title: Performance of variations of carbolfuchsin staining of sputum smears for AFB under field conditions.
abstract: METHODS
  A field project in Bangladesh.
  
  
  OBJECTIVE
  To compare the effectiveness of commonly used carbolfuchsin staining variations.
  
  
  METHODS
  Routine hot Ziehl-Neelsen (ZN) 1% basic fuchsin staining for 15 min in 75 field clinics. Blind reading of duplicate smears stained by ZN 1% vs. 0.3% basic fuchsin applied for 5 min, or by ZN 1% 5 min vs. Kinyoun cold staining. Rechecking of discordant series.
  
  
  RESULTS
  For comparable numbers of false positives, sensitivity was significantly lower with Kinyoun than with ZN 1% 5 min (85.6% vs. 93.0%, P < 0.001). Sensitivity with ZN 1% 5 min was not significantly higher than with 0.3% 5 min staining (89.9% vs. 86.5%). Routine examination using 1% 15 min ZN identified more positives than any of the study techniques.
  
  
  CONCLUSIONS
  Kinyoun cold staining sensitivity was unsatisfactory in field clinics. The sensitivity of the WHO/IUATLD recommended 0.3% fuchsin for 5 min was not significantly different from the original 1% ZN for 5 min, but 1% 15 min hot staining might be superior. A reduced fuchsin concentration together with a short staining time may leave too narrow a margin for error. TB programmes using hot ZN with a concentrated stain or longer staining time should not be urged to change.
authors.affiliation: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerpen, Belgium. avdeun@itg.be
authors.forename: A
authors.initials: A
authors.lastname: Van Deun
authors.forename: A
authors.initials: A
authors.lastname: Hamid Salim
authors.forename: K J M
authors.initials: KJ
authors.lastname: Aung
authors.forename: Md A
authors.initials: MA
authors.lastname: Hossain
authors.forename: N
authors.initials: N
authors.lastname: Chambugonj
authors.forename: Md A
authors.initials: MA
authors.lastname: Hye
authors.forename: A
authors.initials: A
authors.lastname: Kawria
authors.forename: E
authors.initials: E
authors.lastname: Declercq
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D016009:Chi-Square Distribution; D004396:Coloring Agents; D006801:Humans; D008853:Microscopy; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D013194:Staining and Labeling / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C006898:carbol-fuchsin solution