Abstract
Sputum smear microscopy (SSM), the most widely available tool for tuberculosis (TB) detection, has limited performance in paucibacillary patients and requires highly experienced technicians. The objective of this study was to determine whether the addition of sodium dodecyl sulfate (SDS), a detergent that thins sputum, at 4% and 10%, improves the detection of acid-fast bacilli (AFB), the clarity of slides, and the biosafety of the technique. Thirty participants with presumptive TB were enrolled. Three independent, blinded technicians examined the slides. Regular sputum concentrated AFB smear and sputum culture were used as standard control methods. Sputum culture was also performed before and after 10% SDS addition for safety analysis. We found that neither SSM with SDS 4% nor SSM with SDS 10% improved the test’s performance. However, slides with 4% and 10% SDS, compared with slides prepared without SDS, had significantly better clarity scores. The 10% SDS-prepared sputum samples were all culture negative. While adding SDS detergent does not improve the performance of SSM slides, it does improve the clarity and biosafety. Where experienced technicians are scarce, especially in low resource settings, use of SDS may enhance the ease of slide reading in sputum smear microscopy.
Highlights
Tuberculosis (TB) is one of the leading causes of infectious disease-related morbidity and mortality worldwide (WHO, 2018)
Around 95% of these TB cases occur in low- and middle-income countries (LMICs) where sputum smear microscopy (SSM) is often the only available TB diagnostic tool because of its relative low-cost, simplicity, and minimum equipment requirement
Many pulmonary TB cases still do not have any bacteriological confirmation and are empirically treated, this approach, based on symptoms and radiological lesions, has a sensitivity of 61% and specificity of 69% for TB patients, and only 50% sensitivity for HIV co-infected cases (Theron et al, 2014). Molecular assays such as Xpert MTB/RIFTM are overcoming some of the diagnostic limitations of SSM, but they remain expensive and are not available in many LMIC settings
Summary
Tuberculosis (TB) is one of the leading causes of infectious disease-related morbidity and mortality worldwide (WHO, 2018). Many pulmonary TB cases still do not have any bacteriological confirmation and are empirically treated, this approach, based on symptoms and radiological lesions, has a sensitivity of 61% and specificity of 69% for TB patients, and only 50% sensitivity for HIV co-infected cases (Theron et al, 2014). Molecular assays such as Xpert MTB/RIFTM are overcoming some of the diagnostic limitations of SSM, but they remain expensive and are not available in many LMIC settings
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