Light Emitting Diode Fluorescence Microscopy increased the detection of smear-positives during follow-up of Tuberculosis patients in India: program implications.
BACKGROUND
In India, since July 2012, at designated Microscopy Centers (DMCs) in 200 medical colleges, sputum smear examination for tuberculosis bacilli changed from Ziehl Neelsen (ZN) method to auramine based Light Emitting Diode Fluorescent Microscopy (LED-FM) method. We assessed the additional yield of smear positives among patients undergoing follow-up sputum examination during TB treatment before and after deploying LED-FM.


METHODS
This was a before and after comparison study in eight conveniently selected medical college DMCs across North India. We extracted data from TB laboratory registers on number of TB patients examined for follow-up and their smear microscopy results including the grades by ZN (before; July-December 2011) and LED-FM (after; July-December 2012) and compared them.


RESULTS
Altogether, 2868 TB patients were examined by LED-FM and 2740 were examined by ZN during follow-up. LED-FM increased the proportion of follow-up smear positives from 5.0 % (n = 136) to 7.4 % (n = 213) with an additional yield of 77 follow-up smear-positives-with the highest increase in smears graded scanty (2.6 vs 1.2 %) (p value <0.05).


CONCLUSIONS
Since all smear positives during follow-up are considered 'presumptive multidrug resistant (MDR)-TB patients' in India, introduction of LED-FM would result in additional number of patients eligible for MDR-TB testing, which would have otherwise been missed by ZN.
Tuberculosis Department, International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6, Qutub Institutional Area, 110016, New Delhi, India. badri_bishal@yahoo.com.
Badri
B
Thapa
Tuberculosis Department, International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6, Qutub Institutional Area, 110016, New Delhi, India. lwreza@gmail.com.
Lord Wasim
LW
Reza
Tuberculosis Department, International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6, Qutub Institutional Area, 110016, New Delhi, India. akumar@theunion.org.
Ajay Mv
AM
Kumar
Tuberculosis Department, International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6, Qutub Institutional Area, 110016, New Delhi, India. apandey@theunion.org.
Ashish
A
Pandey
Tuberculosis Department, International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6, Qutub Institutional Area, 110016, New Delhi, India. drsrinaths@gmail.com.
Srinath
S
Satyanarayana
Tuberculosis Department, International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6, Qutub Institutional Area, 110016, New Delhi, India. schadha@theunion.org.
Sarabjit
S
Chadha
D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008856:Microscopy, Fluorescence / Q000379:methods*; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis*