B. L.; Vanschoubroeck, I. J.; Kockx, M. M.; Mortelé, K J // European Radiology;Nov2005, Vol. 15 Issue 11, p2264 

    Paradoxical clinical deterioration of miliary tuberculosis, characterized by pulmonary and abdominal manifestations, is reported in a patient with the acquired immunodeficiency syndrome, after initiation of treatment with highly active antiretroviral therapy. Paradoxical reaction was attributed...

  • Deadly consequences.  // Nature;11/8/2007, Vol. 450 Issue 7167, p136 

    The article offers information on the 38th Union World Conference on Lung Health held in Cape Town, South Africa. It discusses the move of health authorities to respond to the combination of HIV and tuberculosis (TB) including multiple-drug resistance to TB. According to the report from the U.S....

  • Viral Decay Rates are Similar in HIV-infected Patients with and without TB Coinfection during Treatment with an Efavirenz-based Regimen. Lartey, Margaret; Sagoe, Kwamena W.; Hongmei Yang; Kenu, Ernest; Xexemeku, Fafa; Oliver-Commey, Joseph; Boima, Vincent; Seshie, Markafui; Sagoe, Augustine; Mingle, Julius A. A.; Flanigan, Timothy P.; Hulin Wu; Kwara, Awewura // Clinical Infectious Diseases;2/15/2011, Vol. 52 Issue 4, p547 

    Viral decay rates during efavirenz-based therapy were compared between human immunodeficiency virus (HIV)-infected patients without tuberculosis (n = 40) and those with tuberculosis coinfection who were receiving concurrent antituberculous therapy (n = 34). Phase I and II viral decay rates were...

  • HIV infection and sputum-culture conversion in patients diagnosed with Mycobacterium tuberculosis A population-based study. Aliyu, Muktar H.; Salihu, Hamisu M.; Ratard, Raoul // Wiener Klinische Wochenschrift;2003, Vol. 115 Issue 10, p340 

    Objectives: To estimate the effect of human immunodeficiency virus infection on treatment outcome of anti-tuberculosis therapy at the population level. Materials and methods: A retrospective cohort study based on data collected through the expanded program on tuberculosis surveillance on all...

  • Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia. Sinkala, Edford; Gray, Sylvia; Zulu, Isaac; Mudenda, Victor; Zimba, Lameck; Vermund, Sten H.; Drobniewski, Francis; Kelly, Paul // BMC Infectious Diseases;2009, Vol. 9 Issue 1, Special section p1 

    Background: The diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical...

  • Test characteristics and potential impact of the urine LAM lateral flow assay in HIV-infected outpatients under investigation for TB and able to self-expectorate sputum for diagnostic testing. Peter, Jonny; Theron, Grant; Chanda, Duncan; Clowes, Petra; Rachow, Andrea; Lesosky, Maia; Hoelscher, Michael; Mwaba, Peter; Pym, Alex; Dheda, Keertan // BMC Infectious Diseases;Jul2015, Vol. 15 Issue 1, p1 

    Background: The commercially available urine LAM strip test, a point-of-care tuberculosis (TB) assay, requires evaluation in a primary care setting where it is most needed. There is currently inadequate data to guide implementation in TB and HIV-endemic settings. Methods: Adult HIV-infected...

  • A Diagnostic Accuracy Study of Xpert MTB/RIF in HIVPositive Patients with High Clinical Suspicion of Pulmonary Tuberculosis in Lima, Peru. Carriquiry, Gabriela; Otero, Larissa; González-Lagos, Elsa; Zamudio, Carlos; Sánchez, Eduardo; Nabeta, Pamela; Campos, Miguel; Echevarría, Juan; Seas, Carlos; Gotuzzo, Eduardo // PLoS ONE;Sep2012, Vol. 7 Issue 9, Special section p1 

    Background: Diagnosis of pulmonary tuberculosis (TB) among human immunodeficiency virus (HIV) patients remains complex and demands easy to perform and accurate tests. Xpert®MTB/RIF (MTB/RIF) is a molecular TB diagnostic test which is rapid and convenient; the test requires minimal human...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics