title: A comprehensive comparison of Ziehl-Neelsen and fluorescence microscopy for the diagnosis of tuberculosis in a resource-poor urban setting.
abstract: METHODS
  Nairobi City Council Chest Clinic, Kenya.
  
  
  OBJECTIVE
  To establish the efficiency, costs and cost-effectiveness of six diagnostic strategies using Ziehl-Neelsen (ZN) and fluorescence microscopy (FM).
  
  
  METHODS
  A cross-sectional study of 1398 TB suspects attending a specialised chest clinic in Nairobi subjected to three sputum examinations by ZN and FM. Lowenstein-Jensen culture was used as the gold standard. Cost analysis included health service and patient costs.
  
  
  RESULTS
  Of 1398 suspects enrolled, 993 (71%) had a complete diagnostic work-up involving three sputum specimens for ZN and FM, culture and chest X-ray (CXR). Irrespective of whether ZN or FM was used on one, two or three smears, the overall diagnostic process detected 92% culture-positive cases. Different strategies affected the ratio of smear-positive to smear-negative TB; however, FM was more sensitive than ZN (P < 0.001). FM performance was not affected by the patient's HIV status. The cost per correctly diagnosed smear-positive case, including savings, was 40.30 US dollars for FM on two specimens compared to 57.70 US dollars for ZN on three specimens.
  
  
  CONCLUSIONS
  The FM method used on one or two specimens is more cost-effective and shortens the diagnostic process. Consequently, more patients can be put on a regimen for smear-positive TB, contributing to improved treatment and reducing transmission.
authors.affiliation: Kenya Medical Research Institute, Center for Respiratory Diseases Research, Nairobi, Kenya.
authors.forename: L E A
authors.initials: LE
authors.lastname: Kivihya-Ndugga
authors.forename: M R A
authors.initials: MR
authors.lastname: van Cleeff
authors.forename: W A
authors.initials: WA
authors.lastname: Githui
authors.forename: L W
authors.initials: LW
authors.lastname: Nganga
authors.forename: D K
authors.initials: DK
authors.lastname: Kibuga
authors.forename: J A
authors.initials: JA
authors.lastname: Odhiambo
authors.forename: Paul R
authors.initials: PR
authors.lastname: Klatser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques / Q000191:economics* / Q000379:methods; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006295:Health Resources; D006801:Humans; D007630:Kenya; D016015:Logistic Models; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011203:Poverty; D011336:Probability; D011933:Reagent Kits, Diagnostic / Q000191:economics; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000191:economics*; D014505:Urban Population
chemical_list: D011933:Reagent Kits, Diagnostic