title: Microbiological validation of smear microscopy after sputum digestion with bleach; a step closer to a one-stop diagnosis of pulmonary tuberculosis.
abstract: BACKGROUND
  Smear microscopy is relatively insensitive for the diagnosis of TB. The digestion of sputum with household bleach prior to smear preparation has been reported to improve its sensitivity. This method has not been validated.
  
  
  METHODS
  Seven hundred and fifty six patients with symptoms suggestive of pulmonary TB (PTB) were asked to submit 3 sputum specimens for direct microscopy. One specimen was selected at random for culture and another specimen was digested to prepare a further smear. The WHO case definition (>or=2 positive smears or one positive smear and positive culture) was used to compare the sensitivity and specificity of the smears.
  
  
  RESULTS
  Four hundred and fifty five (60%) patients were culture-positive. Of these, 235 (31%) had "definite" PTB and 223 (29%) "very likely" PTB (smear-negative, culture-positive). The WHO case definition identified 51% (235/458) of the patients with "definite" or "very likely" PTB. One digested smear detected 219 (93%) of the 235 patients with "definite" PTB and 10 patients with "very likely" PTB (sensitivity (95%CI) 50% (45-55%); specificity 99% (97-100%)). The positive and negative predictive values for one digested smear were 98% (95-99%) and 56% (52-60%) respectively, which were not different (p>0.5) to the WHO case definition (100% and 57%, respectively).
  
  
  CONCLUSIONS
  One bleach-digested smear is as sensitive and specific as the WHO case definition for the diagnosis of PTB.
authors.affiliation: Zankli Medical Centre, Plot 1021, B5 Shehu Yar'adua Way, Abuja, Nigeria, and Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
authors.forename: L
authors.initials: L
authors.lastname: Lawson
authors.forename: M A
authors.initials: MA
authors.lastname: Yassin
authors.forename: A
authors.initials: A
authors.lastname: Ramsay
authors.forename: I
authors.initials: I
authors.lastname: Olajide
authors.forename: T D
authors.initials: TD
authors.lastname: Thacher
authors.forename: P D O
authors.initials: PD
authors.lastname: Davies
authors.forename: S B
authors.initials: SB
authors.lastname: Squire
authors.forename: L E
authors.initials: LE
authors.lastname: Cuevas
mesh_terms: D001431:Bacteriological Techniques / Q000379:methods; D003430:Cross-Sectional Studies; D004202:Disinfectants; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009549:Nigeria; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D004202:Disinfectants