title: Same day sputum smear microscopy for the diagnosis of pulmonary tuberculosis: Ziehl-Neelsen versus fluorescent staining.
abstract: BACKGROUND
  Sputum smear microscopy is the main tool for the diagnosis of pulmonary tuberculosis (TB), especially in low- and middle-income countries (LMICs). Limited sensitivity of smear microscopy and patient dropouts (PDs) are the important obstacles of national TB control programs.
  
  
  OBJECTIVE
  (1) To assess the diagnostic utility of the same day (SS2) approach (2) To compare the smear results of the spot morning (SM) and the SS2 approaches.
  
  
  METHODS
  The study was conducted in the Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India from January 2011 to February 2015. Three sputum samples were collected [spot (S), second spot (S2) 1 h after S, and morning sample (M)] from the volunteers. The sputum smears were stained by Ziehl-Neelsen (ZN), modified ZN (MZN), and fluorescent staining (FS) techniques and the results were pooled and compared under SM and SS2 approaches.
  
  
  RESULTS
  Of the 3,186 study participants, sputum smear positivity (SSP) for SM approach was 9.6% and 10.8% and for SS2 approach, it was 9.4% and 10.6%, respectively, with ZN and FS and the results were statistically insignificant (Mann-Whitney U test, P > 0.05).
  
  
  CONCLUSIONS
  Technically SSP was similar for both the approaches and no improvement was observed with the SS2 approach. Hence, there is an urgent need to improve SSP.
authors.affiliation: Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India.
authors.forename: T Jaya
authors.initials: TJ
authors.lastname: Chandra
authors.affiliation: Centre for Laboratory Animal Technology and Research, Sathyabama University, Chennai, Tamil Nadu, India.
authors.forename: R
authors.initials: R
authors.lastname: Selvaraj
authors.affiliation: Department of Pathology, GSL Medical College, Rajahmundry, Andhra Pradesh, India.
authors.forename: Y V
authors.initials: YV
authors.lastname: Sharma
keywords: Fluorescent staining; Ziehl-Neelsen staining; patient dropouts; same day (SS2) approach; spot morning approach; sputum smear positivity