title: Application of modern microbiological diagnostic methods for tuberculosis in Macha, Zambia.
abstract: METHODS
  Macha, Zambia.
  
  
  OBJECTIVE
  To assess the benefits of auramine-O staining fluorescence microscopy and Mycobacterial Growth Indicator Tube (MGIT) liquid culture with molecular identification in tuberculosis (TB) diagnostics.
  
  
  METHODS
  One hundred patients suspected of TB were subjected to three sputum sample examinations applying Ziehl-Neelsen (ZN) and auramine-O staining and MGIT culture. Positive cultures were identified using the GenoType CM assay; cultures identified as Mycobacterium tuberculosis complex were the gold standard for a diagnosis of TB.
  
  
  RESULTS
  The 100 patients produced 271 sputum samples; of these, 30 patients had positive cultures. M. tuberculosis complex bacilli were isolated in 17 (56.7%) patients, non-tuberculous mycobacteria (NTM) in 11 (36.7%) and other acid-fast bacilli in two. Forty-eight samples (17.7%) were contaminated. Auramine-O detected 16 (57.1%) patients culture-positive for mycobacteria and 12 patients with culture-proven TB, vs. respectively 8 (28.6%, P = 0.008) and 7 (41.2%, P = 0.044) for ZN. Three of eight auramine-positive/ZN-negative patients were culture-positive for NTM only.
  
  
  CONCLUSIONS
  The auramine-O method significantly increases sensitivity, although the higher NTM detection rate implies that this does not in itself lead to a more accurate diagnosis of TB. MGIT culture is highly sensitive, although contamination rates were a drawback; the high frequency of NTM isolation warrants a robust identification method.
authors.affiliation: Medical/Malaria Institute, Macha Hospital, Choma, Zambia. evelyneverweij@gmail.com
authors.forename: K E
authors.initials: KE
authors.lastname: Verweij
authors.forename: A R
authors.initials: AR
authors.lastname: Kamerik
authors.forename: J
authors.initials: J
authors.lastname: van Ingen
authors.forename: J H
authors.initials: JH
authors.lastname: van Dijk
authors.forename: P
authors.initials: P
authors.lastname: Sikwangala
authors.forename: P
authors.initials: P
authors.lastname: Thuma
authors.forename: J L
authors.initials: JL
authors.lastname: Nouwen
authors.forename: D
authors.initials: D
authors.lastname: van Soolingen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques; D001576:Benzophenoneidum; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D013194:Staining and Labeling / Q000379:methods; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult; D015024:Zambia
chemical_list: D001576:Benzophenoneidum