title: Implementation of LED fluorescence microscopy for diagnosis of pulmonary and HIV-associated tuberculosis in a hospital setting in Indonesia.
abstract: BACKGROUND
  Fluorescence microscopy (FM) has not been implemented widely in TB endemic settings and little evaluation has been done in HIV-infected patients. We evaluated diagnostic performance, time and costs of FM with light-emitting diodes technology (LED-FM), compared with conventional (Zieh-Neelsen) microscopy in a hospital in Indonesia which acts as referral centre for HIV-infected patients.
  
  
  METHODS
  We included pulmonary tuberculosis suspects from the outpatient and HIV clinic. Direct and concentrated sputum smears were examined using LED-FM and ZN microscopy by two technicians who were blinded for the HIV-status and the result of the comparative test. Mean reading time per slide was recorded and cost of each slide was calculated. Mycobacteria culture served as the reference standard.
  
  
  RESULTS
  Among 404 tuberculosis suspects from the outpatient clinic and 256 from the HIV clinic, mycobacteria culture was positive in 12.6% and 27%, respectively. The optimal sensitivity of LED-FM was achieved by using a threshold of ≥2 AFB/length. LED-FM had a higher sensitivity (75.5% vs. 54.9%, P<0.01) but lower specificity (90.0% vs 96.6%, P<0.01) compared to ZN microscopy. HIV was associated with a lower sensitivity but similar specificity. The average reading time using LED-FM was significantly shorter (2.23±0.78 vs 5.82±1.60 minutes, P<0.01), while costs per slide were similar.
  
  
  CONCLUSIONS
  High sensitivity of LED-FM combined with shorter reading time of sputum smear slides make this method a potential alternative to ZN microscopy. Additional data on specificity are needed for effective implementation of this technique in high burden TB laboratories.
authors.affiliation: Health Research Unit, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia.
authors.forename: Lidya
authors.initials: L
authors.lastname: Chaidir
authors.forename: Ida
authors.initials: I
authors.lastname: Parwati
authors.forename: Jessi
authors.initials: J
authors.lastname: Annisa
authors.forename: Soni
authors.initials: S
authors.lastname: Muhsinin
authors.forename: Intan
authors.initials: I
authors.lastname: Meilana
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis* / Q000191:economics; D006761:Hospitals; D006801:Humans; D007214:Indonesia; D008297:Male; D008856:Microscopy, Fluorescence / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D055095:Optics and Photonics / Q000191:economics / Q000379:methods*; D012372:ROC Curve; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000191:economics