Evaluation of the FluoreslenS and fluorescence microscopy blinded rechecking trial, Nairobi, Kenya.
METHODS
Three busy laboratories in Nairobi, Kenya.


OBJECTIVE
To determine the performance of an affordable fluorescence system (FluoreslenS) for tuberculosis microscopy, and to test an auramine-smear rechecking system.


METHODS
Alternating routine use of Ziehl-Neelsen (ZN) and fluorescence microscopy (FM) was performed to compare detection and errors found while rechecking.


RESULTS
Overall, 19.5% of 25,250 ZN and 23% of 21,104 FM smears were positive (P < 10(-3)). The proportional increment of FM over ZN was 18% (range -6%-29%), with one centre detecting fewer positives (non-significant, NS). The average error frequencies were comparable (1.8% vs. 2.6% false-negative and 0.2% vs. 0.4% high false-positive for ZN and FM, respectively, NS). The superior performance of controllers and the overall equal ZN/FM quality in the laboratories could be demonstrated only after converting error percentages to relative sensitivity (RS).


CONCLUSIONS
FM with the FluoreslenS system considerably improved sensitivity without loss of specificity in two of the busy routine laboratories, but the system is not sufficiently practical or user-friendly. Rechecking by FM can be done using guidelines for ZN smears, provided that routine ZN confirmation of positives is omitted. Calculation of RS allows an objective comparison of microscopy quality, independent of the variable prevalence of positives and sample size.
Torrea
G
G
Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Chakaya
J
J
Mayabi
M
M
Van Deun
A
A
D001576:Benzophenoneidum; D006801:Humans; D007630:Kenya; D008856:Microscopy, Fluorescence; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis
D001576:Benzophenoneidum