title: ZIEHL-NEELSEN MICROSCOPY IN THE DIAGNOSIS OF TUBERCULOSIS IN SETTINGS OF HIGH HUMAN IMMUNODEFICIENCY VIRUS PREVALENCE.
abstract: OBJECTIVE
  To determine the accuracy of Ziehl-Neelsen microscopy in the diagnosis of TB in setings of high HIV prevalence.
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  Hospitals serving areas of high human immunodeficiency virus prevalence in western Kenya. The study was conducted between September 2007 and September 2009.
  
  
  RESULTS
  In total, 341/872(39.1%) of the TB suspects were positive in ZN, 53.1% (181/341) of them culture positive. Only 3.8% (20/531) of the ZN smear negatives were culture positive. Of the 695 suspects evaluated for both Mycobacterium and HIV infection, 255 (36.7%) were ZN smear positive, 42.7% of them HIV positive. Out of the 440 ZN smear negatives, 37% were HIV positive. Similarly, 168 suspects were culture positive, 46.4% of them HIV positive. The HIV infection did not significantly reduce ZN smear positivity rate (P = 0.42) and culture sensitivity (P = 0.09). The ZN sensitivity and specificity were 88.1% and 79.7%, respectively. The predictive values were 58.0 (PPV), and 95.5% (NPV), respectively. However, the area under the ROC curve was 0.84, with 95% CI between 0.80-0.87 and P < 0.001). The ZN smear microscopy had a lesser ability to distinguish between TB and non-TB cases compared to culture.
  
  
  CONCLUSIONS
  ZN microscopy causes a significant over-diagnosis of TB in settings of high HIV/AIDS prevalence. There is need for further studies on this subject taking into consideration the various confounding factors.
authors: Moi University School of Medicine, Eldoret, Kenya.
authors: H D N
authors: HD
authors: Nyamogoba
authors: G
authors: G
authors: Kikuvi
authors: S
authors: S
authors: Mpoke
authors: P G
authors: PG
authors: Waiyaki
authors: D
authors: D
authors: Van Soolingen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004396:Coloring Agents; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D013194:Staining and Labeling / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D004396:Coloring Agents