Validation of bleach-treated smears for the diagnosis of XXXX .

@entity1 @entity378 @entity1907
SETTING: Health centres in Awassa, southern Ethiopia. DESIGN: Consecutive @entity1 visiting health centre laboratories for the evaluation of suspected @entity1907 ( @entity378 ) between June and September 2006 were investigated. On-the-spot, morning and second on-the-spot sputum samples were pooled for each @entity1 . Direct smears were stained with hot Ziehl-Neelsen (ZN) technique and aliquots cultured for mycobacteria on L  wenstein-Jensen media. The remaining sputum was treated with household bleach, aliquoted and processed with short-term digestion, centrifugation and sedimentation techniques, and stained with ZN. RESULTS: Acid-fast bacilli were detected in respectively 126 (25%), 141 (28%), 169 (34%) and 198 (40%) of the 497 pooled sputum samples processed by the direct, short-term, sedimentation and centrifugation techniques (P < 0.001). The sensitivity of the direct, short-term, sedimentation and centrifugation techniques was respectively 51.1%, 53.2%, 57.6% and 63.6%. The difference between the direct smear and centrifugation (P < 0.001) or sedimentation (P < 0.005) methods was significant. The specificity of the direct, short-term digestion, sedimentation and centrifugation techniques was respectively 97%, 93%, 86.5% and 80.8%. CONCLUSIONS: Bleach treatment of sputum and centrifugation significantly improves the sensitivity of smear microscopy for the diagnosis of @entity378 in a health centre in a high @entity378 burden area. It is more sensitive, but possibly less specific, than other bleach methods.
