LED-fluorescence microscopy for diagnosis of pulmonary tuberculosis under programmatic conditions in India

Lord Wasim Reza; Srinath Satyanarayna; Donald A Enarson; Ajay M V Kumar; Karuna Sagili; Sujeet Kumar; Levi Anand Prabhakar; N M Devendrappa; Ashish Pandey; Nevin Wilson; Sarabjit Chadha; Badri Thapa; Kuldeep Singh Sachdeva; Mohan P Kohli

doi:10.1371/journal.pone.0075566

LED-fluorescence microscopy for diagnosis of pulmonary tuberculosis under programmatic conditions in India

PLoS One. 2013 Oct 9;8(10):e75566. doi: 10.1371/journal.pone.0075566. eCollection 2013.

Authors

Lord Wasim Reza¹, Srinath Satyanarayna, Donald A Enarson, Ajay M V Kumar, Karuna Sagili, Sujeet Kumar, Levi Anand Prabhakar, N M Devendrappa, Ashish Pandey, Nevin Wilson, Sarabjit Chadha, Badri Thapa, Kuldeep Singh Sachdeva, Mohan P Kohli

Affiliation

¹ International Union against Tuberculosis and Lung Disease(The Union), South-East Asia Regional Office, New Delhi, India.

Abstract

Background: Light-emitting diode fluorescence microscopy (LED-FM) has been shown to be more sensitive than conventional bright field microscopy using Ziehl-Neelsen (ZN) stain in detecting sputum smear positive tuberculosis in controlled laboratory conditions. In 2012, Auramine O staining based LED-FM replaced conventional ZN microscopy in 200 designated microscopy centres (DMC) of medical colleges operating in collaboration with India's Revised National Tuberculosis Control Programme. We aimed to assess the impact of introduction of LED-FM services on sputum smear positive case detection under program conditions.

Methods: This was a before and after comparison study. In 15 randomly selected medical college DMCs, all presumptive TB patients who underwent sputum smear examination in the years 2011 (before LED-FM) and 2012 (after LED-FM) were compared. An additional 15 comparable DMCs that implemented conventional ZN sputum smear microscopy were also selected for comparison between 2011 and 2012.

Results: The proportion of presumptive TB patients (PTP)found sputum smear positive increased by 30%- from 13.6% (3432/25159) in 2011 to 17.8% (4706/26426) in 2012 (P value <0.01) in the sites that implemented LED-FM microscopy, whereas in DMCs where the ZN staining procedure is followed the proportion of sputum smear positive had remained unchanged (13.0%versus 12.6%;P value0.31).

Conclusion: Use of LED-FM significantly increased the proportion of smear positive cases among presumptive TB patients under routine program conditions in high workload laboratories. The study provides operational evidence needed to scale-up the use of LED-FM in similar settings in India and beyond.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Adult
Aged
Child
Child, Preschool
Humans
India
Infant
Infant, Newborn
Microscopy, Fluorescence / methods*
Middle Aged
Sputum / microbiology
Tuberculosis, Pulmonary / diagnosis*
Young Adult

Grants and funding

This project was supported by TB REACH Initiative of Stop TB Partnership (through a grant from the Canadian International Development Agency,) grant no T9-370-114. This study was a part of Operational Research course. Funding for the operational research course was made possible from by the support of the American People through the United States Agency for International Development (USAID). Funders had no role in study design, data collection, analysis or interpretation of data. The donor had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The contents of this paper do not necessarily reflect the views of USAID or the United States Government or The Union.